Secondary Prevention of Falls in Older People: A Systematic Review

老年人跌倒的次級預防：系統性回顧

陳晶瑩(Chin-Ying Chen) ； Arminee Kazanjian ； Martha Donnelly

《臺灣家庭醫學研究》 3卷2期&3 (2005/04) Pp. 49-64

https://doi.org/10.29475/TFMR.200504.0001

摘要

雖然有很多有關老年人跌倒預防的系統性回顧文獻，但卻沒有有關次級預防的系統性回顧文獻。
本研究目的爲評估老年人跌倒次級預防介入計畫的有效性。
本研究設計爲選取對有跌倒病史的老人所做的有對照組的臨床試驗，作系統性回顧。
我們由MEDLINE、CINAHL及EMBASE三個資料庫，選取1996年2002年3月的英文文獻，符合以下選取標準者：(1)隨機有對照組之臨床試驗，(2)研究對象有跌倒病史者，(3)研究對象年齡是65歲以上，(4)跌倒的次鰓預防是研究的目的。
結果總計有五個隨機有對照組之臨床試驗符合上述選取標準。有兩個多面項介入計畫的結果，顯示可顯著降低跌倒的危險，及／或反覆性跌倒的危險。另一個多面項介入計畫的結果，顯示最近反覆性跌倒（兩次或以上）者有減少跌倒危險之傾向。一個以職能治療爲單一介入計畫，對有跌倒病史的亞群在跌倒的次級預防是有效的。一個以運動爲單一介入計畫，對跌倒的次級預防是沒有效的。
結論顯示：到目前爲上，以運動爲單一介入計畫，對跌倒的次級預防是沒有效的。以職能治療爲單一介入計畫，雖對有跌倒病史的亞群有效，需要進一步設計以有跌倒病史者爲研究對象的研究來證實。幾個研究顯示多面項介入計畫，可顯著降低跌倒的危險，但對兩次以上跌倒的反覆性跌倒者，多面項介入計畫則需要進一步的研究。

並列摘要

Although several systematic reviews have been reported on fall prevention for older people, there is no review on secondary prevention of falls for older people.
Our objective is to assess the effectiveness of intervention programs on secondary prevention of falls in older people.
The study design is a systematic review of published controlled clinical designed studies for older people with a history of falls.
We used keyword searches of MEDLINE, CINAHL, and EMBASE from 1996 to March 2002. Only English literatures were reviewed. Studies were reviewed if they met the following criteria: (1) randomized controlled trials (RCT); (2) participants were aged 65 years or older; (3) participants had history of falls; (4) secondary prevention of falls was an aim of the study.
A total of 5 RCT met the criteria. Two multifactorial targeted intervention programs showed significant reduction of the risk of falling and/or recurrent falling. One multifactorial targeted intervention program revealed the tendency of reduction for subjects with recent recurrent falls (2 falls). One occupational therapy intervention was effective in the subgroup with history of falls, one exercise program as a single intervention was not effective.
There is no evidence of exercise as a single intervention for secondary prevention of falls in older people. Occupational therapy home assessment is effective in the subgroup with history of falls, but further study is indicated for the widespread implementation as an individual fall prevention strategy. Several well-designed studies have shown the effectiveness of multifactorial targeted intervention. The tendency of effectiveness by multifactorial targeted intervention in subjects with recent recurrent falls need further study.

並列關鍵字

accidental falls ； aged ； review literature