Postupci za sprječavanje padova starijih ljudi koji žive u zajednici

Populacija stari. A, kako stare, ljudi češće padaju, i to zbog niza razloga kao što su problemi s ravnotežom, slabiji vid i demencija. Čak 30% osoba starijih od 65 godina, koji žive u zajednici, padne barem jednom tijekom godine. Jedan od pet padova zahtijeva liječenje, a manje od 10% padova uzrokuje prijelom kosti.
Cochrane sustavni pregledni članak u kojem su analizirane intervencije za sprječavanje padova starijih ljudi koji žive u zajednici uključio je 159 kliničkih pokusa s ukupno 79.193 ispitanika.
Grupno vježbanje i programi vježbanja koji se provode u kući učinkovito smanjuju padove, kao i Tai Chi. Vježbe kojima je cilj smanjiti padove smanjuju i broj prijeloma kosti.
Intervencije kojima se povećava sigurnost vlastitoga doma također se čine učinkovitima, osobito u osoba koje imaju veći rizik od pada, i kad ih provodi radni terapeut. Naprave za cipele koje sprječavaju proklizavanje na ledu također mogu smanjiti padove.
Uzimanje vitamina D ne smanjuje broj padova u većine starijih ljudi u zajednici, ali bi moglo biti korisno u osoba koje imaju manjak vitamina D.
Neki lijekovi povećavaju vjerojatnost padova. Postupno uskraćivanje nekih vrsta lijekova koji se uzimaju za spavanje, smanjenje anksioznosti i depresiju (psihotropni lijekovi) korisno je za smanjenje broja padova starijih ljudi.
Operacija katarakte (zamućene očne leće) smanjuje padove, kao i postavljanje srčanog elektrostimulatora (engl. pacemaker) u osoba koje imaju određene srčane probleme.
U starijih osoba koje trpe jake bolove u stopalima, procjena obuće, ulošci izrađeni po mjeri i vježbe za stopalo i gležanj mogu smanjiti broj padova. Dokazi za korištenje edukacijskih materijala kao jedine intervencije za prevenciju padova nisu bili uvjerljivi.

Zaključci autora: 

Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.

Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.

Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.

Pročitajte cijeli sažetak...
Dosadašnje spoznaje 

Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.

Ciljevi: 

To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community.

Način pretraživanja literature: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library 2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers.

Izbor studija: 

Randomised trials of interventions to reduce falls in community-dwelling older people.

Prikupljanje i analiza podataka: 

Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled data where appropriate.

Ključni rezultati: 

We included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Sixty-two per cent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment.

Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; 7 trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; 6 trials; 714 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; 5 trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; 6 trials; 1625 participants). Overall, exercise interventions significantly reduced the risk of sustaining a fall-related fracture (RR 0.34, 95% CI 0.18 to 0.63; 6 trials; 810 participants).

Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants).

Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; 7 trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26,747 participants), but may do so in people with lower vitamin D levels before treatment.

Home safety assessment and modification interventions were effective in reducing rate of falls (RaR 0.81, 95% CI 0.68 to 0.97; 6 trials; 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; 7 trials; 4051 participants). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety interventions appear to be more effective when delivered by an occupational therapist.

An intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity.

Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; 3 trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; 1 trial; 306 participants), but second eye cataract surgery did not.

Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; 1 trial; 93 participants), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; 1 trial; 659 participants).

An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; 1 trial; 109 participants). One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling.

There is no evidence of effect for cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; 1 trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; 2 trials; 350 participants).

Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; 1 trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; 4 trials; 2555 participants).

Thirteen trials provided a comprehensive economic evaluation. Three of these indicated cost savings for their interventions during the trial period: home-based exercise in over 80-year-olds, home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors.

Tools
Information
Podijeli/Sačuvaj