血液透析老人之平衡能力與害怕跌倒相關性

背景：台灣地區末期腎臟疾病發生率及盛行率居世界之冠，血液透析人口數增加且年齡呈老化之趨勢。老人因長期接受透析治療，容易出現肌肉無力、疲憊及眩暈、步態不穩定的症狀，其身體功能比一般老人較差，跌倒的風險勢必會增加。因此，預防透析老人發生跌倒是件刻不容緩的事情。故本研究目的旨在探討血液透析老人之平衡能力與害怕跌倒相關性。方法：本研究採橫斷式前瞻性設計，以中部兩家區域性醫院血液透析室，規律接受血液透析三個月以上的65歲（含）以上老人為收案對象，共計111名。評估血液透析老人害怕跌倒之工具使用老人害怕跌倒量表(Geriatric fear of falling measure)，評估平衡能力之工具則使用伯格氏身體平衡量表(Berg balance scale)。所有的統計分析採用SPSS for Windows 19.0統計套裝軟體進行資料分析。結果：血液透析老人害怕跌倒與平衡能力呈負相關(P < 0.001)，但與年齡、過去一年發生跌倒的次數呈正相關(P < 0.01)。在過去一年發生跌倒1次(P= 0.004)或≧2次(P = 0.002)者比較無發生跌倒者有較高的害怕跌倒程度。多變量迴歸分析顯示年齡、過去一年發生跌倒次數、平衡能力為害怕跌倒的影響因子，解釋變異量為50.2%。結論：本研究證實血液透析老人的平衡能力與害怕跌倒有很強的負相關，年齡與跌倒經驗之增加，使老人害怕跌倒的心理更鞏固。改善血液透析老人的營養狀況是穩定平衡能力的基礎，以及預防老人跌倒措施，使其害怕跌倒程度的風險減少。

關鍵字

血液透析老人；平衡能力；害怕跌倒

並列摘要

Background: In Taiwan the incidence and prevalence of end-stage renal disease (ESRD) are the highest ones in the world. The number of hemodialysis patients is increasing, and the sick age is tending to be older. The symptoms of this disease in the elderly due to long-term hemodialysis include muscle weakness, fatigue, dizziness, and gait instability. The body functions in dialysis elderly are worse than that in normal ones. The risk of falling must be increasing. Therefore, preventing fall for the elderly in dialysis is an urgent matter. Thus, the purpose of this study was to explore the relationships between balance and fall of falling in dialysis elderly. Methods: A cross-sectional and prospective research is designed. In the two hemodialysis centers of two regional hospitals in central Taiwan the elders above 65 years old receiving regular hemodialysis more than 3 months are recruited. There are a total of 110 participants. Fear of falling was assessed using the Geriatric fear of falling measure (GFFM). Balance was assessed by the Berg Balance Scale (BBS). All data were analyzed by SPSS 19.0 for Windows statistical software. Results: There was a signiﬁcant negative correlation between GFFM and BBS scores (P < 0.001), and a positive correlation between GFFM and age, the fall number in the last year (P < 0.01). Compared with subjects with no fall experiences in the last year, there were signiﬁcantly higher GFFM scores in participants either who experienced fall once (P= 0.004) or twice and more times (P= 0.002). The multi-varient regression showed that age, fall number in the last year, and BBS were the influencing factors of GFFM with the variance of 50.2%. Conclusion: The results of the present study revealed a signiﬁcant strong negative relationship between fear of falling and balance ability in hemodialysis elders. The older age and more falling experience, the more the hemodialysis elders fear of falling. Stable balance ability of hemodialysis elders is based on improvement of their nutrition status, and taking appropriate measures to prevent falling, thus to decrease the risk of fear of falling of hemodialysis elders.