老年黃斑部病變病人跌倒及相關因素探討

背景及研究目的老化過程中跌倒為一大健康問題，本研究目的針對老年黃斑部病變者， (1)探討過去12個月跌倒發生率; (2)比較視力障礙與否對平衡影響;(3)以單變項分析，比較跌倒與未跌倒組在多面向因素之差異; (4)以多變項分析確認跌倒最重要因素。研究方法: 本橫斷性研究於北部某二家醫學中心收案，符案病人為60歲以上老年黃斑部病變者。眼底視網膜病變程度、視力、重要人口學特質、慢性病狀況、是否合併其他眼部疾病，下肢肌力測試、平衡能力，以及雙重能力障礙變項 (優眼視力障礙與否與平衡正常與否之變項，非優眼視力障礙與否與平衡正常與否之變項)，過去12個月是否發生跌倒，分為跌倒組及未跌倒組。以單變項分析，並以邏輯斯回歸同時分析以上變項，找出影響跌倒風險最重要因素。研究結果本研究共收194名符案病人，30.4% 個案在過去12個月有跌倒，優眼視力障礙組於整體與四項日常活動時之平衡任務 (站姿手向前伸、旋轉360度、兩腳前後站及單腳站立)皆有明顯差異; 女性、視力、下肢肌力、平衡能力差者、併有其他眼睛疾病、優眼及非優眼視力與平衡能力皆較差者，其跌倒風險較高。邏輯斯回歸結果，優眼視力及平衡兩項功能皆差者，同時有白內障及青光眼者，顯著有跌倒風險。結論與討論本研究證實老年黃斑部病變病人跌倒發生率高，除完整的視力檢查，建議增加平衡與肌力評估，並進一步發展相關介入措施，預防黃斑部病變病人之跌倒。

關鍵字

老年黃斑部病變；跌倒；視力障礙；平衡；下肢肌力

並列摘要

Background Fall is one of the most severe health problems in elderly. However, relatively limited investigations have explored in patients with age-related macular degeneration (ARMD). Objectives The purposes of the study were to explore (1) the incidence of falls; (2) the differences of balance between groups with normal vision vs. impaired vision of better eye; (3) the differences of fall in variables (factors) across selected demographic factors, chronic diseases, ocular and vision-related status, muscle strengths in low limbs (best and worst) , and two variables combining functions of vision and balance (in better eye and worse eyes) by univariate analysis; and (4) the robust factors of fall identified through multivariate logistic analysis using the above variables in patients with ARMD. Patients were recruited after IRB approval and having their consents. Methods This cross-sectional study was conducted in two medical centers of northern Taiwan. Eligible subjects were ARMD with aged 60 or older. Patients were assessed of their times of fall during the past 12 months, visual acuity (better eye and worse eyes), severity of ARMD, two variables combining functions of vision and balance in better eye and worse eyes, levels of balance (Berg’s balance scale), and low limb strengths (best and worst). The univariate analysis was applied to examine the difference between fall and non-fall groups across above variables. Multivariate logistic regression was applied to identify the most robust factors related to the risk of falls. Results A total of 194 ARMD patients were recruited with 30.4% of them having fall in the past 12 months. The overall balance and balance in 4 individual daily activities were significantly worse in group of vision dysfunction of better eye. Several factors were identified as significance in univariate analysis, including gender, visual acuity, low limb strength, balance, multiple eye disease, and the factors combining vision and balance. In logistic regression, patients with worse vision, poor balance, worse level of better eye vision and balance combined status, and having cataract and glaucoma together had significantly higher risk of fall. Conclusion The study demonstrates that fall is a problem to ARMD patients. Multiple factors were identified to influence patients fall. Systematical assessment of these related factors and further patient education are strongly suggested for clinical care. Development of related intervention and examining of its effects to decrease fall are needed in future research.