Muñoz Cobos Francisca, Alarcón Pariente Enrique, Gaspar Solanas Adriana, Méndez Ramos Marina, Canalejo Echeverría Alberto, Burgos Varo Mª Luz
Centro de Salud El Palo. Málaga. España.
>Centro de Salud El Palo. Málaga. España.
Rev Esp Salud Publica. 2019 Jun 19;93:e201906032.
Falls in the elderly are a major health problem. There are multiple experiences of intervention in primary care. Aim: To evaluate the impact of a multifactorial intervention in the prevention of falls in elderly people. To compare the differential effect of the practice of Tai Chi.
Non-randomized before-after quasi-experimental design in an urban health center between the years 2014-2017. The study population was those over 65 years old with a high risk of falls. The intervention consisted of an individual assessment of risk factors: sensory problems, balance, orthostatic hypotension, treatments (psychotropic drugs, hypotensive drugs), barriers, technical aids. It was intervened in its correction. Tai Chi group participation is proposed. The dependent variables (baseline and year measurements) were Barthel, Unipodal Station Test (TEU), number of falls per year, Anxiety/Depression Goldberg Scale (EADG), number of medical consultations per year, walking aids, Daily Dose Defined of analgesics (DDD)/ year. The before-after analysis was performed using the Chi2 and T Student statistics for paired samples.
A total of 93 patients participated with an average age of 76+06,65, 84.9% women. Falls/year baseline 1.65 + 0.24; no significant differences between groups with or without Tai Chi in any baseline variable. At one year, average reduction of falls/year 0.53 (IC95% 0,07-0,99) (p=0.023), EADG anxiety 1.4±0.33 points (p<0.0001), EAGD depression 0.73±0.26 points (p=0.007). 44 patients practiced Tai Chi; finding: reduction of 1.88 (IC95% 0.90-2.80) points (p<0.0001) in EADG anxiety and 0.86 points (IC95% 0.12-1.60) (p=0.024) in EADG depression; 30.9% of patients abandoned technical aids (p<0.0001); 11% started psychotropic drugs. 49 patients did not practice Tai Chi; of them: EADG anxiety reduction of 1,020 points (IC95% 0.07-1.96) (p=0.035); 41.2% of patients initiated psychotropic drugs (p=0.001); none of the patients abandoned technical aids and 14.3% started them (p<0.001).
The intervention reduced the number of falls, anxiety, the use of psychotropic drugs, depression, and the use of walking aids, with differential benefit of Tai Chi in these last three aspects.
老年人跌倒问题是一个重大的健康问题。在初级保健中有多种干预经验。目标：评估多因素干预对预防老年人跌倒的影响。比较太极拳练习的不同效果。
2014年至2017年在一个城市健康中心采用非随机前后对照准实验设计。研究对象为65岁以上有高跌倒风险的人群。干预包括对危险因素进行个体评估：感觉问题、平衡能力、直立性低血压、治疗情况（精神药物、降压药物）、障碍因素、辅助器具。针对这些问题进行纠正。建议太极拳组参与。因变量（基线和年度测量值）包括巴氏指数、单足站立试验（TEU）、每年跌倒次数、焦虑/抑郁戈德堡量表（EADG）、每年就诊次数、助行器、每年定义日剂量的镇痛药（DDD）。采用配对样本的卡方检验和t检验进行前后分析。
共有93名患者参与，平均年龄76±6.65岁，女性占84.9%。每年跌倒次数基线值为1.65±0.24次；在任何基线变量上，练习太极拳组和未练习太极拳组之间均无显著差异。一年后，每年跌倒次数平均减少0.53次（95%置信区间0.07 - 0.99）（p = 0.023），EADG焦虑量表得分降低1.4±0.33分（p < 0.0001），EAGD抑郁量表得分降低0.73±0.26分（p = 0.007）。44名患者练习太极拳；结果显示：EADG焦虑量表得分降低1.88分（95%置信区间0.90 - 2.80）（p < 0.0001），EADG抑郁量表得分降低0.86分（95%置信区间0.12 - 1.60）（p = 0.024）；30.9%的患者不再使用辅助器具（p < 0.0001）；11%的患者开始使用精神药物。49名患者未练习太极拳；其中：EADG焦虑量表得分降低1.02分（95%置信区间0.07 - 1.96）（p = 0.035）；41.2%的患者开始使用精神药物（p = 0.001）；没有患者不再使用辅助器具，14.3%的患者开始使用辅助器具（p < 0.001）。
该干预减少了跌倒次数、焦虑情绪、精神药物的使用、抑郁症状以及助行器的使用，在最后三个方面太极拳有不同的益处。
