Rubenstein L Z, Robbins A S, Josephson K R, Schulman B L, Osterweil D
Veterans Affairs Medical Center, Sepulveda, California.
Ann Intern Med. 1990 Aug 15;113(4):308-16. doi: 10.7326/0003-4819-113-4-308.
To measure the effects of a specialized postfall assessment intended to detect causes and underlying risk factors for falls, and to recommend preventive and therapeutic interventions.
Randomized, controlled trial.
A long-term residential care facility for elderly persons.
Within 7 days of a fall, 160 ambulatory subjects (mean age, 87 years) were randomly assigned to receive either a comprehensive postfall assessment (intervention group, n = 79) or usual care (control group, n = 81).
The postfall assessment included a detailed physical examination and environmental assessment by a nurse practitioner; laboratory tests; electrocardiogram; and 24-hour Holter monitoring. Probable cause or causes for the fall, identified risk factors, and therapeutic recommendations were given to the patient's primary physician.
Through use of the assessment, many remediable problems (for example, weakness, environmental hazards, orthostatic hypotension, drug side effects, gait dysfunction) were detected. At the end of the 2-year follow-up period, the intervention group had 26% fewer hospitalizations (P less than 0.05) and a 52% reduction in hospital days (P less than 0.01) compared with controls. Patients in the intervention group had 9% fewer falls and 17% fewer deaths than controls by 2 years, but these trends were not statistically significant.
Our study suggests that falls are a marker of underlying disorders easily identifiable by a careful postfall assessment, which in turn can reduce disability and costs.
评估一项专门的跌倒后评估的效果，该评估旨在检测跌倒的原因及潜在风险因素，并推荐预防和治疗干预措施。
随机对照试验。
一家老年人长期居住护理机构。
在跌倒后7天内，160名能走动的受试者（平均年龄87岁）被随机分为两组，分别接受全面的跌倒后评估（干预组，n = 79）或常规护理（对照组，n = 81）。
跌倒后评估包括由执业护士进行详细的体格检查和环境评估；实验室检查；心电图检查；以及24小时动态心电图监测。将跌倒的可能原因、已确定的风险因素及治疗建议告知患者的主治医生。
通过该评估，发现了许多可补救的问题（如虚弱、环境危险因素、体位性低血压、药物副作用、步态功能障碍）。在2年随访期结束时，与对照组相比，干预组的住院次数减少了26%（P < 0.05），住院天数减少了52%（P < 0.01）。到2年时，干预组患者的跌倒次数比对照组少9%，死亡人数比对照组少17%，但这些趋势无统计学意义。
我们的研究表明，跌倒是潜在疾病的一个标志，通过仔细的跌倒后评估很容易识别，而这反过来又可以减少残疾和费用。
