The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people
The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people
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DOI：
10.1093/ageing/afn192
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发表时间：
2009-01-01
期刊：
影响因子：
6.7
通讯作者：
Gordon, Christopher J.
中科院分区：
文献类型：
--
作者：
Spice, Claire L.;Morotti, Wendy;Gordon, Christopher J.
背景：老年人福尔斯的死亡率和发病率是显著的，反复跌倒者的风险增加。在这一组中减少福尔斯跌倒的最有效方法尚不清楚。目的：确定两种干预措施的有效性，一种是基于初级保健，另一种是基于二级保健，以防止复发性跌倒者进一步福尔斯跌倒。设计：群集随机对照试验。参与者：65岁或以上，居住在社区，在前一年中有两次或两次以上的福尔斯跌倒，并且没有因指数跌倒而到急诊科就诊。设置：英国汉普郡中部。干预：将18个一般实践随机分配到三组之一。社区护士通过风险因素审查并随后有针对性地转介给其他专业人员，对初级保健组进行评估。二级护理组在日间医院接受多学科评估，然后确定适当的干预措施。对照组给予常规护理。随访1年。结果：505名参与者被招募。83%（421/505）完成随访。二级护理组再次跌倒的受试者比例（75%，158/210）显著低于对照组[84%，133/159，调整后比值比（OR）0.52（95% CI 0.35-0.79）P = 0.002]。初级护理组显示出与对照组相似的结果[87%，118/136，调整OR 1.17（95%CI 0.57-2.37）P = 0.673]。结论：对复发性跌倒者进行结构化多学科评估可显著减少再次发生福尔斯的人数，但以社区为基础的护士主导的评估并有针对性地转诊给其他专业人员则没有。
Background: the mortality and morbidity of falls in older people is significant, with recurrent fallers being at an increased risk. The most effective way to reduce falls in this group is not clear.Objective: to determine the effectiveness of two interventions, one based in primary care and the other in secondary care, at preventing further falls in recurrent fallers.Design: cluster randomised controlled trial.Participants: sixty-five years or over, living in the community, two or more falls in the previous year and not presenting to an emergency department with index fall.Setting: Mid Hampshire, UK.Intervention: eighteen general practices were randomly allocated to one of three groups. The primary care group was assessed by nurses in the community, using a risk factor review and subsequent targeted referral to other professionals. The secondary care group received a multi-disciplinary assessment in a day hospital followed by identified appropriate interventions. The control group received usual care. Follow-up was for 1 year.Results: five hundred and five participants were recruited. Follow-up was completed in 83% (421/505). The proportion of participants who fell again was significantly lower in the secondary care group (75%, 158/210) compared to the control group [84%, 133/159, adjusted odds ratio (OR) 0.52 (95% CI 0.35-0.79) P = 0.002]. The primary care group showed similar results to the control group [87%, 118/136, adjusted OR 1.17 (95% CI 0.57-2.37) P = 0.673].Conclusion: a structured multi-disciplinary assessment of recurrent fallers significantly reduced the number experiencing further falls, but a community-based nurse-led assessment with targeted referral to other professionals did not.