不同跌倒風險個案防跌訓練之介入成效分析

Analysis of the effects of fall prevention programs on older people with different risk of falls

李郡鳳(Chun-Feng Lee)

指導教授 ： 蕭世芬

高雄醫學大學/護理學院/高齡長期照護碩士學位學程/碩士(2019年)

摘要

本回溯性研究之目的在探討使用28處高雄市社區關懷據點的長輩，透過專業整合之平衡綜合運動訓練後，跌倒高風險(High risk, HR)以及跌倒低風險(Lower risk, LR) 兩組人口學是否有差異、跌倒HR組運動之介入之成效、並探討介入成效的影響因子(年齡、性別、每周運動總時數、危險因子總數等)。經人體試驗委員會之倫理審查通過後，將長輩資料加以分析，篩檢出具跌倒HR組368人、LR組230人，兩組共598人，再依年齡各分為初老組(65-74歲)、中老組(75-84歲)、老老組(>85歲)三組以進行比較，其中LR組只有初老組與中老組。研究結果發現，高低風險組長輩在人口學上無統計上的差異。比較前後結果發現，HR組長輩在每一項訓練後的前後測都具顯具差異(p<.05)，但老老組(>85歲)在30秒椅子坐立、2.44公尺椅子坐立繞物、單腳站立的改善較有限；LR組的長輩則是在30秒椅子坐立的結果無顯著改善。而對後測跌倒風險危險因子下降的影響因子，影響力順序依次為30秒椅子坐立成效大過2.44椅子坐立繞物成效、年齡、單腳站立成效。研究討論發現，無論哪個年齡分組，在前測以2.44公尺椅子坐立繞物這項測試作為跌倒風險因子可篩出最多高風險人數。而在後測中則以30秒椅子坐立(初老組減少33.8%人次；中老組減少25.6%人次)、單腳站立(中老組降低了56.4%人次)兩個危險因子減少最多。另外，不同性別長輩在下肢肌力訓練成效上具顯著差異，男性下肢肌力訓練效果顯著優於女性。本研究認為體適能檢測中之30秒椅子坐立、單腳站立、2.44公尺椅子坐立繞物等三項適合用於台灣社區長輩以作為跌倒風險測試。對於跌倒高風險的長輩每周給予1小時以上的綜合平衡防跌課程也證明是有效的。但建議一般長輩(跌倒低風險)在社區綜合平衡訓練課程的介入應更多元，並且時間應該要每周超過2小時才可能見到成效。

關鍵字

跌倒風險 ； 社區老人 ； 綜合性平衡訓練 ； 社區關懷據點

並列摘要

Abstract
The purpose of this retrospective study was to explore whether there were differences between the high and low falling risk groups of those community elderly utilizing the 28 Kaohsiung Community-based Care Centers in their demographic profiles, the effects of exercise training, and factors (such as age, gender, weekly exercise hours, number of fall risk factors, etc.) affected the training outcome, after the professional integrated balance exercise training. With ethical approval, the records of participation in those training programs from those elderlies in the community-based care centers were analyzed; in total there were 598 older people who further categorized as high risk of falling (HR group; 368 people) and low risk of falling (LR group; 230 people). They were then grouped according to the age into the young-old (65-74 years old), old-old (75-84 years old) and oldest-old (>85 years old) groups for comparison. LR group only classified as young-old and old-old group only. Analysis showed that there was no significant difference in demographic profile between the HR and LR groups. There was significant improvement on HR group in all training items after the exercise program (p<0.05) but the improvement in 30-second chair stand test, 2.44m Up-and-Go test, single-leg standing was more limited in the Oldest-Old population. There was no significant different in the 30-second chair stand test in the LR group. The number of fall risk factors after training was found to be affected by the training effect in 30-second chair stand, training effect in 2.44m Up-and-Go test, age, and training effect of single-leg standing, respectively. We also found that during the screening pre-test, the highest number of elderly were classified as having risk of falls with the 2.44m Up-and-Go Test in all age groups. In the post-test, number of HR group elderly decreased most in the 30-second chair stand test (33.8% reduction in the young-old group; 25.6% reduction in the old-old group) and single-leg standing (56.4% reduction in the old-old group). Comparing the pre- and post-tests, both male and female elderly had significant progress in the 30-second chair stand test indicating that the lower limb muscle strength training was effective, especially in male elderly. Therefore, this study concluded that the 30-second chair stand, single-leg stance, and 2.44m Up-&-Go tests in the senior fitness test are suitable for the Taiwanese community elderly as a fall risk test. One-hour integrated balance training program per week was effective in changing the falling risk in the HR elderly. However, it is recommended for the LR elderly, the integrated balance exercise training should last longer (ie > 2 hours per week) and more divered to achieve possible improvement.

並列關鍵字

risk of falls ； community elderly ； integrated balance exercise training ； community-based Care Centers

參考文獻

中文資料

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