老年人跌倒的篩檢與評估

Screening and Evaluation of Elderly Patients Who Fall

魏大森(Ta-Sen Wei)

《台灣老年醫學暨老年學雜誌》 3卷2期 (2008/05) Pp. 91-105

https://doi.org/10.29461/TGG.200805.0003

摘要

老化使老年人之感官系統退化、肌力降低、平衡與步態之功能明顯下降，增加意外跌倒之風險。適當之跌倒風險因子篩檢與評估對其跌倒之預防及介入非常重要，許多研究結果之跌倒風險因子不盡相同，多爲研究設計所致，如研究對象、地域屬性或評估變項之不同。由於住院患者的高異質性，即使最好的評估工具亦無法將多數的跌倒者事先篩檢出來，必須針對特定單位或族群稍作區隔，評估工具才能做最佳之跌倒危險性預測。我們必須注意，過度、廣泛的篩檢可能會有過多的金錢或人力耗費，因此評估或介入的方向應以常見、可修飾或易見成效的跌倒危險因子爲目標，例如詳細評估曾經跌倒之患者、檢討用藥、環境之安全性檢查等會是較實際與有效的作法。
住院患者之跌倒風險篩檢以STRATIFY量表、Morse量表及Hendrich Ⅱ量表爲主；門診或社區除人口學、合併疾病、認知、藥物、環境與鞋具之評估外，若高風險因子或曾經跌倒與平衡、步態能力相關，則需進一步接受客觀之實驗室評估，包括電腦化平衡測試、步態分析、表面肌電圖檢查等，以做爲後續跌倒防制之依據。

關鍵字

篩檢與評估 ； 風險因子 ； 意外跌倒 ； 老年人

並列摘要

Aging in the elderly can result in impaired vision, reduced muscle strength, and poor balance and gait performance, increasing thereby the risk of accidental falls. Adequate screening and evaluation of the risk factors of falls are therefore crucial for the development of further prevention and intervention strategies. Extensive studies have shown that the risk factors of falls are not consistent, which may be due to different study subjects, settings, or tested variables. Great heterogeneity of in-patients makes it difficult to identify highest-risk fallers; even the ”best” or ”most effective” assessment tool needs to be applied to a specific group of subjects to acquire optimal predictivity. General and excessive screening can be expensive and may consume a great deal of manpower. Evaluation should therefore be focused on common, easy-to-fix, and effective-to-modify risk factors, including comprehensive assessment of previous fallers, review of anti-epileptic prescriptions or benzodiazepines, and modification of environmental hazards.
STRATIFY, Morse and Hendrich Ⅱ fall risk assessment tools are commonly used for in-patients. Screening for outpatients and community-dwelling elderly may include demographics, co-morbidity, cognition, medication, environment and footwear. For previous fallers or those at high risk of falls, objective laboratory tests, such as computerized gait and balance and surface electromyography, are required to provide clues for future intervention.

並列關鍵字

screening and evaluation ； risk factor ； accidental falls ； elderly