老年人跌倒防控信息管理系统的建立及其应用

目的：探索建立老年人跌倒防控信息管理系统,并进行应用及效果评价。方法：依托物联网技术和信息化手段,将老年人跌倒综合防控策略从线下导入线上,建立集风险评估、远程教育、反馈评价于一体的老年人跌倒防控信息管理系统。运用该系统对126名干休所老年人（年龄≥ 60岁）进行评估,量化跌倒风险等级,对筛选出的84名高危老年人进行远程连续综合干预,干预措施包括分发宣传画册,制作宣教幻灯片及视频进行远程播放与讲解。采用自身前后对照,分析评价干预6个月后跌倒相关情况。结果：高危人群跌倒发生率由21.43%降至4.76%（P<0.01）;身体平衡能力和步态稳定性改善情况明显（P<0.01）;能够自觉进行正确防控行为的比例显著提高（P<0.01）;进行复杂行为时更有信心不会跌倒（P<0.01）;居家环境安全性整体提高（P<0.01）。结论：老年人跌倒防控信息管理系统可通过全面评估筛选出高危人群,实施远程连续综合干预,降低跌倒发生率,可进一步推广应用。     

CBO guidelines to prevent accidental falls in the elderly: how can it be used in the institutionalized elderly?

Fall incidents occur frequently in the community dwelling elderly and even more in the institutionalised elderly. Fall-related research data indicate positive effects of a multifactorial intervention targeted on prevention of falls and fall-related injuries. In November 2004 the guideline "Prevention of fall incidents in the elderly" developed by The Dutch Institute for Healthcare Improvement (CBO) was published. This guideline pays attention to the risk factors for falling and the prevention of fall incidents in all settings. The highlights for nursing homes are: all nursing home patients are at risk; perform a fall risk assessment to direct fall preventive activities; together with specific fall prevention for the patient general fall prevention for the institute has to be undertaken; a multifactorial approach is indicated. In nursing homes it is possible to perform such approach multidisciplinary.     

Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

Objective To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay.Design Cluster randomised trial.Setting 24 elderly care wards in 12 hospitals in Sydney, Australia.Participants 3999 patients, mean age 79 years, with a median hospital stay of seven days.Interventions A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients.Main outcome measure Falls during hospital stay.Results Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. Overall, 381 falls occurred during the study. No difference was found in fall rates during follow-up between intervention and control wards: respectively, 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days (P=0.96). The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 (95% confidence interval 0.72 to 1.28).Conclusion A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay.Trial registration Australian New Zealand Clinical Trials Registry ACTRNO 12605000467639.     

Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis

Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis.Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews.Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors.Data extraction Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral.Conclusions Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.     

Prevention of falls in the elderly--a key role for the falls clinic

Falls are a major health problem among elderly people, because of the incidence and because of the consequences. Current practice commonly focuses on the injury with little attention of the underlying cause, the risk factors for a new fall and the possibilities for future prevention. Most of the falls are a result of multiple risk factors. Several of this risk factors are potentially modifiable. The Dutch Falls Prevention Collaboration have made a protocol to assist health care professionals at a standardised and evidence based way with their assessment of fall risk. With the risk factors identified in the assessment it is possible to make an individual multifactorial fall prevention program. Such an intervention can give a significant reduction of falls in the elderly. The protocol is presented in this article.     

Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial

ObjectiveTo determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department.DesignRandomised controlled trial.Participants274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group).SettingTwo accident and emergency departments, Newcastle upon Tyne.ResultsIntention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year''s follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures.ConclusionsMultifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall.

What is already known on this topic

Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fallFall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall

What this study adds

No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency departmentThe intervention was less effective in these patients than in cognitively normal older people     

Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial

ObjectivesTo assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.DesignRandomised controlled trial with one year''s follow up.SettingCommunity health service at a New Zealand hospital.Participants240 women and men aged 75 years and older.Intervention121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial.ResultsFalls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (£523) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered.ConclusionA home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.

What is already known on this topic

Falls are the costliest type of injury among elderly people, and the healthcare costs increase with frequency of falls and severity of injuriesAn exercise programme delivered by a physiotherapist was successful in reducing falls and moderate injuries in elderly people

What this study adds

An exercise programme to prevent falls in elderly people worked well when delivered by a district nurse from a home health service in the suburbs of a large cityResearchers, public health administrators, and health practitioners can work together to benefit elderly people in the community     

Intervenciones basadas en el ejercicio y el entorno para la prevención de caídas en personas con deterioro cognitivo que viven en centros de cuidado: revisión sistemática y metaanálisis

This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities.In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered.Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate.Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments.     

Randomised trial of impact of model of integrated care and case management for older people living in the community

Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Design: Randomised study with 1 year follow up. Setting: Town in northern Italy (Rovereto). Subjects: 200 older people already receiving conventional community care services. Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status. Results: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). Conclusion: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.

Key messages

• Responsibility for management of care of elderly people living in the community is poorly defined
• Integration of medical and social services together with care management programmes would improve such care in the community
• In a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced costs

     

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera)

Objective

To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community.

Material and methods

The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions.

Results

The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001).

Conclusion

An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.     

A clinico-demographic analysis of maxillofacial trauma in the elderly

doi: 10.1111/j.1741‐2358.2010.00431.x A clinico‐demographic analysis of maxillofacial trauma in the elderly Introduction: The elderly represent an increasing proportion of society. Management of maxillofacial trauma in this population may be complicated by coexisting medical conditions, requiring multi‐disciplinary care. Methods: This retrospective audit assesses the incidence and pattern of maxillofacial trauma in elderly patients (≥60 years) presented to the Merseyside Regional Maxillofacial Unit. Over the time period of 2003, 2004 and 2005, 7905 trauma patients presented to the accident and emergency department, of whom 757 were elderly (10%). Results: Results indicated that the male to female ratio was 1:1.4. The commonest cause of injury was a fall (83%) followed by an assault (6%); the majority of falls occurring in the home. Conclusion: Management of maxillofacial injuries in this population should focus on targeted prevention programmes, which address known risk factors for falling. We believe that this is a public health issue. Members of the maxillofacial team should be aware of common risk factors of falls in elderly. Better collaboration with the Medicine for Elderly team should be considered at an early stage on managing these patients.     

Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study.

OBJECTIVE: To assess the role of rhinoviruses in elderly people living in the community. DESIGN: Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction. SETTING: Leicestershire, England. SUBJECTS: 533 subjects aged 60 to 90. MAIN OUTCOME MEASURES: Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status. RESULTS: A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections. CONCLUSIONS: Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza.     

Intervenciones para reducir los riesgos multifactoriales de caídas

This article provides an overview of common intervention strategies used to prevent falls and fall-related injuries in older people. Fall incidence increases with age and causes a tremendous amount of morbidity, mortality, and use of healthcare services. Major risk factors for falling are diverse, and many of them —such as balance impairment, unsteady gait, muscle weakness, drug side effects, and environmental hazards— are potentially modifiable. Medical assessment of fall risks and provision of appropriate interventions is challenging due to the complex nature of falls. Consensus panels of experts have developed evidence-based practice guidelines for fall prevention and management. Numerous fall prevention strategies have been studied, and there is considerable evidence to suggest that certain types of fall prevention strategies are more effective than others. Findings from individual studies have been substantiated by careful meta-analysis of large numbers of controlled clinical trials. These meta-analyses have concluded that the most effective (and cost-effective) fall reduction programs involve systematic fall risk assessment and targeted interventions, exercise programs, and environmental inspection and hazard reduction programs. One large recent meta-analysis showed that interventions using multidimensional risk assessment and risk reduction lowered the risk of falling by 18%, while exercise reduced the risk of falls by 12%. Home modification was effective when incorporated into a multi-factorial intervention, targeted to fall-prone individuals. These findings indicate that the most promising approaches to fall prevention will involve interdisciplinary collaboration in assessment and interventions.     

中老年黄斑变性患者跌倒风险与视力的关系及对生存质量的影响

摘要 目的：分析中老年黄斑变性患者跌倒风险与视力的关系及其影响因素,并分析其对生存质量的影响。方法：研究对象为我院2018年1月~2020年12月期间收治的中老年黄斑变性患者95例,采用修订版社区老年人跌倒危险评估工具（MFROP-COM）评估患者跌倒风险。采用世界卫生组织生存质量量表（WHOQOL-BREAF）评价患者的生存质量。采用本院自制的调查问卷获取患者的临床资料。中老年黄斑变性患者跌倒风险的影响因素采用单因素及多因素Logistic回归分析。结果：本次研究共发放调查问卷95份,回收有效问卷95份,回收率100.00%。其中存在跌倒风险的患者38例（40.00%）。无跌倒风险的患者视力、生存质量各领域评分均优于有跌倒风险的患者（P<0.05）。单因素分析显示：中老年黄斑变性患者跌倒风险与视力、文化程度、年龄、家中安全行走、婚姻状况、居住方式、日常生活能力、居家环境安全、足部疾病、社区安全行走有关（P<0.05）。多因素Logistic回归分析结果显示：日常生活能力、视力、家中安全行走、足部疾病、社区安全行走、居家环境安全是中老年黄斑变性患者跌倒风险的影响因素（P<0.05）。结论：中老年黄斑变性患者存在跌倒风险的人数占比较高,且跌倒风险受多种因素影响,有跌倒风险的患者生存质量更低,因此临床需积极评估并帮助此类患者建立科学防跌倒生活行为,对改善中老年黄斑变性患者生存质量具有重要意义。     

衰弱对老年射血分数保留的心力衰竭患者左室舒张功能、认知功能和跌倒风险的影响

摘要 目的：观察衰弱对老年射血分数保留的心力衰竭（HFpEF）患者左室舒张功能、认知功能和跌倒风险的影响。方法：选择2021年1月至 2022年11月期间西安交通大学第一附属医院收治的176例老年HFpEF患者。根据衰弱情况将患者分为非衰弱组（n=92）、衰弱前期组（n=48）、衰弱组（n=36）。对比三组左室舒张功能[左心室射血分数（LVEF）、二尖瓣Ｅ峰血流速度（E）/二尖瓣Ａ峰血流速度（A）、左室收缩末期内径（LVESD）、E/二尖瓣环间隔侧和侧壁侧平均组织多普勒速度（e''）、左室舒张末期内径（LVEDD）]、认知功能[简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）]、跌倒风险[汉化的预防老年人意外、死亡、伤害工具（STEADI）评分]以及心脏不良事件总发生率。结果：三组LVEF、LVEDD、LVESD、E/A组间对比未见统计学差异（P>0.05）。衰弱组、衰弱前期组的E/e''高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的MMSE、MoCA评分低于非衰弱组，且衰弱组低于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的跌倒风险评分高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的心脏不良事件总发生率高于非衰弱组，且衰弱组高于衰弱前期组（P<0.05）。结论：衰弱可在一定程度上影响老年HFpEF患者左室舒张功能，降低患者的认知功能，增加跌倒风险和心脏不良事件总发生率。     

Defining inappropriate practices in prescribing for elderly people: a national consensus panel

OBJECTIVE: To develop a consensus-based list of inappropriate practices in prescribing for elderly people. DESIGN: Mail survey of a 32-member national panel. SETTING: Academic medical centres across Canada. PARTICIPANTS: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. OUTCOME MEASURES: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. RESULTS: The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. CONCLUSION: The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.     

Number of teeth and selected cardiovascular risk factors among elderly people

doi:10.1111/j.1741‐2358.2009.00328.x
Number of teeth and selected cardiovascular risk factors among elderly people Objective: To produce evidence on an association between the number of teeth and selected cardiovascular risk factors among an elderly population. Materials and methods: The study population comprised of 523 community‐living elderly people who participated in the population‐based Kuopio 75+ study. The data for each subject were collected using a structured clinical health examination, an interview and laboratory tests. Linear regression models were used to estimate adjusted mean values and confidence limits. Results: Edentulous persons and persons with a small number of teeth had lower serum HDL cholesterol and higher triglyceride, leucocyte and blood glucose levels and a higher body mass index (BMI) compared with subjects to a large number of teeth. Conclusion: The study showed that, in the Finnish home‐dwelling population aged 75 years or older, those with a large number of teeth were less likely to have cardiovascular risk factors such as a low serum HDL cholesterol level, a high triglyceride level and a high BMI than did subjects with a small number of teeth or who were edentulous.     

Beleidsaanbevelingen omtrent de implementatie van val- en fractuurpreventie bij thuiswonende ouderen

Several factors impede the implementation of effective strategies for fall and fracture prevention. The Centre of Expertise for Fall & Fracture prevention Flanders organized a symposium, “Implementation of fall en fracture prevention in older people”, with the aim to elaborate on the facilitation of effective strategies for falls and fall-related injuries in community-dwelling older people in Flanders. This article summarizes the main bottlenecks for implementation and provides recommendations for optimizing dissemination and implementation.     

Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres

ObjectivesTo assess the effectiveness of trained nurses based in general practices individually prescribing a home exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.DesignControlled trial with one year''s follow up.Setting32 general practices in seven southern New Zealand centres.Participants450 women and men aged 80 years and older.Intervention330 participants received the exercise programme (exercise centres) and 120 received usual care (control centres); 87% (371 of 426) completed the trial.ResultsFalls were reduced by 30% in the exercise centres (incidence rate ratio 0.70, 95% confidence interval 0.59 to 0.84). The programme was equally effective in men and women. The programme cost $NZ418 (£121) (at 1998 prices) per person to deliver for one year or $NZ1519 (£441) per fall prevented. Fewer participants had falls resulting in injuries, but there was no difference in the number who had serious injuries and no difference in hospital costs resulting from falls in exercise centres compared with control centres.ConclusionsAn individually tailored exercise programme, delivered by trained nurses from within general practices, was effective in reducing falls in three different centres. This strategy should be combined with other successful interventions to form part of home programmes to prevent falls in elderly people.

What is already known on this topic

One half of those aged 80 years and older will fall in any one year, often with serious health and social consequencesAn exercise programme delivered by a physiotherapist or trained district nurse was successful in reducing falls and moderate injuries in elderly people

What this study adds

An exercise programme to prevent falls in elderly people can be delivered safely and effectively by trained nurses in general practicesThe nurses obtained results that were consistent with the physiotherapist in the research setting and the district nurse in the accompanying paper