Gulka Heidi J, Patel Vaidehi, Arora Twinkle, McArthur Caitlin, Iaboni Andrea
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
J Am Med Dir Assoc. 2020 Aug;21(8):1024-1035.e4. doi: 10.1016/j.jamda.2019.11.012. Epub 2020 Jan 23.
To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia.
Systematic review and meta-analysis.
NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions.
Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers.
Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94).
Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.
确定养老院跌倒干预项目的效果，以及这些干预措施对认知障碍和痴呆患者的适用性。
系统评价和荟萃分析。
养老院居民（n = 30,057），养老院被定义为为通常年龄≥65岁、患有多种复杂慢性健康问题的人群提供全天24小时监护、个人护理和一些临床护理的居住设施。
对预防跌倒干预措施在跌倒次数、跌倒者和反复跌倒者方面进行荟萃分析。
36项研究符合系统评价的纳入标准。总体而言，预防跌倒干预措施减少了跌倒次数[风险比（RR）= 0.73，95%置信区间（CI）= 0.60 - 0.88]、跌倒者数量（RR = 0.80，95% CI = 0.72 - 0.89）和反复跌倒者数量（RR = 0.70，95% CI = 0.60 - 0.81）。亚组分析显示，单一干预措施对减少跌倒者（RR = 0.78，95% CI = 0.69 - 0.89）和反复跌倒者（RR = 0.60，95% CI = 0.52 - 0.70）有显著效果，而多种干预措施可减少跌倒者（RR = 0.69，95% CI = 0.39 - 0.97），多因素干预措施可减少跌倒次数（RR = 0.65，95% CI = 0.45 - 0.94）。
作为单一干预措施，运动可使养老院居民中的跌倒者和反复跌倒者数量分别减少36%和41%。其他有效的干预措施包括员工教育以及多种和多因素干预措施。然而，需要对包括认知障碍和痴呆患者在内的运动进行更多研究，以提高这些干预措施对典型养老院居民的适用性。
