Tinetti M E, McAvay G, Claus E
Department of Medicine, Yale Univesity School of Medicine, New Haven, CT 06520-8025, USA.
Am J Epidemiol. 1996 Aug 15;144(4):389-99. doi: 10.1093/oxfordjournals.aje.a008940.
In a recent study of fall prevention in 301 community-living older persons (the Yale FICSIT Trial, 1990-1993), participants in the multifactorial targeted intervention (TI) group experienced significantly fewer falls than participants in the social visit (SV) control group. In the present paper, the authors explore the relation between changes in the studied risk factors and the occurrence of falling. In comparison with SV participants, TI participants showed significantly greater improvements in postural blood pressure change (p = 0.01), step length (p = 0.004), use of > or = 4 medications (p = 0.003), and unsafe tub and toilet transfers (p = 0.05), while change in balance was of borderline significance (p = 0.08). Reduction in the occurrence of falling, in turn, was at least marginally associated with improvements in balance, postural blood pressure change, step length, lower extremity strength/range of motion, and transfers. When participants were divided into tertiles based on a composite risk factor change score, a significantly higher percentage of TI participants (42%) than SV participants (22%) were in the greatest risk factor reduction tertile. Among TI participants, there was a progressively lower fall rate per person per year in the tertiles with the least, intermediate, and greatest risk reduction (0.832, 0.624, and 0.260), respectively. A similar but weaker relation between risk factor reduction and fall rate was seen in the SV group. When compared within tertiles, essentially adjusting for the amount of risk factor reduction, the fall rates among TI and SV participants in the greatest risk factor reduction tertile were identical (0.260 falls per person per year), and the rates in the least reduction tertile were similar (0.832 vs. 1.040 falls per person per year); this suggests that risk factor reduction at least partially mediated the treatment effect. These results support the feasibility of implementing and analyzing the effectiveness of a multiple risk factor reduction strategy in the aged.
在一项针对301名社区居住老年人的近期跌倒预防研究（耶鲁FICSIT试验，1990 - 1993年）中，多因素目标干预（TI）组的参与者跌倒次数显著少于社会探访（SV）对照组的参与者。在本文中，作者探讨了所研究的风险因素变化与跌倒发生之间的关系。与SV组参与者相比，TI组参与者在姿势性血压变化（p = 0.01）、步长（p = 0.004）、使用≥4种药物（p = 0.003）以及不安全的浴缸和马桶转移（p = 0.05）方面有显著更大的改善，而平衡变化具有临界显著性（p = 0.08）。反过来，跌倒发生率的降低至少在一定程度上与平衡、姿势性血压变化、步长、下肢力量/活动范围以及转移方面的改善相关。当根据综合风险因素变化评分将参与者分为三分位数时，TI组参与者（42%）处于最大风险因素降低三分位数的比例显著高于SV组参与者（22%）。在TI组参与者中，风险降低最少、中等和最大的三分位数中，每人每年的跌倒率逐渐降低（分别为0.832、0.624和0.260）。在SV组中也观察到了风险因素降低与跌倒率之间类似但较弱的关系。在三分位数内进行比较时，基本调整了风险因素降低的程度，最大风险因素降低三分位数中TI组和SV组参与者的跌倒率相同（每人每年0.260次跌倒），最小降低三分位数中的跌倒率相似（每人每年0.832次与1.040次跌倒）；这表明风险因素降低至少部分介导了治疗效果。这些结果支持了在老年人中实施和分析多风险因素降低策略有效性的可行性。
