- 期刊
周全性老年評估個案報告：眩暈症患者之跌倒與日常生活功能下降
Comprehensive Geriatric Assessment of a Patient with Vertigo, Falls and Functional Decline: A Case Report
摘要
頭暈（dizziness）是大於75歲老人尋求醫療協助第一多的原因，頭暈症狀可再細分為眩暈（vertigo）、不平衡感（disequilibrium）、頭輕飄飄感（lightheadedness）及暈厥前的情形（presyncope）。而頭暈和平衡紊亂、功能下降、生活品質下降和增加跌倒發生率相關；最常造成老人跌倒的頭暈原因為良性陣發性頭位眩暈（benign paroxysmal positional vertigo, BPPV）。雖然造成眩暈症（vertigo）之原因大部分為良性，但仍需依據詳細的病史、理學及實驗室檢查排除嚴重、致命病因。治療眩暈症應以治療造成眩暈之根本病因為主，急性期使用藥物緩解症狀，並配合復健療程改善眩暈症狀。本個案為一位患有呼吸衰竭經插管後導致雙側聲帶麻痺經氣切治療、風濕性心臟病、高血壓等多重慢性病患者，因眩暈症發作造成反覆跌倒，導致活動力及日常生活功能下降，因初步評估治療後沒有明顯改善，故嘗試以周全性老年評估的方式介入，在詳細的評估之後，診斷疑為椎基底動脈循環不全（vertebrobasilar insufficiency）合併多重原因導致眩暈發作，並透過跨領域的醫療團隊幫助病人與家屬了解病因、建立多重介入的治療方式及預防追蹤。
並列摘要
Dizziness is the most common reason among individuals aged over 75 year who seek for medical help. It can be classified into four categories: vertigo, disequilibrium, presyncope, and light headedness. Dizziness is associated with balance disorders, functional decline, poor quality of life, and falls. Older persons with benign paroxysmal positional vertigo (BPPV) are more likely to fall than those with other types of dizziness. Although the most common causes of vertigo are benign, a structured and comprehensive assessment is required to rule out potential serious or life-threatening etiology. The most important management for vertigo is to identify and address the underlying problems. Medications to suppress vestibular symptoms are used for alleviating acute episodes of vertigo. Vestibular rehabilitation should be provided for preventing falls and increasing activity. In this article, a 91-year-old woman with rheumatic heart diseases, hypertension and status post tracheostomy, suffered from progressive functional decline after recurrent falls with vertigo during the past year. Because of no significant improvement after initial treatment, a comprehensive geriatric assessment was conducted. Vertebrobasilar insufficiency and other multiple factors, including anemia, poor nutritional status and polypharmacy, were impressed. Through interdisciplinary team assessment, we endeavored to develop an integrated plan for intervention and prevention of recurrent falls.