Zusammenfassung
Hintergrund: Stürze sind im Alter sehr häufig und eine erhebliche Gefahr für die Gesundheit. Stürze
sind in der Regel komplexe Ereignisse und die Sturzprävention ist eine Herausforderung
für das Gesundheitswesen. Prävention durch einzelne Interventionen sind weniger effektiv,
aber leichter durchzuführen und einfacher zu evaluieren.
Methode: Pragmatische Literaturübersicht 2002-2007
Ergebnisse: Kraft- und Balancetraining sind das effektivste Mittel, bei zu Hause lebenden alten
Menschen die Häufigkeit von Stürzen zu reduzieren. Auf eine ausreichende Versorgung
mit Kalzium und Vitamin D ist zu achten, um Stürze und Frakturen zu vermeiden. Gegebenenfalls
ist es effektiv eine Visuseinschränkung zu korrigieren und eine Medikation mit psychotropen
Medikamenten anzupassen. Die intensivierte Behandlung vorbestehender Grunderkrankungen
ist wahrscheinlich auch zur Reduzierung der Sturzgefährdung effektiv und als ein Argument
in gesundheitsbezogene Entscheidungen einzubeziehen. Gezielte präventive Hausbesuche
können im Gegensatz zu opportunistischen Hausbesuchen geeignet sein, Sturzgefährdung
zu reduzieren. Interventionen mit mehreren Ansatzpunkten sind in ihrer Effektivität
stark von der Zielgruppe und dem Design der Intervention abhängig. Generell sind derartige
Interventionen im ambulanten Sektor eher als effektiv anzusehen, als bei Heimbewohnern
oder in der stationären Pflege. Hüftprotektoren zur Vermeidung von sturzbedingten
Hüftfrakturen sind nach einer anfänglichen Euphorie in ihrer Effektivität zurückhaltender
zu beurteilen. Ihre Wirksamkeit ist stark vom Wirkprinzip (Energieabsorption oder
-ableitung), von der Zielgruppe (hohes, mittleres oder niedriges Sturzrisiko) und
von flankierenden Maßnahmen abhängig.
Abstract
Background: Accidental falls are common in elderly people and a major public health concern.
Falls usually are complex and prevention of falls a serious challenge for health service.
Prevention of falls by single interventions is less effective, but more feasible and
more suitable for evaluation.
Method: Pragmatic literature review 2002-2007.
Results: Strength and balance training are most effective in preventing falls in community
dwelling elderly. Adequate supply with calcium and vitamin D is important to prevent
falls and fractures. If applicable, correction of a visual impairment and gradual
withdrawal of psychotropic medication can reduce the risk of falling. Intensified
therapy of preexisting comorbidity also might be a fall-preventive measure, but falls’
prevention is one of many arguments in health related decision making. Specific home
visits for hazard assessment and modification seem to be effective in contrast to
“opportunistic” home visits. Interventions aimed at multiple risk factors simultaneously
are very dependent on the target population and the adequate design of the preventive
program. Generally, they seem to be more effective in community dwelling persons then
in institutional care or inpatient settings. Enthusiasm about hip protectors is slowly
fading. Their protective effect depends on the kind of protector (energy absorbing
vs. protective) and the target population (high vs. medium vs. low risk) and supportive
measures.
Schlüsselwörter
Stürze - Sturzprävention - Geriatrie - Übersicht
Key words
falls - falls prevention - old age - review
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Korrespondenzadresse
Dr. M. GulichMSc
Universität Ulm
Institut für Allgemeinmedizin
Helmholtzstraße 20
89069 Ulm
Email: markus.gulich@uni-ulm.de
