Jensen Jane, Lundin-Olsson Lillemor, Nyberg Lars, Gustafson Yngve
Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, SE-901 85, Umeå, Sweden. ,
Ann Intern Med. 2002 May 21;136(10):733-41. doi: 10.7326/0003-4819-136-10-200205210-00008.
Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited.
To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries.
A cluster randomized, controlled, nonblinded trial.
9 residential care facilities located in a northern Swedish city.
439 residents 65 years of age or older.
An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff.
The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls.
During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models.
An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.
在居住护理机构中的老年人中，跌倒及由此导致的损伤尤为常见，但关于跌倒预防的知识有限。
调查多因素干预项目是否能减少跌倒及与跌倒相关的损伤。
一项整群随机、对照、非盲试验。
瑞典北部城市的9家居住护理机构。
439名65岁及以上的居民。
一项为期11周的多学科项目，包括通用策略和针对居民个体的定制策略。这些策略包括对工作人员进行教育、改善环境、实施锻炼项目、提供和维修辅助器具、审查药物治疗方案、提供免费髋部保护器、召开跌倒后问题解决会议以及指导工作人员。
主要结局为跌倒居民的数量、跌倒次数以及首次跌倒发生的时间。次要结局为跌倒导致的损伤数量。
在34周的随访期内，干预项目组中有82名居民（44%）发生跌倒，而对照组中有109名居民（56%）发生跌倒（风险比，0.78 [95%可信区间，0.64至0.96]）。调整后的优势比为0.49（可信区间，0.37至0.65），跌倒的调整发病率比为0.60（可信区间，0.50至0.73）。干预组有3名居民和对照组有12名居民发生了1例股骨骨折（调整后的优势比，0.23 [可信区间，0.06至0.94]）。在所有回归模型中均考虑了聚类情况。
针对居民、工作人员和环境的跨学科多因素预防项目可能会减少跌倒和股骨骨折。
