Stevens M, Holman C D, Bennett N, de Klerk N
Department of Public Health, The University of Western Australia, Nedlands, Australia.
J Am Geriatr Soc. 2001 Nov;49(11):1448-55. doi: 10.1046/j.1532-5415.2001.4911236.x.
To evaluate the outcome of an intervention to reduce hazards in the home on the rate of falls in seniors.
Randomized controlled trial, with follow-up of subjects for 1 year.
Community-based study in Perth, Western Australia.
People age 70 and older.
One thousand eight hundred seventy-nine subjects were recruited and randomly allocated by household to the intervention and control groups in the ratio 1:2. Because of early withdrawals, 1,737 subjects commenced the study. All members of both groups received a single home visit from a research nurse. Intervention subjects (n = 570) were offered a home hazard assessment, information on hazard reduction, and the installation of safety devices, whereas control subjects (n = 1,167) received no safety devices or information on home hazard reduction.
Both groups recorded falls on a daily calendar. Reported falls were confirmed by a semistructured telephone interview and were assigned to one of three overlapping categories: all falls, falls inside the home, and falls involving environmental hazards in the home. Analysis was by multivariate modelling of rate ratios and odds ratios for falls, corrected for household clustering, using Poisson regression and logistic regression with robust variance estimation.
Overall, 86% of study subjects completed the 1 year of follow-up. The intervention was not associated with any significant reduction in falls or fall-related injuries. There was no significant reduction in the intervention group in the incidence rate of falls involving environmental hazards inside the home (adjusted rate ratio, 1.11; 95% CI = 0.82-1.50), or the proportion of the intervention group who fell because of hazards inside the home (adjusted odds ratio, 0.97; 95% CI = 0.74-1.28). No reduction was seen in the rate of all falls (adjusted rate ratio, 1.02; 95% CI = 0.83-1.27) or the rate of falls inside the home (adjusted rate ratio, 1.17; 95% CI = 0.85-1.60). There was no significant reduction in the rate of injurious falls in intervention subjects (adjusted rate ratio, 0.92; 95% CI = 0.73-1.14).
The intervention failed to achieve a reduction in the occurrence of falls. This was most likely because the intervention strategies had a limited effect on the number of hazards in the homes of intervention subjects. The study provides evidence that a one-time intervention program of education, hazard assessment, and home modification to reduce fall hazards in the homes of healthy older people is not an effective strategy for the prevention of falls in seniors.
评估一项减少家庭危险因素的干预措施对老年人跌倒发生率的影响。
随机对照试验，对受试者进行为期1年的随访。
在西澳大利亚州珀斯开展的基于社区的研究。
70岁及以上的人群。
招募了1879名受试者，并按家庭以1:2的比例随机分配到干预组和对照组。由于早期退出，1737名受试者开始参与研究。两组的所有成员都接受了研究护士的一次家访。干预组受试者（n = 570）接受了家庭危险因素评估、减少危险因素的信息以及安全装置的安装，而对照组受试者（n = 1167）未获得安全装置或家庭危险因素减少方面的信息。
两组均通过日常日历记录跌倒情况。通过半结构化电话访谈确认报告的跌倒情况，并将其归入三个重叠类别之一：所有跌倒、家中跌倒以及涉及家中环境危险因素的跌倒。采用泊松回归和稳健方差估计的逻辑回归对跌倒的率比和比值比进行多变量建模分析，校正家庭聚类情况。
总体而言，86%的研究受试者完成了1年的随访。该干预措施与跌倒或跌倒相关伤害的显著减少无关。干预组中涉及家中环境危险因素的跌倒发生率没有显著降低（调整后的率比为1.11；95%置信区间 = 0.82 - 1.50），因家中危险因素而跌倒的干预组受试者比例也没有显著降低（调整后的比值比为0.97；95%置信区间 = 0.74 - 1.28）。所有跌倒的发生率（调整后的率比为1.02；95%置信区间 = 0.83 - 1.27）或家中跌倒的发生率（调整后的率比为1.17；95%置信区间 = 0.85 - 1.60）均未降低。干预组中造成伤害的跌倒发生率也没有显著降低（调整后的率比为0.92；95%置信区间 = 0.73 - 1.14）。
该干预措施未能降低跌倒的发生率。这很可能是因为干预策略对干预组受试者家中危险因素数量的影响有限。该研究提供了证据表明，针对健康老年人家庭开展的一次性教育、危险因素评估和家庭改造干预计划，并非预防老年人跌倒的有效策略。
