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| 題 名 | 跌倒預防門診推展經驗--臺灣南部某醫學中心之先驅性研究=Falls Prevention Clinic for the Elderly--Experience of a Medical Center in Southern Taiwan |
|---|---|
| 作 者 | 陳仕瑜; 陳清惠; 白惠文; 林桑伊; 郭乃文; 林麗娟; 黃盈翔; 楊宜青; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
| 卷 期 | 6:4 2011.11[民100.11] |
| 頁 次 | 頁268-282 |
| 分類號 | 417.7 |
| 關鍵詞 | 老年人; 跌倒預防門診; 跌倒危險因子; Elderly; Falls prevention clinic; Fall risk factor; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 目的:介紹台灣南部某醫學中心跌倒預防門診之推展現況,由跨領域之醫療團隊提供預防老人跌倒的整合性多重因子介入措施服務,以期提供臨床老人跌倒防治之參考。 方法:本文為描述性研究,針對 2008年 5月至 2009年 10月間,跌倒預防門診照護模式之推展及接受該照護模式的老年病人進行資料蒐集及分析,並嘗試找出跌倒危險因子。 結果:本研究之照護模式乃採整合性多重因子介入措施,以家醫科為整合協調中心的醫療團隊進行照護,參與之醫療專業人員包括家醫科或老年科醫師、物理治療師、營養師、護理個案管理師、臨床心理師及體適能專業人員等,共同擬定跌倒危險因子系統性之評估與提供照護的機制。此試驗性門診收案期間共服務 46位老年病人,排除無法聯繫或拒絕者 (共 4位),共 42位納入分析。病人來源以各科門診轉介為主 (50%),平均年齡為 78.4±8.3歲,其中 54.8%為女性。在四肢及平衡功能檢測方面的跌倒危險因子中,以右腳單腳站立 (88.1%)、左腳單腳站立 (81%) 及起走測試 (69%) 等異常者較多。在整合性評估跌倒危險因子中,以「過去一年有跌倒病史」為最多 (83.3%),其次「害怕跌倒」、「使用藥物種類 ≧4種」、年紀在 75歲以上、有高血壓病史、女性、有尿失禁症狀者等均為易跌倒之高危險群。整合性評估後與初步評估跌倒因子相比較,兩者之間危險因子的差異,以「害怕跌倒」、「使用藥物種類≧4種」、「輔具或鞋子不適當」等方面差別較大。 結論:本門診之運作模式,因先經轉介者 (如臨床醫師) 及病人自評跌倒危險因子,再經本門診整合性評估,此照護模式能提升門診醫療人員及病人對跌倒危險因子之認識,繼而提供更具個別化之照護措施,但確實之照護成效仍須進一步探究。未來對於多重用藥、平衡能力、下肢肌力、適當輔具使用之評估與介入,為跌倒預防不可忽視的要項。 |
| 英文摘要 | Objective: The aim of this study is to introduce the development of our fall prevention clinic, establish a care service model of comprehensive multidisciplinary assessment, and provide essential reference for improving geriatric health care. Methods: For this descriptive study, we enrolled elderly subjects visiting the fall clinic of a medical center in southern Taiwan during the period from May 2008 to October 2009; related data of the enrolled subjects were analyzed to help identify main fall risk factors. Results: The service model of the fall clinic is multidisciplinary and multifactorial intervention. The clinic team incorporates geriatricians, family physicians, physical therapists, nutritionists, clinical psychologists, physical fitness specialists, and case managers with a nursing background; all members work together to perform a systematic, comprehensive evaluation of potential fall risks. Of the 46 subjects visiting this fall prevention clinic, 4 were excluded due to loss of follow-up or refusal to participate in the study, resulting in a total of 42 subjects available for analysis. Patients, with an average age of 78.4±8.3 years old, were mostly referred from other clinics (50%) while 54.8% of the enrolled subjects were female. Muscle power and balance tests in extremities were conducted to examine major fall risks; the percentages of patients reporting abnormalities in right leg standing test, left leg standing test, and timed up-and-go test emerged to be 88.1%, 81.0%, and 69.0% respectively. Generally speaking, major fall risk factors include previous fall history in the past year, number of medications taken≧4, age over 75 years, hypertension history, urinary incontinence history, and female gender. The following three fall risk factors were marked with obvious difference in initial and comprehensive assessments: fear of a repeat fall; number of medications taken≧4; inappropriate use of a walking aid. Conclusion: The fall prevention clinic service model can be expected to equip medical staff with a better understanding of essential fall risk factors for providing patients with more effective, individualized care. Further studies, however, are needed to verify the model’s actual effectiveness. Moreover, future evaluation and intervention of fall prevention should direct more attention towoard multiple medication, balance, lower extremities muscle training, and proper use of walking aids. |
本系統中英文摘要資訊取自各篇刊載內容。