Abstract:
OBJECTIVES:To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN:Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES:Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS:1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION:There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Oliver D,Connelly JB,Victor CR,Shaw FE,Whitehead A,Genc Y,Vanoli A,Martin FC,Gosney MAdoi
10.1136/bmj.39049.706493.55subject
Has Abstractpub_date
2007-01-13 00:00:00pages
82issue
7584eissn
0959-8138issn
1756-1833pii
bmj.39049.706493.55journal_volume
334pub_type
杂志文章,meta分析,评审abstract::In most European countries health has been shown to be linked to social circumstances--gradients in health status have persisted for decades, despite major changes in the principal causes of death. In central and eastern Europe life expectancy has stagnated since the mid-60s, whereas in the West it has increased; but ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.308.6937.1153
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abstract:OBJECTIVE:To assess body shape trajectories in early and middle life in relation to risk of mortality. DESIGN:Prospective cohort study. SETTING:Nurses' Health Study and Health Professionals Follow-up Study. POPULATION:80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and p...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
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更新日期:2016-05-04 00:00:00
abstract:OBJECTIVE:To examine the effect of the method of data display on physician investigators' decisions to stop hypothetical clinical trials for an unplanned statistical analysis. DESIGN:Prospective, mixed model design with variables between subjects and within subjects (repeated measures). SETTING:Comprehensive cancer c...
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abstract:OBJECTIVE:To identify additional factors, such as maternal age or factors related to previous reproductive outcome or family history, and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN:Nested case-control study. SETTING:Six centres for clinical gene...
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更新日期:1995-04-22 00:00:00
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更新日期:1995-04-01 00:00:00
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更新日期:2020-11-25 00:00:00
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更新日期:1995-12-16 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1995-12-23 00:00:00
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更新日期:1997-03-01 00:00:00
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更新日期:2016-05-17 00:00:00
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更新日期:2016-06-15 00:00:00
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更新日期:2002-09-07 00:00:00
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更新日期:2012-03-12 00:00:00
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更新日期:2010-06-15 00:00:00