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老年人的跌倒與骨折預防

Prevention of Falls and Fracture in the Elderly

摘要


老年人發生跌倒次數和傷害嚴重度隨年紀而相對增高,常會引起頭部外傷甚至死亡,其他如骨折(腕部、脊椎、肩部和髖部等),扭傷及挫傷等,許多人在跌倒後活動力變差,失去自立自主能力,甚至需要住院,或住在護理之家以度晚年,可見跌倒是威脅老年人生命及健康的元凶。研究證實,由於跌倒後引起骨折的老年人,日後發生各種骨折的危險性都會增高,尤其是在骨折後5-10年之間。臺灣研究也顯示,65歲以上老年人在1年內發生跌倒者佔1/3,且年紀越大,跌倒的危險性越高。 引發跌倒的因素分爲環境因素和個人因素。環境因素如有障礙物的地面、不平的地面、光滑積水路面、光線昏暗場所等;個人因素則包括運動功能變差、跌倒時保護反應變慢、罹患影響行動功能的疾病,如視力障礙、失智症、服用藥物、中風或帕金森氏病(症)等,都會增加跌倒機會,對此皆應審慎評估,適當改善,以期預防跌倒。此外,骨質脆弱,跌倒及撞擊力大小,乃是決定骨折的重要因素,平日除保健骨骼和體能外,更應小心防範跌倒,才可減少跌倒造成骨折的危險性。 基本上,要預防跌倒的發生,應執行周詳計畫以減少危險因子方可奏效,包括注意個人疾病保健、指導用藥、矯正知覺障礙、改變生活行爲、營養、從事復健治療、指導正確使用輔具/護具、運動課程、平衡訓練、改善居家及公共環境、增設防護設施等,其次,評估與治療骨質疏鬆症也很重要,如補充足量鈣和維生素D,使用藥物治療或髖部保護墊,能夠如此,才可有效避免意外傷害和骨折。因此乃撰寫本文,介紹老年人跌倒的相關研究,包括跌倒盛行率、臨床意義、危險因子評估、跌倒防範等。

關鍵字

跌倒 骨質疏鬆症 骨折 危險因子

並列摘要


The frequency and severity of falls in the elderly rise with the increased age. Among the complications after falls, head injury and death rank as the most serious outcomes. Others include fractures (wrist, spine, shoulder and hip, etc.), sprain, contusions and other minor but mobility-impairing problems. Patients may lose their independent mobility to handle daily life activities, need hospitalization, and even spend the rest of their lives at nursing homes. Fall is therefore cited as a leading cause impairing both the health and life of the elderly. According to previous studies, elderly patient suffering fractures after falls are at a great risk of experiencing fractures again, especially during the 5 to 10 years after the first incidence. Moreover, in Taiwan, of all the elderly people aged over 65 years who sustain falls, nearly one third are found to experience falls again within one year, and the incidence of falls increases with older age. The causes of falls can be grouped into environmental factors and personal factors. The environmental factors include the untidy or uneven ground, slippery or wet surfaces, poorly lit room, stairs, toilets, etc. The personal factors cover the impaired motion ability, slow protection response during falls, disorders influencing the mobility, such as visual impairment, dementia, medications, stroke, and Parkinson's disease. All these conditions will increase the risks of falls, and careful evaluation and effective improvement are needed to prevent accidental falls. In addition, fragility of bone, fall and force are three main factors determining the occurrence of fractures. Thus we need to take care of the bone and health as well as to prevent falls before we can reduce the risk of fractures in the elderly. To reduce risk factors of falls and fracture, a comprehensive program needs to be implemented. Major components of the program include: personal health care and disease self-management, medications instructions, correction of the cognitive impairment, change of lifestyle, nutrition support, rehabilitative program, correct use of orthoses and brace, exercise program, balance training, changes in the environments to reduce the risks of falls, improve indoors and outdoors safety. Additionally, evaluation and improvement of osteoporosis, such as supplement of vitamin D and calcium, medications, and hip protectors, also play an important role to effectively reduce the accidental injuries and fracture of falls. In this study, we review and discuss related researches on the falls in the elderly, including prevalence of falls, clinical significance, risk factors analysis, and prevention of falls.

並列關鍵字

fall osteoporosis fracture risk factors

被引用紀錄


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巫秉儒(2013)。就在宅老化需求探討居住空間之建築改造-以鄉村地區住宅標準建築圖樣為例〔碩士論文,長榮大學〕。華藝線上圖書館。https://doi.org/10.6833%2fCJCU.2013.00118
林孟臻(2013)。「2010臺北國際花卉博覽會」活動期間疾病與外傷之流行病學〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2013.00145
蕭伃伶(2011)。社區長者跌倒預防知識、信念及行為之研究—以健康信念模式為基礎〔博士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2011.00093
李佳燕、林秋琴、郭堉圻(2019)。五禽戲運動對健康的效益臺灣體育學術研究(67),81-92。https://doi.org/10.6590%2fTJSSR.201912_(67).05

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