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  • 學位論文

台灣地區老年人跌倒之預測因子

Predictors of Fall among The Elderly in Taiwan

指導教授 : 李孟智

摘要


研究目的: 跌倒所造成傷害,會危害到老年人健康及生活品質。預防老人跌倒已成為公共衛生及長期照護之重要議題。本篇研究之目的,在於找出臺灣老年族群跌倒的危險因子。 研究方法及資料: 本研究使用國民健康局「臺灣中老年人身心社會狀況長期追蹤調查」以1999年70歲以上2,310位老人為研究對象,經四年追蹤至2003年,扣除掉死亡、失聯及資料不全者,有效樣本為1,645人。跌倒的認定,以2003一年內發生跌倒或摔倒之事件為依據,採老人自己主觀認定與通報。 研究設計採長期追蹤研究,選定以1999年老人之年齡、性別、教育程度、婚姻狀態、高血壓、糖尿病、心血管疾病、腦中風、肺部疾病、關節炎、白內障、脊椎骨骨刺、疼痛史、過去一年住院、過去一年急診、抽菸習慣、喝酒習慣、服用安眠藥、鎮靜藥、運動習慣、補充綜合維他命或礦物質、補充鈣片、視覺障礙、聽覺障礙、大便或小便失禁、跌倒史、自覺健康不佳、一年內體重減輕3公斤、憂鬱、認知功能障礙、身體活動受限、日常生活障礙、工具性日常生活障礙、行動不方便、使用行動輔具等自變項作為危險因子,並以2003年老人發生跌倒事件為依變項。 先以卡方檢定進行單變項分析;再將有顯著差異的變項,依據(1)人口學變項、(2)慢性疾病及醫療利用、(3)健康行為及藥物、(4)身體功能損傷、(5)營養健康及心理社會狀態、(6)活動及行動力等六大類變項,建立起六種模式,依序進入階層邏輯斯迴歸分析,並計算其勝算比(Odds Ratio;OR)與95%信賴區間(95%confidence interval;95%CI)。 研究結果: 在2003年中,共有395位老人發生跌倒,盛行率為24%,其中有201人(12.2%)發生多次跌倒。透過階層邏輯斯迴歸分析發現,六種模式的整體適配度良好。跌倒史(OR=1.69, 95% CI=1.27-2.24),大小便失禁(OR=1.62, 95% CI=1.17-2.35),糖尿病史(OR==1.38, 95% CI=1.00-1.91) 及女性(OR= 1.36, 95% CI=1.04-1.77),顯著增加跌倒的風險。 結論與建議: 跌倒史、大小便失禁、糖尿病史及女性,為預測台灣老人跌倒的獨立危險因子。針對跌倒的高危險族群,需要周全的評估及防治計劃,以期能降低老人跌倒的發生。

關鍵字

跌倒 老人 危險因子 長期追蹤研究 臺灣

並列摘要


Objectives: Fall constitutes a significant hazard to the health and well-being of seniors. Preventing falls in the elderly is an important public health issue. The purpose of this research is to identify the risk factors for falls among the elderly population in Taiwan. Materials and Methods: Data were drawn from the population-based Longitudinal “Survey of Health and Living Status of the Elderly in Taiwan” Study. A total of 2310 seniors , aged 70 years and older were interviewed in 1999 and followed over a four year period in 2003.The final sample consisted of 1,645 participants, excluding death and incomplete data. This study was designed as a longitudinal study. A fall was defined as any episode of falling by self-report within 2003. Independent variables including age, gender, education level, marriage, hypertension, diabetes, cardiovascular disease, lung disease, stroke, arthritis, cataract, osteophyte, pain, admission to hospital, visiting the emergency room , smoking, alcohol drinking, exercise, taking sedatives or hypnotics, calcium or vitamin supplement, visual or hearing impairment, incontinence, prior fall, self-perceived health status, body weight lost, depression, cognitive impairment, physical activity, ADL, IADL, mobility, mobility aids were collected at baseline in 1999 as risk factors. The occurrence of fall in 2003 was dependent variable. The associations of predictor variables with fall were examined on univariate analyses by chi-square test first. Secondly, significant variables in the univariate models were then entered into six stratum logistic regression models established by six categories of independent variables including: (1) demographic variables,(2) chronic diseases and use of medical resources,(3)life style factors and medication,(4) physical impairments, (5)nutrition, health and psycho-social status,(6)Activity and mobility. The odds ratio and 95% confidence interval of risk factors were estimated. Results: A total of 395 participants had the episode of fall during 2003.The prevalence rate of falls at the 4-year follow-up point was 24% ,including 201 participants (12.2%) reported two falls or more. Through the six models of stratum logistic regression analysis, the goodness of fit seemed adequate enough. In the logistic regression analysis adjusted for age, sex, education and other covariates, risk factors of falls existed among persons with prior fall history (OR=1.69, 95% CI=1.27-2.24), incontinence (OR=1.62, 95% CI=1.17-2.35), diabetes history (OR==1.38, 95% CI=1.00-1.91) and females (OR= 1.36, 95% CI=1.04-1.77). Conclusion and Suggestion: The study concludes that prior fall history, incontinence, diabetes history and female are independent risk factors for falls. Those who are at high risk of falls should require more detailed assessment and active management to reduce the occurrence of fall.

並列關鍵字

Fall Elderly Risk Factors Longitudinal Study Taiwan

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