Assantachai Prasert, Chatthanawaree Wichai, Thamlikitkul Visanu, Praditsuwan Rungnirand, Pisalsarakij Dujpratana
Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2002 Feb;85(2):215-22.
Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fall prevention among the healthy elderly in the community.
不稳定或跌倒在老年人中是潜在严重疾病的重要警示症状之一，因此许多研究都集中在跌倒的风险因素上。然而，下一步是开展一项涉及降低跌倒发生率的策略性方法的研究，这也是本研究的主要目标。招募了1043名居住在曼谷诗里拉吉医院医学院周边市区的老年人，其中585人被分配到研究组，458人被分配到对照组。仅在研究组中，一张包含其社区内跌倒重要风险因素信息的传单与一张随访明信片一同寄出。此外，如果该特定组的老年人有任何健康问题，可免费前往诗里拉吉医院的老年诊所就诊。所有人都收到一张明信片，询问他们在过去2个月内是否发生过跌倒，共询问6次，若明信片未寄回团队，则会接到电话询问。从第一次随访到最后一次随访，保持联系的老年人比例分别为92.5%、90.6%、89.3%、89.2%、86.2%和85.45%。经过一年的纵向研究，研究组的跌倒总发生率为6.6%，对照组为10.1%。在第四次和第六次随访时，两组之间的跌倒发生率开始显示出统计学上的显著差异（P = 0.002和0.004）。Kaplan-Meier生存分析也显示两组之间的跌倒发生率存在统计学上的显著差异（P = 0.01）。总之，研究组的跌倒发生率显著降低，并且反复开展活动提醒老年人跌倒风险是社区中健康老年人预防跌倒的一种经济有效的方法。
