住院老年精神疾病患者跌倒之危險因子

Risk Factors for Falling in Psychogeriatric Inpatients

張鈺姍(Yu-San Chang) ； 蔡東杰(Tung-Chieh Tsai) ； 陳明招(Ming-Chao Chen) ； 陳泰瑞(Tai-Jui Chen)

《台灣精神醫學》 19卷3期 (2005/09) Pp. 216-224

https://doi.org/10.29478/TJP.200509.0006

摘要

目的：探討老年精神病房內老年精神病人跌倒之相關因素，以便作為預防之參考。方法：本研究為一回溯性之研究，收集自民國88年7月至民國93年6月，由老年精神病房出院且大於60歲之患者共587位。分析個案基本資料、出院時診斷（包括DSM-Ⅳ之第一、三軸診斷）、住院日、有無行動不便、與跌倒有關之情形與診察結果以及住院期間所服用之藥物。在有、無跌倒患者之間的差異，再以逐步邏輯迴歸分析的統計方法進行確認影響跌倒之危險因素。結果：跌倒比率為21.0%，以發生在大、小夜班(34.1%、35.0%)、病床旁(37.4%)與姿勢改變時(43.1%)居多，診察結果以頭臉部、下肢(36.6%、34.1%)著地佔多數，大部份無身體受損(64.2%)，其次為於病房內密切觀察(22.0%)，但有17位(13.8%)需轉介至綜合醫院進一步評估。多重邏輯迴歸分析顯示，與跌倒有關之因素有：高齡、住院日較長、行動不便、服用mood stabilizers，hypnotics，L-dopar，dopamine agonists，cardiac medications與medications for constipation等藥物。結論：大於60歲之老年精神病患者，跌倒之危險因素有：高齡、住院日較長、行動不便、服用mood stabilizers，hypnotics，L-dopar，dopamine agonists，cardiac medications與medications for constipation等藥物，應進一步以前瞻性研究來探討預測跌倒之危險因素。

關鍵字

跌倒 ； 老年精神病患

並列摘要

Objective: To identify risk factors associated with falls in a psychogeriatric inpatient population. Methods: Five hundred and eighty seven patients, aged 60 and over, who were discharged from a psychogeriatric inpatient unit between July 1999 and June 2004 were included in this retrospective study. Socio-demographic variables, psychiatric diagnoses at discharge (based on DSM-Ⅳ axis I and Ⅲ), length of stay, assisted walking, circumstances of falling, types of injuries and medications received during hospitalization were compared between those who fell and those who did not fall. Logistic regression analysis was applied to identify possible risk factors for falling. Results: Over the study period, 21.0% of the patients experienced at least one fall. Falls were more likely to occur during the evening and night shift (35.0%, 34.1%), to occur at a bedside location (37.4%) and to be associated with postural change (43.1%). The most common anatomical sites for injury were the head/face (36.6%) and lower extremities (34.1%). Most falls (64.2%) did not result in injury, however, 22.0% of the falls required medical attention in the unit and an additional 13.8% required an evaluation in a general hospital emergency room. The logistic regression model revealed that the significant risk factors for falling were elderly, longer hospital stay, mobility impairment, and treatment with mood stabilizers, hypnotics, L-dopar, dopamine agonists, cardiac medications and medications for constipation. Conclusion: This study found that significant risk factors for falling in psychogeriatric patients were elderly, longer hospital stay, mobility impairment, and treatment with mood stabilizers, hypnotics, L-dopar, dopamine agonists, cardiac medications and medications for constipation The role of these risk factors in predicting falls needs to be investigated using a prospective design.

並列關鍵字

falls ； psychogeriatrics

參考文獻

Alzenberg D,Sigler M,Weizman A,Barak Y(2002).Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study.Internat Psychogeriatr.14,307-310.

American Psychiatric Association(1994).Diagnostic and statistical Manual of Mental Disorders.Washington DC:American Psychiatric Press.

Caele Al,Kohn R(2001).Risk factors for falling in a psychogeriatric unit.Int J Geriatr Psychiatry.16,762-767.

Caley LM,Pinchoff DM(1994).A comparison study of patients falls in a psychiatric setting.Hosp Comm Psychiatry.45,823-825.

Cambell AJ,Spears GF,Borrie MJ(1990).Examination by logistic regression modeling of the variables which increase the relative risk of elderly women falling compared to elderly men.J Clin Epidemiol.43,115-120.