Pliannuom Suphawita, Phinyo Phichayut, Buawangpong Nida, Nantsupawat Nopakoon, Atthakomol Pichitchai, Vaseenon Tanawat, Kitcharanant Nitchanant, Yotruangsri Thanachat, Lerttrakarnnon Peerasak, Pinyopornpanish Kanokporn
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, Sri Phum, Muang, 50200, Chiang Mai, Thailand.
Department of Biomedical Informatics and Clinical Epidemiology (BioCE), Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Eur Geriatr Med. 2025 Aug 6. doi: 10.1007/s41999-025-01284-y.
Fear of falling (FoF) is common in older adults with fragility hip fractures after hospital discharge, leading to negative health outcomes. Evidence on tele-home visits' effectiveness in managing FoF remains limited. This study compares FoF outcomes between tele-home visits and usual home visits 2 months post-discharge.
A prospective observational cohort study was conducted at a tertiary care hospital in Thailand, involving older adults aged 60 years and above who experienced fragility hip fractures and were hospitalized between March 2023 and May 2024. Participants were assigned to either tele-home or usual home visits based on their travel time from the hospital. The primary outcome was the change in FoF from 2 weeks to 2 months after discharge, measured using the Short Falls Efficacy Scale-International (Short FES-I). The study tested whether tele-home visits were non-inferior to usual home visits, using inverse probability of treatment weighting (IPTW) to adjust for baseline differences and a non-inferiority margin of 3.51.
The study included 106 patients (mean age 78.96 ± 9.24 years; 77.36% female). After IPTW, both groups showed improvement in FoF, with a mean reduction of -5.06 (95% confidence interval; 95% CI -5.90 to -4.22) in the tele-home visits group and -4.02 (95% CI -5.24 to -2.80) in the usual home visits group. The difference was -1.04 (95% CI -2.52 to 0.45), supporting the non-inferiority of tele-home visits.
Tele-home visits are non-inferior to usual home visits in reducing FoF and can be provided for older adults with fragility hip fractures after hospital discharge. These findings offer greater convenience for continued care and improved access to care, even in remote areas.
出院后，髋部脆性骨折的老年人普遍存在跌倒恐惧（FoF），这会导致不良健康后果。关于远程家访在管理跌倒恐惧方面有效性的证据仍然有限。本研究比较了出院后2个月远程家访和常规家访在跌倒恐惧方面的结果。
在泰国一家三级护理医院进行了一项前瞻性观察队列研究，纳入年龄在60岁及以上、2023年3月至2024年5月期间因髋部脆性骨折住院的老年人。根据参与者从医院出发的行程时间，将其分配到远程家访组或常规家访组。主要结局是出院后2周和2个月之间跌倒恐惧的变化，使用国际跌倒效能简短量表（Short FES-I）进行测量。该研究使用治疗权重逆概率（IPTW）来调整基线差异，并设定非劣效界值为3.51，以检验远程家访是否不劣于常规家访。
该研究纳入了106名患者（平均年龄78.96±9.24岁；77.36%为女性）。经过IPTW后，两组的跌倒恐惧均有所改善，远程家访组平均降低了-5.06（95%置信区间；95%CI -5.90至-4.22），常规家访组平均降低了-4.02（95%CI -5.24至-2.80）。差异为-1.04（95%CI -2.52至0.45），支持远程家访的非劣效性。
在降低跌倒恐惧方面，远程家访不劣于常规家访，可用于出院后的髋部脆性骨折老年人。这些发现为持续护理提供了更大的便利，并改善了医疗服务的可及性，即使在偏远地区也是如此。
