エビデンスからみた転倒予防プログラムの効果―1.狭義の転倒予防―

  • 大高 洋平
    慶友整形外科病院リハビリテーション科 慶應義塾大学医学部リハビリテーション医学教室
  • 里宇 明元
    慶應義塾大学医学部リハビリテーション医学教室
  • 宇沢 充圭
    慶友整形外科病院整形外科
  • 千野 直一
    慶應義塾大学医学部リハビリテーション医学教室

書誌事項

タイトル別名
  • The Effectiveness of Fall Prevention Programs: A Review-1. Fall Prevention in the Narrow Sense-
  • エビデンス カラ ミタ テントウ ヨボウ プログラム ノ コウカ 1 キョウギ ノ テントウ ヨボウ
  • 1. Fall Prevention in the Narrow Sense
  • 1.狭義の転倒予防

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抄録

Fall prevention is one of the major issues in health care in our aging society. The aim of this review is to provide useful information for researchers and practitioners who plan to start fall prevention programs for elderly persons with various risk levels and in different settings. Fifty-three randomized controlled trials (RCTs) and several meta-analyses retrieved with extensive literature search formed the basis for this review. Available evidence suggests that several preventive strategies have been proven beneficial in fall prevention. For the community-dwelling elderly, two RCTs and one meta-analysis demonstrated that an individually tailored home exercise program provided by nurses or physical therapists could reduce the rate of falls and injuries. One RCT suggested that Tai Chi Chuan might have a high potential to reduce falls. Two large RCTs indicated that programs including group exercise classes could also reduce the number of fallers. For people with known risk factors living in the community, three RCTs showed that home visits to address multiple risk factor modification were an effective way to reduce falls. One RCT with a relatively small sample showed that psychotropic withdrawal reduced falls in elderly persons taking psychotropic medication. A subgroup analysis of one RCT showed that home hazard reduction at hospital discharge reduced subsequent falls in patients with a past history of falls. However, more evidence is needed to prove its effectiveness, because this effect was also observed outside of homes. Dual chamber pacemaker for elderly persons with hypersensitive carotid sinus, who were detected when investigated for undiagnosed falls, markedly reduced subsequent falls with or without syncope. In institutional settings, two RCTs showed that comprehensive risk assessment and modification reduced the rate of falls and fractures or the number of recurrent fallers. Three RCTs performed in hospital settings failed to show any effectiveness. However, a meta-analysis of 3 controlled trials and 7 cohort studies with a historical control suggested that fall prevention program in hospitals could be promising. There are some methodological problems in fall prevention research such as the definition, measures, and monitoring method of falls, inadequate sample size and a short follow-up period. In the future, we need research based on strong and comprehensive methodological designs.

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