【文献Abstract】高齢者の転倒予防に対する多因子介入への無作為試験

〈要点〉

・転倒は高齢者の合併症と死亡の主な原因である。多くの転倒を防ぐことができるという有効性試験の証拠があるにもかかわらず、負傷をもたらす転倒の割合は減少していないため、多因子介入への無作為試験を行った。

・看護師による多因子介入では、強化された通常のケアよりも、転倒による損傷の発生率は有意に低くならなかった。

〈雑感〉

・在宅患者に対し廃用予防のリハビリや福祉用具などの利用というアプローチを行っているものの、転倒予防に著効したという印象は確かになかったが、研究で結果が出てしまったことに対しては衝撃。。

・理学療法士や作業療法士等の専門職が介入した場合にはどうなるのだろうか…？！

〈文献〉

N Engl J Med. 2020 Jul 9;383(2):129-140. doi: 10.1056/NEJMoa2002183.
A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries

Abstract
Background: Injuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.

Methods: We conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.

Results: The demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.

Conclusions: A multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).

Copyright © 2020 Massachusetts Medical Society.