A Randomized Controlled Trial of a Multifactorial Falls Prevention Intervention for Older Fallers Presenting to Emergency Departments
A Randomized Controlled Trial of a Multifactorial Falls Prevention Intervention for Older Fallers Presenting to Emergency Departments
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DOI：
10.1111/j.1532-5415.2010.03191.x
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发表时间：
2010-12-01
影响因子：
6.3
通讯作者：
Dharmage, Shyamali C.
中科院分区：
文献类型：
--
作者：
Russell, Melissa A.;Hill, Keith D.;Dharmage, Shyamali C.
目的研究基于转诊的针对性多因素预防跌倒干预对跌倒后到急诊科(ED)就诊并从急诊科直接出院的老年人再跌倒和伤害发生的影响。设计：随机对照试验。结果的评估者不知道小组分配。设置澳大利亚墨尔本大都市的七名急诊室。部分纳入标准是社区住宅，年龄在60岁及以上，跌倒后向急诊室提出，并直接出院。排除标准不能遵循简单的指导或独立行走。干预基于基线评估中发现的跌倒危险因素，转介到现有的社区服务和健康促进建议。测量主要结果衡量标准是在12个月的随访期内发生的跌倒和继发性伤害。跌倒和受伤的数据是使用有医疗记录支持的跌倒日历收集的。结果：161名参与者被随机分为标准护理组和351名干预组。在12个月的随访期内，两组在跌倒人数(相对风险(RR)=1.11，95%可信区间(CI)=0.95-1.31)或因跌倒受伤的参与者数量(RR=1.06，95%CI=0.86-1.29)方面没有发现显著差异。结论本研究不支持使用基于转诊的有针对性的多因素干预计划来减少跌倒后向急诊科就诊的老年人随后的跌倒或跌伤。
OBJECTIVESTo investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED.DESIGNRandomized controlled trial. Assessors of outcomes were unaware of group allocation.SETTINGSeven EDs in metropolitan Melbourne, Australia.PARTICIPANTSInclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently.INTERVENTIONTargeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment.MEASUREMENTSPrimary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews.RESULTSThree hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95-1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86-1.29).CONCLUSIONThis study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.