Ray Wayne A, Taylor Jo A, Brown Anne K, Gideon Patricia, Hall Kathi, Arbogast Patrick, Meredith Sarah
Division of Pharmacoepidemiology and Center for Education and Research on Therapeutics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Arch Intern Med. 2005 Oct 24;165(19):2293-8. doi: 10.1001/archinte.165.19.2293.
Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities.
A cluster randomization clinical trial with 112 qualifying facilities and 10,558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period.
There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10).
More intensive interventions are required to prevent fall-related injuries in long-term care facilities.
在长期护理中，与跌倒相关的伤害是一个主要的公共卫生问题，改善安全措施的干预措施可能会减少此类伤害。先前的研究表明，安全措施干预可以减少跌倒；然而，在长期护理中，这些措施严重依赖外部资金和工作人员。本研究的目的是测试针对工作人员的安全措施培训计划是否可以减少长期护理机构中与跌倒相关的伤害。
一项整群随机临床试验，有112家符合条件的机构和10558名65岁及以上且非卧床的研究对象。干预措施是一个为期2天的强化安全培训计划，并进行12个月的随访。培训计划的目标包括生活空间和个人安全；轮椅、拐杖和助行器；精神药物的使用；以及转移和行走。主要结局指标是随访期间与跌倒相关的严重伤害。
干预组和对照组机构之间的伤害发生率没有差异（调整后的率比为0.98；95%置信区间为0.83-1.16）。对于在计划依从性最佳的机构中曾有过跌倒经历的居民，干预组的伤害有减少的非显著趋势（调整后的率比为0.79；95%置信区间为0.57-1.10）。
需要更强化的干预措施来预防长期护理机构中与跌倒相关的伤害。
