單次跌倒與反覆跌倒之盛行率與相關因素探討－以都會區老人為例

Prevalence and Associated Factors of a Single Fall and Recurrent Falls in an Urban Elderly Population

10.6288/TJPH2008-27-04-07

張念慈(Nien-Tzu Chang)；楊南屏(Nan-Ping Yang)；李建賢(Chen-Hsen Lee)；周碧瑟(Pesus Chou)

單次跌倒 ； 反覆跌倒 ； 老人 ； a single fall ； recurrent falls ； the elderly

台灣公共衛生雜誌

27卷4期（2008 / 08 / 01）

330 - 340

繁體中文

目標：探討台灣都會區的老人單次跌倒與反覆跌倒之盛行率及其相關因素。方法：本研究是以社區為基礎的調查研究法，以1999-2002年設籍並居住在台北市北投區年滿65歲以上的老人為研究樣本，總共4,056人完成跌倒事件調查及問卷訪查。再透過單變項分析及多變項邏輯斯迴歸分析，以嘗試建立跌倒預測模式。結果：都會區老人一年內曾經跌倒的比例為13.8%；單次跌倒的盛行率是10.0%，反覆跌倒是3.8%。女性不論是單次跌倒或反覆跌倒的盛行率都顯著高於男性。多變項邏輯斯迴歸分析顯示單次跌倒的主要相關因子為性別、關節炎、精神疾患和視力障礙等病史。多變項分析顯示反覆跌倒顯著相關的因子包括：性別、糖尿病、心臟病、關節炎、精神疾患等病史。結論：本研究發現女性、關節炎病史、精神疾患病史是台灣都會區老人單次跌倒和反覆跌倒的共同相關因素。視力障礙與單次跌倒有關，而糖尿病和心臟病等慢性病況則與反覆跌倒有關。

Objectives: The aim of this study was to investigate the prevalence and associated factors of a single fall and recurrent falls among the elderly in an urban community in Taiwan. Methods: A community-based, cross-sectional study involving interviews with residents aged 65 years and over was conducted in Beitou, Taipei, Taiwan, between 1999 and 2002. A total of 4,056 subjects completed a structured questionnaire that included items on falling episodes and possible associated factors. Chi-square tests and multiple logistic regression models were used to examine the relationship between falls and possible related factors. Results: Among the elderly urban residents who participated in this study, 13.8% had experienced falls in the preceding year; the prevalence of a single fall and recurrent falls were 10.0% and 3.8%, respectively. Females were found to be much more susceptible to falls than males (p＜0.001). Multiple logistic regression showed that female gender, history of arthritis, psychiatric disorder, and visual impairment were the major factors associated with a single fall, while female gender, history of diabetes, cardiovascular disease, arthritis, and psychiatric disorder were the major factors associated with recurrent falls. Conclusions: Falls were prevalent among elderly residents of the urban community studied. Females and several medical conditions were found to be associated with falls in this population, with arthritis and psychiatric disorder being related to both a single fall and recurrent falls.

1. Huang TT(2005).Home environmental hazards among community-dwelling elderly persons in Taiwan.J Nurs Res,13,49-57.
   連結：
2. 林茂榮、王夷暐(2004)。社區老人跌倒的危險因子與預防。台灣衛誌，23，259-271。
   連結：
3. 林茂榮、蔡素蘭、陳淑雅、曾信嘉(2002)。台灣中部某鄉村社區老人跌倒之危險因子。台灣衛誌，21，73-82。
   連結：
4. 黃少君、陳曾基、周碧瑟(2005)。石牌地區老年人跌倒累積發生率及其相關因素之探討。台灣衛誌，24，136-145。
   連結：
5. American Geriatrics Society(2001).Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention.J Am Geriatr Soc,49,664-672.
6. Bath PA,Morgan K(1999).Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK.Eur J Epidemiol,15,65-73.
7. Bergland A,Wyller TB(2004).Risk factors for serious fall related injury in elderly women living at home.Inj Prev,10,308-313.
8. Blake AJ,Morgan K,Bendall MJ(1988).Falls by elderly people at home: prevalence and associated factors.Age Ageing,17,365-372.
9. Centers for Disease Control and Prevention(2003).Public health and aging: nonfatal injuries among older adults treated in hospital emergency departments-United States, 2001.MMWR Morb Mortal Wkly Rep,52,1019-1022.
10. Centers for Disease Control and Prevention(2008).Self-reported falls and fall-related injuries among persons aged > or =65 years-United States.MMWR Morb Mortal Wkly Rep,57,225-229.
11. Chan KM,Pang WS,Ee CH,Ding YY,Choo P(1997).Epidemiology of falls among the elderly community dwellers in Singapore.Singapore Med J,38,427-431.
12. Chu LW,Chi I,Chiu AY(2005).Incidence and predictors of falls in the chinese elderly.Ann Acad Med Singapore,34,60-72.
13. Chu LW,Chiu AY,Chi I(2007).Falls and subsequent health service utilization in community-dwelling Chinese older adults.Arch Gerontol Geriatr,46,125-135.
14. Cumming RG,Miller JP,Kelsey JL(1991).Medications and multiple falls in elderly people: the St Louis OASIS study.Age Ageing,20,455-461.
15. Cummings SR,Nevitt MC,Kidd S(1998).Forgetting falls. The limited accuracy of recall of falls in the elderly.J Am Geriatr Soc,36,613-616.
16. Health and vital statistics
17. Donald IP,Bulpitt CJ(1999).The prognosis of falls in elderly people living at home.Age Ageing,28,121-125.
18. Dunn JE,Rudberg MA,Furner SE,Cassel CK(1992).Mortality, disability, and falls in older persons: the role of underlying disease and disability.Am J Public Health,82,395-400.
19. Faulkner KA,Cauley JA,Zmuda JM(2005).Ethnic differences in the frequency and circumstances of falling in older community-dwelling women.J Am Geriatr Soc,53,1774-1779.
20. Fletcher PC,Hirdes JP(2002).Risk factors for falling among community-based seniors using home care services.J Gerontol A Biol Sci Med Sci,57,504-510.
21. Fried LP,Ferrucci L,Darer J,Williamson JD,Anderson G(2004).Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.J Gerontol A Biol Sci Med Sci,59,255-263.
22. Ganz DA,Bao Y,Shekelle PG,Rubenstein LZ(2007).Will my patient fall.JAMA,297,77-86.
23. Gerdhem P,Ringsberg KA,Akesson K,Obrant KJ(2005).Clinical history and biologic age predicted falls better than objective functional tests.J Clin Epidemiol,58,226-232.
24. Gill T,Taylor AW,Pengelly A(2005).A population-based survey of factors relating to the prevalence of falls in older people.Gerontology,51,340-345.
25. Gillespie LD,Gillespie WJ,Robertson MC,Lamb SE,Cumming RG,Rowe BH(2008).Interventions for preventing falls in elderly people.Cochrane Database Syst Rev,1,15.
26. Graafmans WC,Ooms ME,Hofstee HM,Bezemer PD,Bouter LM,Lips P(1993).Falls in the elderly: a prospective study of risk factors and risk profiles.Am J Epidemiol,143,1129-1136.
27. Hanlon JT,Landerman LR,Fillenbaum GG,Studenski S(2002).Falls in African American and white communitydwelling elderly residents.J Gerontol A Biol Sci Med Sci,57,473-478.
28. Ho SC,Woo J,Chan SS,Yuen YK,Sham A(1996).Risk factors for falls in the Chinese elderly population.J Gerontol A Biol Sci Med Sci,51,195-198.
29. ICD-9-CM(2005).International Classification of Diseases and Health-related Problems, 9th Revision; Clinical Modification, Color Coded.Los Angeles, CA:Practice Management Information Corporation.
30. Kannus P,Sievanen H,Palvanen M,Jarvinen T,Parkkari J(2005).Prevention of falls and consequent injuries in elderly people.Lancet,366,1885-1893.
31. Klein BE,Moss SE,Klein R,Lee KE,Cruickshanks KJ(2003).Associations of visual function with physical outcomes and limitations 5 years later in an older population: the Beaver Dam eye study.Ophthalmology,110,644-650.
32. Lee JS,Kwok T,Leung PC,Woo J(2006).Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study.Age Ageing,35,246-251.
33. Leung KK(1992).Report No: NSC 81-0412-B002-633.Taipei:The National Science Council.
34. Liu WL(1997).Report No: NSC86-2314-B030-002.Taipei:The National Science Council.
35. Lord SR(2006).Visual risk factors for falls in older people.Age Ageing,35(2),42-45.
36. Lord SR,Ward JA,Williams P,Anstey KJ(1994).Physiological factors associated with falls in older communitydwelling women.J Am Geriatr Soc,42,1110-1117.
37. Luukinen H,Koski K,Kivela SL,Laippala P(1996).Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly.Public Health,110,115-118.
38. Morris M,Osborne D,Hill K(2004).Predisposing factors for occasional and multiple falls in older Australians who live at home.Aust J Physiother,50,153-159.
39. National Institute for Clinical Excellence(2004).Falls: the Assessment and Prevention of Falls in Older People.London:National Institute for Health and Clinical Excellence.
40. Nevitt MC,Cummings SR,Kidd S,Black D(1989).Risk factors for recurrent nonsyncopal falls. A prospective study.JAMA,261,2663-2668.
41. Nickens H(1985).Intrinsic factors in falling among the elderly.Arch Intern Med,145,1089-1093.
42. Niino N,Yasumura S,Haga H,Ueno H,Oshima M,Higuchi Y(1995).Falls among the elderly living in a rural community--prevalence and circumstances of falls by season.Nippon Koshu Eisei Zasshi,42,975-981.
43. Nnodim JO,Alexander NB(2005).Assessing falls in older adults: a comprehensive fall evaluation to reduce fall risk in older adults.Geriatrics,60,24-28.
44. Norris SL,High K,Gill TM(2008).Health care for older Americans with multiple chronic conditions: a research agenda.J Am Geriatr Soc,56,149-159.
45. Northridge ME,Nevitt MC,Kelsey JL(1996).Non-syncopal falls in the elderly in relation to home environments.Osteoporos Int,6,249-255.
46. Northridge ME,Nevitt MC,Kelsey JL,Link B(1995).Home hazards and falls in the elderly: the role of health and functional status.Am J Public Health,85,509-515.
47. O`Loughlin JL,Robitaille Y,Boivin JF,Suissa S(1993).Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly.Am J Epidemiol,137,342-354.
48. Oliver D,Hopper A,Seed P(2000).Do hospital fall prevention programs work? A systematic review.J Am Geriatr Soc,48,1679-1689.
49. Ooi WL,Hossain M,Lipsitz LA(2000).The association between orthostatic hypotension and recurrent falls in nursing home residents.Am J Med,108,106-111.
50. Oswald AE,Pye SR,O`Neill TW(2006).Prevalence and associated factors for falls in women with established inflammatory polyarthritis.J Rheumatol,33,690-694.
51. Pluijm SM,Smit JH,Tromp EA(2006).A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.Osteoporos Int,17,417-425.
52. Russell MA,Hill KD,Blackberry I,Day LL,Dharmage SC(2006).Falls risk and functional decline in older fallers discharged directly from emergency departments.J Gerontol A Biol Sci Med Sci,61,1090-1095.
53. Stalenhoef PA,Diederiks JP,de Witte LP,Schiricke KH,Crebolder HF(1999).Impact of gait problems and falls on functioning in independent living persons of 55 years and over: a community survey.Patient Educ Couns,36,23-31.
54. Stalenhoef PA,Diederiks JP,Knottnerus JA,Kester AD,Crebolder HF(2002).A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study.J Clin Epidemiol,55,1088-1094.
55. Stel VS,Smit JH,Pluijm SM,Lips P(2004).Consequences of falling in older men and women and risk factors for health service use and functional decline.Age Ageing,33,58-65.
56. Stevens JA,Olson S(2000).Reducing falls and resulting hip fractures among older women.MMWR Recomm Rep,49,3-12.
57. Tinetti ME,Baker DI,McAvay G(1994).A multifactorial intervention to reduce the risk of falling among elderly people living in the community.N Engl J Med,331,821-827.
58. Tinetti ME,Richman D,Powell L(1990).Falls efficacy as a measure of fear of falling.J Gerontol,45,239-243.
59. Tinetti ME,Speechley M,Ginter SF(1988).Risk factors for falls among elderly persons living in the community.N Engl J Med,319,1701-1707.
60. Tinetti ME,Williams CS(1997).Falls, injuries due to falls, and the risk of admission to a nursing home.N Engl J Med,337,1279-1284.
61. Tinetti ME,Williams CS(1998).The effect of falls and fall injuries on functioning in community-dwelling older persons.J Gerontol A Biol Sci Med Sci,53,112-119.
62. Tromp AM,Pluijm SM,Smit JH,Deeg DJ,Bouter LM,Lips P(2001).Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly.J Clin Epidemiol,54,837-844.
63. Ueno M,Kawai S,Mino T,Kamoshita H(2006).Systematic review of fall-related factors among the house-dwelling elderly in Japan.Nippon Ronen Igakkai Zasshi,43,92-101.
64. Yasumura S,Haga H,Nagai H,Suzuki T,Amano H,Shibata H(1994).Rate of falls and the correlates among elderly people living in an urban community in Japan.Age Ageing,23,323-327.
65. Yiannakoulias N,Rowe BH,Svenson LW,Schopflocher DP,Kelly K,Voaklander DC(2003).Zones of prevention: the geography of fall injuries in the elderly.Soc Sci Med,57,2065-2073.
66. Zijlstra GA,van Haastregt JC,van Eijk JT,van Rossum E,Stalenhoef PA,Kempen GI(2007).Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of communityliving older people.Age Ageing,36,304-309.
67. 邱淑媞、曹昭懿、王榮德(1993)。1974-90年間台灣地區老年人口意外災害死亡率及潛在生命損失之分析。中華衛誌，12，405-419。
68. 徐慧娟、吳淑瓊、江東亮(1996)。跌倒對社區老人健康生活品質的影響。中華衛誌，15，525-532。

1. 陳全裕、張嘉凌、張軒睿、張秦松、張尹凡、邱郁婷、林怡貝、吳至行(2012)。臺灣南部某一社區男性老人跌倒盛行率及相關因子之研究。臺灣家庭醫學雜誌，22(1)，1-10。