台灣中部某鄉村社區老人跌倒之危險因子

Risk Factors for Elderly Falls in a Rural Community of Central Taiwan

10.6288/TJPH2002-21-01-08

林茂榮(Mau-Roung Lin)；蔡素蘭(Su-Lan Tsai)；陳淑雅(Shu-Ya Chen)；曾信嘉(Shinn-Jia Tzeng)

追蹤研究 ； 計時起走測試 ； 老人 ； 跌倒 ； 鄉村 ； elderly ； fall ； prospective study ； rural ； timed Up & Go test.

台灣公共衛生雜誌

21卷1期（2002 / 02 / 01）

73 - 82

繁體中文

目標：以一年的追蹤式研究探討台中縣新社鄉368位六十五歲以上老人跌倒的年發生率及其危險因子。 方法：基線資料收集包括(1)面對面訪視：人口學、健康行為、前一年跌倒經驗、基本及工具性日常生活活動能力、憂鬱程度、健康相關生活品質、視、聽力、認知能力以及慢性疾病數等，以及(2)當場計時起測試(timed Up & Go)。跌倒發生的追蹤由老人或其同住親友以明信片通知研究者以及研究者每兩個月一次的電訪；另外，我們並驗證研究期間老人自述跌倒發生的信、效度。多變項分析以PWP(Prentice, Williams, Peterson)比例危險模式檢驗測量變項與跌倒發生的相關性。 結果：一年內有54位老人共發生78次跌倒，年發生率為226次/1000人年。多變項分析結果顯示前一年曾發生跌倒(危險比為1.76，95%信賴區間＝1.08～2.88)、執行工具性日常生活活動需人協助項數(危險比為1.22，95%信賴區間＝1.08～1.39)、以及起走測試秒數較多(以≦10秒為參照組，11至20秒的危險比＝1.99，95%信賴區間＝1.00～3.97，≧21秒的危險比＝3.01，95%信賴區間＝1.22～7.41)與發生跌倒有顯著相關。另外，75%老人所自述的跌倒能被其親友正確指認；老人自述就診的跌倒中，有69.6%在病歷查閱後獲得證實。 結論：前一年是否曾發生跌倒、工具性日常生活活動能力、以及計時起走測試等簡易的指標可用來篩選鄉村社區易發生跌倒的老人。

Objectives: A one-yea~ prospective study was conducted to determine the incidence rate and risk factors for falls among 368 rural elderly people aged 65 years or older in Shin-Sher Township, Taichung County, Taiwan. Methods: Information on demographics, health-related behaviors, previous fall history, activities of daily living (ADL), health-related quality of life, vision, hearing, cognitive function, and number of chronic diseases was collected through personal interviews at each subject’s home. Furthermore, timed Up & Go test was examined in the field. The elderly were asked to send a postcard to inform researchers when a fall occurred, and researchers also called them every two months to ascertain whether they experienced a fall in the past two months. We validated the” self-reported falls using their next of kin and medical records. The PWP (Prentice, Williams, Peterson) proportional hazards model was employed to investigate the relationship between the potential risk factors and falls. Results: The incidence rate of falls among the rural elderly was 226 per 1000 person years. Furthermore, previous fall history. (relative hazard (RH)= 1.76, 95% confidence interval (CI)= 1.08 to 2.88), impaired number of instrumental activity of daily living (IADL)(RH= 1.22, 95% CI=1.08 to 1.39), and longer duration of timed UP & Go (compared with the elderly with ≦10 second, RH 11-20= 1.99, 95% CI= 1.00 to 3.97; RH≧21=3.01, 95% CI= 1.22 to7.41) were positively associated with the risk of falls. Seventy-five percent of the self-reported falls were identified by their next of kin , and 69.6% of those who reported to seek medical care due to a fall were corroborated by medical records. Conclusions: A high-risk group of falling among rural elderly people can be identified using a set of simple measures such as Fall history, IADL, and timed Up & Go.

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