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研究生:張念慈
研究生(外文):Nien-Tzu Chang
論文名稱:社區老人跌倒之流行病學研究
論文名稱(外文):EPIDEMIOLOGICAL STUDY OF FALLS AMONG THE COMMUNITY ELDERLY IN TAIWAN
指導教授:周碧瑟周碧瑟引用關係楊南屏楊南屏引用關係
指導教授(外文):Pesus ChouNan-Ping Yang
學位類別:博士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:183
中文關鍵詞:單次跌倒反覆跌倒跌傷害怕跌倒
外文關鍵詞:a single fallrecurrent fallsfalling injuryfear of falling
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台灣地區自民國83年邁入老人國之列後,目前65歲以上老年人口已超過10.4%,且老年人口比例仍在持續快速的上升,老人跌倒及跌倒相關的後遺症和傷害人數逐年增加,成為公共衛生領域重要的議題。而因跌倒所伴隨而來的恐懼、活動限制對老人晚年的生活品質亦將有顯著的影響。就公共衛生及社區調查的角度而言,以健康相關的生活品質(SF-36)做為流行病學分析工具,可以多面向的評估跌倒對老人的健康衝擊。本研究採用社區為基礎的調查研究法來探討都會區老人單次跌倒與反覆跌倒之盛行情況與相關因子,老人跌倒性傷害的危險因子,以及跌倒對老人健康相關生活品質的影響。研究目的包括:(1) 探討台北巿北投區老人單次跌倒與反覆跌倒之盛行率及其相關因素;(2) 都會區老人跌倒事件中跌倒性傷害之發生率及其醫療資源利用情形;(3) 探討都會區老人的跌倒和害怕跌倒對健康相關生活品質的衝擊。
方法:本研究是一社區為基礎的觀察性流行病學研究,以1999-2002年設籍並居住在台北市北投區年滿65歲以上的老人有7,151符合收案條件,其中同意接受面對面家庭訪視的社區老人總共有4,056位,為本研究樣本,配合結構式問卷進行人口學變項、個人生活習慣、慢性疾病史、跌倒性傷害特徵、醫療資源利用及健康相關生活品質等資料收集。統計分析方法包括單變項分析及邏輯斯多變項廻歸分析,以建立反覆跌倒和跌倒性傷害的預測模式。
主要研究結果分為三部份:第一,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。多元邏輯斯迴歸分析結果顯示: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則包括:性別、糖尿病、心臟病、關節炎、精神疾患等病史。
第二部分針對跌倒老人的研究發現,有半數以上的老人跌倒時受到輕微的跌傷,而有27.6%的老人跌倒後發生中度至重度跌傷。跌傷的嚴重度與發生地點及時間均無統計上的顯著差異,但是不同的跌傷嚴重度其危險因子和預後則有所不同。多元邏輯斯迴歸分析結果顯示:女性、視力障礙和姿位性低血壓是跌倒性傷害的危險因子;在控制性別因素下,有視力問題的老人受到輕度跌傷的勝算比是沒有視力問題者的2.65倍;有姿位性低血壓問題者得中重度跌傷的勝算比更高達4.03倍。中重度跌傷的老人,其醫療資源利用率和住院率均顯著高於輕度跌傷者,其害怕跌倒的比率也較高,但健康相關生活品質則未有統計上的顯著差異。
第三部分進一步估算在控制跌倒和相關因素的影響下,老人害怕跌倒與健康相關生活品質之相關分析。結果發現,女性害怕跌倒的比率顯著高於男性(62.6% vs. 46.2%);而害怕跌倒及反覆跌倒的老人在八面向健康相關生活品質均顯著低於沒有跌倒的老人。即使在控制其他相關因素之下,害怕跌倒不論在生理層面和心理層面的健康相關生活品質均是顯著相關因子,而跌倒事件主要對生理層面的健康相關生活品質才有顯著的效果。
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。姿位性低血壓是中重度跌傷的危險因子,而害怕跌倒則與老人身心層面的生活品質均有顯著的相關性,在老年醫學領域中應加以重視。
The old age proportion of Taiwanese population is increasing rapidly. Since 1994 the proportion of the Taiwanese elderly aged 65 years or older has exceeded 7%, and approximately 10.4% now. Among them, falls causing injuries and the consequences of those injuries are of increasing concern to public health practitioners. Previous studies reported that falls and fall-related factors are strongly associated with impaired activities of daily living among older people, and their quality of life may be affected. Health-related quality of life (SF-36 questionnaire) is a particularly epidemiological investigation tool to assess the health impact for the elderly. This study was of a community-based design to explore the impacts of falls, falling injuries, fear of falling and demographics factors on health-related quality of life. The main purposes were: (1) to investigate the prevalence and associated factors of a single fall and recurrent falls among the elderly in an urban community in Taipei, Taiwan. (2) to determine the incidence, characteristics, and risk factors for falling injuries among the community-dwelling elderly in Shihpai, Taipei, Taiwan; and the impacts on quality of life and health service utilization were also comprehensively investigated. (3) to investigate the prevalence, characteristics and consequences for fear of falling after the occurrence of falls and the relationship between fear of falling and health-related quality of life (HRQOL) were also be examined.
This study was of a community-based cross-sectional design based on interviews with residents aged 65 years and over in Beitou, Taipei, Taiwan, between 1999 and 2002. A total of 4,056 subjects completed a structured questionnaire including on falling episodes and possible associated factors. Chi-square tests and multiple logistic regression models were performed as the main statistical methods.
The thesis was comprised of three papers: in the first paper, among the elderly dwellers urban community studied, 13.8% had suffered from falls in the past year, and 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 experience fall events (p<0.001). Multiple logistic regression showed that female, history of arthritis, psychiatric disorder, and visual impairment were the major associated factors of a single fall, while female, history of diabetes, cardiovascular disease, arthritis, or psychiatric disorder were those of recurrent falls.
In the second part, among the elderly fallers, up to half had suffered mild injuries, and the incidence of remarkable injury was 27.6%. There were no significant differences in the location and time of falling, but there were different risk factors and consequences among the injury severity strata. Fallers with remarkable injuries had a higher incidence of hospitalization and a greater fear of falling. No statistically significant decline in quality of life with increasing severity of falling injury was identified after the following period.
Finally, of the 4056 participants, the prevalence of fear of falling among females (62.6%) was significantly higher than among males (46.2%). Both falls and fear of falling had significant effects on the eight subscales of the SF-36 (p<0.001) in the elderly subjects. Adjusted for covariate factors, fear of falling had significant effects on the physical and mental component scores of the SF-36, but falling had the main effect on the physical component score.
In conclusion, female, history of arthritis and psychiatric disorder were the common associated factors of a single fall and recurrent falls among the elderly in an urban community in Taiwan. In addition, visual impairment was associated with a single fall and the chronic conditions of diabetes and cardiovascular disease with recurrent falls. Gender, visual impairment and orthostatic hypotension were identified as the major risk factors of falling injury for the elderly. Fear of falling was one of the major factor related to quality of life in the elderly and should be emphasized in order to assist the improvement of HRQOL in geriatrics. All of these identified factors should be emphasized in order to assist the prevention of falling in geriatrics.
目 次 i
表 次 iii
摘 要 1
Abstract 4
第一章 緒論 7
 第一節 研究背景 7
 第二節 研究目的 11
第二章 文獻回顧 12
 第一節 跌倒與跌傷之現況分析 12
  一、單次跌倒與反覆跌倒之盛行率 13
  二、跌傷發生率及其特性 17
 第二節 跌倒相關因子研究 20
  一、內因性相關因子 20
  二、外因性相關因子 22
 第三節 跌傷危險因子研究 25
  一、內因性危險因子 25
  二、外因性危險因子 28
 第四節 跌倒之影響及預後 29
  一、跌倒對身體層面與醫療資源利用之影響 29
  二、跌倒對心理層面的影響:害怕跌倒 32
  三、健康相關生活品質 34
第三章 研究方法 38
 第一節 研究設計 38
 第二節 研究對象 40
 第三節 研究工具及研究變項之操作型定義 42
 第四節 訪視工作的進行及品質管制 47
 第五節 資料處理與分析方法 48
第四章 結果 51
 第一節 單次跌倒與反覆跌倒盛行率及相關因素 51
  一、社區老人之人口學特性 51
  二、單次跌倒及反覆跌倒盛行率 54
  三、跌倒相關因子之單變項分析 54
  四、跌倒相關因子之多變項分析 55
 第二節 跌傷發生率和危險因子以及跌傷後果 58
  一、跌倒老人致傷發生率 58
  二、跌傷特性分佈 60
  三、跌傷之危險因子 62
  四、跌傷的後果 64
 第三節 跌倒與害怕跌倒對老人生活品質的影響 66
  一、害怕跌倒之盛行率與特性分佈 66
  二、害怕跌倒與八面向生活品質之相關分析 68
  三、健康相關生活品質之多變項分析 71
第五章 討論 73
 第一節 單次跌倒與反覆跌倒 73
 第二節 跌傷發生率和危險因子 77
 第三節 害怕跌倒對老人生活品質的影響 82
第六章 結論 85
參考文獻 87
附錄 112
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