Tinetti M E, Baker D I, Garrett P A, Gottschalk M, Koch M L, Horwitz R I
Yale University School of Medicine, New Haven, CT.
J Am Geriatr Soc. 1993 Mar;41(3):315-20. doi: 10.1111/j.1532-5415.1993.tb06710.x.
Based on finding a strong association between number of impairments and risk of falling in earlier studies, Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits (SV) and a targeted risk abatement intervention (TI) strategy in reducing falls among at risk community elderly persons. Subjects include members of a participating HMO who are > or = 70 years of age, cognitively intact, not terminally ill, not too physically active, and possess at least one fall risk factor. The targeted risk factors include postural hypotension; sedative use; at least four targeted medications; upper and lower extremity strength and range of motion impairments; foot problems; and balance, gait, and transfer dysfunctions. The interventions include medication adjustments, behavioral change recommendations, education and training, and home-based exercise regimens targeting the identified risk factors. The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects' homes. The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students. The primary outcome is occurrence of falls during the 12-month followup. Secondary outcomes include change in mobility performance and fall-related efficacy.
基于早期研究发现损伤数量与跌倒风险之间存在紧密关联，耶鲁FICSIT研究人员正在进行一项干预试验，比较常规护理加社会探访（SV）与针对性风险降低干预（TI）策略在降低高危社区老年人跌倒风险方面的有效性。受试者包括参与研究的健康维护组织（HMO）中年龄≥70岁、认知功能完好、非晚期疾病患者、身体活动不过度且至少具有一个跌倒风险因素的成员。针对性风险因素包括体位性低血压；使用镇静剂；至少四种针对性药物；上肢和下肢力量及活动范围受损；足部问题；以及平衡、步态和转移功能障碍。干预措施包括药物调整、行为改变建议、教育与培训，以及针对已确定风险因素的家庭锻炼方案。干预由研究护士从业者和物理治疗师在TI受试者家中实施。SV受试者接受与TI受试者数量相当的家访，期间社会工作专业学生进行结构化的生活回顾。主要结局是12个月随访期间的跌倒发生情况。次要结局包括活动能力表现的变化以及与跌倒相关的效能。
