Mobilität und Sicherheit Ein Modell zur Verbesserung der Mobilität und zur Prävention von Stürzen

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2 Mobilität und Sicherheit Ein Modell zur Verbesserung der Mobilität und zur Prävention von Stürzen Clemens Becker, Ulrich Lindemann, Ulrich Rißmann, Barbara Eichner, Elisabeth Sturm, Marion Hausner, Martina Kron, Sylvia Sander, Christine Stahl, Christane Künzlen-Honold, Thorsten Nikolaus,

3 Inhalt - Vormittag Evidenzbasierte Sturzprävention Teilnehmer des Modellvorhabens Training Assessment Ergebnisse

4 Evidenzbasierte Sturzprävention Dr. Clemens Becker Robert-Bosch Krankenhaus Stuttgart

5 Hintergrund der Planung Wissenstransfer Projekt Übertragung evidenzbasierte Wissens und realistische Rahmenbedingungen Verhinderung von Verlust von Funktionseinschränkungen Verhinderung von Stürzen und Frakturen Lebensqualität Heimeinweisungsraten Tod und Abbruch der Teilnahme

6 Fall related hospital admissions in Germany Fracturetype Cases Incidence Sex ratio Proximal femur /100,000 1:4,7 Wrist /100,000 1:10,4 Humerus /100,000 1:5,3 Pelvis /100,000 1:5,6 Spine /100,000 1:2,9 Federal Bureau of Statistics (1998), 10 % sample

7 Evidenz 67 Studien zur Sturzprävention zeigen: - Zielgruppenorientiert (weiblich, Sturzanamnese, > 75 Jahre) WHO - Risikofaktorgeleitet (basierend auf Assessment) (Tinetti M 1994) - Multimodal (Day 2002) - Nachhaltig (Campbell & Robertson 2002) - Zustimmung durch Hausarzt, Durchführung durch Therapie / Pflege

8 State policy: fall prevention in LTC Since 2002: introduction in 100 facilities per year Pre-/post measurement demonstrate a 30 % reduction in fall related hospital admissions.

9 Risikoreduktion von Stürzen n (%) - K n (%) - I Risikoreduktion Stürze Gestürzte Personen Multiple Stürze 980 (2.09) 546 (1.08) 44 % 247 (52,8) 185 (36,5) 30 % 115 (24,6) 63 (12,4) 45% Sturzpräventionsstudie Ulm, n = 975, K = Kontrolle, I = Intervention

10 Sicherheit im Alltag (Sturzgefährdung) Gehen im Gelände Gardinen aufhängen Stabilität Gefahrenschwelle Gartenarbeit Kochen / Einkaufen Alter Campbell J, Ulm 2001

11 Teilnehmer Teilnehmer Hilfsbedarf oder auch schon Bezug von Pflegeversicherungsleistungen Einwohnerzahl ( Personen davon 15,7 (4) % > 65 (80) Jahre

12 Prädefinierte Risikofaktoren Kraft- und Balancedefizit Einnahme sedierender Medikamente Unsicherer Toilettengang / Dranginkontinenz Seheinschränkung Kognitive Störung Passungsprobleme Wohnumfeld / Teilnehmer

13 Durchführung der Interventionen Ausbildung der Pflegemitarbeiter Curriculum 5 Tage a 8 Stunden zwei Kandidaten mit Supervision Durchführung von Training und HP Beratung Weitervermittlung bei Sehproblemen, Wohnanpassung, Demenzproblemen Medikamentenfragen (Sedativa, Vitamin D / Calcium)

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15 Development of a falls prevention program New Zealand Falls Prevention Research Group Define the problem Identify risk factors Examine possible prevention strategies Design interventions Design evaluation process Evaluation of efficacy and efficiency in research setting Evaluation of feasibility, acceptability, effectiveness, and efficiency in routine healthcare setting Nationwide prevention program Literature review Protocol design Dunedin Study A Dunedin Study B RCTs West Auckland Southern NZ Pragmatic trials M. Clare Robertson, 2001

16 PREVENTION STRATEGIES Strength and balance retraining individually prescribed by a physiotherapist 3x a week, 30 minutes walking plan 2x a week ankle cuff weights and stressed balance

17 Dunedin Study A Women aged =80 years Approved by GP and invited to participate n = 622 Randomisation n = 233 Usual care and social visits Exercise program 4 home visits n = 117 n = 116

18 Dunedin Study A Randomised controlled trial in research setting Program delivered by physiotherapist Falls were reduced by 32% in exercise group compared with control group Fall injuries (serious and moderate) reduced by 39% Effectiveness maintained in year 2 Campbell AJ et al. BMJ 1997; 315: Campbell AJ et al. Age Ageing 1999; 28:

19 PREVENTION STRATEGIES Blinded psychotropic drug withdrawal New study capsules 2 weekly decrease 14 week total reduction

20 Dunedin Study B Women and men aged =65 years Currently taking psychotropic medication n = 547 Randomisation n = 93 Medication Medication Original Original withdrawal withdrawal medication medication Exercise No exercise Exercise No exercise program program program program n = 24 n = 24 n = 21 n = 24

21 Dunedin Study B Randomised controlled trial in research setting Program delivered by physiotherapist Falls were reduced by 66% in medication withdrawal group compared with group continuing to take their regular medication High drop out rate Campbell AJ et al. J Am Geriatr Soc 1999; 47:

22 Development of a falls prevention program New Zealand Falls Prevention Research Group Define the problem Identify risk factors Examine possible prevention strategies Design interventions Design evaluation process Evaluation of efficacy and efficiency in research setting Evaluation of feasibility, acceptability, effectiveness, and efficiency in routine healthcare setting Nationwide prevention program Literature review Protocol design Dunedin Study A Dunedin Study B RCTs West Auckland Southern NZ Pragmatic trials M. Clare Robertson, 2001

23 West Auckland trial Women and men aged =75 years Approved by GP and invited to participate n = 590 Randomisation n = 240 Usual care Exercise program 5 home visits n = 119 n = 121

24 West Auckland trial Randomised controlled trial in home health service setting Program delivered by trained district nurse Falls were reduced by 46% in exercise group compared with control group Fewer serious fall injuries Lower hospital costs related to falls Robertson MC et al. BMJ 2001; 322:

25 Fall prevention - conclusions Fall and fall related injury reduction of 35% Most effective in those 80 years and over Highest absolute reduction in those with a previous fall Cost effective Ongoing encouragement needed Need for intercurrent illness modification

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