行動功能指標 ADL及 IADL預測台灣老年人跌倒風險之探討

Predicting the Risk of Fall with ADL and IADL in Older Taiwanese

鄭秀瑮(CHENG HSIU LI)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2011年)

摘要

背景：跌倒是老人重要健康議題，而行動功能的衰退與跌倒的發生有高度的關聯，但探討 ADL 和 IADL 與跌倒關聯的追蹤研究不多。 目的：本研究之目的在探討台灣地區老年人 ADL與 IADL與跌倒的關聯及預測跌倒的功能，並分析 ADL 與 IADL 障礙程度對四年之後跌倒風險的影響。 方法：本研究資料來源為國民健康局的「台灣地區中老年身心社會生活健康狀況長期追蹤調查研究」。以2003 及 2007年兩次皆完訪並排除資料不完整者共2980人為研究對象。在控制人口學、社經、生活方式與健康狀況等變項下，以邏輯迴歸分析 2007年 ADL及 IADL與跌倒的關聯。 結果：迴歸分析結果顯示在控制上述變項狀況下，ADL 與 IADL 與跌倒的關聯性為 ADL「重度障礙(≥13分)」發生跌倒的可能性為「沒障礙(0 分)」的0.38 倍(p=0.001)；IADL「輕度障礙(1-6 分)」發生跌倒的可能性為「沒障礙(0 分)」的1.43 倍(p=0.002)，「中度障礙(7-12分)」發生跌倒的可能性為「沒障礙(0分)」的1.98 倍(p<0.001)， 「重度障礙(≥13分)」發生跌倒的可能性為「沒障礙(0 分)」的2.01 倍(p=0.006)。縱貫分析個案 2003 年 ADL 與 IADL預測 2007年跌倒的能力顯示，ADL「輕度障礙(1-6分)」發生跌倒的可能性為「沒障礙(0分)」的1.82 倍(p=0.008)， 「重度障礙(≥13分)」發生跌倒的可能性為「沒障礙(0分)」的 0.36 倍(p=0.04)；與 IADL則無顯著關聯。 結論：本研究顯示ADL及 IADL除與跌倒呈顯著關聯外並具有預測老年人跌倒風險的功能。IADL用於預測現況的風險比未來的風險有效。此結果凸顯維持老人 ADL 及 IADL 功能的重要性。定期評估與及時介入，將可有效降低老年人跌倒的風險。

關鍵字

日常生活功能 ； 工具性日常生活功能 ； 跌倒 ； 老年人

並列摘要

Background: Fall is an important health issue for senior citizens and there is a high association between fall and functional ability. However, there are few longitudinal studies to delineate the nature of the association.
Purpose: The objective of this study was to determine the association between functional ability as indicated by ADL (Activities of Daily Living) and IADL
(Instrumental Activities of Daily Living) and the risk of fall in older Taiwanese.
Method: Data for this analysis were the 2003 and 2007 datasets of “The Survey of Health and Living Status of the Elderly in Taiwan”. Subjects were 2980 subjects who completed both surveys. Logistic regression analysis was employed to determine the
cross-sectional association between ADL and IADL status with the risk of fall in 2003 and 2007 and the ability of 2003 ADL and IADL status to predict the risk fall in 2007 controlled for demographic, lifestyle and health-related variables. SPSS 12.0 was used
for all analyses.
Results: Results showed that in a cross-sectional model that controlled for demographic, lifestyle and health-related variables, IADL is the major factor associated with the current risk of fall and ADL is associated with the risk of fall only
when IADL is not included in the model. Compared to those without IADL impairment, the risk was 1.43, 1.98 and 2.01 times for those who had mild, moderate and severe IADL impairment, whereas mild or moderate ADL impairment was not associated with the risk of fall and severe ADL impairment was associated with a 62% reduction in the risk of fall. Results also showed that IADL impairment was not an
effective predictor of fall four years later. Only mild ADL impairment significantly predicted the risk of fall in four years whereas moderate or severe impairment predicted reduced risk of fall in four years.
Conclusion: Results suggest that any level of IADL impairment and mild ADL impairment predict current or near term risk of fall. However, IADL impairment is not an effective predictor of future risk of fall four years later. Moderate and severe ADL
impairment, on the other hand, is associated with reduced current risk of fall probably because these persons have lost mobility. These results highlight the importance of maintaining functional ability of the elderly. IADL should be the tool of choice for
monitoring the risk of fall of the elderly. These findings should be useful to the public health policy makers in designing effective fall prevention programs.

並列關鍵字

ADL (Activities of Daily Living) ； IADL (Instrumental Activities of Daily Living) ； Risk of fall ； Elderly

參考文獻

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