Whitehead Craig H, Wundke Rachel, Crotty Maria
Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Rd, Daw Park SA 5041, Australia.
Clin Rehabil. 2006 Jun;20(6):536-42. doi: 10.1191/0269215506cr984oa.
To ascertain the reasons for not taking up a fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department.
As part of another trial, we identified 60 people who attended the emergency department of a public hospital with a fall.
Participants were interviewed to ascertain the reasons for not taking up a falls prevention strategy, their falls-related health state, and the likelihood of them undertaking a falls and injury prevention strategy.
A total of 31 (52%) of the participants had considered falls prevention after their fall. There were high levels of reluctance to undertake a strategy with 43 (72%) reluctant to take exercise classes, 10 (59%) reluctant to cease psychotropic medications, 26 (43%) reluctant to have a home safety assessment and 17 (28%) reluctant to take osteoporotic medication. When asked specifically about taking up a strategy to prevent a worsening health state, 19 (63%) of participants would take up exercise, 17 (57%) a home safety assessment, 4 of the 17 (59%) already taking implicated medications would stop and 56 (93%) would begin osteoporotic medication. These decisions did not alter when the goal for treatment was to improve a much worse health state. In participants with a lower starting health state, home safety assessments were viewed more favourably.
There were significant obstacles to the implementation of most falls prevention guidelines examined. Treatment for osteoporosis was more acceptable to participants than exercise classes, cessation of psychotropic medication, and having a home safety assessment. Osteoporosis treatment, which had the least resistance, also had the least impact on the participants' lifestyle.
确定在跌倒后前往急诊科就诊的老年人中未采取跌倒或伤害预防策略的原因。
作为另一项试验的一部分，我们确定了60名因跌倒前往公立医院急诊科就诊的患者。
对参与者进行访谈，以确定未采取跌倒预防策略的原因、与跌倒相关的健康状况，以及他们采取跌倒和伤害预防策略的可能性。
共有31名（52%）参与者在跌倒后考虑过预防跌倒。采取预防策略的意愿较低，43名（72%）不愿参加运动课程，10名（59%）不愿停用精神药物，26名（43%）不愿进行家庭安全评估，17名（28%）不愿服用抗骨质疏松药物。当被特别问及采取预防健康状况恶化的策略时，19名（63%）参与者会参加运动，17名（57%）会进行家庭安全评估，17名中4名（59%）已服用相关药物的参与者会停药,56名（93%）会开始服用抗骨质疏松药物。当治疗目标是改善更差的健康状况时，这些决定没有改变。在初始健康状况较低的参与者中，对家庭安全评估的接受度更高。
在所研究的大多数跌倒预防指南的实施方面存在重大障碍。对参与者来说，骨质疏松症治疗比运动课程、停用精神药物和进行家庭安全评估更容易接受。阻力最小的骨质疏松症治疗对参与者生活方式的影响也最小。
