Fall and injury prevention in residential care - Effects in residents with higher and lower levels of cognition
Fall and injury prevention in residential care - Effects in residents with higher and lower levels of cognition
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DOI：
10.1034/j.1600-0579.2003.00206.x
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发表时间：
2003-05-01
影响因子：
6.3
通讯作者：
Lundin-Olsson, L
中科院分区：
文献类型：
--
作者：
Jensen, J;Nyberg, L;Lundin-Olsson, L
目的：评估多因素跌倒和损伤预防项目在认知水平较高和较低的老年人中的有效性。设计：一项预先计划的分组随机、非盲、常规护理、对照试验疗效的亚组比较。周边环境：位于瑞典于默奥（Umea）的九处住宅设施。参与者：所有同意居住在设施中的65岁及以上的居民，可以使用简易精神状态检查（MMSE）进行评估；n = 378)。采用MMSE得分19分将样本分为认知水平较高和较低两组。较低MMSE组年龄较大（平均+/-标准差= 83.9 +/- 5.8 vs 82.2 +/- 7.5），功能受损更严重(Barthel指数，中位数（四分位数范围）11 (6-15)vs 17(13-18))，并且与较高MMSE组相比，跌倒的风险更高（64% vs 36%）。干预：一个多因素的跌倒预防计划，包括员工教育、环境调整、锻炼、药物审查、辅助、髋关节保护和跌倒后问题解决会议。测量：对实验组（干预组与对照组）和MMSE组的跌倒次数、第一次跌倒的时间和受伤次数进行评估和比较。结果：高MMSE组对跌倒有显著干预效果，低MMSE组无显著干预效果（调整后跌倒发生率比P = 0.016和P = 0.121，调整后风险比P < 0.001和P = 0.420）。下MMSE组10例股骨骨折，均发生在对照组（P = 0.006）。结论：在多因素干预方案后，高MMSE组的跌倒次数较少，而低MMSE组对干预的反应不佳，但低MMSE组的股骨骨折减少。
OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition.DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.SETTING: Nine residential facilities in Umea, Sweden.PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group.INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences.MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group.RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P = .016 and P = .121 and adjusted hazard ratio P < .001 and P = .420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P = .006).CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group.