Wagner E H, LaCroix A Z, Grothaus L, Leveille S G, Hecht J A, Artz K, Odle K, Buchner D M
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101.
Am J Public Health. 1994 Nov;84(11):1800-6. doi: 10.2105/ajph.84.11.1800.
Because preventing disability and falls in older adults is a national priority, a randomized controlled trial was conducted to test a multicomponent intervention program.
From a random sample of health maintenance organization (HMO) enrollees 65 years and older, 1559 ambulatory seniors were randomized to one of three groups: a nurse assessment visit and follow-up interventions targeting risk factors for disability and falls (group 1, n = 635); a general health promotion nurse visit (group 2, n = 317); and usual care (group 3, n = 607). Data collection consisted of a baseline and two annual follow-up surveys.
After 1 year, group 1 subjects reported a significantly lower incidence of declining functional status and a significantly lower incidence of falls than group 3 subjects. Group 2 subjects had intermediate levels of most outcomes. After 2 years of follow-up, the differences narrowed.
The results suggest that a modest, one-time prevention program appeared to confer short-term health benefits on ambulatory HMO enrollees, although benefits diminished by the second year of follow-up. The mechanisms by which the intervention may have improved outcomes require further investigation.
鉴于预防老年人残疾和跌倒已成为一项国家重点工作，开展了一项随机对照试验以测试一项多组分干预计划。
从一个年龄在65岁及以上的健康维护组织（HMO）参保者随机样本中，1559名能走动的老年人被随机分为三组之一：一次护士评估访视及针对残疾和跌倒风险因素的后续干预（第1组，n = 635）；一次一般健康促进护士访视（第2组，n = 317）；以及常规护理（第3组，n = 607）。数据收集包括一次基线调查和两次年度随访调查。
1年后，第1组受试者报告的功能状态下降发生率显著低于第3组受试者，跌倒发生率也显著更低。第2组受试者的大多数结果处于中间水平。随访2年后，差异缩小。
结果表明，一项适度的一次性预防计划似乎能为能走动的HMO参保者带来短期健康益处，尽管在随访的第二年益处有所减少。该干预可能改善结果的机制需要进一步研究。
