Niedermann Karin, Meichtry André, Zindel Barbara, Ernst Markus J, Krafft Valérie, Mattli Renato, Nast Irina, Wieser Simon, Wirz Markus, Brunner Beatrice
ZHAW Zurich University of Applied Sciences, School of Health Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland.
BFH Bern University of Applied Sciences, School of Health Professions, Bern, Switzerland.
BMC Geriatr. 2024 Dec 28;24(1):1044. doi: 10.1186/s12877-024-05586-x.
Fall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.
A prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.
Overall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from -1.50 to -1.05), quality of life improved by -0.88 points (95%CI from -1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.
This fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.
在人口老龄化的社会中，预防跌倒计划是至关重要的干预措施。本研究评估了跌倒发生率和其他健康结果，以及针对社区居住老年人的居家预防跌倒计划的成本效益。在一次家访中，经过培训的物理治疗师或职业治疗师进行跌倒风险评估，消除环境危险因素，并提供量身定制的锻炼。
对一项预防跌倒计划的参与者进行了一项前瞻性纵向观察研究，这些参与者同意接受为期一年的随访。基线数据包括干预前一个月和一年的自我报告跌倒情况。通过每两个月一次的电话对参与者进行监测，评估他们的跌倒次数、跌倒恐惧（使用国际跌倒效能量表（FES-I））、生活质量（使用欧洲五维健康量表-5级（EQ-5D-5L））和身体活动（每周分钟数）。数据的统计分析使用广义估计方程（GEE）泊松模型来分析跌倒次数，使用线性混合模型（LMM）来分析跌倒恐惧、生活质量和身体活动。此外，使用医疗保险理赔数据比较干预前后一年接受医学治疗的跌倒次数以及相关的医疗保健支出。该计划与常规护理相比的成本效益估计为预防每次接受医学治疗的跌倒的成本。
总体而言，分析了639人年的观察时间。参与者的平均年龄为81.8岁（±5.2），59%为女性。平均而言，跌倒发生率从每人每年1.35次降至1.02次，即-23.9%（95%CI为-35.92至-9.67），跌倒恐惧降低了-1.27分（95%CI为-1.50至-1.05），生活质量提高了-0.88分（95%CI为-1.09至-0.68），身体活动每天增加了9.87分钟（95%CI为5.65至14.09）。对理赔数据的分析显示，接受医学治疗的跌倒次数减少了48.0%（95%CI为30.5%至61.0%）。预防每次接受医学治疗的跌倒的平均成本估计约为1353美元，该干预措施有50%的概率节省成本。
发现这种单次家访的预防跌倒计划是有效且具有成本效益的。卫生政策应将这种模式确立为可报销的标准护理，以帮助应对跌倒给个人和社会带来的日益增加的负担。
