台灣社區老年人跌倒與生活品質相關因子分析

Factors Associated with Falls and Quality of Life among the Community Dwelling Senior Citizens in Taiwan

吳岱穎(Tai-Yin Wu)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/博士(2013年)

https://doi.org/10.6342/NTU.2013.00571

摘要

前言：跌倒是公共衛生的重要議題。跌倒在老年人相當常見，且跟疾病、失能及生活品質變差有關。過去的研究顯示，跌倒由多種危險因子所致。然而，有關台灣社區老年人的相關資料卻相當匱乏。同時，沒有現成的中文量表可測量老年人的生活品質。
研究目的：我們旨在研究跌倒的相關因素、描述單次與反覆跌倒不同的風險因子、在台灣地區測試中文台灣版的十九題生活品質量表CASP-19 (控制、自主、自覺、滿足)、及探究台灣社區老年人的生活品質。
研究方法：我們在台灣地區的台北市執行了一個以醫院為基礎的世代研究。現有的CASP-19廣東版先被修改成中文台灣版並試測。研究參與者隨機選取自2010或更早年參加台北市立聯合醫院仁愛院區免費年度老人健檢的3680位受檢者。我們以詳盡的問卷訪問參與者，訪問內容包括CASP-19量表。其中有317位長者受邀檢測血清維生素D，之中的91位長者並進一步接受骨密度檢測。一年之後的追蹤，我們以結構性的問卷電話訪問參與者。跌倒事件的紀錄主要來自自述。主要結果變項為十二個月內的跌倒次數及老年人的生活品質。預測變項包括：社經地位與人口學特質、生活型態危險因子、體型、衰弱症、認知功能、健康與用藥情形、驗血、驗尿與驗糞便的實驗室檢測結果、以及骨質疏鬆危險因子。我們也分析了CASP量表的心理計量特徵。
研究結果：共有653位長者完成了一年追蹤，其平均年齡為75.7± 6.4歲，半數(48.7%)為女性。跌倒者與反覆跌倒者分別佔14.5%及6.0%。橫斷面分析顯示女性 (校正後勝算比 (aOR) 2.32)、身高減低 (aOR 1.52)、體重過輕 (aOR 2.69)、腹部肥胖 (aOR 1.67)、衰弱 (aOR 1.56)、多重用藥 (aOR 2.18)與高血糖 (aOR 1.56)為跌倒的風險因子。縱貫分析顯示視力模糊 (aOR 1.93)、缺乏戶外活動 (aOR 2.28)及甲狀腺/副甲狀腺亢進 (aOR 3.49)與單次跌倒相關；衰弱 (aOR 2.81)、身高減低 (aOR 3.15)與服用鎮靜/安眠藥 (aOR 4.23)與反覆跌倒相關。過去跌倒史與單次及反覆跌倒皆有相關 (aOR分別為2.64及5.26)。
699位參與者的平均CASP-19總分為38.2±7.1。探索性因素分析顯示出額外的一個因子：「參與」 (CASPP-19)。量表臨床效度佳，且除了控制向度之外，各向度間內在一致性不錯。以19題的量表而言，第一級的五向度模型 (CASPP-19)有最好的配適度。以12題的量表而言，原始的模型配適度最佳。男性 (校正後β (β) 0.122)與有運動習慣者 (β 0.170)有較佳的生活品質。年長者 (β -0.242)、視力不佳 (β -0.143)、腹部肥胖 (β -0.093)、貧血 (β -0.095)、類風濕性關節炎 (β -0.073)、帕金森氏症 (β -0.079)、憂鬱 (β -0.125)、惡性腫瘤 (β -0.086)的患者及機車騎士 (β -0.086)有較差的生活品質。剖面分析顯示相對較年輕的男性、偶爾喝酒、有運動習慣及開車者有最佳的生活品質 (所有P < 0.001)。
研究結論：台灣社區老年人間，單次與反覆跌倒者似乎有不同的風險因子，需要不同的介入策略。
原始的CASP-12版本可能是在台灣地區使用的最佳版本。我們的研究結果也指出，生活型態對生活品質的影響，遠比實驗室測量來得更重要。

關鍵字

跌倒 ； 生活品質 ； 風險因子 ； 老年 ； 社區

並列摘要

Introduction: Falls are an important public health issue. Falls are common among older people and are particularly associated with increased morbidity, disability, and lower quality of life (QOL). Previous studies have shown that falls were multi-factorial. However, data regarding community dwelling Taiwanese population is minimal. On the other hand, there was no existing scale in Mandarin Chinese to measure QOL in old age.
Objectives: We aimed to study the factors associated with falls; to describe different risk factors for single and recurrent fallers; to validate a Chinese Taiwan version of the CASP-19 (control, autonomy, self-realization, pleasure), a 19-item QOL scale, in Taiwan; and to study the QOL among community dwelling Taiwanese senior citizens.
Methods: We conducted a hospital-based, prospective cohort study in Taipei City, Taiwan. The existing CASP-19 Cantonese version was first modified into Chinese Taiwan version and pilot tested. Participants were then randomly selected from the 3,680 examinees of the free annual Senior Citizens Health Examination in Taipei City Hospital, Renai Branch in year 2010 or earlier. Participants were recruited for a detailed questionnaire interview, including the CASP-19 scale. Among them, 317 participants were invited for serum vitamin D tests, and 91 participants were further evaluated for bone mineral density. In the one year telephone follow-up, participants were interviewed with a structured questionnaire. Falls were based on self-report. The main outcome measures were falls in the past 12 months and QOL in old age. Predictor variables included socio-demographic characteristics, lifestyle risk factors, body stature, frailty, cognition, medical conditions and medications, laboratory data of blood, urine and stool tests, and risk factors for osteoporosis. Psychometrics of the CASP scale was explored.
Results: Six hundred fifty three participants completed the follow up. The mean age was 75.7±6.4 years old. Half (48.7%) were female. Fallers and recurrent fallers comprised 14.5% and 6.0% of participants, respectively. Cross-sectionally, female gender (adjusted odds ratio (aOR) 2.32), decreased body height (aOR 1.52), underweight (aOR 2.69), central obesity (aOR 1.67), frailty (aOR 1.56), polypharmacy (aOR 2.18) and hyperglycemia (aOR 1.56) were the risk factors. Longitudinally, blurred vision (aOR 1.93), minimal outdoor activities (aOR 2.28), and overactive thyroid/parathyroid (aOR 3.49) were associated with single falls. Frailty (aOR 2.81), decreased body height (aOR 3.15) and taking sedatives/hypnotics (aOR 4.23) were associated with recurrent falls. Previous falls were associated with single and recurrent falls (aOR 2.64 and 5.26, respectively). The mean CASP-19 score of the 699 participants was 38.2±7.1. Exploratory factor analysis revealed an additional factor, ‘participation’ (CASPP-19). There were good clinical validity and satisfactory internal consistency for the subscales, except for the control domain. For the 19-item scale, the first order five-domain model (CASPP-19) yielded the best fit. For the CASP-12, the original model performed best. Male gender (adjusted β (β) 0.122) and exercise habit (β 0.170) were associated with a better QOL. Advanced age (β -0.242), blurred vision (β -0.143), central obesity (β -0.093), anemia (β -0.095), rheumatoid arthritis (β -0.073), Parkinsonism (β -0.079), depression (β -0.125), malignancy (β -0.086) and motorcycle riding (β -0.086) were associated with a lower QOL. Profile analysis revealed that young-old males, social drinkers, regular exercisers and car drivers had the best QOL (all P < 0.001).
Conclusions: Among community dwelling senior citizens in Taiwan, single and recurrent fallers appear to have different risk factors which mandate different interventions. The original CASP-12 version may be the best choice for use in Taiwan. Our findings highlight the importance of lifestyle factors over laboratory measurements on QOL.

並列關鍵字

Falls ； quality of life ； risk factors ； old age ； community

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