Reducing falls in the elderly: beyond the laboratory to the community

描述(由申请人提供)： 摘要我们工作的长期目标是减少老年人因跌倒而导致的过早死亡和残疾。这项拟议的随机前瞻性研究将确定一种基于运动的新型预防跌倒干预措施的有效性。到目前为止，我们在运动干预方面的工作已经证明了它在减少老年女性因实验室导致的旅行相关跌倒方面的有效性。预防跌倒干预的基础是以提高代偿性步进反应(CSR)表现为重点的特定任务训练。这项干预特别改善了必要的CSR，以避免在作为旅行生物力学替代物的姿势干扰后摔倒。这项拟议的为期12个月的随机前瞻性研究将在三年内进行。将解决一个具体目标，并检验一个主要假设。没有参加CSR干预的老年妇女将与完成2周-4次CSR干预的老年妇女进行比较。具体目的是量化企业社会责任干预对干预完成后12个月内全因跌倒发生率的影响。我们假设，参与企业社会责任干预的女性因各种原因跌倒的几率将显著减少。第二个假设包括，与对照组相比，完成CSR培训的女性第一次跌倒的时间将显著延长，需要医疗护理的跌倒相关伤害显著减少。 公共卫生相关性： 这些假设的项目叙述支持将提供令人信服的证据，证明针对特定任务的企业社会责任培训能够以具有时间和成本效益的方式对老年人的跌倒预防干预做出有意义的贡献。这些假设的支持将支持更大规模地采用CSR培训计划，将这些方法扩展到其他类型的跌倒，如滑倒和侧向跌倒，并将CSR培训应用于其他具有高跌倒风险的人群，例如那些患有某种类型的神经肌肉和肌肉骨骼疾病导致身体损伤和残疾的人群。

DESCRIPTION (provided by applicant): ABSTRACT The long-term objective of our work is to reduce the premature death and disability due to fall-related injuries to older adults. The proposed randomized prospective study will determine the effectiveness of a novel exercise-based fall-prevention intervention. To date, our work with the exercise-based intervention has demonstrated its efficacy for reducing laboratory-induced trip-related falls by older women. The basis of the fall-prevention intervention is task-specific training focused on improving performance of compensatory stepping responses (CSR). The intervention specifically improves CSR necessary to avoid falling following postural disturbances that serve as a biomechanical surrogate for a trip. The proposed randomized 12-month prospective study will be conducted over a period of three years. One specific aim will be addressed and one primary hypothesis will be tested. Older women who do not participate in the CSR intervention will be compared to those of older women who complete the 2 week-4 session CSR intervention. The specific aim is to quantify the influence of a CSR intervention on the incidence of all-cause falls during the 12 months following completion of the intervention. We hypothesize that women who participate in the CSR intervention will have significantly fewer all-cause falls. Secondary hypotheses include expectations that compared to the control group, the women who complete the CSR training will have a significantly longer period of time to the first fall and significantly fewer fall-related injuries that require medical attention. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Support of the hypotheses will provide compelling evidence that task-specific CSR training can contribute meaningfully, and in a time- and cost- efficient manner, to fall prevention interventions for older adults. Support of the hypotheses will support the larger-scale adoption of CSR training programs, extension of these methods to additional types of falls, such as slips and laterally-directed falls, and application of CSR training to other populations having high fall-risk such as those with some type of neuromuscular and musculoskeletal conditions that give rise to physical impairments and disabilities.