臺灣博碩士論文加值系統

在許多老人的健康問題中，跌倒對公衛及臨床來說是一個重要的健康議題，除了會造成傷害甚至失能外，亦會帶來高罹病率及死亡率。本研究運用周全性老年評估，以中部一家地區醫院復健病房為例，對463例65歲以上老人進行評估，統計分析使卡方檢定及邏輯斯迴歸等方法分析比較跌倒情形，及其影響因子。研究結果顯示：復健病房65歲以上老人過去一年內發生303次跌倒事件，跌倒盛行率為38%；過去一年有重覆跌倒盛行率為16.4%。跌倒前幾乎沒有任何不適的症狀(69.52%)。跌倒時的時間主要在早上發生跌倒(48.13%)，對於老人跌倒時的地點以平坦的路面最多(27.27%)。與復健病房老人跌倒有顯著相關危險因子為行動力與平衡力變差、貧血、白蛋白異常、營養不良、慢性肝炎、骨質疏鬆、關節炎。而行動力與平衡力變差、多重用藥、骨質疏鬆、關節炎則與復健病房老人重覆跌倒有顯著相關。運用邏輯斯迴歸分析預測危險因子發現：營養不良高危險群、慢性肝炎、骨質疏鬆是跌倒的危險因子，而關節炎及多重用藥則是重覆跌倒的危險因子。本研究發現老年人發生跌倒與重覆跌倒的危險因子是環環相扣，但一般專業人員在處理老人的跌倒仍是以通報，處理急性問題為主，缺乏全面性的考量。本研究透過周全性老人評估，辨識出造成跌倒的危險因子及可能影響因素，即早發現問題並採取防範措施，以提昇老年病患安全，並進一步減少醫療資源的耗用。

Falls of the older people are an important health issue in the public health and clinical aspect. Falls not only can cause injury or disability but also bring high morbidity and mortality. The study used the Comprehensive Geriatric Assessment (CGA) to evaluate falls experiences and related risk factors of 463 patients aged 65 and over selected by rehabilitation wards in a regional hospital. The chi-square test and logistic regression analysis were used for data analysis. The results showed that the prevalence of falls is 38% over the past year and the prevalence of recurrent falls is 16.4%. 69.52% patients were found that there were not any comfortable symptoms (before falls happened. 48.13% patients were estimated that falls often occurred in the morning and at home. The fall risk factors are mobility, worse balance, anemia, abnormal albumin and malnutrition, chronic hepatitis, osteoporosis, arthritis. And the mobility, worse balance polypharmacy, osteoporosis and arthritis have significant correlations with the recurrent falls. Logistic regression analysis found that malnutrition, chronic hepatitis, osteoporosis are the risk factors of falls and polypharmacy and arthritis are the risk factors of the recurrent falls.This study also found that the risk factors of falls and recurrent falls are closely interlinked. Most professionals often called for help to deal with the falls problems and were lack of comprehensive evaluation. The study applied Comprehensive Geriatric Assessment to identify risk factors of falls. It not only can early detect the problems and take preventive measures but also can enhance the safety of elderly patients and reduce the medical costs.

誌謝 i
中文摘要 ii
英文摘要 iii
目錄 iv
表目錄 vi
圖目錄 viii
第1章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究範圍 3
1.4 研究流程 4
第2章 文獻探討 6
2.1 周全性老年評估 6
2.2 國內外跌倒相關文獻 7
2.3 國內外重覆跌倒相關文獻 13
2.4 文獻總結 16
第3章 研究材料與方法 23
3.1 研究架構 23
3.2 研究假設 24
3.3 研究對象 25
3.4 研究工具 25
3.5 名詞定義 28
3.6 研究方法 28
3.7 資料處理與分析 29
第4章 研究結果與討論 30
4.1 研究對象基本資料、自覺健康狀況及健康特性資料 30
4.2 研究對象跌倒、重覆跌倒盛行率及跌倒相關資料分析 37
4.3 影響跌倒相關危險因子分析 43
4.4 影響重覆跌倒相關危險因子分析 70
4.5 研究結果之各項假設結果 97
4.6 討論 100
第5章 結論與建議 104
5.1 結論 104
5.2 研究限制 104
5.3 貢獻 105
5.4 建議未來研究方向 106
參考文獻 107
自傳 113

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