Population-based interventions for the prevention of fall-related injuries in older people

  • Review
  • Intervention

Authors


Abstract

Background

Fall-related injuries are a significant cause of morbidity and mortality in older populations. Summary information about countermeasures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll out of these countermeasures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regard to fall-related injuries among older people.

Objectives

To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people.

Search methods

We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, National Research Register, AgeInfo, PsycInfo and Web of Knowledge. We also searched the internet, carried out handsearches of selected journals and checked the reference lists of relevant papers to identify any further studies. The latest search was conducted in May 2007.

Selection criteria

Studies were independently screened for inclusion by two review authors. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention.

Data collection and analysis

Data were independently extracted by two review authors. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

Main results

Out of 35 identified studies, six met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in each of the included studies, with the relative reduction in fall-related injuries ranging from 6% to 33%.

Authors' conclusions

Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.

摘要

背景

以民眾為基礎的介入措施用以預防老年人與跌倒相關的傷害

與跌倒相關的傷害是老年人口發病率與死亡率的重要原因。整體資訊有關研究機構成功解決與跌倒相關傷害之風險因子的對策已被廣泛地傳播。然而,在更廣泛的社區中成功推行這些公共衛生計畫對策的實證資訊並不多。假設多策略,多重點式之以民眾為基礎的計畫可以減少全人口的傷害率。這篇回顧檢驗老年人口與跌倒相關傷害的假設。

目標

評估以民眾為基礎之介入措施的效果,其定義為整合的,全社區,多策略的措施,用來減少老年人口與跌倒相關的傷害。

搜尋策略

檢索策略是根據電子檢索,人工檢索特定的期刊,並從篩選的發表文章中以滾雪球的方式檢索參考文獻。

選擇標準

兩名回顧者分別檢閱研究以納入回顧中。納入的研究為報告在實施以民眾為基礎的介入措施後,醫學治療老年人與跌倒相關傷害的改變量。

資料收集與分析

兩名回顧者分別摘錄資料。由於納入研究的異質性,因此不適合進行統合分析。

主要結論

確定了23篇研究,其中五篇符合納入標準。沒有隨機對照試驗。納入的五篇試驗均報告與跌倒相關的傷害有顯著減少或下降的趨勢,與跌倒相關的傷害相對減少了6至33%。

作者結論

儘管回顧中研究的方法學有限制,所有計畫皆一致報告與跌倒相關的傷害有減少,支持了最初的假設,即以民眾為基礎的方法來預防與跌倒相關的傷害是有效的,並可以作為公共衛生實踐的基礎。需要有以民眾為基礎之介入措施的隨機,多社區試驗來增加支持以民眾為基礎的方法的證據程度。研究也需要釐清以民眾為基礎之介入措施的障礙與促進者,其影響著何種民眾計畫是有效的。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以民眾為基礎的計畫用於預防老年人與跌倒相關的傷害。跌倒造成的傷害在老年人中是常見的且會造成嚴重的醫療問題。生活在機構中的老年人,如輔助的照護機構與護理之家,與80歲以上的老年人特別可能跌倒與受傷。嚴重受傷包括骨折,頭部受傷或皮膚撕裂(撕裂傷),且通常需要住院治療。髖骨骨折幾乎都需要住院,且許多社區住宅的個人並不會恢復他們的行走或完成日常生活活動的能力,這對於獨立生活與生活品質有很大的影響。人口(流行病學)研究顯示,髖骨骨折是老年人中最嚴重之與跌倒相關的傷害,15%的老年人死於醫院,而1/3在事發後不會活超過一年。許多國家已制定準則來預防老年人跌倒。現有有效的介入措施可預防跌倒並包括增加身體活動與髖骨保護。目標為預防跌倒的策略包括規定,教育,環境改變與以民眾或以社區為基礎之整合計畫。以民眾為基礎的介入措施計畫讓整個社區,專家與社區成員分擔傷害的問題。共同的責任便是確定優先事項並適當地廣泛推廣介入措施。回顧的作者沒有發現任何預防全社區因跌倒而受傷的隨機對照試驗。五篇有良好配對之對照社區的評估研究(前瞻性對照的社區試驗)一致報告,計畫中所使用的介入措施可以減少與跌倒相關的傷害。這結果支持了以民眾為基礎的方法作為公共衛生實踐的基礎。在澳洲,丹麥,挪威,與瑞典進行長達八年的試驗指出,與跌倒相關的傷害減少了6至33%。其中三篇是依據世界衛生組織的安全與預防受傷之安全社區模式。研究限制為使用之以民眾為基礎之介入措施的精確本質,如何將其外推到其他的社區與試驗方法學。

Plain language summary

Population-based programmes for the prevention of fall-related injuries in older people

Injuries caused by falls are common in older people and can cause serious medical problems. Older people who live in institutions, such as assisted care facilities and nursing homes, and people over 80 years old are particularly likely to fall and injure themselves. Serious injuries include bone fracture, a head injury or tears to the skin (lacerations) that often require hospital treatment. Hip fractures almost always require hospitalisation and many community-dwelling individuals do not recover their ability to walk or carry out daily activities of living, which impacts greatly on their ability to live independently and their quality of life. Population (epidemiological) studies show that hip fractures are the most serious fall-related injury in older people, with 15% dying in hospital and a third not surviving beyond one year afterwards. A number of countries have prepared guidelines to prevent falls in the elderly. Effective interventions are available to prevent falls and include increased physical activity and hip protectors. Strategies targeted at fall prevention include regulation, education, environmental change and population or community-based coordinated programmes. A population-based intervention programme shares ownership of the injury problem with the whole community, experts and community members. Joint responsibility is taken for determining priorities and appropriate interventions are widely promoted.

The review authors could not find any randomised controlled trials on prevention of injuries from falls that involved whole communities. Six evaluation studies (prospective, controlled community trials) with well-matched control communities consistently reported reductions in fall-related injuries across the programmes used. This provides support for a population-based approach as a basis of public health practice. The relative reduction in fall-related injuries ranging from 6% to 75%, in studies conducted in Australia, Denmark, Norway, Taiwan and Sweden over up to eight years. Three of the studies were based on the World Health Organization Safe Communities model of safety and injury prevention.
Limitations were the exact nature of the population-based intervention used, how it could be generalised to other communities and trial methodologies.

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