Ray W A, Taylor J A, Meador K G, Thapa P B, Brown A K, Kajihara H K, Davis C, Gideon P, Griffin M R
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
JAMA. 1997 Aug 20;278(7):557-62.
Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.
To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.
Randomized controlled trial.
Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention.
Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety.
The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention.
The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P=.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P=.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year.
The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs.
跌倒在养老院是一个重大的健康问题，但尚无干预措施被证明可预防养老院居民跌倒。
评估一项旨在预防高危养老院居民跌倒及相关伤害的干预项目。
随机对照试验。
田纳西州中部的七对养老院，每对中的一个机构被随机分配到干预组。这些机构共有482名居民（261名对照组，221名干预组）符合研究条件，因为他们有跌倒的高风险以及一个可通过干预解决的潜在安全问题。
进行全面的结构化个体评估，并给出针对环境和个人安全、轮椅使用、精神药物使用以及转移和行走等次优做法的具体安全建议。鼓励机构工作人员实施个体建议并改善整体机构安全。
干预后一年中机构内再次跌倒者的平均比例以及伤害性跌倒的发生率。
干预机构中再次跌倒者的平均比例（43.8%）比对照机构（54.1%）低19.1%（95%置信区间，2.4%-35.8%）（P = 0.03）。干预机构的伤害性跌倒平均发生率有降低的趋势，但不显著（每100人年分别为13.7次和19.9次，降低31.2%，P = 0.22）。亚组分析表明，对于实施了推荐干预措施的居民或前一年跌倒3次或更多次的居民，获益最大。
养老院中跌倒及相关伤害的高发生率不应被视为不可避免，而应被视为可通过结构化安全项目大幅改善的结果。
