地域在住高齢者を対象としたHome Hazard Modification Programの効果

Effectiveness of a Home Hazard Modification Program forOlder Adults Living in the Community

　本研究の目的は，地域在住高齢者を対象に，自宅内の転倒予防・安全対策教育としてHome hazard modification program（以下：HHMP）を実施した効果を評価することである．HHMPは，自宅内の危険箇所と安全策等を理解する講義，転倒事故予防教育用住宅模型教材（実用新案3148203号）を用いた演習等の30分のプログラムで，これを転倒骨折予防実践講座（週2時間×4回）内で実施した．研究対象者73名（平均年齢76.7（SD 6.2）歳）を無作為に介入群（38名），コントロール群（35名）に割り付け，分析対象者介入群27名（71.1％），コントロール群29名（82.9％）のベースライン，講座終了時，12週後の3時点の知識，転倒発生状況等を縦断的に分析した．その結果，知識量には両群で交互作用（p＝.047），および単純主効果（p＝.033）が認められ，多重比較では介入群のほうが講座終了時知識量が有意に高かった（Bonferroni's multiple comparison test p＝.027）．介入群の低転倒リスク群は講座終了時（Fisher's exact test p＝.020），12週後（Fisher's exact test p＝.047）の自宅内安全知識の正答者割合が有意に高かった．さらに12週の累積転倒者数は介入群に有意に少なかった（Log rank test p＝.025）．以上から，HHMPは高齢者への自宅内の安全知識の向上と短期維持，および短期転倒予防効果がある可能性が示唆された．

　The purpose of this study was to evaluate the effectiveness of a home hazard modification program (HHMP) for preventing elders' falls in their own residence. HHMP was a 30-minute educational program to create a safer living environment by decreasing residents' fall risks and hazards. The HHMP consisted of short lectures, risks and hazards home assessment and improving safety. Educational materials consisted of a mock-up of a Japanese-style house (Japanese registered utility model ID3148203), and specific tools designed to increase home safety. The HHMP was part of a fall prevention practice held two hours each week for four weeks with a follow-up class at three months and a final class one year later.

　Consenting to participate was a convenience sample of 73 elders (mean age 76.7 SD 6.2) from the community randomly assigned to the intervention (n＝38) or control group (n＝35). Completing the 12-week HHMP were 27 (71.1%) in the intervention group and 29 (82.9%) in the control group. Data, such as a 10-item hazard knowledge test and Flemming Fall Risk Assessment were analyzed using repeated measures ANOVA at three times: (a) baseline, (b) end of the class, and (c) after twelve weeks. Probability of falling was analyzed using survivor analysis: Kaplan-Meier analysis and log-rank test.

　As a result, the intervention group's knowledge of home hazard and safety showed a significant interaction effect (p＝.047) and a simple main effect (p＝.033) between baseline and end of the class (Bonferroni's multiple comparison test p＝.027). Only low-risk elders in the intervention group showed significantly higher correct responses on the preventing falls on the three-point scale item, between baseline and end of the class (Fisher's exact test p＝.020), and after twelve weeks (Fisher's exact test pp＝.047). Moreover the number of falls was significantly lower in the intervention group compared to the control group (log-rank test p＝.025). Our HHMP has the possibility for short-term fall prevention and improved knowledge of hazards for elders living in the community.