老人照顧缺乏導致跌倒骨折與潛在老人虐待

Lack of Care in an Elderly Woman Leading to Fall and Fracture and Suspected Elder Abuse

姚騰傑(Teng-Chieh Yau) ； 謝正芳(Cheng-Fang Hsieh)

《台灣老年醫學暨老年學會雜誌》 16卷3期 (2021/08) Pp. 238-250

https://doi.org/10.29461/TGGa.202108_16(3).0006

摘要

台灣高齡人口逐年增加，加以現代子女與父母同住的情形逐漸下降，老人又常因失能或行動不便需倚賴他人，導致老人照顧問題越來越需被重視。在高齡人口裡，獨居老人又因僅能依靠自己維持自我照顧，照顧不足時無人知曉，更需被關注是否有照顧缺乏及老年受虐的可能性。本個案報告介紹一位82歲女性病患，平時只與兒子同住，但兒子是一位有思覺失調症的聾啞人士，尚需個案照顧，四位女兒則極少訪視，此情況符合獨居老人定義。近日因在家中跌倒右腿骨折後送醫。於老年醫學科住院後，經由周全性老年評估與跨領域醫療團隊整合照護方式，了解到病患有認知功能退化，步態不穩反覆跌倒，也疑似有反覆尿失禁，懷疑有常壓性水腦症；且這段期間無家人協助就醫疑有照顧忽略，導致功能退化及跌倒骨折。藉由本個案我們了解到周全性老年評估對於獨居老人的重要性，能以跨專業團隊的方式釐清個案的多重問題，除了處理急性問題以外也分析並減少相關危險因子，發覺並介入潛在照顧忽略的問題，最終提升了個案的照顧品質。

關鍵字

周全性老年評估 ； 老人照顧 ； 老人虐待 ； 老人跌倒

並列摘要

This case report presents an 82-year-old woman brought to the emergency department for right leg fracture caused by a fall at home. After admission to our Geriatrics ward, comprehensive geriatric assessment (CGA) revealed that she had experienced functional decline for 3 months, associated with gait instability with frequent falls, suspected recurrent urinary incontinence, and progressive mild cognitive decline. It had also come to our attention that the woman lived alone with her schizophrenic son, who was unable to take care of himself, and elderly neglect was suspected as her daughters brought her to no clinic or hospital for medical help despite noticing her frequent falls. With the integrated care of a multidisciplinary team, we were able to cope with her acute problems such as urinary tract infection and fractures on her right radius and femur, initiate nutrition intervention and rehabilitation to prevent deconditioning, and arrange a family meeting to address the issue concerning neglect and help the daughters understand the importance of caring for their mother. Through this case, we emphasize the crucial role of CGA in detecting and treating elderly patients who may be suffering from elderly abuse. Though it is difficult to notice elderly abuse in clinical practice, with good history taking, physical examination, and the help of CGA, we can increase the probability of detecting and helping these patients.

並列關鍵字

comprehensive geriatric assessment ； elder care ； elder abuse ； elder falls