A randomized trial of a consultation service to reduce falls in nursing homes.
A randomized trial of a consultation service to reduce falls in nursing homes.
复制标题
一项旨在减少疗养院跌倒的咨询服务的随机试验。
DOI：
10.1001/jama.1997.03550070049037
复制
发表时间：
1997
期刊：
影响因子：
--
通讯作者：
M. Griffin
中科院分区：
文献类型：
--
作者：
W. Ray;Jo A. Taylor;K. Meador;P. Thapa;Anne K. Brown;Henry K. Kajihara;Claudia Davis;Patricia S. Gideon;M. Griffin
上下文
福尔斯是养老院的一个主要健康问题，但没有任何干预措施可以预防养老院居民的福尔斯。
目的
评估一项旨在预防高危疗养院居民福尔斯跌倒及相关伤害的干预计划。
设计
随机对照试验。
地点和对象
七对田纳西州中部的疗养院，每对疗养院有一个设施，随机分配到干预。设施有482名（261名对照，221名干预）居民，他们有资格参加这项研究，因为他们有福尔斯的高风险和潜在的安全问题，可以通过干预来解决。
干预
全面的结构化个人评估，针对环境和人身安全、轮椅使用、精神药物使用以及转移和监护的次优做法提出具体的安全建议。鼓励设施工作人员执行各项建议，并改善设施的整体安全。
主要观察指标
干预后一年该机构中复发性跌倒者的平均比例和伤害性福尔斯跌倒的发生率。
结果
干预设施中复发性跌倒者的平均比例（43.8%）为19.1%（95%置信区间，2.4%-35.8%），低于对照设施（54.1%，P= 0.03）。干预机构的伤害性福尔斯平均发生率较低，但无显著性趋势（13.7 vs 19.9/100人-年，降低31.2%，P= 0.22）。亚组分析表明，对那些进行了推荐干预或在前一年有3次或3次以上福尔斯跌倒的居民受益最大。
结论
疗养院的高福尔斯跌倒率和相关伤害不应被视为不可避免的，而是可以通过结构化的安全计划得到实质性改善的结果。
CONTEXT
Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.
OBJECTIVE
To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.
DESIGN
Randomized controlled trial.
SETTING AND PARTICIPANTS
Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention.
INTERVENTION
Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety.
MAIN OUTCOME MEASURES
The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention.
RESULTS
The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P=.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P=.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year.
CONCLUSION
The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs.
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DOI：
10.1056/nejm198904203201606
发表时间：
1989
期刊：
The New England journal of medicine
影响因子：
--
作者：
Tinetti,ME;Speechley,M
通讯作者：
Speechley,M
影响因子：
158.5
作者：
TINETTI, ME;SPEECHLEY, M;GINTER, SF
通讯作者：
GINTER, SF
DOI：
10.1016/0197-2456(90)90005-m
发表时间：
1990-04-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DUPONT, WD;PLUMMER, WD
通讯作者：
PLUMMER, WD
预防老年人跌倒和跌倒受伤：研究议程。
影响因子：
5.1
作者：
Tinetti,ME
通讯作者：
Tinetti,ME
多重风险因素的减少是否可以解释耶鲁大学 FICSIT 试验中跌倒率的降低？
影响因子：
5
作者：
Tinetti,ME;McAvay,G;Claus,E
通讯作者：
Claus,E