跌倒對台灣鄉村社區老人日常生活活動能力衰退與害怕跌倒心理的影響

Effect of Falls on ADL Independence and Fear of Falling among Elderly Fallers in a Rural Community

蔡素蘭(Su-Lan Tsai) ； 林茂榮(Mau-Roung Lin)

《物理治療》 27卷4期 (2002/08) Pp. 155-164

摘要

目的：以一年的追蹤性研究探討台中縣新社鄉54位老人跌倒後日常生活活動能力衰退以及害怕跌倒的影響因素，期經由了解鄉村社區老人跌倒後身心的立即影響，儘早篩選須介入的跌倒老人，給予正確且即時的幫助。方法：跌倒的追蹤是由老人或其同住親友以明信片通知以及研究者每兩個月一次的電話訪談，當知道老人跌倒後，約於一星期內造訪老人家中收集跌倒相關資料。本研究以邏輯迴歸模式估計測量變項與跌倒後日常生活活動能力衰退及害怕的相關，並以概括估計法(generalized estimating equations)調整同一位老人有多次重複跌倒的非獨立性。結果：多變項分析結果顯示年齡（與65~69歲老人比較，75歲以上老人發生日常生活活動能力衰退的勝算比＝1.49，95%信賴區間為1.22~1.82；80歲以上者的勝算比＝1.55，95%信賴區間為1.16~2.06）、前一年曾發生跌倒（勝算比＝1.26，95%信賴區間為1.06~1.49）、跌倒後躺臥地面超過10分鐘以上（勝算比＝1.42，95%信賴區間為1.18~1.72）、以及跌倒有受傷（與未受傷老人比較，受輕傷的勝算比＝1.19，95%信賴區間為1.00~1.42；受重傷者勝算比＝1.80，95%信賴區間為1.37~2.38）與跌倒後日常生活活動能力衰退有顯著正相關；最初日常生活活動有四項以上無法獨立執行則為負相關（勝算比＝0.79，95%信賴區間為0.40~0.83）。另外，年齡75歲以上（勝算比＝1.38，95%信賴區間為1.16~1.65）、最初日常生活活動有四項以上無法獨立執行（勝算比＝1.96，95%信賴區間為1.61~2.40）、跌倒前有腿無力症狀（勝算比＝1.50，95%信賴區間為1.25~1.81）、前一年曾發生跌倒（勝算比＝1.27，95%信賴區間為1.05~1.53）、以及跌倒後日常生活活動能力衰退（勝算比＝1.27，95%信賴區間為1.05~1.53）與走路害怕跌倒有顯著正相關。結論：應避免或降低老人跌倒後之日常生活活動能力衰退與害怕跌倒心理，以減少日後社會醫療成本負擔。

關鍵字

日常生活活動能力 ； 走路害怕跌倒 ； 老人 ； 跌倒

並列摘要

Purposes: This study was to determine factors associated with activity limitation and fear of falling among 54 community-dwelling elderly fallers, involved in 78 falling events during an 1-year period in Shin-Sher Township of Taichung County, Taiwan. Methods: In addition to baseline demographic information, fall history and basic activities of daily living (ADL) were procured through personal interviews at subjects' residence, characteristics on human and environment factors at the time of falling, medical cares due to a fall, ADL independence, and fear of falling were also collected soon after a fall. The logistic regression model accounted for multiple falls within an elder using generalized estimating equations (GEE) was applied to investigate the relationships between potential factors and ADL decline and fear of falling. Results: Over 50% of these fallers reported a decline of ADL independence. Furthermore, the multivariate analysis result showed that age (comparing to fallers aged 65-69 years, those aged 75 to 79 had an odds ratio (OR(subscript 75-79)) of 1.49 and OR(subscript 80+) was 1.55), fall history (OR=1.26), time duration of lying on the ground due to a fall for more than 10 minutes (OR=1.42), and injury severity (compared with non-injuries, ORmild injury=1.19 and ORsevere injury=1.80) were significantly associated with ADL declines. Moreover, older fallers (OR(subscript 75-79)=1.38), more ADL dependence at baseline (OR=1.96), fall history (OR=1.27), weakness of the legs (OR=1.50), and ADL declines (OR=1.27) were significantly associated with fear of falling. Conclusions: Health programs are needed to prevent or reduce a decline of ADL independence and an increase of the fear of falling among the elderly soon after a fall occurs.

並列關鍵字

Fall ； Activity of daily living ； Fear of falling ； Older people