臺灣博碩士論文加值系統

大部分老人跌倒預防研究著重在跌倒危險因子探討，對於跌倒機轉與傷害嚴重度之相關研究並不多。因此，我們以前瞻性世代研究(prospective cohort study)方法對1200位社區老人進行一年(2003/4-2004/3)追蹤研究，收集跌倒的相關資料，並將跌倒老人的傷害嚴重度分為Abbreviated Injury Scale(AIS)≧2、AIS=1及未受傷三個等級，以比例式勝算模式(Proportional Odds Model)分析導致傷害等級較嚴重的危險因子。結果發現在12個月追蹤研究期間，共有128位老人發生跌倒，其中26.0％ AIS≧2、49.6％ AIS＝1及24.4％未受傷。多變項結果顯示女性的傷害較男性嚴重(勝算比為4.08；95%信賴區間1.80-9.21)；宅外跌倒的傷害較宅內嚴重(勝算比為3.05；95%信賴區間1.32-7.04)；上下床(勝算比為7.62；95%信賴區間1.51-38.6)與做家事(勝算比為4.35；95%信賴區間0.95-19.9)的傷害較行走嚴重；前方跌倒(勝算比為4.85；95%信賴區間1.96-12.0)與側面跌倒(勝算比為7.95；95%信賴區間2.72-23.2)的傷害較後方嚴重。結論為本研究發現跌倒方向(前方、側面)、女性、宅外跌倒、上下床及做家事與嚴重跌傷有密切相關，可提供老人如何安全跌倒以及如何保護跌倒時免於傷害的參考。

Background: There were only a few studies analyzed the relation between the fall mechanism and injury severity in elderly. Study objective: A cohort of 1,200 community-indwelling persons aged 65 and older was studied to determine risk factors for increased injury severity of falls. Methods: Fall mechanism and other characteristics were collected by home interview soon after falls were noted. The proportional odds model was used to investigate the 3 levels of fall injuries: non-injuries, Abbreviated Injury Scale (AIS) =1, and AIS≧2, with the multiple potential risk factors. Result: A total of 128 fall events occurred over a 12-month period from April 2003 to March 2004. There were 24.4% non-injuries, 49.6% AIS=1, and 26.0% AIS≧2. The odds ratio (OR) of female to male having a greater level of injury severity was 4.08. Compared with indoor, outdoor (OR=3.05) increased the odds for greater level of injury severity. Forward (OR=4.85) and sideway (OR=7.95) falls had greater level of injury compared with backward. Falls while housekeeping (OR=4.35) and getting into or out of bed (OR=7.62) also increased the odds of greater injury severity compared with walking. Conclusion: Several risk factors such as fall direction (forward or sideways), female, outdoor, housekeeping, and getting into or out of bed increased the severity of fall injuries. These factors may provide the information about safety fall and fall injuries prevention for the elderly

目 錄
致 謝-------------------------------------------Ⅰ
中文摘要-----------------------------------------Ⅱ英文摘要-----------------------------------------Ⅲ
第一章 緒 論
第一節 研究背景----------------------------1
第二節 文獻回顧----------------------------2
第三節 研究目的----------------------------4
第二章 研究方法及步驟
第一節 研究對象----------------------------5
第二節 基線評測----------------------------6
第三節 跌倒之追蹤--------------------------7
第四節 統計分析----------------------------9
第三章 結 果---------------------------------10
第四章 討 論---------------------------------13
第五章 結論與建議-----------------------------20
參考文獻----------------------------------------22
圖一 1992-2001年臺灣65歲以上老人事故死亡率-----------29
圖二 1992-2001年臺灣65歲以上老人跌倒死亡率-----------29
圖三 跌倒時間次數分佈：(a)月份；(b)星期；(c)時刻------30
表一 跌倒老人基線評測特性-----------------------------31
表二 跌倒機轉與傷害型態的分佈-------------------------32
表三 跌倒種類、跌倒方向及最先著地部位之共同分佈-------33
表四 跌倒老人傷害嚴重度與基線評測特性的分佈-----------34
表五 跌倒老人傷害嚴重度與行為情境、環境、跌倒機轉
及傷害型態等因子的分佈---------------------------35
表六 跌倒老人傷害嚴重度為結果變項的多變項
比例式勝算模式分析-------------------------------37

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