Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education
Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education
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DOI：
10.1093/gerona/glz026
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发表时间：
2019-09-01
影响因子：
5.1
通讯作者：
Boudville, Amanda
中科院分区：
文献类型：
--
作者：
Hill, Anne-Marie;McPhail, Steven M.;Boudville, Amanda
背景：老年人出院后发生福尔斯的风险较高。这项研究的目的是评估提供个性化的福尔斯预防教育的效果，除了通常的护理福尔斯率在老年人出院后相比，提供一个社会干预，除了通常的care.Methods：一项随机临床试验在三家医院在西澳大利亚州：参与者出院后6个月。基线和结果由对组分配设盲的评估者测量。参与者：60岁及以上，入院接受康复治疗。资格包括：认知能力能够接受教育（简明精神测试得分>7/10）。干预：量身定制的教育，包括患者视频和练习册，由训练有素的治疗师领导的结构化讨论和目标设定。主要成果：出院后6个月内的福尔斯;持续一次或多次福尔斯的参与者比例。结果：共有382名（194名干预者; 188名对照者）参与者（平均年龄77.7 [SD 8.7]岁）。在出院后6个月内，164名（42.9%）受试者报告了378例福尔斯（跌倒率/1,000患者-天，5.9例干预; 5.9例对照）;其中188例（49.7%）福尔斯为伤害性跌倒。干预组和对照组之间的福尔斯率没有显著差异：（调整后的IRR，1.09; 95% CI [0.78 - 1.52]）或跌倒一次或多次的受试者比例（调整后的OR，1.37; 95% CI [0.90 - 2.07]）。在出院前提供个体化的福尔斯预防教育并没有减少出院后在家发生的福尔斯。进一步的研究是必要的，以调查如何减少福尔斯在这个高风险的过渡期。
Background: Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care.Methods: A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls.Results: There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]).Conclusions: Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.