長期照護機構老人的身體平衡功能與跌倒發生的前瞻性研究

A Prospective Study of Elderly People's Balance Function and Falls in a Long-term Care Facility

10.6540/NTJN.2018.1.002

李鴻春(Hung-Chun Lee)；蔡芳文(Fang-Wen Tsai)；林惠如(Hung-Ru Lin)；劉介宇(Chieh-Yu Liu)；謝佳容(Chia-Jung Hsieh)

長期照護 ； 機構住民 ； 跌倒 ； 危險因素 ； 平衡功能 ； long-term care ； institutional residents ； falls ； risk factors ； balance function

新臺北護理期刊

20卷1期（2018 / 03 / 01）

11 - 25

繁體中文

研究背景：影響機構老人跌倒的危險因素，在過去的跌倒研究中已被明確探究。然而，針對長期照護機構中的住民發生跌倒事件與身體的平衡功能之間的關係，目前研究所知仍然有限。研究目的：本研究旨在探討影響長期照護機構住民的身體平衡功能，跌倒發生事件之危險因素及其之間的關係。研究方法：採前瞻性研究設計，以台北某機構中心老年住民為對象（N=133），採立意取樣原則收集資料。研究工具主要為巴氏量表、Tinetti平衡步態評估表、簡易智能測驗、老人憂鬱量表、康乃爾失智憂鬱量表、精神行為症狀、Hendrich跌倒危險評估量表、跌倒事件等，並以SPSS20.0套裝軟體進行階層性迴歸與邏輯性迴歸分析。研究結果：於階層迴歸分析結果發現「性別」（ß = .80，p ＜ .001）、「平衡功能」（ß = -.10，p ＜ .05）、「認知功能」（ß = -.09，p＜ .001）、「NPI精神行為徵候」（ß = -.09，p ＜ .05）之迴歸係數達顯著，共可解釋跌倒危險因子47%的變異量。另透過一年期的追蹤，共有28人次發生跌倒，再以羅吉斯迴歸分析結果得知，平衡功能中的起立、坐下的動作為跌倒發生的重要危險因素。結論與建議：本研究發現機構住民的性別、健康狀況、疾病因素和機構治療模式皆為跌倒的危險因素。機構住民的身體平衡功能為預測跌倒事件發生的重要變項，此發現可作為未來發展長照機構預防跌倒照護策略之參考。

Background: The risk factors for falls happening to institutionalized elderly have been clearly explored. However, studies of the relation between the elderly residents' balance function and fall events occurring in long-term care facilities are still limited. Objective: This study aimed to explore the balance function of elderly residents in a long-term care facility, the risk factors for the residents' falls, as well as the relation between the balance function and the risk factors for the falls. Methods: This study was based on a prospective research design. Data were collected in a purposive sampling method from a long-term care facility/institution in Taipei. A total of 133 residents participated in this study (N = 133). Instruments for data collection included the Barthel index, Tinetti performance oriented mobility assessment scale, Mini-mental state examination, geriatric depression scale, Comell scale for depression in dementia, neuropsychatric inventory, and Hendrich II fall risk assessment tools and fall events. The data were analyzed with the use of hierarchical regression models and logistic regression models offered in SPSS 20.0 software package. Results: Firstly, the results of hierarchical regression analysis showed that gender (ß = .80, p ＜.001), balance function (ß = .10, p ＜.05), cognitive function (ß = .90, p ＜.001), as well as behavioral and psychological symptoms (ß = .09, p ＜.05) could predict the falls and explain 47% of the variance. Secondly, during one year’s follow-up in this research, 28 fall events happened and the results of logistic regression analysis showed that in terms of balance function, the action of standing up and the action of sitting down were important risk factors for the falls. Conclusion and suggestions: The results of this study revealed that the risk factors for falls happening to the institutional residents included gender, health status, disease factors, and treatment models provided in the facility, and that the residents’ balance function was an important variable to predict the fall events. It is suggested that the findings of this study can be references to the development of fall prevention strategies in long-term care facilities.

1. 林忠尼, J. N.,王靜枝, J. J.(2008)。康乃爾失智者憂鬱量表之中文信效度評量。護理研究，16(3)，202-210。
   連結：
2. 林威秀, W. H.,黎俊彥, J. Y.(2004)。身體姿勢平衡與老年人的跌倒。中華體育，18(1)，68-75。
   連結：
3. 林億雄, Y. H.,賴美嬌, M. C.,張嘉倩, C. C.,陳莉姝, L. S.(2010)。運用簡易智能測驗協助篩檢老年失智症。應用心理研究，48，183-200。
   連結：
4. 曾淑芬, S. F.,王淑慧, S. H.,陳惠芳, H. F.,郭姵伶, P. L.(2011)。機構式長期照護住民之跌倒危險性探討。嘉南學報，37，365-374。
   連結：
5. 曾雅梅, Y.M.,余承萍, C. P.,賴冠郎, K.L.,高森永, S. Y.(2012)。長期照護機構高風險群老人跌倒因素與防跌課程介入成效之探討。台灣衛誌，31(3)，263-276。
   連結：
6. 黃盈達, Y. D.,李皓綸, H. L.,成和正, H. J.(2012)。運動對失智症的預防及對生理與心理的影響。嘉大體育健康休閒期刊，11(1)，272-278。
   連結：
7. 鄭秀瑮, H. L.,蔡仲弘, A. C.(2012)。行動功能指標「日常生活功能」及「工具性日常生活功能」預測台灣老年人跌倒風險之探討。台灣衛誌，31(1)，21-30。
   連結：
8. Cakar, E.,Dincer,U.,Kiralp, M.Z.,Cakar, D.B.,Durmus, O.,Kilac, H.,Alper, C.(2010).Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.European journal of physical and rehabilitation medicine,46(1),59-67.
9. Chan, W. C.,Lam, L. C.,Tam, C. W.,Lui, V. W.,Leung, G. T.,Lee, A. T.,Chan, W. M.(2011).Neuropsychiatric symptoms are associated with increased risks of progression to dementia: A 2-year prospective study of 321 Chinese older persons with mild cognitive impairment.Age Ageing,40(1),30-35.
10. Chen, T. F.,Chiu, M. J.,Tang, L. Y.,Chiu, Y. H.,Chang, S. F.,Su, C. L.,Chen, R. C.(2007).Institution type-dependent high prevalence of dementia in long-term care units.Neuroepidemiology,28(3),142-149.
11. Damián, J.,Pastor, B. R.,Valderrama, G. E.,Pedro, C.(2013).Factors associated with falls among older adults living in institutions.Biological Medicine Central,13(6),1-9.
12. Donna, M. W.,Corrine, D. T.(2004).Evaluating institutionalization by comparing the use of health services before and after admission to a long-term-care facility.Eval Health Prof,27(3),219-236.
13. Elizabeth, J. P.,Carey, H.,Christie, M.,Melanie, R.(2000).Sensitivity of a clinical scale of balance and gait in frail nursing home residents.Disability and Rehabilitation,22(8),372-378.
14. Farrell, M. K.,Rutt, R. A.,Lusardi, M. M.,Williams, A. K.(2011).Are scores on the physical performance test useful in determination of risk of future falls in individuals with dementia?.Journal Geriatr Psychiatric Therapy,34(2),57-63.
15. Folstein, M. F.,Folstein, S. E.,McHugh, P. R.(1975).Minimental state: A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research,12(3),189-198.
16. Fun, J. L.,Liu, C. K.,Mega, M. S.,Wang, S. J.,Cummings, J. L.(2001).Behavioral disorders and caregivers’’ reaction in Taiwanese patients with Alzheimer's disease.International Psychogeriatrics,13(1),121-128.
17. Hall, R. K.,Landerman, L. R.,O'Hare, A. M.,Anderson, R. A.,Colon-Emeric, C. S.(2015).Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study.Geriatr Nursing,36(2),136-141.
18. Hendrich, A. L.,Bender, P. S.,Nyhuis, A.(2003).Validation of the hendrich II fall risk model: A large concurrent case/control study of hospitalized patients.Applied Nursing Research,16(1),9-21.
19. Jacobsen, G.(Ed),Newman, C.(Ed),Kartush, J.(Ed)(1993).Handbook of balance function and testing.St. Louis MO:Mosby Year Book.
20. Jenny, S.,Mathew, K.(2006).A randomized controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia.Contemporary Nurse,21(2),32-40.
21. Mahoney, F. I.,Barthel, D.W.(1965).Functional evaluation: The barthel index.Maryland State Medical Journal,14,61-65.
22. Maki, B. E.,Holliday, P. J.,Tropp, A. K.(1994).A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population.Journal of Gerontology,49,M72-M84.
23. Marcella, K.,Jacqueline, C.,Alfred, K.,Stephen, L.(2011).Falls incidence risk factors and consequences in Chinese older people: A systematic review.Journal American Geriatrics Society,59(3),536-543.
24. Maxwell, S. E.(2000).Sample size and multiple regression analysis.Psychological Methods,5,434-458.
25. Merlo, A.,Zemp, D.,Zanda, E.,Rocchi, S.,Meroni, F.,Tettamanti, M.,Quadri, P.(2012).Postural stability and history of falls in cognitively able older adults: The Canton Ticino study.Gait Posture,36(4),662-666.
26. Morag, E. T.,Marjolein, M. K.,Kim, D.,Stephen, R. L.,Stefanie, M.,Jacqueline, C. T.(2012).Gait impairment and falls in cognitively impaired older adults: An explanatory model of sensorimotor and neuropsychological mediators.Age Ageing,41(5),665-669.
27. Noam, U. E.,Jaswinder, P. S.,Rong, G.,Martin, R. F.,Fisher, M.(2013).Medication for alzheimer's disease and associated fall hazard: A retrospective cohort study from the alzheimer's disease neuroimaging initiative.Drugs Aging,31,125-129.
28. Salva, A.,Roque, M.,Rgano, X.,Inzitari, M.,Andrieu, S.,Schiffrin, E. J.,Vellas, B.(2012).Falls and risk factors for falls in community-dwelling adults with dementia.Alzheimer Disease Assoc Disorder,26(1),74-80.
29. Saraph, D. B.,Yanyan, Z.,Hyon, C.,Douglas, P. K.,Yuqing, Z.(2012).Diuretic initiation and the acute risk of hip fracture.Osteoporos International,24(2),689-695.
30. Sherry, A. G.(2007).The geriatric depression scale: Short form.The American journal of nursing,107(10),60-69.
31. Sylliaas, H.,Selbaek, G.,Bergland, A.(2012).Do behavioral disturbances predict falls among nursing home residents?.Aging Clinical and Experimental Research,24(3),251-256.
32. Teixeira-Leite, H.,Manhães, A. C.(2012).Association between functional alterations of senescence and senility and disorders of gait and balance.Clinics,67(7),719-729.
33. Tinetti, M. E.,Inouye, S, K.,Gill, T, M.,Doucette, J. T.(1995).Shared risk factors for falls incontinence and functional dependence unifying the approach to geriatric syndromes.Journal American Medicine Association,273,1348-1353.
34. Whitney, B.,Audrey, L.,Dara, Z.,Vivian, V.,Geoffrey, A.(2006).A pan-Canadian perspective on institutional long-term care.Health Policy,79(2-3),175-194.
35. Zasadzka, E.,Borowicz, A.M.,Roszak, M.,Pawlaczyk, M.(2015).Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis.Journal of Clinical Interventions in Aging,10,1289-1298.
36. 行政院經濟建設委員會, Taiwan, ROC, Council for economic planning and development(2013).中華民國 2012 年至 2060 年人口推計.
37. 李宗育, Z. Y.,陸鳳屏, F. P.,詹鼎正, D. C.(2014)。老年人跌倒之危險危險因子。內科學誌，25，137-142。
38. 胡名霞, M. H.,林慧芬, H. F.(1994)。成人站立平衡之研究─感覺統合與年齡效應之分析。中華物療誌，19，66-77。
39. 黃惠璣, H.C.,吳森琪, S.C.,蘇秀娟, H. C.(2010)。養護機構住民日常生活活動受限與下肢運動之關連性。台灣老人保健學刊，6(1)，37-47。
40. 黃資雅, Z. Y.,杜明勳, M. S.,陳宏益, H. I.,陳弘哲, H. S.(2015)。老人跌倒之評估與預防。家庭醫學與基層醫療，30(1)，1-7。
41. 楊博仁, P. J.,林惠文, H. W.,楊宜瑱, Y. S.,陳俊傑, C. C.,陳宣志, S. C.,汪正青, C. C.,李孟智, M. C.(2012)。臺灣地區老人跌倒之預測因子探討。臺灣老年醫學暨老年學雜誌，7(1)，41-55。
42. 趙建蕾, C. L.,古巧琴, C. C.,龔建吉, C. C.,許哲瀚, C. H.(2007)。機構式照護之特性與安全研究─以中部為例。長期照護雜誌，11(2)，162-175。
43. 衛生福利部統計處（2015年9月）‧衛生統計資訊網‧取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4176.〔Ministry of Health and Welfare. (September , 2015). Health statistics information network. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4176.〕
44. 黎家銘, C. M.,張皓翔, H. H.,李世代, S. D.,陳晶瑩, C. Y.(2012)。長期照護機構住民的跌倒預防。台灣醫學，16，538-544。
45. 魏大森, T.S.(2008)。老年人跌倒的篩檢與評估。台灣老年醫學暨老年學雜誌，3(2)，91-105。

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2. 戴雪玲,楊佩欣,邱燕甘(2021)。運用多重因子介入策略降低住院病人傷害性跌倒發生率。志為護理-慈濟護理雜誌，20(2)，75-86。
3. 謝伶瑜(2021)。Otago運動對老年長者防跌效益之相關論述。嘉基護理，21(1)，84-94。
4. 楊生娟,唐子涴,林佳慧,林玉閔(2022)。降低老年人直腸超音波與尿流速重複檢查發生率之護理專案。源遠護理，16(增訂刊)，49-59。
5. 鄭繡媖,黃惠滿,連雅棻(2022)。提升身心科病人下肢肌力與平衡能力之改善專案。國立金門大學學報，11(1)，43-56。