Interventions for preventing falls in elderly people.
Interventions for preventing falls in elderly people.
复制标题
预防老年人跌倒的干预措施。
DOI：
10.1016/s0031-9406(05)60487-7
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
B. Rowe
中科院分区：
文献类型：
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作者：
L. Gillespie;W. Gillespie;M. Robertson;S. Lamb;Robert G Cumming;B. Rowe
背景每年大约有30%的65岁以上居住在社区的人跌倒；机构中的数字更高。尽管不到十分之一的跌倒事件会导致骨折，但五分之一的跌倒事件需要就医。 目的 评估旨在降低老年人跌倒发生率的干预措施（生活在社区、机构或医院护理中）的效果。 检索方法我们检索了 Cochrane 骨、关节和肌肉创伤组专业登记册（2003 年 1 月）、Cochrane 对照试验中央登记册（Cochrane 图书馆，第 1 期， 2003 年）、MEDLINE（1966 年至 2003 年 2 月）、EMBASE（1988 年至 2003 年第 19 周）、CINAHL（1982 年至 2003 年 4 月）、国家研究登记册，2003 年第 2 期、当前对照试验（www.controlled-trials.com，2003 年 7 月 11 日访问）和文章参考列表。没有应用语言限制。通过与该领域的研究人员联系确定了进一步的试验。选择标准旨在最大限度地减少老年人跌倒危险因素的影响或接触的干预措施的随机试验。感兴趣的主要结果是跌倒者或跌倒的数量。仅报告中间结果的试验被排除在外。数据收集和分析两名评审员独立评估试验质量并提取数据。在适当的情况下使用固定效应模型汇总数据。 主要结果 纳入了涉及 21,668 人的 62 项试验。 可能有益的干预措施：社区中的多学科、多因素、健康/环境风险因素筛查/干预计划，既针对未经选择的老年人群（4 项试验，1651 名受试者，汇总 RR 0.73，95% CI 0.63 至 0.85），又针对有病史的老年人跌倒或因已知危险因素而被选择（5 项试验，1176 名受试者，汇总 RR 0.86，95%CI 0.76 至 0.98），以及在寄宿护理机构中（1 项试验，439 名受试者，整群调整后的发病率比 0.60，95%CI 0.50 至 0.73） 肌肉强化和平衡再训练计划，由训练有素的健康专业人员在家中单独处方（3 项试验， 566 名受试者，汇总相对风险 (RR) 0.80，95% 置信区间 (95%CI) 0.66 至 0.98) 为有跌倒史的老年人进行专业的家庭危险评估和修改（3 项试验，374 名受试者，RR 0.66，95% CI 0.54 至 0.81） 撤回精神药物（1 项试验，93 名受试者，相对风险0.34, 95%CI 0.16 至 0.74) 对心脏抑制性颈动脉窦过敏的跌倒者进行心脏起搏（1 项试验，175 名受试者，WMD ‐5.20，95%CI ‐9.40 至 ‐1.00） 为期 15 周的太极拳组运动干预（1 项试验，200 名受试者，风险比 0.51，95%CI 0.36 至 0.73）。
效果未知的干预措施：团体运动干预（9 项试验，1387 名受试者） 个体下肢力量训练（1 项试验，222 名受试者） 营养补充（1 项试验，46 名受试者） 补充维生素 D，含或不含钙（3 项试验，461 名受试者） 家庭危险修正结合优化药物治疗建议（1 项试验，658 名受试者），或结合运动和降低跌倒风险的教育包（1 项试验，3182 名受试者）参与者） 药物治疗（萝巴辛-二氢麦角新碱，1 项试验，95 名参与者） 仅使用认知/行为方法进行干预（2 项试验，145 名参与者） 无跌倒史的老年人的家庭危险修正（1 项试验，530 名参与者） 激素替代疗法（1 项试验，116 名参与者） 视力缺陷矫正（1 项试验，276 名参与者……
BackgroundApproximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.ObjectivesTo assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).Search methodsWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled‐trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field.Selection criteriaRandomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded.Data collection and analysisTwo reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.Main resultsSixty two trials involving 21,668 people were included.Interventions likely to be beneficial:Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster‐adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73)
A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98)
Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81)
Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74)
Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD ‐5.20, 95%CI ‐9.40 to ‐1.00)
A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73).
Interventions of unknown effectiveness:Group‐delivered exercise interventions (9 trials, 1387 participants)
Individual lower limb strength training (1 trial, 222 participants)
Nutritional supplementation (1 trial, 46 participants)
Vitamin D supplementation, with or without calcium (3 trials, 461 participants)
Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants)
Pharmacological therapy (raubasine‐dihydroergocristine, 1 trial, 95 participants)
Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants)
Home hazard modification for older people without a history of falling (1 trial, 530 participants)
Hormone replacement therapy (1 trial, 116 participants)
Correction of visual deficiency (1 trial, 276 participants …