出院居家安全指導提升老人跌倒預防之成效探討

The Effect of Home Safety Guidance Program for Elderly Fall Prevention

徐菊容(Chu-Jung Hsu)

指導教授 ： 陳靜敏

臺北醫學大學/護理學院/護理學研究所/碩士(2008年)

https://doi.org/10.6831/TMU.2008.00087

摘要

跌倒是老人重要的健康議題，本研究係探討居家安全指導對出院後老人居家環境危險因素、避免跌倒自我效能及預防跌倒行為改善之成效。採類實驗研究設計，以北部某醫學中心65歲以上老年病患為研究對象，共收集實驗組37位、對照組38位個案。研究工具包括「居家內、外在環境評估表」、「避免跌倒自我效能量表」及「預防跌倒行為量表」，以居家訪視評估及問卷調查方式，了解出院居家安全指導對提升老人跌倒預防之成效。
研究對象平均年齡為75.47歲（SD = 6.23）、男女性分布相當、以不識字及三代同堂居住者為多，77.33﹪的長者罹患一種以上之慢性病、平均為1.24種、70.67﹪有長期使用藥物、平均使用1.11類藥物、60﹪在日常生活上能夠完全自理、95.0﹪之認知功能為正常，在過去一年及二個月分別有34.7﹪及20.0﹪個案有跌倒經驗；兩組在上述之基本資料除教育程度、平均罹病數及用藥種類，實驗組明顯高於對照組外，其他皆具同質性。
研究介入兩個月後，以Paired-t檢定發現，實驗組在避免跌倒自我效能得分，由6.91分提升至8.96分（paired-t = 4.32, p < .001）、對照組由7.76分提升至7.73分（paired-t = -0.08, p = .940），在預防跌倒行為變項，實驗組由3.04分降低至3.69分（paired-t = 8.78, p < .001）、對照組由3.12分提升至3.50分（paired-t = 3.36, p < .01），於兩個月跌倒發生頻率變項，實驗組由0.86次降至0.06次（paired-t = -2.50, p < .05）、對照組由0.19次升高為0.46次（paired-t = 2.25, p < .05），實驗組個案之居家環境危險數量，介入前為5.49個，實驗後減為3.37個（paired-t = -4.90, p < .0001）；以t檢定在後測時，比較兩組得分發現，實驗組不論在避免跌倒自我效能（t = 3.19, p < .01）、預防跌倒行為( t = 2.40, p < .05)、及兩個月跌倒發生頻率（t = -3.13, p < .01），均明顯較對照組改善，顯示居家安全指導對於跌倒相關危險因子及跌倒頻率之改善均有其成效。期望此結果，除作為日後相關預防跌倒研究之參考外，亦提供護理人員在臨床及社區工作中，於老人出院準備服務及跌倒預防指導之參考，同時建議護理教育設計時，能將老人居家環境危險評估納入護理人員養成教育之學習項目。

關鍵字

跌倒頻率 ； 居家環境危險 ； 避免跌倒自我效能 ； 預防跌倒行為

並列摘要

Fall is a major issue for elderly health. This study was to examine the effect of home safety guidance program for elderly fall prevention through decreasing subjects’ home environment hazards, improving fall avoidance self-efficacy and falling prevention behavior. The quasi-experimental design was adopted, subjects who were 65 years old and over were invited from an acute medical center, a total of 37 in the experimental group and 38 in the control group were recruited. The research instruments used including “Inside/Outside Home Environmental Hazard Evaluation Scale”, “Fall self-efficacy Scale” and “Falls Behavior (FaB) Scale”. Home visit and questionnaire were used for data collection.
The subjects’ mean age was 75.47 years old (SD=6.23), male and female were equally distributed. Most of them were illiterate and live with family including grandkids. 77.33﹪of them suffered from one to several kinds of chronic disease(s) (M= 1.24); 70.67﹪of them were under long-term medical treatment and used in average 1.11 types of medications. Based on functional evaluation, 60﹪of the subjects were independent and 95.0% were normal in cognition. 34.7﹪and 20﹪ of them experienced falling incident one year and two months previous to home visiting respectively. In comparing 2 groups’ homogenous, higher educational level, more underlined diseases and regular controlled medicines were noted in experimental group.
Two months after the home safety guidance program intervention, results indicated that the experimental group improves from 6.91 to 8.96 in Fall self-efficacy (paired-t = 4.32, p < .001), 3.04 to 3.69 in FaB (paired-t = 8.78, p < .001) and 0.86 to 0.06 times in fall frequency (paired-t = -2.50, p < .05); compared to 7.76 to 7.73 (paired-t = -0.08, p = .940), 3.12 to 3.50 (paired-t = 3.36, p < .01), and 0.19 to 0.46 (paired-t = 2.25, p < .05) in control group respectively. There was a significantly improvement for intervention group in avoiding fall self-efficacy ( t = 3.19, p < .01), preventing falls behavior ( t = 2.40, p < .05) and two month’s falling frequency( t = -3.13, p < .01) using t test analyses in post test. Based on results of this study, the following strategies will be recommended in research, clinical practice and nursing educations.

並列關鍵字

fall frequency ； home environment hazards ； self-efficacy ； preventing falls behavior

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