住院老人跌倒的影響與相關因素-以某醫學中心為例

Influence and related factors of falls for elderly residents- A Case Study of a Medical Center

王美文(Mei-Wen Wang)

指導教授 ： 李易蓁

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00095

摘要

研究目的：探討住院老人跌倒危險因素及其傷害嚴重度，了解住院老
人的個人因素、照護因素及環境因素等三大構面與跌倒的相關性。
研究方法：本研究採回溯性調查研究設計，研究對象係以2012年01
月~2014年12月南部某醫學中心65歲(含)以上全體住院病人為母群體，研究樣本分為跌倒組和對照組兩組。跌倒組係為該醫學中心｢跌倒事件資料庫｣三個年度的跌倒通報個案，排除急診、加護病房及手術室，總計285人。對照組選取是將2012~2014年所有的65歲以上住院病人扣除跌倒組，依據對照組住院三個年度，依分配比例隨機選取285人；故跌倒組加上對照組的樣本數共計為570人。
研究結果：由研究結果顯示：一、跌倒相關因素：個人因素：住院科別、有使用輔助物、意識模糊、右下肢肌肉張力低、一年內有跌倒經驗、入院高危跌倒總分越低；照護因素：住院期間約束；環境方面：床欄未拉上、睡前未將床高度調至最低，個案發生跌倒的風險較高。二、跌倒傷害程度：個人因素：住院科別、肌肉左下肢及右下肢肌肉張力低；照護因素：跌倒班別；受到傷害的情形較高。三、跌倒傷害程度：大夜、小夜班及二人房B床為影響跌倒個案傷害程度之主要因子。
結論及建議：本研究顯示影響住院老人跌倒的因素是多面向的，臨床照護時應落實執行高危跌倒評估及收集相關資料，並將病人及家屬納入共同討論，提早進行各項跌倒的計畫及預防措施，降低住院中跌倒發生率及傷害程度，建置老人安全友善的住院環境，提升醫療照護品質。

關鍵字

住院老人 ； 跌倒

並列摘要

Research purpose:
Probe into the fall risk factors of the elderly in-patients and the degree of injury caused by the fall, and find out the correlation between the fall and the three dimensions -the personal factor, caring factor and environmental factor of the elderly in-patient.
Research method:
This research adopted retrospective study and the objects of the research were based on the population which included all the in-patients at the age of over 65 years old of a medical center in the south from January of 2012 to December of 2014. The research samples were divided into the fall group and the control group. The fall group, 285 persons in total, was the fall reported cases of three years from the medical center’s “Fall Incident Database”, excluding those from emergency ward, intensive care unit, and the operating room. The control group, 285 persons in total, chose randomly the persons from all the in-patients over 65 years old, from 2012 to 2014, excluding the persons of the fall group, according to the allocation proportion. The samples of the fall group and the control group were 570 persons in number.
Research results:
The research results showed that:
1.With or without the relevant fall factors:Personal factor: the hospitalization
departments, aids offered, blurred consciousness, low muscular tension at right lower limb, had a fall in one year, lower score of hospitalization high-risk fall;Caring factor: constraint during hospitalization;Environmental factor: didn’t raise the bed rails, didn’t lower the bed to the lowest before rest.The risk of falling was higher.
2.The degree of injury caused by the fall:Personal factor: the hospitalization
departments, low muscular tension of the left and right lower limbs;Caring
factor: fall occurred during different shifts.The chance to suffer injuries was
higher.
3.The degree of injury caused by the fall: Graveyard shift, night shift and the B
bed in the double room are the main factors to affect the degree of injury from
a fall.
Conclusions and Suggestions:
This research showed that the fall factors of the elderly in-patients were multi-faceted. The high-risk fall assessment and the collection of the relevant information should be carried out during the clinical caring, and the patients and the families should be involved in the discussion. Earlier implement various fall plans and prevention measures to decrease the occurrence rate of fall and the degree of injury during hospitalization. Construct a safe and friendly hospitalization environment for the old and upgrade the quality of medical care.
Keywords: the elderly in-patient, fall

並列關鍵字

the elderly in-patient ； falls

參考文獻

洪如慧、李佩樺、張育菘、張偉洲 (2005)．住院病患跌倒事件探討分析．福爾摩莎醫務管理雜誌，1(1)，87-96。

Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD: Independent pre-Dictors of all osteoporosis-related fractures in healthy postmenopausal Women: the OFELY study. Bone 2003; 32:78-85.

Atsuko, N., Akihito, H., Kazuo, H., Shigeki, N., & Jiro, O. (2007). Identifying interacting predictors of falling among hospitalized elderly in Japan: A signal detection approach. Geriatrics and Gerontology International, 7(2), 160-166.

Akihito, N. (2006). Incidence and risk factors for inpatient falls in an academic acute-care hospital Journal of Nippon Medical School, 73(5), 265-270

Berdot, S., Bertrand, M., Dartigues, J.-F., Fourrier, A., Tavernier, B., Ritchie, K., et al. (2009). Inappropriate medication use and risk of falls: A prospective study in a large community-dwelling elderly cohort. Bio Med Centra Geriatrics, 9(1), 30-34.