社區老人跌倒相關因素模式之研究

A Model of Fall Correlates in Community-Dwelling Older Adults

洪麗玲(Li-Ling Hung)

指導教授 ： 郭鐘隆

國立臺灣師範大學/教育學院/衛生教育學系/博士(2011年)

摘要

高齡化社會的來臨，跌倒是影響社區老年人健康及失能之重要因素，因此，老人跌倒是公共衛生重要議題。本研究係以社區為基礎的橫斷性調查研究，主要目的係應用PRECEDE模式為架構，探討社區老人跌倒現況及建構與驗證社區老人的跌倒模式。
方法：研究對象採立意取樣，以台灣地區各縣市參與保命防跌計畫班的65歲以上老年人為主，自2008年3月至6月收集資料，總共來自42個社區，計904名社區老人為研究樣本。應用PRECEDE模式，配合結構式問卷及身體功能檢測，進行社會人口學變項、跌倒預防知識、信念、行為效能、環境支持、身體功能及跌倒相關資訊等資料收集。主要統計分析方法包括統合分析、邏輯斯廻歸分析及結構方程模式分析，建立及驗證社區老人跌倒相關因素模式。
結果：主要研究結果分為四部份：第一部份，社區老年人過去一年跌倒發生率為16.92%。第二部份統合分析(社區來源)結果顯示，增強因素中「慢性病」及「輔助器使用」與過去一年跌倒發生率間的成效值介於微弱和中等效果之間。第三部份邏輯斯迴歸分析結果顯示素質因素之「跌倒預防知識」；使能因素之「行為效能」、「支持性環境」、「反應時間」、「二十尺行走距離時間」及增強因素之「獨居」、「輔助器使用」及「慢性病」等為社區老人跌倒重要預測因子；判別分析整體預測分類的百分比為82.9%。第四部份，本研究模式經修正後與資料的適合度良好，參數估計結果與關係的方向性皆與理論相符合。潛在變項「增強因素」對潛在依變項「跌倒狀況」的解釋力最大，且其徑路係數達顯著水準；其次為「素質因素」；最後則為「使能因素」。
結論：社區老人跌倒是多重因素結構，本研究嘗試以PRECEDE模式之架構及結構方程模式分析，測試社區老人跌倒相關因素模式的研究，模式經修正後與資料的適合度良好，「增強因素」是社區老人最重要結構因素，研究結果可應用在老人跌倒預防計畫及政策擬定之依據。

關鍵字：社區老人、PRECEDE模式、跌倒模式、環境支持、跌倒預防行為效能

關鍵字

社區老人 ； PRECEDE模式 ； 跌倒模式 ； 環境支持 ； 跌倒預防行為效能

並列摘要

With the advent of an aging society, falls are the most common and serious public health issue for older adults. Along with significant health and disability impacts, Moreover, falls are leading cause of injury-related death among the elderly. The aims of this study were to investigate the incidences of falling and test a model that explains the relationships between the correlates of falling among the community-dwelling elderly within the framework of the PRECEDE model, through a community- base and by using a cross-sectional survey.
Method: Purposive samples of older adults were living in 42 communities in Taiwan were selected to participate in the fall prevention program, A total of 904 subjects aged 65 years and above. Based upon PRECEDE model and used structured questionnaires, including personal profiles and scales to obtain data on the knowledge, health beliefs, self-efficacy of fall prevention, environmental support, and physical function. Meta-analysis, logistic regression, and structural equation modeling analysis were performed as the main statistical methods.
Results: The main findings were divided into four sections: First, 16.92% of the subjects had suffered from falls in the past year. Second, the meta-analysis (Community sources) showed that “chronic disease” and “use of assistive devices” were the major relevant factors among the reinforcing factors are significantly related to incidences of falls in the preceding year; the effect sizes r value was between small and medium. Third, logistic regression identified the following significant predictors of falls were: “knowledge of fall prevention” among the predisposing factor; “self-efficacy of fall prevention,” “supportive environment,” “reaction time,” “20-meters walking test, ” among the enabling factors; and “living alone,” “use of assistive devices, ” and “chronic disease” among the reinforcing factors. Discriminant analysis showed that classified the percentage of the overall prediction was 82.9%. Fourth, after model modefication, the results indicated a good model fit, and parameter estimates and the direction of the relationship were consistent with the theory. The significant path coefficients with “reinforcing factor,” followed by “prediposing factor,” and finally “enabling factor.”
Conclusion: The above model had a multifactor structure. This study is base upon PRECEDE model framework and uses structural equation modeling to explain the fall model. The results indicated a good model fit . Thus, future programs and policies can apply this model to prevent falls.
Keywords: community-dwelling older adult, PRECEDE model, fall model, environmental support, self-efficacy of fall prevention

並列關鍵字

community-dwelling older adult ； PRECEDE model ； fall model ； environmental support ； self-efficacy of fall prevention

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