University Medical Department Center Schleswig-Holstein, Department of Orthopedic and Trauma Surgery, Kiel, Germany.
Christian-Albrechts-University, Medical faculty, Kiel, Germany.
J Am Geriatr Soc. 2022 Jun;70(6):1754-1763. doi: 10.1111/jgs.17725. Epub 2022 Feb 28.
Many falls in older people occur at home, and home hazards (HOHA) are often involved. Fear of falling (FOF) is a frequent and serious consequence of falls. This study aimed to analyze the effectiveness of an autonomous reduction of HOHA on FOF.
In this single-blinded, prospective cohort study design, the inclusion criteria were female sex, age ≥60 years, no known dementia, community-dwelling, and written informed consent. Using a 54-item room-by-room checklist, the participants identified and autonomously reduced as many HOHA as possible, within 14 days. The FOF was measured using a dichotomous scale (D-FOF) and the Falls Efficacy Scale International (FES-I). Logistic regression models were used to identify the predictors of a substantial reduction of HOHA (≥50%) and FOF (≥25%).
A total of 782 women fulfilled the inclusion criteria, and 431 (60.5%) returned the complete checklist on time. The mean age was 72.5 [SD 7.1] years. 43.8% of participants reduced ≥50% of the HOHA. The D-FOF (odds ratio 22.4 [95% confidence interval 11.0-45.3]), age ≥ 75 years (14.1 [7.5-26.4]), polypharmacy (3.0 [1.4-6.5]), and assumed improvability of housing conditions (2.4 [1.3-4.3]) were identified as predictors for substantially reducing HOHA with an area under the curve of 0.91. The initial FES-I score decreased from 24.5 to 19.5. Prior to the intervention, 53.1% showed a high FOF (>22 FES-I scores). Of these, 70.7% participants reduced their high FOF to low FOF. 29.2% of all participants reduced FOF ≥25% postinterventionally, associated with a substantial reduction in HOHA (3.5 [2.2-5.7]) as the strongest independent factor in the multiple logistic regression analysis.
The use of a self-administered checklist led to a substantial reduction of HOHA and subsequently to a clinically relevant reduction of FOF in older community-dwelling women. Autonomous competence of older people should be considered when developing fall prevention strategies.
许多老年人跌倒发生在家里，而家庭隐患（HOHA）往往是跌倒的原因。对跌倒的恐惧（FOF）是跌倒的常见且严重的后果。本研究旨在分析自主减少家庭隐患对 FOF 的有效性。
在这项单盲、前瞻性队列研究设计中，纳入标准为女性、年龄≥60 岁、无已知痴呆、居住在社区和书面知情同意。参与者使用 54 项房间到房间的检查表识别并在 14 天内自主减少尽可能多的家庭隐患。使用二分法（D-FOF）和跌倒效能量表国际版（FES-I）测量 FOF。使用逻辑回归模型识别大量减少家庭隐患（≥50%）和 FOF（≥25%）的预测因素。
共有 782 名女性符合纳入标准，其中 431 名（60.5%）按时返回完整的检查表。平均年龄为 72.5 [SD 7.1] 岁。43.8%的参与者减少了≥50%的家庭隐患。D-FOF（比值比 22.4 [95%置信区间 11.0-45.3]）、年龄≥75 岁（14.1 [7.5-26.4]）、多药治疗（3.0 [1.4-6.5]）和假设住房条件可改善（2.4 [1.3-4.3]）被确定为大量减少家庭隐患的预测因素，曲线下面积为 0.91。初始 FES-I 评分从 24.5 降至 19.5。在干预前，53.1%的人 FOF 较高（>22 FES-I 评分）。其中，70.7%的参与者将高 FOF 降低为低 FOF。干预后，29.2%的参与者 FOF 降低≥25%，与家庭隐患大量减少（3.5 [2.2-5.7]）密切相关，是多因素逻辑回归分析中最强的独立因素。
使用自我管理的检查表可显著减少家庭隐患，进而显著降低老年社区居住女性的 FOF。在制定跌倒预防策略时，应考虑老年人的自主能力。
