急診高齡病人之衰弱、跌倒風險與醫療資源利用之相關性探討

The Correlations between Frailty, Fall Risk and Utilization of Medical Resources among the Older Patients in Emergency Department

澎安琪(An-Chi Peng)

指導教授 ： 林淑媛

高雄醫學大學/護理學院/護理學系碩士班/碩士(2018年)

摘要

高齡病人因老化與疾病因素而容易出現衰弱的危機，進而面臨跌倒、失能、依賴、住院或急診就醫，甚至導致死亡之不良結果，國內緊急醫療最前線的急診鮮少有對高齡衰弱病人盛行率及相關因素探討，故本研究目的在調查高齡急診病人在衰弱、跌倒風險與醫療利用之相關性，期望提高急診醫護人員對高齡衰弱問題的重視，以進一步了解急診高齡衰弱病人在跌倒風險與醫療資源利用之現況。
本研究採橫斷式、描述性相關性調查研究設計，以方便取樣於南部某醫學中心急診室，進行353位60歲(含)以上高齡病人之SOF衰弱篩檢，並針對94位篩檢結果符合衰弱前期及衰弱者收案，以自擬「急診高齡病人基本屬性、就醫屬性與醫療資源利用調查表」收集資料，並利用跌倒風險評估量表(PH-FRAT)進行跌倒風險評估、完成手握力及行走測試，以SPSS 18.0進行資料分析。使用描述性統計說明急診高齡病人衰弱盛行率及基本屬性、就醫屬性、衰弱及跌倒風險、醫療資源利用之分佈，以Spearman’s相關分析檢定研究對象之衰弱、跌倒風險與醫療資源利用間的相關性。
研究對象平均年齡73歲，急診檢傷級數以三級最多 (69.1%)。本研究發現急診病人衰弱盛行率為39.9%，收案樣本符合SOF判定標準者，有56.4%為衰弱前期，有43.6%為衰弱；手握力衰弱有70.2%，行走衰弱有61.7%；跌倒風險結果發現：有28.7%為高跌倒風險者。
SOF衰弱與行走測試、跌倒風險、三個月內曾住院和三個月內照護需求改變呈顯著正相關(r= .21 ~ .48; p < .05 ~ < .01)；跌倒風險程度與SOF衰弱、手握力、行走測試及三個月內照護需求改變有顯著正相關(r= .30; p < .01)。醫療資源利用與SOF衰弱、跌倒風險、手握力、行走測試呈顯著正相關(r= .21~ .38; p < .05 ~ < .01)。
急診高齡病人之衰弱、跌倒風險程度、醫療資源利用間具有顯著正相關，透過衰弱與跌倒風險程度之即早評估，有助於急診照護提出預防衰弱與預防跌倒事件之發生。建議急診高齡病人可使用衰弱量表、手握力及行走測試作為評估衰弱的工具，可利用跌倒風險評估量表(PH-FRAT)工具進行跌倒風險的篩檢。透過急診訊息提供醫療與照護專科轉介，達成衰弱的預防或改善，亦可降低跌倒風險與醫療資源之利用。

關鍵字

急診高齡病人 ； 衰弱 ； 跌倒風險 ； 醫療資源利用

並列摘要

Frailty caused by aging and diseases makes geriatric patients face risks of falls, incapacitation, dependence, emergency medical treatment, hospitalization, and even death. Emergency department is at the frontlines of caring for elderly patients, however, few studies have investigated the correlation between frailty and risks of falls and medical utilization among the elderly patients in emergency department. In this study, we investigate the characters of frailty of geriatric patients in emergency department, and its effects on risk of fall and medical resource utilization.
We conducted a cross-sectional, descriptive, correlative study among 353 geriatric patients ( older than 60 years old ) in the emergency department of a medical center in southern Taiwan. 94 patients in frail and pre-frail status were included after screening by Study of Osteoporotic Fracture ( SOF ) screen. We used the “Questionnaire of the geriatric Patients' personal Attributes, Medical Attributes and Medical Resource Utilization” for key characters collecting , assessed the fall risk by using the Peninsula Health Fall Risk Assessment Tool ( PH-FRAT ) , and performed grip strength test and walking tests. Data was analyzed by SPSS 18.0. Descriptive statistics was used to describe the prevalence of frailty and character of personal attributes, medical attributes, frailty, fall risk, and medical resource utilization. Spearman’s correlation analysis was used to determine the correlation between frailty, fall risk, and medical resource utilization.
The prevalence of frailty of geriatric patients in emergency department is 39.9%. The mean age of the included patients is 73years old. Most of them were in Taiwan Triage and Acuity Scale ( TTAS ) level three ( 69.1% ). 56.4% of them met the SOF criteria of pre-frail , and 43.6% of them were frail. 70.2% of grip tests met the judgment of frailty , and 61.7% of walking tests met the judgment of frailty. 28.7% are high risk for fall.
Frailty in walking test, fall risk in PH-FRAT, hospitalization within three months, and increase in care needs within three months are significantly correlate to the results of SOF ( r= .21~ .48; p< .05~ < .01); SOF frailty, frailty in grip test and walking test, hospitalization within three months, and increase in care needs within three months are significantly correlate to fall risk in PH-FRAT( r = .30; p < .01); SOF frailty, fall risk in PH-FRAT, and frailty in grip test and walking test are significantly correlate to medical resources utilization ( r= .21~ .38; p< .05~ < .01).
There are significant correlations between the frailty, risk of fall, and medical resources utilization of the geriatric patients in emergency department. Assessment of frailty and fall risk can help to manage frailty and prevent falls in emergency care. We recommend using the Frailty Scales, Hand Grip and Walking Test as a tool to assess frailty for geriatric patients in the emergency department. The PH-FRAT can be used to screen for fall risk. Management and prevent of frailty of geriatric patients by information providing and care referral probably would reduce the risk of fall and medical resource utilization.

並列關鍵字

Emergency geriatric patient ； frailty ； fall risk ； utilization of medical resources

參考文獻

Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489-497. doi: 10.1002/nur.20147

中文部分

王靜怡、葉志嶸、許清芳(2010)．Mobility Performance in Older Adults at Different Levels of Health and Independence．中山醫學雜誌，21(2)， 145-159。doi: 10.30096/csmj.201006.0003

史芳瑛、徐祥清、林育瑩、佘翠紋、吳秋慧、林念蓉，．．． 施欣怡 (2015)． 因跌倒至急診就診之老年病患分析．台灣老年醫學暨老年學雜誌，10(1)， 16-27。

江瑞坤、鄭宇翔、陳欣欣、陳淑娟、蔡坤維(2006)．雲嘉老人跌倒之研究．台灣老年醫學雜誌，1(3)，174-181。doi: 10.29462/tgg.200602.0004