老人跌倒之預防介入策略

Strategies for fall-prevention in Older People

林茂榮(Mau-Roung Lin) ； 黃慧芬(Hei-Fen Hwang)

《台灣公共衛生雜誌》 27卷6期 (2008/12) Pp. 447-462

https://doi.org/10.6288/TJPH2008-27-06-01

摘要

老人跌倒預防是全球公共衛生最重要議題之一。老人跌倒預防介入策略主要包括：跌倒風險評估、多重因子介入、運動訓練、調整用藥、改善環境、改善視力、補充維他命D與鈣、裝置心律調節器以及教育等。介入前應評估老人跌倒風險，對社區老人可使用簡易的步態平衡測試，對機構內（含安養院及醫院）老人可使用周全性跌倒風險評估。多重因子介入為同時減少跌倒多項危險因子，已被證明是最有效且可靠的跌倒預防方法，但人力與經濟成本也最高；平衡運動（如太極拳）不只降低跌倒發生且能同時獲得其他身心健康利益；減少老人精神異常治療用藥可大幅較低跌倒，但老人用藥習慣不易改變；環境改善介入適合過去曾跌倒的老人；白內障手術能減少大部分視力不良老人的跌倒；維他命D與鈣補充與髖部護具對機構內老人跌倒的減少有顯著效果；裝置心律調節器只適合極少數老人；教育無法顯著降低老人跌倒。最後，本文討論跌倒預防介入方法選擇、臨床人員角色、機構內跌倒預防與研究、跌倒相關教育、以及健康專業間結合等老人跌倒預防相關議題。

關鍵字

老人 ； 跌倒預防 ； 多因子介入 ； 運動 ； 太極拳

並列摘要

Fall prevention in the elderly is one of the most important public health issues worldwide. Strategies for fall-prevention consist of fall-risk assessment, multifactorial interventions, exercise training, reduction in medications use, environmental modifications, vision improvement, vitamin D and calcium supplementation, cardiac pacing, and education. Before an intervention can be prescribed, a fall-risk assessment, including functional balance and mobility tests for the community-dwelling elderly and a more comprehensive battery of tests for the institutionalized and hospitalized elderly, needs to be conducted. Labor intensive and costly multifactorial interventions are the most effective and most consistent in reducing falls. Balance exercise programs, particularly tai chi, efficiently and effectively reduce falls and have other health-related benefits. Psychotropic medications can be reduced to prevent many falls, but it is difficult to change medication-taking behavior in the elderly. Changing the environment is an appropriate response in cases with a history of falls, and cataract surgery can reduce falls in those who are visually impaired. Vitamin D, calcium supplementation, and hip protectors are also effective for institutionalized elderly. Cardiac pacing can help only a few elderly people while educational programs are ineffective. Finally, fall-related issues (including selection of an appropriate strategy for prevention), role playing of clinicians, study of falls prevention in institutionalized and hospitalized elderly, fall-related education, and coordination of health care practices, are discussed in detail.

並列關鍵字

older people ； falls prevention ； multifactorial intervention ； exercise ； tai chi

參考文獻

Lin MR,Wang YW(2004).Risk factors and prevention of falls among community-dwelling older people.Taiwan J Public Health.23,259-271.

Tinetti ME(1986).Performance-oriented assessment of mobility problems in elderly patients.J Am Geriatr Soc.34,119-126.

Podsiadlo D,Richardson S(1991).The timed "Up & Go": a test of basic functional mobility for frail elderly persons.J Am Geriatr Soc.39,142-148.

Duncan PW,Weiner DK,Chandler J,Studenski S(1990).Functional reach: a new clinical measure of balance.J Gerontol Med Sci.45,192-197.

Vellas BJ,Wayne SJ,Romero L,Baumqartner RN,Rubenstein LZ,Garry PJ(1997).One-leg balance is an important predictor of injurious falls in older persons.J Am Geriatr Soc.45,735-738.