Gillespie L D, Gillespie W J, Cumming R, Lamb S E, Rowe B H
37 Newington Avenue, Dunedin 9001, New Zealand.
Cochrane Database Syst Rev. 2000(2):CD000340. doi: 10.1002/14651858.CD000340.
Fractures in the elderly often result from a simple fall.
To assess the effects of programmes designed to reduce the incidence of falls in community dwelling, institutionalised, or hospitalised elderly people.
We searched MEDLINE, EMBASE, CINAHL, PsycLIT, Social Science Citation Index, Dissertation Abstracts, Index to UK Theses, the Cochrane Register of Controlled Trials, and bibliographies of identified studies. We contacted known workers in the field. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: May 1997.
Randomised trials of interventions designed to minimise the effect of, or prevent exposure to, any putative risk factor for falling in elderly individuals living in the community, in institutional care, or in hospital. The main outcomes of interest were number of fallers or falls, or the number sustaining a fall resulting in injury. Trials that focused on intermediate outcomes such as improved balance or did not report fall outcomes, were excluded.
Two reviewers selected trials for inclusion. For each included trial, quality assessment and data extraction was carried out independently by two reviewers. Results of trials of similar design were pooled.
Eighteen trials and one pre-planned meta-analysis were included. The analysis of four trials which studied the effect of exercise alone did not establish protection against falling (Peto odds ratio 1.05; 95% confidence interval 0.74 to 1.48). Based on one trial, there was no evidence to support exercise in conjunction with health education classes (Peto odds ratio 1.72; 95% confidence interval 0.78 to 3.75), or of health education classes alone (Peto odds ratio 1.25; 95% confidence interval 0.51 to 3.03) for the prevention of falls. However, significant protection against falling was apparent from interventions which targeted multiple, identified, risk factors in individual patients (Peto odds ratio 0.77; 95% confidence interval 0. 64 to 0.91), and from interventions which focused on behavioural interventions targeting environmental hazards plus other risk factors (Peto odds ratio 0.81; 95% confidence interval 0.71 to 0.93).
REVIEWER'S CONCLUSIONS: Health care purchasers and providers contemplating fall prevention programmes should consider health screening of at risk elderly people, followed by interventions which are targeted at both intrinsic and environmental risk factors of individual patients. There is inadequate evidence for the effectiveness of single interventions such as exercise alone or health education classes for the prevention of falls.
老年人骨折常因简单的跌倒所致。
评估旨在降低社区居住、机构照护或住院老年人跌倒发生率的项目效果。
我们检索了MEDLINE、EMBASE、CINAHL、PsycLIT、社会科学引文索引、学位论文摘要、英国论文索引、Cochrane对照试验注册库以及已识别研究的参考文献。我们联系了该领域的知名研究人员。试验还从Cochrane肌肉骨骼损伤组试验注册库中获取。最近一次检索日期：1997年5月。
针对社区居住、机构照护或住院老年人中任何假定跌倒风险因素，旨在最小化其影响或预防暴露于该因素的干预措施的随机试验。主要关注的结局是跌倒者数量或跌倒次数，或因跌倒导致受伤的人数。专注于诸如改善平衡等中间结局或未报告跌倒结局的试验被排除。
两名综述员选择纳入试验。对于每项纳入试验，由两名综述员独立进行质量评估和数据提取。对设计相似的试验结果进行汇总。
纳入了18项试验和1项预先计划的荟萃分析。对仅研究运动效果的4项试验的分析未证实运动可预防跌倒（Peto比值比1.05；95%置信区间0.74至1.48）。基于1项试验，没有证据支持运动结合健康教育课程（Peto比值比1.72；95%置信区间0.78至3.75）或仅健康教育课程（Peto比值比1.25；95%置信区间0.51至3.03）可预防跌倒。然而，针对个体患者多个已识别风险因素的干预措施（Peto比值比0.77；95%置信区间0.64至0.91）以及专注于针对环境危害和其他风险因素的行为干预措施（Peto比值比0.81；95%置信区间0.71至0.93）对预防跌倒有显著保护作用。
考虑实施跌倒预防项目的医疗保健购买者和提供者应考虑对高危老年人进行健康筛查，随后针对个体患者的内在和环境风险因素进行干预。对于诸如单纯运动或健康教育课程等单一干预措施预防跌倒的有效性，证据不足。
