King's College London, Institute of Gerontology, Strand, London, UK.
BMC Health Serv Res. 2010 Dec 3;10:327. doi: 10.1186/1472-6963-10-327.
Older adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies.Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined.
METHODS/DESIGN: This prospective proof of concept study, currently being conducted in two London boroughs, (Southwark and Lambeth) aims to reduce the incidence of both fires and falls in community-dwelling older adults. It comprises two concurrent 12-month interventions: the integration of 1) fall risk assessments into the Brigade's Home Fire Safety Visit and 2) fire risk assessments into Falls services by inviting older clinic attendees to book a Visit. Our primary objective is to examine the feasibility and effectiveness of these interventions. Furthermore, we are evaluating their acceptability and value to key stakeholders and services users.
If our approach proves feasible and the risk assessment is both effective and acceptable, we envisage advocating a partnership model of working more broadly to fire and rescue services and health services in Britain, such that effective integration of preventative services for older people becomes routine for an ageing population.
老年人跌倒和遭遇家庭火灾的风险都增加了。除了年龄较大之外，这些不良事件还存在平衡或移动问题、认知障碍和社会经济贫困等共同风险因素。对于这两种情况，后果包括严重受伤和死亡，以及对个人和非正式照顾者以及紧急服务、卫生和社会保健机构的巨大社会经济成本。针对跌倒或处于跌倒高风险的老年人的二级预防服务包括 NHS 跌倒诊所，多学科团队提供个性化的多因素针对性干预措施，包括力量和平衡运动计划、药物调整和家庭危险物修改。大多数消防和救援服务机构也采取类似的预防方法，他们进行家庭消防安全访问，以评估和必要时消除家庭火灾风险，免费安装带有使用和维护说明的烟雾报警器，并计划逃生路线。我们认为，风险人群、地点、具体风险因素以及所采用的预防方法的相似性，如果这两种预防方法的活动相结合，在可行性、有效性和可接受性方面可能会带来净收益。
方法/设计：这项正在伦敦的两个行政区（南华克和兰贝斯）进行的前瞻性概念验证研究旨在降低社区居住的老年人跌倒和火灾的发生率。它包括两项同时进行的为期 12 个月的干预措施：将 1）跌倒风险评估纳入消防队的家庭消防安全访问，以及 2）通过邀请老年诊所就诊者预约访问，将火灾风险评估纳入跌倒服务。我们的主要目标是检查这些干预措施的可行性和有效性。此外，我们正在评估其对主要利益相关者和服务用户的可接受性和价值。
如果我们的方法被证明是可行的，并且风险评估既有效又可接受，我们设想倡导一种更广泛的工作伙伴关系模式，为英国的消防和救援服务以及卫生服务机构提供服务，以便为老龄化人口有效整合老年人预防服务成为常规。
