Lee Seon Heui, Kim Hee Sun
Associate Professor, Department of Nursing Science, College of Nursing, Gacheon University, Incheon, Republic of Korea.
Assistant Professor, College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea.
Worldviews Evid Based Nurs. 2017 Feb;14(1):74-80. doi: 10.1111/wvn.12193. Epub 2016 Dec 16.
Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial.
To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities.
A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality.
Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97).
This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings.
老年人跌倒属常见问题，常导致相当程度的发病率。然而，运动干预对护理机构预防跌倒的总体效果仍存在争议。
评估运动干预对护理机构跌倒发生率及跌倒者数量的有效性。
对截至2014年12月发表的随机对照试验进行荟萃分析。检索了八个数据库，包括Ovid-Medline、Embase、CINAHL、Cochrane图书馆、KoreaMed、KMbase、KISS和KisTi。两名研究者独立提取数据并评估研究质量。
选取了21项研究，包括5540名参与者。15项研究将运动作为单一干预措施，其余6项研究将运动与根据每位居民跌倒风险量身定制的两种或更多种跌倒干预措施相结合（即药物审查、环境改造或员工教育）。荟萃分析表明，运动对跌倒发生率有预防作用（风险比[RR]0.81，95%置信区间0.68 - 0.97）。当运动与其他跌倒干预措施相结合时，对跌倒发生率（RR 0.61，95%置信区间0.52 - 0.72）和跌倒者数量（RR 0.85，95%置信区间0.77 - 0.95）的影响更强。包括平衡训练（即步态、平衡和功能训练；或平衡与力量训练）的运动干预措施可降低跌倒发生率。敏感性分析表明，运动干预措施可减少再次跌倒者的数量（RR 0.71，95%置信区间0.53 - 0.97）。
本综述为制定针对居住在护理机构的老年人的循证运动干预方案提供了重要依据。应将与量身定制的其他跌倒干预措施相结合并挑战平衡训练以提高平衡技能的运动项目应用于机构环境中功能受限的体弱老年人。
