防跌方案導入跨專業團隊合作模式以降低安養機構長者跌倒風險成效分析

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

10.6224/JN.202410_71(5).10

林書存(Shu-Tsun LIN)；張淑芳(Shu-Fang CHANG)

安養機構 ； 長者 ； 跌倒 ； 跨專業團隊 ； 防跌方案 ； long-term care ； elderly ； falls ； interdisciplinary team ； fall prevention programs

護理雜誌

71卷5期（2024 / 10 / 01）

79 - 88

繁體中文;英文

背景：隨著人口老齡化，老年人跌倒問題成為公共衛生具挑戰的議題。北部某安養機構近三年跌倒密度有上升趨勢，主因包括年齡增長、生理衰老、慢性疾病、多重用藥、骨質疏鬆和缺乏運動等因素，使高風險跌倒住民佔12.6%。目的：本專案旨在透過防跌方案，設立主要目標為跌倒發生率降低至18%，而次要目標為防跌認知、行為和自我效能及下肢肌力、平衡和步態平均後測較前測提升10%。解決方案：從2023年9月30日至2024年2月29日，導入跨專業團隊合作模式，實施為期六週的健康促進活動和防跌運動課程，並為參與者提供個別化運動處方。結果：納入20位平均年齡88歲長者，90%有慢性病（18人），25%使用超過九種藥物（5人），70%骨量減少（14人），40%（8人）為高危險跌倒群，一年內跌倒發生率高達30%。介入後跌倒發生率降至5%，而防跌認知、行為和自我效能正確率提升18.3%，下肢肌力、平衡和步態正常值提升11.7%，防跌認知、行為改變、自我效能、與下肢肌力、平衡及步態之後測皆比前測佳，且達統計顯著差異。結論：專案結果證明跨專業團隊的防跌方案能有效提升長者體能、預防並降低跌倒風險，為安養機構提供了實施跌倒預防策略的寶貴參考。

Background: Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. Purpose: A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. Resolution: From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. Result: The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. Conclusion: The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.