Staeger P, Burnand B, Santos-Eggimann B, Klay M, Siffert C, Livio J J, Burckhardt P, Paccaud F
Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland.
Aging (Milano). 2000 Feb;12(1):13-21. doi: 10.1007/BF03339823.
Our objective was to describe the interventions aimed at preventing a recurrent hip fracture, and other injurious falls, which were provided during hospitalization for a first hip fracture and during the two following years. A secondary objective was to study some potential determinants of these preventive interventions. The design of the study was an observational, two-year follow-up of patients hospitalized for a first hip fracture at the University Hospital of Lausanne, Switzerland. The participants were 163 patients (median age 82 years, 83% women) hospitalized in 1991 for a first hip fracture, among 263 consecutively admitted patients (84 did not meet inclusion criteria, e.g., age>50, no cancer, no high energy trauma, and 16 refused to participate). Preventive interventions included: medical investigations performed during the first hospitalization and aimed at revealing modifiable pathologies that raise the risk of injurious falls; use of medications acting on the risk of falls and fractures; preventive recommendations given by medical staff; suppression of environmental hazards; and use of home assistance services. The information was obtained from a baseline questionnaire, the medical record filled during the index hospitalization, and an interview conducted 2 years after the fracture. Potential predictors of the use of preventive interventions were: age; gender; destination after discharge from hospital; comorbidity; cognitive functioning; and activities of daily living. Bi- and multivariate associations between the preventive interventions and the potential predictors were measured. In hospital investigations to rule out medical pathologies raising the risk of fracture were performed in only 20 patients (12%). Drugs raising the risk of falls were reduced in only 17 patients (16%). Preventive procedures not requiring active collaboration by the patient (e.g., modifications of the environment) were applied in 68 patients (42%), and home assistance was provided to 67 patients (85% of the patients living at home). Bivariate analyses indicated that prevention was less often provided to patients in poor general conditions, but no ascertainment of this association was found in multivariate analyses. In conclusion, this study indicates that, in the study setting, measures aimed at preventing recurrent falls and injuries were rarely provided to patients hospitalized for a first hip fracture at the time of the study. Tertiary prevention could be improved if a comprehensive geriatric assessment were systematically provided to the elderly patient hospitalized for a first hip fracture, and passive preventive measures implemented.
我们的目标是描述在首次髋部骨折住院期间以及随后两年内为预防髋部骨折复发和其他伤害性跌倒所采取的干预措施。次要目标是研究这些预防性干预措施的一些潜在决定因素。本研究的设计是对瑞士洛桑大学医院首次髋部骨折住院患者进行为期两年的观察性随访。参与者为1991年因首次髋部骨折住院的163名患者（中位年龄82岁，83%为女性），这163名患者来自连续收治的263名患者（84名不符合纳入标准，如年龄>50岁、无癌症、无高能创伤，16名拒绝参与）。预防性干预措施包括：首次住院期间进行的医学检查，旨在发现可改变的、增加伤害性跌倒风险的病理状况；使用作用于跌倒和骨折风险的药物；医务人员给出的预防性建议；消除环境危害；以及使用家庭援助服务。信息来自基线调查问卷、首次住院期间填写的病历以及骨折后两年进行的访谈。预防性干预措施使用的潜在预测因素为：年龄；性别；出院后的去向；合并症；认知功能；以及日常生活活动能力。测量了预防性干预措施与潜在预测因素之间的二元和多变量关联。仅20名患者（12%）在住院期间进行了排除增加骨折风险的医学病理状况的检查。仅17名患者（16%）减少了增加跌倒风险的药物使用。68名患者（42%）采用了无需患者积极配合的预防性措施（如环境改造），67名患者（在家居住患者的85%）获得了家庭援助。二元分析表明，一般状况较差的患者接受预防措施的频率较低，但多变量分析未确定这种关联。总之，本研究表明，在研究环境中，在研究时，因首次髋部骨折住院的患者很少接受旨在预防跌倒复发和伤害的措施。如果对因首次髋部骨折住院的老年患者系统地进行全面老年医学评估并实施被动预防措施，三级预防可能会得到改善。
