近日，哈尔滨医科大学田懋一团队研究了中国农村老年人初级卫生保健中的跌倒预防计划的有效性。该项研究成果发表在2025年8月25日出版的《美国医学会杂志》上。

随着全球人口迅速老龄化，在资源有限地区社区居住老年人中缺乏有效预防跌倒策略的证据。

为了评估初级卫生保健系统中预防跌倒项目对中国农村老年人跌倒风险的有效性，研究组进行了一项为期12个月、开放标签、集群随机临床试验，在中国4个省的128个农村进行，纳入有跌倒风险的60岁及以上成年人（招募时间为2023年9月19日至2023年11月15日；最后一次随访时间为2025年1月15日）。干预措施为预防跌倒干预，包括平衡和功能练习和社区参与的健康教育，与农村初级卫生保健系统相结合。对照组接受常规护理，仅接受健康教育，不积极参与社区活动。

主要结局是干预后12个月内报告至少跌倒1次的参与者比例。6项次要结局包括跌倒率、3项功能活动能力测量、报告跌倒相关损伤的参与者比例以及与健康相关的生活质量。与跌倒相关的数据通过季度参与者自我报告收集，并配有日历；在基线和12个月的随访中使用有效的测量方法测量功能活动度。

在招募的2616名参与者中，6人在随机化前死亡，2610名参与者（年龄中位数为70.0岁[IQR， 66.4-74.2]； 1553名女性[59.5%]）被随机分为干预组（来自64个村庄的1311人）和对照组（来自64个村庄的1299人）。在平均358.0 （SD, 31.3）天的随访期间，干预组388名参与者（29.7%）报告在12个月的随访期间至少跌倒一次，对照组497名参与者（38.3%）报告跌倒一次（优势比0.67;95% CI, 0.48-0.91; P = 0.01）。除Timed Up and Go Test（功能性活动能力）外，所有次要结果均有利于干预组，没有显著差异。

研究结果表明，该集群随机试验发现，在初级卫生保健系统中整合预防跌倒项目与中国农村老年人自我报告跌倒风险的显著降低有关。这一干预措施包括平衡和功能锻炼以及社区参与的健康教育，有望在中国和其他老龄化人口迅速增长的中低收入国家推广。

附：英文原文

Title: A Fall Prevention Program Integrated in Primary Health Care for Older People in Rural China: The FAMILY Cluster Randomized Clinical Trial

Author: Junyi Peng, Pengpeng Ye, Boya Nan, Shichun Yan, Zhifang Li, Qian Li, Ruilin Meng, Yangchun Li, Tianyou Hao, Lan Zhang, Dandan Peng, Zijian Xu, Yanni Wang, Lei Si, Minghui Yang, Yao Yao, Jing Zhang, Wei Tian, Yongchen Wang, Rebecca Ivers, Maoyi Tian

Issue&Volume: 2025-08-25

Abstract:

Importance  With rapidly aging populations globally, there is a lack of evidence on effective fall prevention strategies among community-dwelling older people in resource-constrained areas.

Objective  To assess the effectiveness of a fall prevention program integrated in primary health care systems on the risk of falls among Chinese rural older adults.

Design, Setting, and Participants  A 12-month, open-label, cluster randomized clinical trial, conducted in 128 rural villages from 4 Chinese provinces, involving adults 60 years or older at risk of falls (recruitment from September 19, 2023, to November 15, 2023; last follow-up, January 15, 2025).

Interventions  The fall prevention intervention, consisting of balance and functional exercises and community-engaged health education, was integrated with the rural primary health care system. The control group received usual care, health education alone, without active involvement with the communities.

Main Outcomes and Measures  The primary outcome was the proportion of participants who reported at least 1 fall in 12 months following the intervention. Six secondary outcomes included the rate of falls, 3 measures of functional mobility, the proportion of participants who reported fall-related injury, and health-related quality of life. Fall-related data were collected via quarterly participant self-reports supported by a calendar; functional mobility was measured at baseline and 12-month follow-up using validated measures.

Results  Of the 2616 participants recruited, 6 died before randomization and 2610 (median age, 70.0 years [IQR, 66.4-74.2]; 1553 female [59.5%]) were randomized either to the intervention group (1311 from 64 villages) or to the control group (1299 from 64 villages). During a mean follow-up of 358.0 (SD, 31.3) days, 388 participants (29.7%) in the intervention group reported falling at least once during the 12-month follow-up compared with 497 (38.3%) in the control group (odds ratio, 0.67; 95% CI, 0.48-0.91; P=.01). All secondary outcomes favored the intervention except the Timed Up and Go Test (for functional mobility), which showed no significant difference.

Conclusions and Relevance  This cluster randomized trial found that integrating a fall prevention program in a primary health care system was associated with a significant reduction in the risk of self-reported falls among Chinese rural older people. This intervention, comprising balance and functional exercises and community-engaged health education, has the potential to be scaled-up in China and other low- and middle-income countries with rapidly growing aging populations.

DOI: 10.1001/jama.2025.12724

Source: https://jamanetwork.com/journals/jama/fullarticle/2838003