探討社區老人自宅內與自宅外的跌倒相關因子

Study on Factors Related to Residential and Non-residential Falls in Elderly Community Dwellers

蔡益堅(Yih-Jian Tsai) ； 孫文榮(Wen-Jung Sun)

《台灣老年醫學暨老年學會雜誌》 15卷1期 (2020/02) Pp. 11-26

https://doi.org/10.29461/TGGa.202002_15(1).0002

摘要

目的：探討社區老人自宅內與自宅外的跌倒相關因子。方法：使用1999年中老年調查資料研究過去一年跌倒及自宅內、外跌倒的歸因（環境因素、個人因素），及與社會人口學危險因子（年齡、性別、日常生活活動功能／工具性日常生活活動功能－是否有任何一項困難）、生物危險因子（視力、慢性病罹病數、憂鬱症狀、認知功能）及行為危險因子（服用安眠藥或鎮定劑、使用助行器及平常運動頻次）的相關性。先分析跌倒及自宅內、外跌倒的歸因，並以雙變項分析及多變項羅吉斯迴歸模式辨識其特定的危險因子。結果：2,825位完訪者平均年齡74.6±6.1歲，跌倒盛行率18.1%。在雙變項分析中與各個參考組相比，年邁、女性、ADL或IADL失能、服用安眠藥或鎮定劑、視力不清楚、使用助行器、罹患一種或兩種以上慢性病、有憂鬱症狀或認知功能異常等可能有較高的自宅內、外跌倒盛行率，規律運動者可能有較低的自宅內、外跌倒盛行率（卡方檢定，p＜0.05）。自宅內跌倒者傾向歸因於個人因素，自宅外跌倒者傾向歸因於環境因素。多變項羅吉斯迴歸模式所辨識顯著的危險因子可依照跌倒及自宅內、外跌倒之任兩者配成三對：跌倒與自宅內跌倒共同的危險因子包括年齡70-79歲、女性、服用安眠藥或鎮定劑、使用助行器，而跌倒與自宅外跌倒共同的危險因子包括使用助行器、罹患2種以上慢性病。自宅內、外跌倒共同的危險因子則僅有使用助行器。ADL或IADL失能及視力不清楚則僅是自宅內跌倒的危險因子。討論：老人自宅內與自宅外的跌倒相關因子不同，防跌策略須差異化。

關鍵字

老人跌倒 ； 歸因 ； 危險因子

並列摘要

Objectives: To investigate the attributed causes and risk factors of residential and non-residential falls in elderly community dwellers. Methods: Data of the 1999 Taiwan Longitudinal Study on Ageing (TLSA) were used to investigate the attributed causes (both extrinsic and intrinsic) and risk factors of falls (both residential fall ＂RF＂ and non-residential fall ＂NRF＂). The explanatory variables included sociodemographic variables (age, sex, difficulty in ADLs/IADLs), biological variables (vision, number of comorbidity, depressive symptoms or cognitive impairment), and behavioral risk factors (use of sleeping pills or sedative, use of a walking aid, and frequency of exercise). We analyzed the attributed causes of RF and NRF and identified their specific risk factors using bivariate analyses and multiple logistic regression models. Results: Among the 2,825 surveyed elderly community dwellers (mean age 74.6±6.1 years), 18.1% had at least one fall in the previous year. Bivariate analyses indicated that, compared to those in the reference group, those who were more advanced in age, female, having difficulty in ADLs/IADLs, using sleeping pills or sedative, poorer in vision, dependent on a walking aid, with one or more comorbidities, and showing depressive symptoms or cognitive impairment were associated with a higher prevalence of RF or NRF, while the prevalence was lower in those who exercised regularly (Chi-square test, p＜0.05). RF was more likely attributed to intrinsic causes, and NRF to extrinsic causes. Statistically significant risk factors identified in the multiple logistic regression models were categorized for each pair of falls, RF, and NRF. The identified risk factors for falls and RF included age 70-79, female gender, use of sleeping pills or sedative, and use of a walking aid, while those for falls and NRF included use of walking aid, and having two or more comorbidities. Use of a walking aid was the only common risk factor of both RF and NRF. Having difficulty in ADLs/IADLs and poorer vision are exclusive risk factors of RF. Conclusion: The significant differences in the identified risk factors between RF and NRF imply the necessity to tailor falls prevention strategies.

並列關鍵字

elderly ； falls ； risk factors