Screening and Intervention to Prevent Falls and Fractures in Older People
Screening and Intervention to Prevent Falls and Fractures in Older People
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预防老年人福尔斯和骨折的筛查和干预
DOI：
10.1056/nejmoa2001500
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发表时间：
2020-11-05
影响因子：
158.5
通讯作者：
Underwood, Martin
中科院分区：
文献类型：
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作者：
Lamb, Sarah E.;Bruce, Julie;Underwood, Martin
背景社区筛查和治疗性预防策略可能会减少老年人跌倒的发生率。这些措施对骨折发生率、卫生资源利用和健康相关生活质量的影响尚不清楚。方法在一项务实的三组整群随机对照试验中，我们评估了通过邮件发送的建议、跌倒风险筛查和有针对性的干预措施(多因素预防跌倒或针对跌倒高危人群的锻炼)与仅通过邮件发送的建议相比的效果。主要结果是在18个月内每100人年的骨折发生率。次要结果是跌倒、与健康相关的生活质量、虚弱和平行的经济评估。结果我们从英格兰各地的63个一般做法中随机选择了9803名70岁或以上的人：3223人被分配给单独通过邮件提供建议，3279人被分配到跌倒风险筛查和有针对性的锻炼，3301人被分配到跌倒风险筛查和有针对性的多因素预防，除了通过邮件提供建议。一份跌倒风险筛查问卷被发送给被分配到运动组和多因素防跌组的人。运动组3279名受试者中有2925人(%)和多因素防跌组3301名受试者中有2854人(87%)收回了完成的筛查问卷。在来自这两组的5779名参与者中，有2153人(37%)被认为摔倒的风险增加，并被邀请接受干预。9803名参与者中有9802人获得了骨折数据。筛查和针对性干预并不能降低骨折发生率；锻炼骨折与邮件建议的骨折发生率比为1.20(95%可信区间为0.91~1.59)，多因素预防跌倒的骨折发生率比为1.30(95%CI为0.99~1.71)。锻炼策略与与健康相关的生活质量的小幅增长和最低的总成本相关。在试验期间，有三个不良事件(一次心绞痛发作，一次多因素预防跌倒评估中的跌倒，以及一次髋部骨折)。结论通过邮寄咨询、跌倒风险筛查以及有针对性的锻炼或预防跌倒的多因素干预并不会导致骨折的发生少于单独通过邮寄的建议。(由国家健康研究所资助；ISRCTN编号，ISRCTN71002650。)预防老年人跌倒很重要。在这项务实的整群随机对照试验中，通过邮件提供的建议、跌倒风险的筛查以及针对跌倒风险增加的老年人的有针对性的干预(多因素跌倒预防或锻炼)并不比仅通过邮件提供的建议更能预防骨折。
BackgroundCommunity screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.MethodsIn a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.ResultsWe randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.ConclusionsAdvice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.)Prevention of falls in older people is important. In this pragmatic, cluster randomized, controlled trial, advice given by mail, screening for risk of falls, and targeted interventions (multifactorial fall prevention or exercise) for older people at increased risk for falls did not prevent fractures more than advice by mail alone.