南投縣社區老人防跌介入方案成效評估

The effectiveness evaluation of the intervention program for preventing elderly falls in the Nantou County community

陳淑怡(Sue-Yi Chen)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2010年)

摘要

目的：1999年至2005年期間台灣老人跌倒盛行率高達20.5%。跌倒對老人生活品質產生負面影響，且造成失能照護及依賴成本增加。本研究旨在探討社區老人預防跌倒介入方案之成效。
方法：採用為單組前後測之準實驗設計，以立意取樣南投縣65歲以上社區老人為研究對象，進行18週衛教及運動之防跌介入方案。介入前後以問卷評估跌倒預防認知、健康信念、自我效能、身體功能及居家環境風險值的改變情形，以及介入結束後12週內之跌倒發生率。共380人完成介入方案，男性103名，女性277名，平均年齡為76.5歲。所得資料以卡方檢定、成對樣本/獨立樣本t檢定及邏輯斯迴歸進行分析，並比較曾經跌倒及未曾跌倒老人之介入成效。
結果：方案介入前有26.6％的社區老人曾有跌倒經驗，持續監測介入後12週跌倒發生率為2.6％。若排除1位帕金森氏症病患多次跌倒無法改善者及8位騎乘機車事故跌倒者，跌倒發生率則降至0.3％。介入後之跌倒預防認知、健康信念、自我效能（環境抉控、心理抉控及增強抉控）與步態功能皆有效改善（p<0.001）。再者，居家環境風險（照明度、地板、硬體設備與輔具）則明顯減低（p<0.001）。整體而言，性別、運動習慣、預防跌倒認知（環境因素）、預防跌倒自我效能（環境抉控、增強效能、行動效能）、以及居家環境風險值為影響南投縣老人跌倒的危險因子。對曾經跌倒老人而言，居家環境風險值（地板與輔具）是關鍵危險因子（p<0.05），但對未曾跌倒老人之危險因素則為跌倒預防認知（環境因素）（p<0.01）。
結論：本研究顯示介入方案對預防跌倒發生有助益。曾經跌倒之老人除了增加預防跌倒認知外，另需加強居家環境檢視並針對高風險因素進行改善；未曾跌倒之老人則以增強預防跌倒之健康信念進而強化自我效能為主要。部分跌倒預防認知答對率低（憂鬱、多種藥物、鮮艷花色地毯、少出門、走道或角落放置椅子、門檻、低床鋪、軟坐墊）為社區老人需加強部分。本研究建議日後社區老人之跌倒預防介入方案應依據個別老人跌倒史分別進行介入。

關鍵字

社區老人 ； 跌倒 ； 介入研究 ； 成效評估

並列摘要

Objective: The Taiwanese elderly fall prevalence rate reached as high as 20.5% between 1999 and 2005. Falls significantly cause negative impacts to the seniors’ livelihood, the increasing demand of disability care and cost inefficient for the family. This research aims to investigate the effect of the intervention program for preventing elderly falls in the community.
Methods: The experimental method of one-group pretest-posttest quasi- experimental design was performed. Selecting seniors over 65 years old in the Nantou County as the research subjects through purposive sampling whereby executed an eighteen-week intervention program for falls prevention including training on health and exercise. Assess the knowledge of preventing falls, health beliefs, self- efficacy, physical functions, variables of environmental hazards and the incidence of falling down within a period of 12 weeks after the intervention program through comparing the questionnaires which conducted before and after the program. A total number of 380 participants consisted of 103 males and 277 females with an average age of 76.5 years who completed the intervention program. Using the applied chi-square test, paired sample/independent sample T- test, and logistic regression to obtain statistical data and compared the intervention effects on the elderly who have and have not fallen down. Results: 26.6% of the elderly in the community had the experiences of stumbling and the fall rate was 2.6% through a 12 weeks continuous monitoring after the intervention program. However, the rate of falling reduced to 0.3% excluding a Parkinson's disease patient who repeatedly fell and was unable to improve, and 8 fallers caused by motorcycle accidents. There were effective improvements in the knowledge of preventing falls, health beliefs, self- efficacy (environment, psychology, enhance action) and gait function (p<0.001) after the intervention program. Moreover, the environmental hazards (illumination, floor, safety hardware equipment and auxiliary) decreased obviously (p<0.001). As a whole, gender, exercise habit, the knowledge of preventing falls (environmental factor), self- efficacy of preventing falls (environmental factor, enhance efficacy, action efficacy), and the environmental hazards were the risk factors which affected the likelihood of elderly in the Nantou County. The environmental hazards (floor and the safety auxiliary) were the key risk factors (p<0.05) to the elderly who had the experiences of falling down; however, the knowledge of preventing falls (environmental factor) (p<0.01) was critical to the seniors without previous experiences.
Conclusion: This study demonstrates the intervention program is effective to prevent falls. The elderly who had previous experiences of falling down require enhancing the knowledge of preventing falls through reinforcing regular inspections and taking serious action within areas associated in high risk factor. On the other hand, enhancing the health belief of fall prevention and further strengthens the self- efficacy is significant to those without experiences. The lack of knowledge towards preventing falls (depression, medication side-effect, bright colored patterned rug, lack of social interaction, suggesting putting chairs in the pathway and around the corner, door sill, low profile bed, and soft cushion) has been a common symptom for these elderly. Therefore, the need of improvement in such areas should be taken into account. This research suggests the intervention program for preventing elderly falls in the community should categorize individually based on their different histories of stumble.

並列關鍵字

elderly ； falls ； intervention programs ； effectiveness evaluation

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