陡峭居住地形對年長者身體活動表現及跌倒風險之影響探討

Influence of Residential Hilly Environments on Physical Performance and Fall Risks in the Elderly

趙珮瑛(Pei-Ying Chao)

指導教授 ： 鄭尊仁

共同指導教授 ： 陳保中

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.10212

摘要

前言
年長者的跌倒風險分析是預防跌倒事件發生的最重要議題，然而至今為止尚未有良好的報告評估居住地的陡峭地形與年長者的身體行動功能以及跌倒風險的相關性。

目的
本研究旨在探討居住地的陡峭地形是否會影響年長者的身體行動功能以及跌倒風險。

研究設計
本研究採橫斷式設計，以多數居民居住於較陡峭地形的北台灣某海岸城市做為研究區域，研究對象為居住於該城市之年紀大於65歲社區年長者，收案時間自2007年9月至2008年5月。主要測量指標為跌倒因子調查問卷、過去一年之跌倒紀錄、3公尺站起來及跌倒測試、Google地形圖中分析所測得之居住地海拔高度及居住地鄰近區域地形之高度差異。

結果
共計有215位男性，255位女性參與本研究。結果發現居住在海拔較高地區的居民，3公尺站起來及行走測試結果較佳(居住高於海拔40公尺至海拔60公尺以上區域，有測式結果為10秒以上的odds ratio為0.296，95%信賴區間0.136–0.643，p值0.002；居住在高於海拔60公尺以上區域，測式結果為10秒以上的odds ratio為0.266，95%信賴區間0.101–0.700，p值0.007)，居住地鄰近區域1000公尺直徑內之地形高度差異大於100公尺的受試者，其3公尺站起來及行走測試結果亦較佳(結果為10秒以上的odds ratio為0.417, 95%信賴區間0.184–0.945，p值0.036)。此外，居住在海拔高於60公尺地區的居民其跌倒風險較居住在低海拔地區的居民高(odds ratio 2.340，95%信賴區間1.032–5.307，p值0.013)。而不同海拔區域中，居住地鄰近區域的地形起伏對跌倒風險似乎有不同的影響。居住於低於海拔40公尺之區域者，居住地鄰近區域內之地形高度差異越大，則過去一年曾跌倒機率較居住於平坦區域之居民為低。與地形平坦之區域相比較，鄰近區域500公尺直徑內高度差異20公尺的居民過去一年曾跌倒之odds ratio為0.314，95%信賴區間0.111-0.892，p值0.03，而高度差異40公尺的居民過去一年曾跌倒之odds ratio為0.217，95%信賴區間0.070-0.617，p值0.008。鄰近區域1000公尺直徑內，地形最大高度差異60公尺的居民相較於高度差異0~20公尺之居民過去一年曾跌倒之odds ratio為0.175，95%信賴區間0.045-0.681，p值0.012。而鄰近區域1000公尺直徑內，地形最大高度差異80公尺的居民相較於高度差異0~20公尺之居民過去一年曾跌倒之odds ratio為0.135，95%信賴區間0.030-0.603，p值0.009。然而，居住於高於海拔40公尺之區域且鄰近區域地形高度差異越大者，跌倒機率則顯著上升。與地形平坦之區域相比較，鄰近區域500公尺直徑內高度差異達40公尺的居民過去一年曾跌倒之odds ratio為4.398，95%信賴區間1.016-19.030，p值0.048。

結論
我們發現居住地的陡峭地形會影響年長者的身體行動功能以及跌倒風險。居住在海拔較高地區或鄰近區域地形高度差異較大的居民有較佳的身體行動能力。以居住地海拔高度為單一地形指標時，可發現居住在海拔較高地區的年長者其跌倒風險也較高。然而在較低海拔區域，居住地鄰近區域的地形起伏較大區域年之長者的跌倒風險較小，而在較高海拔區域，居住地鄰近區域的地形起伏較大區域之年長者的跌倒風險則顯著升高。

關鍵字

陡峭居住地形 ； 跌倒風險 ； 身體行動能力

並列摘要

Objective
Fall risks evaluation is the most important part of fall preventions programs in the elderly. However, the effects of hilly environments of residential area on physical mobility and fall risks in the elderly were poorly understood. The aim of this study is to determine the association of residential hilly environment with physical mobility and fall risks in the community-living elderly.

Methods

Design, Setting, and Participants
A cross-sectional study was designed for investigation. Participants enrolled from Sep 2007 to May 2008 were the elderly aged at least 65 years old from community in a harbor city in northern Taiwan.

Main Outcome Measure
Self-reported fall histories in past one year, results of Timed Up-and-Go Test, residential altitude and parameters of hilly neighborhoods derived from calculation on Google Contour Map.

Results
There were 215 males and 255 female residents of the city participated in our study. After assessing the information of their address on the Google Contour Map, we found the higher altitude the subjects lived on, the better results of Time UP-and-Go Test observed. Odds ratio for TUGT abnormality was 0.296(95% confidence interval [C.I.] 0.136-0.643, p=0.002) in zones of altitude between 40 to 60 meters, and odds ratio for TUGT abnormality in zones over 60 meters was 0.266(95% C.I. 0.101-0.700, p=0.007), comparing to zones of altitude 20 meters and below. Subjects who had lived in zones with hilly neighborhoods were found to have less abnormal TUGT results that odds ratio for TUGT abnormality was 0.417 (95% C.I.0.184–0.945, p=0.036) where altitude difference was more than 100 meters in the neighboring area diameter 1000m. Higher zones of residential altitude over 60 meters were positively associated with greater risks of falls in past one year, odds ratio 2.340 (95% C.I. 1.032–5.307, p=0.042), when comparing to zones of residential altitude 20 meters and below. Besides, the presence of hilly neighborhoods has different influence on annual risk of falls according to zones of residential altitude. In zones of altitude below 40 meters, greater altitude difference in neighboring area was negatively associated with annual risk of falls. As comparing to non-hilly areas, altitude difference of 20 meters in neighboring area diameter 500 meters had lower risk of falls in past one year, odds ratios 0.314(95% C.I. 0.111-0.892, p=0.03). And the risk was also lower with altitude difference 40 meters in neighboring area diameter 500 meters with odds ratio 0.217(95%C.I. 0.070-0.617, p=0.008). Similar results were observed in neighboring area diameter 1000meters that annual risk of falls in past one year was lower when altitude difference reached 60 meters, odds ratio 0.175(95%C.I. 0.045-0.681,p=0.012), when comparing to altitude difference 0~20 meters. When altitude difference reached 80 meters in neighboring area diameter 1000 meters, the odds ratio for annual risk of falls was 0.135(95% C.I.0.030-0.603, p=0.009).
On the other hand, for those who had lived in zones of altitude 40 meters and higher, greater altitude difference in neighboring area was significantly associated with increased annual risk of falls. In residential altitude 40 and higher, when comparing to residents with even neighboring areas, residents who has altitude difference of 40 meters in Near Neighborhoods had greater risk of falls, odds ratio 4.398(95% C.I. 0.016-19.030, p=0.048).

Conclusions
Hilly living environments have an influence on both physical performance and fall risks in the elderly. Both in zones of higher altitudes the elderly lives, or with hilly neighborhoods they have nearby, the better mobility and balance function were observed. The elderly who lived in zones of higher altitudes had greater risk of falls. However, parameters of hilly neighborhoods have difference influence on annual risk of falls according to zones of residential altitude. Decreased risk of falls was observed in places with hilly neighborhoods in lower zones of altitude, but increased risk of falls in the elderly was observed in places with hilly residential neighborhoods in higher zones of altitude on the contrary.

並列關鍵字

Residential hilly environments ； fall risk ； physical mobility

參考文獻

AGS/BGS/AAOS Panel on Falls Prevention. Guidelines in prevention of falls in the elderly; J Am Geriatr Soc.2001; 49:664-672.

Baracco R, Mohanna S, Seclen S. A Comparison of the Prevalence of Metabolic Syndrome and Its Components in High and Low Altitude Populations in Peru. Met Syndr Relat Disord. 2007; 5(1): 55-64.

Bohannon RW. Reference Values for the Timed Up and Go Test: A Descriptive Meta-Analysis. J Geriatr Phys Ther. 2006

Blyth FM, Cumming R, Mitchell P, Wang JJ. Pain and falls in older people. Eur J Pain. 2007;11(5):564-571.

Chang JC, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trial. BMJ. 2004; 328: 680-686