臺灣中部原住民族長者文化合適性延緩失能方案介入之成效：以跌倒防治為例

世界衛生組織於2002年，為因應世界人口的老化現狀，而提出活躍老化（Active Ageing），主張以健康、參與及安全等三大面向提升高齡者的生活品質。許多文獻指出老人跌倒的發生率高、而死亡率也同步攀升，而65歲以上原住民族十大死因的第八位即為事故傷害，其中意外墜落（跌倒）為事故傷害中的第二名。國內現行的預防及延緩失能的課程與方案，其中的肌力強化運動即為應因老人跌倒問題可透過採取有效的預防跌倒介入措施，藉而加以達成跌倒防治。目前臺灣所使用的預防及延緩失能的課程與方案兩百餘種，但卻未能依族群文化與原住民族部落自主性，設計不同文化合適性之預防及延緩失能課程。因此，本研究的目的為探討中部地區原住民長者於運用文化合適性延緩失能方案介入後，其相關跌倒防治之成效。本研究採取介入性研究，研究對象為臺灣中部地區年齡大於55歲以上的原住民族長者共60人，採立意取樣以文化健康站為取樣地點，分三階段進行，第一階段：資料蒐集、相關量表內容文化合適性之討論與分析，並邀請諮詢部落耆老、部落意見領袖及原鄉健康照顧專家等修訂量表，做為前後測進行評估成效；第二階段：設計文化合適性延緩失能方案「跌倒防治-肌力訓練教案」；第三階段：進行12週文化合適性之延緩失能方案「肌力訓練」之介入，並同時進行量表前後測。以SPSS 24.0統計軟體進行資料建檔及統計分析。結果發現：(一)文化合適性肌力訓練介入前後影響各項跌倒評估指標的差異，結果發現BMI與ADL (p=.009)、IALD (p=.000)、BSR (p=.029)、認知態度 (p=.026)、Tinetti平衡 (p=.037)等皆有顯著差異；過去病史與ADL(p=.003)、認知態度(p=.019)、Tinetti步態(p=.009)、 Tinetti平衡(p=.004)有顯著差異。(二)經過12週文化照顧方案-肌力課程介入後，結果發現BMI (t=0.203,p=0.351)、ADL (t=-0.778,p=0.438)、IADL (t=-0.711,p=0.478)、Tinetti步態 (t=-2.264,p=0.26)、認知態度 (t=-3.663,p=<.000)等皆有統計學上之意義。(三)文化照顧方案介入前、後各變項發現，BMI與BSR (r=-.273,p=.024)、ADL(r=-.327,p=.002)、IADL (r= .348,p=.001)、Tinetti平衡 (r= .312,p=.005)有顯著的相關性；而BSR與ADL(r=-.528,p=.000)、IADL(r=-.517,p=.000)、認知態度(r=-.328,p=.002)、Tinetti步態(r=-.434,p=.000)、Tinetti平衡(r=-.539,p=.000)有顯著的相關性；ADL與IADL(r=-.664,p=.000)、認知態度(r=.359,p=.000)、Tinetti步態(r=.520,p=.000) Tinetti平衡(r=.582,p=.000)；IADL與認知態度(r=.418,p=.000)、Tinetti步態(r=.614,p=.000)、Tinetti平衡(r=.528,p=.000)有顯著的相關性；認知態度與Tinetti步態 (r=.327,p=.001)、Tinetti平衡(r=.300,p=.002)有顯著的相關性；而Tinetti平衡與Tinetti步態有顯著的相關性(r=.717,p=.000)。(四)文化照顧方案介入後，IADL能顯著預測跌倒的發生。研究結論為執行12週文化合適性介入性肌力訓練方案後，能有效降低臺灣中部地區原住民族長者的跌倒的風險性與；期待以此結果能供臨床實務與政策做為參考依據，並能為其他原住民族長者量身訂做最為適切的文化照顧模式，強化原住民族長期照顧服務資源。

關鍵字

原住民族長者；長期照顧；跨文化照顧；延緩失能方案；跌倒風險

並列摘要

In 2002, the World Health Organization (WHO) proposed “Active Ageing” in response to the world's aged population. Some literature points out that the fall incidence among the elders remains high, and the death rate is rising simultaneously. Accident injuries ranked the eighth among the top ten causes of death for tribal people over 65 years old, and accidental falls are the second among accident injuries. Among the current courses and programs for preventing and delaying disability in Taiwan, the muscle strengthening exercise is to prevent falls by taking effective measures to prevent elders’ falls. At present, there are more than 200 kinds of courses and programs for preventing and delaying disability in Taiwan. However, it is impossible to design different culturally appropriate prevention and delay courses according to ethnic culture and the autonomy of aboriginal tribes. Therefore, the study investigates the effectiveness of fall prevention for indigenous elders in the central part of Taiwan after the intervention of the culturally appropriate delaying disability program. The research objects were 60 tribal elders over 55 years old. The first stage: data collection, discussion and analysis of the cultural suitability of the content of the relevant scales, and invitation to consult tribal elders, tribal opinion leaders, and hometown health care experts to revise the scales as a pre- and post-test to evaluate the effectiveness. The second stage: designing a culturally appropriate anti-disability program "Fall Prevention - Muscle Strength Training Lesson Plan". The third stage: 12-week intervention of the Cultural Suitability Delayed Disability Program "strength training", and pre- and post-test were processed. Then, the SPSS 24.0 statistical software was used for data filing and statistical analysis. The results showed that: (1) The differences in the fall assessment indicators before and after the intervention of culturally appropriate muscle strength training showed that BMI was closely related to ADL (p=.009), IALD (p=.000), BSR (p=.029), cognitive attitude (p=.026), and Tinetti balance (p=.037) were all significantly different Past medical history was significantly different from ADL (p=.003), cognitive attitude (p=.019), Tinetti gait (p=.009), and Tinetti balance (p=.004). (2) After 12 weeks of cultural care program-muscle strength course intervention, it was found that BMI (t=0.203, p=0.351), ADL (t=-0.778, p=0.438), IADL (t=-0.711, p= 0.478), Tinetti gait (t=-2.264, p=0.26), and cognitive attitude (t=-3.663, p<.000) were all statistically significant. (3) For the variables, before and after the intervention, we found that BMI and BSR (r=-.273, p.024), ADL (r=-.327, p.002), IADL (r=.348, p=.001), Tinetti balance (r = .312, p.005) had a significant correlation, while BSR was associated with ADL (r=-.528, p=.000), IADL (r=-.517, p=.000), cognitive attitude (r=-.328, p=.002), Tinetti gait (r=-.434, p=.000), Tinetti balance (r=-.539, p=.000) had a significant correlation. ADL and IADL (r=-.664, p=.000), cognitive attitude (r=.359, p=.000), Tinetti gait (r=.520, p=.000) Tinetti balance (r=.582, p=.000) and IADL was significantly correlated with cognitive attitude (r=.418, p=.000), Tinetti gait (r=.614, p.000), and Tinetti balance (r=.528, p=.000). Cognitive attitude was significantly correlated with Tinetti gait (r=.327, p.001) and Tinetti balance (r=.300, p=.002); while Tinetti balance was significantly correlated with Tinetti gait (r= .717, p=.000). (4) After the intervention of the cultural care program, IADL can significantly predict the occurrence of falls. The conclusion indicates that the implementation of a 12-week culturally appropriate interventional muscle strength training program can effectively reduce the risk of falls among tribal elders in the central part of Taiwan. It is hoped that this result can be used as a reference for clinical practice and policies, and can tailor the most appropriate cultural care model for other tribal elders, and strengthen the long-term care service resources for indigenous people.