Hart D, Bowling A, Ellis M, Silman A
London Hospital.
BMJ. 1990 Jul 28;301(6745):216-20. doi: 10.1136/bmj.301.6745.216.
To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living.
Population based randomised controlled trial of subjects aged greater than or equal to 85 living independently in an inner London borough.
21 Electoral wards of the London Borough of Hackney.
1255 Subjects aged greater than or equal to 85 living in their own home whose names were obtained from general practitioner lists and cross checked against the electoral register, 511 of whom were subsequently found to be ineligible. Of the 744 remaining, those with disability on screening were randomised and allocated to an intervention group (36) or a control group (43), in which intervention was postponed until four weeks, after the follow up assessment. Subjects with aids supplied previously were excluded from the intervention phase.
Provision of raised toilet seat, teapot tipper, tap turner, shoe horn and elastic laces, and double handled saucepan.
Degree of difficulty (grades 1-4) with specific tasks (getting on and off a toilet, pouring from a teapot into a cup, turning taps on and off, carrying a saucepan of standard weight, and putting on shoes) and time taken to perform them.
545 (73%) Of the 744 eligible subjects assessed; 428 had no disability and 118 had difficulty with at least one task. Some had had their disability recognised before the study and already had aids, representing half of those with difficulty getting on and off the toilet but 24% for putting on shoes and 13% for pouring from a teapot and turning on a tap. The mean number of difficulties was similar between the groups (intervention group 1.7, control group 1.6). Time taken to complete the tasks corresponded with the observed grade of difficulty. All aids were associated with reduced difficulty according to observer assessment (% improvement intervention group v control group: raised toilet seat, 71 v 13 teapot tipper 100 v 33; tap turner 100 v 0; saucepan 88 v 0; shoe horn 50 v 13) and time taken to complete the tasks. A cost benefit analysis of this screening-intervention programme suggested a total cost of 32 pounds per individual benefit.
Appreciable degrees of unrecognised locomotor disability are detected on screening of very elderly people living independently. Providing aids offers a feasible and cost effective means of improving function in such people.
评估老年受试者中潜在可逆转的运动功能障碍的患病率以及提供日常生活辅助器具的成本效益。
对伦敦市中心一个行政区内年龄大于或等于85岁、独立生活的受试者进行基于人群的随机对照试验。
哈克尼伦敦自治市的21个选区。
从全科医生名单中获取1255名年龄大于或等于85岁、居住在自己家中的受试者，并与选民登记册进行交叉核对，其中511人随后被发现不符合条件。在其余的744人中，筛查出有残疾的受试者被随机分配到干预组（36人）或对照组（43人），干预推迟到随访评估四周后进行。之前已提供辅助器具的受试者被排除在干预阶段之外。
提供抬高的马桶座圈、茶壶倾倒器、水龙头旋转器、鞋拔和弹力鞋带以及双柄平底锅。
完成特定任务（上下马桶、从茶壶往杯子里倒水、开关水龙头、端起标准重量的平底锅、穿鞋）的困难程度（1 - 4级）以及完成这些任务所需的时间。
在评估的744名符合条件的受试者中，545名（73%）；428名无残疾，118名至少有一项任务存在困难。一些人在研究前其残疾就已被识别且已有辅助器具，在上、下马桶困难的人群中占一半，但穿鞋困难的人群中占24%，从茶壶倒水和开水龙头困难的人群中占13%。两组的平均困难数量相似（干预组1.7，对照组1.6）。完成任务所需时间与观察到的困难程度相符。根据观察者评估，所有辅助器具都与困难程度降低相关（干预组与对照组改善百分比：抬高的马桶座圈，71%对13%；茶壶倾倒器100%对33%；水龙头旋转器100%对0；平底锅88%对0；鞋拔50%对13%）以及完成任务所需时间。对该筛查 - 干预项目的成本效益分析表明，每位受试者的总效益成本为32英镑。
在对独立生活的高龄老人进行筛查时，发现了相当程度未被识别的运动功能障碍。提供辅助器具为改善这类人群的功能提供了一种可行且具有成本效益的方法。
