腦中風急性後期病人居家環境改造後跌倒發生率相關分析

Correlation Analysis of the Incidence of Falls in Patients with Acute Stroke after Home Environment Modification

賴慧貞(Huey-Jen Lai)；蘇希洵(His-Hsun Su)；黃建華(Chien-Hua Huang)

急性後期照護 ； 居家無障礙 ； 跌倒率 ； Postacute care ； Home accessibility ； Fall rate

醫學與健康期刊

10卷2期（2021 / 07 / 01）

73 - 82

繁體中文

目的：過去研究支持透過建議居家環境改造，可有效改變中風病人之行為增進居家安全性。本研究目的在於探討透過居家環境改造是否可有效降低腦中風急性後期照護（post-acute care, PAC）病人出院後跌倒率與傷害率。方法：研究設計採回溯性研究（retrospective），蒐集2017年1月1日到2018年7月31日期間中部某區域教學醫院PAC的出院病人資料，調查分析其返家後一年內跌倒發生率及傷害率。結果：PAC病人為跌倒高風險者（n=62）進行居家改造（n=36），與沒有進行居家改造（n=26）者相比，其返家後跌倒發生率有顯著差異（p=0.040）；PAC病人進行居家改造者（n=36），返家後有無跌倒，兩組間改造之平均扶手長度無顯著差異（p=0.521），平均改造花費金額也無顯著差異（p=0.751）。結論：腦中風急性後期計畫對於中風病人返家後跌倒發生率確實有顯著降低；進行居家環境改造者相較於無改造者其跌倒率也顯著降低；至於改造的扶手長度與花費的總金額對於是否跌倒之間差異不顯著。

Objectives. Injuries caused by falls are the biggest threat to patients with stroke. Studies have indicated that suggesting a change in home environment can effectively change a patient's behavior and improve home safety. The purpose of this study was to explore whether recommendations for home environment improvement can effectively reduce the rates of fall-related injury after discharge from a post-acute care (PAC) program. Methods. This was a retrospective case-control study based on data on patients discharged from a PAC program at a teaching hospital in central Taiwan from January 1, 2017, to July 31, 2018, Data included fall and injury rates. Results. Patients discharged from the PAC program had a high risk of falling (n=62). The incidence of falls differed significantly between those with (n=36) and without home improvements (n=26) (p=0.040). No significant difference was observed in the average handrail length between patients with and without falling after returning home (p=0.521), and there was no significant difference in the average cost of home improvement (p=0.751). Conclusion. The PAC program significantly reduced the incidence of falls among patients with stroke after they had returned home. However, the fall rate among patients who performed home improvement was significantly lower than the rate among patients who did not.

1. Afifi, M,Al-Hussein, M,Bouferguene, A(2015).Geriatric bathroom design to minimize risk of falling for older adults-a systematic review.Eur. Geriatr. Med,6,598-603.
2. Cumming, RG,Thomas, M,Clemson, L(2001).Adherence to Occupational Therapist Recommendations for Home Modifications for Falls Prevention.Am. J. Occup. Ther,55,641-648.
3. Cumming, RG,Thomas, M,Szonyi, G(1999).Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention.J. Am. Geriatr. Soc,47,1397-1402.
4. Dusenberry, DO,Simpson, H,DelloRusso, SJ(2009).Effect of handrail shape on graspability.Appl. Ergon,40,657-669.
5. Keall, MD,Pierse, N,Chapman, PH(2017).Cost-benefit analysis of fall injuries prevented by a programme of home modifications: A cluster randomised controlled trial.Inj. Prev,23,22-26.
6. Keall, MD,Pierse, N,Chapman, PH(2015).Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: A cluster-randomised controlled trial.Lancet,385,231-238.
7. Keysor, JJ,Jette, AM,Coster, W,Bettger, JP,Haley, SM(2006).Association of Environmental Factors With Levels of Home and Community Participation in an Adult Rehabilitation Cohort.Arch. Phys. Med. Rehabil,87,1566-1575.
8. Oliver, D,Daly, F,Martin, FC,McMurdo, M(2004).Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review.Age Ageing,33,122-130.
9. Steffen, TM,Hacker, T,Mollinger, L(2002).Age- and gender related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds.Phys. Ther,82,128-137.
10. Stephen, R,Hylton, B,Menz, CS(2006).Home environment risk factors for falls in older people and the efficacy of home modifications.Age Ageing,35,1155-1159.
11. Struckmeyer, LR,Pickens, ND(2016).Home modifications for people with Alzheimer’s disease: A scoping review.Am. J. Occup. Ther
12. Talbot, LA,Musiol, RJ,Witham, EK,Metter, EJ(2005).Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury.BMC Public Health,5,86.
13. Unwin, BK,Andrews, CM,Andrews, PM,Hanson, JL(2009).Therapeutic home adaptations for older adults with disabilities.Am. Fam. Physician,80
14. William, C,Mann, O,Kenneth, J(1999).Effectiveness of Assistive Technology and Environmental Interventions in Maintaining Independence and Reducing Home Care Costs for the Frail Elderly: A Randomized Controlled Trial.Arch. Fam,8,210-217.
15. Winstein, CJ,Stein, J,Arena, R(2016).Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.Stroke,47
16. 洪一仁, YJ,廖慧伶, HL,李明輝, MH(2013)。藥物與老人跌倒。醫學與健康期刊，2，9-17。
17. 蔡益堅, YJ,孫文榮, WJ(2020)。探討社區老人自宅內與自宅外的跌倒相關因子。臺灣老年醫學暨老年學會雜誌，15，11-26。