Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial.

摘要

OBJECTIVES: To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent falls in an elderly population. METHODS: The study was conducted among 555 (67%) home-dwelling Finnish persons aged 85 years or older of a representative population sample (N=827) in 2000-2003. Altogether 486 subjects (88%) had a history of recurrent falls or at least one risk factor for disability in the activities of daily living or mobility and were randomly assigned to receive suggestions for a programme consisting of home exercise, walking exercise, group activities or self-care exercise or alternatively routine care. Falls were monitored for a median of 16 months during the intervention. RESULTS: The time to first four falls and all falls did not significantly differ in the targeted intervention group (N=217); compared to controls (N=220), hazard ratio 0.88 (95% CI 0.74 to 1.04) and 0.93 (0.80-1.09), respectively. Among those able to move outdoors, the corresponding hazard ratios in the intervention group (N=168) compared to the controls (N=178) were 0.78 (0.64-0.94) and 0.88 (0.74-1.05). After the intervention period, impaired balance was less common in the intervention than in the control subjects; 64 (45%) and 89 (59%) (p<0.05). CONCLUSIONS: A pragmatic intervention was not effective in reducing the falling risk at the population level, but slowed down the reduction of balance performance. Among those able to move outdoors, the intervention was also effective in reducing the risk of first four falls.