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Erschienen in: Osteoporosis International 6/2008

01.06.2008 | Original Article

Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up

verfasst von: M. Berggren, M. Stenvall, B. Olofsson, Y. Gustafson

Erschienen in: Osteoporosis International | Ausgabe 6/2008

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Abstract

Summary

A randomized, controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient falls and injuries. No statistically significant effects of the intervention program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone old people.

Introduction

This study evaluates whether a postoperative multidisciplinary, multifactorial fall-prevention program performed by a geriatric team that reduced inpatient falls and injuries had any continuing effect after discharge. The intervention consisted of staff education, systematic assessment and treatment of fall risk factors and vitamin D and calcium supplementation.

Methods

The randomized, controlled trial with a one-year follow-up at Umeå University Hospital, Sweden, included 199 patients operated on for femoral neck fracture, aged ≥70 years.

Results

After one year 44 participants had fallen 138 times in the intervention group compared with 55 participants and 191 falls in the control group. The crude postoperative fall incidence was 4.16/1,000 days in the intervention group vs. 6.43/1,000 days in the control group. The incidence rate ratio was 0.64 (95% CI: 0.40–1.02, p = 0.063). Seven new fractures occurred in the intervention group and 11 in the control group.

Conclusion

A team applying comprehensive geriatric assessment and rehabilitation, including prevention and treatment of fall-risk factors, reduced inpatient falls and injuries, but no statistically significant effects of the program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone elderly.
Literatur
1.
Zurück zum Zitat Melton LJ, 3rd (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14(Suppl 1):S1–S8CrossRefPubMed Melton LJ, 3rd (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14(Suppl 1):S1–S8CrossRefPubMed
2.
Zurück zum Zitat Thorngren KG, Hommel A, Norrman PO et al (2002) Epidemiology of femoral neck fractures. Injury 33(Suppl 3):C1–C7CrossRefPubMed Thorngren KG, Hommel A, Norrman PO et al (2002) Epidemiology of femoral neck fractures. Injury 33(Suppl 3):C1–C7CrossRefPubMed
3.
Zurück zum Zitat Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S; discussion 17S–19SCrossRefPubMed Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S; discussion 17S–19SCrossRefPubMed
4.
Zurück zum Zitat Nyberg L, Gustafson Y, Berggren D et al (1996) Falls leading to femoral neck fractures in lucid older people. J Am Geriatr Soc 44:156–160CrossRefPubMed Nyberg L, Gustafson Y, Berggren D et al (1996) Falls leading to femoral neck fractures in lucid older people. J Am Geriatr Soc 44:156–160CrossRefPubMed
5.
Zurück zum Zitat Fuller GF (2000) Falls in the elderly. Am Fam Physician 61:2159–2168, 2173–2154PubMed Fuller GF (2000) Falls in the elderly. Am Fam Physician 61:2159–2168, 2173–2154PubMed
6.
Zurück zum Zitat Pils K, Neumann F, Meisner W et al (2003) Predictors of falls in elderly people during rehabilitation after hip fracture-who is at risk of a second one? Z Gerontol Geriatr 36:16–22CrossRefPubMed Pils K, Neumann F, Meisner W et al (2003) Predictors of falls in elderly people during rehabilitation after hip fracture-who is at risk of a second one? Z Gerontol Geriatr 36:16–22CrossRefPubMed
7.
Zurück zum Zitat Stenvall M, Olofsson B, Lundström M et al (2006) Inpatient falls and injuries in older patients treated for femoral neck fracture. Arch Gerontol Geriatr 43(3):389–399 Stenvall M, Olofsson B, Lundström M et al (2006) Inpatient falls and injuries in older patients treated for femoral neck fracture. Arch Gerontol Geriatr 43(3):389–399
8.
Zurück zum Zitat Colon-Emeric C, Kuchibhatla M, Pieper C et al (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–883CrossRefPubMed Colon-Emeric C, Kuchibhatla M, Pieper C et al (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–883CrossRefPubMed
9.
Zurück zum Zitat Stenvall M, Elinge E, von Heideken Wågert P et al (2005) Having had a hip fracture-association with dependency among the oldest old. Age Ageing 34:294–297CrossRefPubMed Stenvall M, Elinge E, von Heideken Wågert P et al (2005) Having had a hip fracture-association with dependency among the oldest old. Age Ageing 34:294–297CrossRefPubMed
10.
Zurück zum Zitat (2001) Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49:664–672 (2001) Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49:664–672
11.
Zurück zum Zitat Kallin K, Lundin-Olsson L, Jensen J et al (2002) Predisposing and precipitating factors for falls among older people in residential care. Public Health 116:263–271CrossRefPubMed Kallin K, Lundin-Olsson L, Jensen J et al (2002) Predisposing and precipitating factors for falls among older people in residential care. Public Health 116:263–271CrossRefPubMed
12.
Zurück zum Zitat Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707CrossRefPubMed Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707CrossRefPubMed
13.
Zurück zum Zitat Gillespie LD, Gillespie WJ, Robertson MC et al (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev CD000340 Gillespie LD, Gillespie WJ, Robertson MC et al (2003) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev CD000340
14.
Zurück zum Zitat Chang JT, Morton SC, Rubenstein LZ et al (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328:680CrossRefPubMedPubMedCentral Chang JT, Morton SC, Rubenstein LZ et al (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328:680CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Stenvall M, Olofsson B, Lundström M et al (2007) A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 18:167–175CrossRefPubMed Stenvall M, Olofsson B, Lundström M et al (2007) A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 18:167–175CrossRefPubMed
16.
Zurück zum Zitat Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999–2006CrossRefPubMed Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999–2006CrossRefPubMed
17.
Zurück zum Zitat Boonen S, Lips P, Bouillon R et al (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92:1415–1423CrossRefPubMed Boonen S, Lips P, Bouillon R et al (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92:1415–1423CrossRefPubMed
18.
Zurück zum Zitat Jonsson A, Gustafson Y, Schroll M et al (2003) Geriatric rehabilitation as an integral part of geriatric medicine in the Nordic countries. Dan Med Bull 50:439–445PubMed Jonsson A, Gustafson Y, Schroll M et al (2003) Geriatric rehabilitation as an integral part of geriatric medicine in the Nordic countries. Dan Med Bull 50:439–445PubMed
19.
Zurück zum Zitat Sletvold O, Tilvis R, Jonsson A et al (1996) Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment. Dan Med Bull 43:350–359PubMed Sletvold O, Tilvis R, Jonsson A et al (1996) Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment. Dan Med Bull 43:350–359PubMed
20.
Zurück zum Zitat American Psychiatric Association (1994) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC American Psychiatric Association (1994) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC
21.
Zurück zum Zitat Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed
22.
Zurück zum Zitat Jensen E, Dehlin O, Gustafson L (1993) A comparison between three psychogeriatric rating scales. Int J Geriatr Psychiatry 8:215–229CrossRef Jensen E, Dehlin O, Gustafson L (1993) A comparison between three psychogeriatric rating scales. Int J Geriatr Psychiatry 8:215–229CrossRef
23.
Zurück zum Zitat Sheikh J, Yesavage JA (1986) A Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5:165–172CrossRef Sheikh J, Yesavage JA (1986) A Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5:165–172CrossRef
24.
Zurück zum Zitat Sonn U (1996) Longitudinal studies of dependence in daily life activities among elderly persons. Scand J Rehabil Med Suppl 34:1–35PubMed Sonn U (1996) Longitudinal studies of dependence in daily life activities among elderly persons. Scand J Rehabil Med Suppl 34:1–35PubMed
25.
Zurück zum Zitat Hasselgren-Nyberg L, Omgren M, Nyberg L et al (1997) S-COVS. The Swedish version of Physiotherapy Clinical Outcome Variables. Den svenska versionen av Physiotherapy Clinical outcome Variables. Nordisk Fysioterapi 1:1–5 Hasselgren-Nyberg L, Omgren M, Nyberg L et al (1997) S-COVS. The Swedish version of Physiotherapy Clinical Outcome Variables. Den svenska versionen av Physiotherapy Clinical outcome Variables. Nordisk Fysioterapi 1:1–5
26.
Zurück zum Zitat Seaby L, Torrence G (1989) Reliability of a physiotherapy functional assessment used in a rehabilitation setting. Physiotherapy Canada 41:264–271 Seaby L, Torrence G (1989) Reliability of a physiotherapy functional assessment used in a rehabilitation setting. Physiotherapy Canada 41:264–271
27.
Zurück zum Zitat Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94CrossRefPubMed Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94CrossRefPubMed
28.
Zurück zum Zitat Berg KO, Wood-Dauphinee SL, Williams JI et al (1992) Measuring balance in the elderly: validation of an instrument. Can J Public Health 83(Suppl 2):S7–S11PubMed Berg KO, Wood-Dauphinee SL, Williams JI et al (1992) Measuring balance in the elderly: validation of an instrument. Can J Public Health 83(Suppl 2):S7–S11PubMed
29.
Zurück zum Zitat Cameron ID, Handoll HH, Finnegan TP et al (2001) Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures. Cochrane Database Syst Rev CD000106 Cameron ID, Handoll HH, Finnegan TP et al (2001) Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures. Cochrane Database Syst Rev CD000106
30.
Zurück zum Zitat Donald IP, Pitt K, Armstrong E et al (2000) Preventing falls on an elderly care rehabilitation ward. Clin Rehabil 14:178–185CrossRefPubMed Donald IP, Pitt K, Armstrong E et al (2000) Preventing falls on an elderly care rehabilitation ward. Clin Rehabil 14:178–185CrossRefPubMed
31.
Zurück zum Zitat Mayo NE, Gloutney L, Levy AR (1994) A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil 75:1302–1308PubMed Mayo NE, Gloutney L, Levy AR (1994) A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil 75:1302–1308PubMed
32.
Zurück zum Zitat Tideiksaar R, Feiner CF, Maby J (1993) Falls prevention: the efficacy of a bed alarm system in an acute-care setting. Mt Sinai J Med 60:522–527PubMed Tideiksaar R, Feiner CF, Maby J (1993) Falls prevention: the efficacy of a bed alarm system in an acute-care setting. Mt Sinai J Med 60:522–527PubMed
33.
Zurück zum Zitat Haines TP, Bennell KL, Osborne RH et al (2004) Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ 328:676CrossRefPubMedPubMedCentral Haines TP, Bennell KL, Osborne RH et al (2004) Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ 328:676CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Vassallo M, Vignaraja R, Sharma JC et al (2004) The effect of changing practice on fall prevention in a rehabilitative hospital: the Hospital Injury Prevention Study. J Am Geriatr Soc 52:335–339CrossRefPubMed Vassallo M, Vignaraja R, Sharma JC et al (2004) The effect of changing practice on fall prevention in a rehabilitative hospital: the Hospital Injury Prevention Study. J Am Geriatr Soc 52:335–339CrossRefPubMed
35.
Zurück zum Zitat Healey F, Monro A, Cockram A et al (2004) Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing 33:390–395CrossRefPubMed Healey F, Monro A, Cockram A et al (2004) Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing 33:390–395CrossRefPubMed
36.
Zurück zum Zitat Bischoff-Ferrari HA, Willett WC, Wong JB et al (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257–2264CrossRefPubMed Bischoff-Ferrari HA, Willett WC, Wong JB et al (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257–2264CrossRefPubMed
37.
Zurück zum Zitat Dawson-Hughes B, Heaney RP, Holick MF et al (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716CrossRefPubMed Dawson-Hughes B, Heaney RP, Holick MF et al (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716CrossRefPubMed
38.
Zurück zum Zitat Broe KE, Chen TC, Weinberg J et al (2007) A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 55:234–239CrossRefPubMed Broe KE, Chen TC, Weinberg J et al (2007) A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 55:234–239CrossRefPubMed
39.
Zurück zum Zitat Boonen S, Bischoff-Ferrari HA, Cooper C et al (2006) Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int 78:257–270CrossRefPubMed Boonen S, Bischoff-Ferrari HA, Cooper C et al (2006) Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int 78:257–270CrossRefPubMed
40.
Zurück zum Zitat Law M, Withers H, Morris J et al (2006) Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 35:482–486CrossRefPubMed Law M, Withers H, Morris J et al (2006) Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 35:482–486CrossRefPubMed
41.
Zurück zum Zitat Kallin K, Gustafson Y, Sandman PO et al (2004) Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 16:270–276CrossRefPubMed Kallin K, Gustafson Y, Sandman PO et al (2004) Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 16:270–276CrossRefPubMed
42.
Zurück zum Zitat Parker MJ, Gillespie WJ, Gillespie LD (2005) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev CD001255 Parker MJ, Gillespie WJ, Gillespie LD (2005) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev CD001255
43.
Zurück zum Zitat Kallin K, Gustafson, Y, Sandman, PO et al (2005) Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study. Am J Geriatr Psychiatry 13:501–509CrossRefPubMed Kallin K, Gustafson, Y, Sandman, PO et al (2005) Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study. Am J Geriatr Psychiatry 13:501–509CrossRefPubMed
44.
Zurück zum Zitat Stenvall M, Olofsson B, Nyberg L et al (2007) Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med 39:232–238CrossRefPubMed Stenvall M, Olofsson B, Nyberg L et al (2007) Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med 39:232–238CrossRefPubMed
Metadaten
Titel
Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up
verfasst von
M. Berggren
M. Stenvall
B. Olofsson
Y. Gustafson
Publikationsdatum
01.06.2008
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 6/2008
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0507-9

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