Randomised factorial trial of falls prevention among older people living in their own homes
Randomised factorial trial of falls prevention among older people living in their own homes
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DOI：
10.1136/bmj.325.7356.128
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发表时间：
2002-07-20
影响因子：
--
通讯作者：
Lord, S
中科院分区：
文献类型：
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作者：
Day, L;Fildes, B;Lord, S
目的探讨预防老年人福尔斯跌倒的三种干预措施的有效性和相互作用。设计：一项全因子设计的随机对照试验。研究背景：澳大利亚墨尔本的城市社区。参与者1090名，年龄70岁及以上，住在家里。大多数是澳大利亚出生的，并评价他们的健康状况良好，以优秀的，刚刚超过一半lived alone.Interventions三个干预措施（基于组的运动，家庭危险管理，视力改善）提供给8组定义的存在或不存在的每个intervention.Main结果测量时间到第一次跌倒确定的18个月的福尔斯日历和生存分析技术分析。通过测量股四头肌力量、平衡、视力和家庭中的危险因素来评估目标危险因素的变化。结果运动的比率为0.82（95%置信区间为0.70 ~ 0.97，P=0.02），观察到运动干预组合的显著效果（P < 0.05）。运动组的平衡指标明显改善。无论是家庭危险管理还是视力不良的治疗都没有显着效果。观察到所有三种干预措施组合的最强效果（率比0.67（0.51至0.88，P=0.004）），估计每年跌倒率降低14.0%。需要治疗的人数，以防止一个秋天一年不等，从32个家庭的危害管理7为所有三个干预combined.Conclusions组为基础的运动是最有力的单一干预测试，并减少福尔斯这组之间似乎已与改善平衡。福尔斯进一步减少家庭危险管理或减少视力管理，或两者兼而有之。成本效益有待审查。这些调查结果最适用于年龄在70-84岁之间、生活在家中的澳大利亚出生的成年人，他们认为自己的健康状况良好。
Objective To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people.Design A randomised controlled trial with a full factorial design.Setting Urban community in Melbourne, Australia.Participants 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone.Interventions Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention.Main outcome measure Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home.Results The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P < 0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined.Conclusions Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.