RESUMEN
Firstly, to explore whether depressive symptoms and fear of falling have been used as outcome measures in fall prevention trials. Secondly, to determine the effects of fall prevention trials on these variables among the aged. A literature search covering various medical databases was conducted to identify randomised controlled trials regarding the effects of fall prevention programmes on depressive symptoms and fear of falling among the aged. The studies were classified according to the intervention method (single/multifactorial) and study results (positive/negative) regarding depressive symptoms or fear of falling. Methodological quality was assessed in relation to blinding at outcome assessment, follow-up and whether intention-to-treat analysis was used. Depressive symptoms were used as an outcome measure in eight and fear of falling in 21 studies. A multifactorial approach seems the most effective method in reducing fear of falling, while some single methods such as Tai Chi also seem beneficial. Little evidence was found relating to the effects of fall prevention trials on depressive symptoms. Fear of falling may be reduced by fall prevention programmes. More studies assessing the effects on depressive symptoms, especially among the depressed aged are needed.
Asunto(s)
Accidentes por Caídas/prevención & control , Depresión/psicología , Técnicas de Ejercicio con Movimientos/métodos , Miedo/psicología , Anciano , Anciano de 80 o más Años , Determinación de Punto Final , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Autoeficacia , Taichi Chuan/psicología , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the implementation and the effects of a multifactorial fall prevention trial on the specified risk factors of falling, incidence of falls and injurious falls, and on specified secondary outcome measures; to describe the design of the study and to assess the success of randomization. STUDY DESIGN: Randomized-controlled trial. METHODS: Recruitment started in March 2003 and lasted until the end of January 2005, when a total number of 591 participants was reached. Participants were randomized into two age groups (65-74 years and 75 years and over), then into an intensive multifactorial risk-based prevention programme or into a one-time counselling on fall prevention. The intervention included individual geriatric assessment, guidance and treatment, individual guidance on fall prevention, physical exercise in small groups, psychosocial group activities, lectures, home-exercises and home hazards assessment. RESULTS: A total of 293 people were randomized into the 1-year prevention programme and 298 into the control condition. The mean age was 73.5 years in both groups; 84% of the participants were women. The groups were well balanced at baseline in relation to risk factors of falls, and the only statistically significant difference was found in the amount of regularly taken medicines, which was significantly lower in the control group: mean 3.7 (SD 3.0) vs. 4.2 (SD 3.1), P=0.028. CONCLUSIONS: Participants were successfully randomized into a multifactorial fall prevention trial.