預防社區老人跌倒介入研究之前驅研究：城鄉之比較

邱寶萱

指導教授 ： 鄭惠美

國立臺灣師範大學/教育學院/衛生教育學系/碩士(2002年)

摘要

近年來，由於社會快速的高齡化，老人健康問題日益突顯，尤其老年人跌倒後所發生的後遺症，更是國內外老人學研究中很受矚目的焦點，但目前國內甚少對於此議題作介入方面之研究，故本研究欲探討國外行之有年的預防跌倒介入策略是否能適用於國內老人，研究內容針對台北地區城市25位老人與鄉村16位老人進行一週之教育課程及五週之運動課程，並於介入前後測量其自變項「社會人口學特徵變項」、中介變項「運動行為社會支持體系、預防跌倒知識、預防跌倒健康信念、預防跌倒自我效能、預防跌倒運動」以及依變項「預防跌倒行為、身體功能」，以瞭解本研究之介入效果，並可做為日後研究之參考，其結果可歸納如下：

一、研究對象之居住地不同、教育程度不同、過去一年是否曾跌倒、過去一年是否因跌倒而受傷，對其「預防跌倒知識」有顯著影響；研究對象之視物清楚度不同，對其「預防跌倒運動」有顯著影響。
二、研究對象之使用手杖與否，將顯著影響其「預防跌倒行為」；年齡不同、使用手杖與否，將顯著影響其「身體功能」。
三、對城市組與鄉村組之老人而言，教育介入對其「預防跌倒知識」皆有顯著效果，對城市組老人「預防跌倒健康信念」有顯著效果。
四、鄉村組老人於介入後其「身體功能」有顯著效果，但城市組則無。
五、針對中介變項對依變項之預測力分析，結果顯示：「預防跌倒自我效能」能顯著影響「預防跌倒行為」；而五個中介變項皆不是影響「身體功能」的重要因素。

雖然台灣城鄉老人由於教育程度的差異而導致預防跌倒知識之介入效果受到影響，但兩組仍有顯著進步。研究推論：除了台灣城市老人之預防跌倒健康信念有顯著介入效果之外，大體上城鄉老人之其他變項介入效果類似，也就是說台灣城市與鄉村之老人兩組之預防跌倒有相似的效果。

關鍵字

預防 ； 跌倒 ； 社區 ； 老人 ； 介入

並列摘要

Since the greatly increase of the population of the elders recently, the importance of the elderly health is getting more evident. The elderly falls and the subsequent sequelae have been the main subject of the gerontics for years in the world. However, the intervention event has not been widely studied in Taiwan. The lack of the intervention for the elderly falls in Taiwan motivates us to propose this study. The intervention has been applied to a sample of 41 elders in Taipei county, 25 urban elders and 16 rural elders, with 1 week class study and 5 weeks exercise in order to quantitatively study the effects of one independent variable (social demographic factors), five mediator variables (social support system of the exercise behavior, knowledge of the fall prevention, health belief of the fall prevention, self-efficacy of the fall prevention, and exercise of the fall prevention), and two dependent variables (behavior of the fall prevention and physical function) . This intervention is a precursor of the fall prevention for elders and coordinates the future study on this field. The questionnaire measurements are performed before and after the intervention. The mains results are summarized as follows.

1. According to the differences of the habitation, education level, experience of the falls in the past one year, and possibility of the injury due to falls, the influence of the knowledge of the fall prevention turns out to be significant. The eye-sight of the subjects strongly influences the exercise of the fall prevention.
2. The usage of the walking assistant strongly influences the behavior of the fall prevention. The age and the usage of the walking assistant are important factors for the physical function; the effect is significant.
3. The effect of the intervention to the knowledge of the fall prevention is significant to the urban and rural subjects. The health belief of the fall prevention is greatly improved only in the urban subjects.
4. The intervention of the physical function has been significantly improved in the rural subjects; no trend has been found in urban subjects.
5. The effect of the intervention to the outcome measures (two dependent variables) is quantified according to the mediator variables. This study infers that (a) the self-efficacy of the fall prevention strongly influences the behavior of the fall prevention and (b) five mediator variables are not important factors to affect the physical function.

Though the intervention to the knowledge of the fall prevention has been disturbed by the difference of the education level between urban and rural elders, the improvement of the fall prevention for urban and rural elders has been significant. An important result of our research on the intervention to the fall prevention is that the fall prevention is influenced only by the health belief. In short, independent variables other than the health belief have similar intervention effects between the urban and rural elders in Taiwan.

並列關鍵字

prevention ； falls ； community ； elder ； intervention

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