台灣65歲以上老人因跌倒而引發腦部受傷之趨勢研究

目的:這個以醫院資料為基礎的回顧性研究最主要的目的在看臺灣65歲以上老人每年跌倒發生率之趨勢。其次是設法找出可預測因跌倒而致頭部外傷的結果及預後的臨床變項。方法: 由1993到2007年頭部外傷資料庫，找出723位65歲以上因跌倒而致頭部外傷住院的病患。其中男性430人，女性293人。我們用linear trend model來看每年因跌倒而致頭部外傷發生之趨勢。此外我們亦試圖找出一些可預測跌倒而致頭部外傷的結果及預後的臨床變項。我們主要的變項有人口學因子、頭部以外傷害、酒精及藥物使用、傷害嚴重度、住加護病房天數、以前是否有因頭部外傷住院。結果: 1993到2007年因跌倒而致頭部外傷之發生率有逐年增加之趨勢，這增加之趨勢是因為男女因跌倒而致頭部外傷之人數增加，以及總頭部外傷人數減少之故。跌倒之前有喝酒及伴隨有顏面骨折者之預後較好。結論: 65歲以上臺灣人跌倒而致頭部外傷之發生率在過去15年有逐年增加之趨勢。預防及注意跌倒以減少頭部外傷益形重要。我們須要更進一步的研究，找出更多會造成老人跌倒潛藏的危險因子。

關鍵字

跌倒而致頭部外傷；頭部外傷；跌倒

並列摘要

Objective: The main goal of this retrospective hospital-based study was to establish trends in incidence of fall-related traumatic brain injuries (TBIs) among adults 65 years of age and older over time in Taiwan. The second purpose of this study was that we sought to identify clinical variables predictive of outcome and prognosis of fall-related TBIs. Mterial and Methods: Fall-related TBI data were obtained from Brain Injury Registry. Patients aged 65 and over were analysed. From 1993 to 2007, there were 723 hospital-admitted fall-related TBI cases (430 males and 293 females) in adults aged 65 and older. The linear trend model was used to determine whether changes of each trend over time were significant. We also tried to identify clinical variables predictive of outcome and prognosis of fall-related TBIs. The examination focused on the following variables: (1) demographic information, (2)extracranial injuries (3) substance use, (4) injury severity, (5) ICU length of stay, and (6) history of hospitalization for previous TBI. The clinical variables were entered in a stepwise fashion in a logistic regression model to detect the significant variables. Multiple logistic regression analysis was performed. Results: There was an increasing trend in the incidence of fall-related TBIs during the years 1993 through 2007 among adults age 65 years and older. The increased fall-related TBI cases in both sexes and decreased all TBI cases contributed to the trend. Patients with pre-injury alcohol exposure and facial bone fracture have more chance to have better prognosis. Conclusion: Fall-related TBIs in elderly Taiwanese over 15-year period have increased. Prevention and awareness of fall-related TBI in the elderly is imperative in reducing the likelihood of TBIs. Further studies need to be conducted to understand more about the unrevealed risk factors for people 65 years and older sustaining a fall related TBI.

並列關鍵字

trend in fall-related TBI ； TBI ； fall

參考文獻

18.Mau-Roung Lin, Su-Lan Tsai, Shu-Ya Chen, Shinn-Jia Tzeng. Risk factors for elderly falls in a rural community of central Taiwan. Taiwan J Public Health 2002；21(1)：73-82

26.George F. Fuller Falls in the Elderly. Am Fam Physician. 2000Apr 1;61(7)2159-2168

19.Chi-Hsiang Chung, Lu Pai, Ping-Hsun Wu, Chien-Cheng Lai, Wu- Chien Chien. Trends of Fall Mortality in Taiwan, 1986-2007. Chinese Journal of Occupational Medicine 17(3)：151-162, 2010

46.Dana A Glei, Ming-Cheng Chang, Yi-Li Chuang, Yu-Hsuan Lin, Shu-Hui Lin, I-Wen Liu, Harvey S. Lin, Noreen Goldman, Maxine Weinstein. Results from the Social Environment and Biomarkers of Aging Study (SEBAS) 2000 Survey Report. Taiwan aging study series, No 9, may, 2006 p52

1.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Costs of falls among older adults. Published September 1, 2010. http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html

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台灣65歲以上老人因跌倒而引發腦部受傷之趨勢研究

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