查詢結果分析
來源資料
頁籤選單縮合
題 名 | 多面向介入對不同跌倒風險老年人之跌倒預防成效=Effects of Multifaceted Fall Prevention Program on Community-dwelling Elderly with Different Fall Risks |
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作 者 | 吳書慧; 曹昭懿; 林桑伊; 張谷州; 李雪楨; | 書刊名 | 物理治療 |
卷 期 | 36:4 2011.12[民100.12] |
頁 次 | 頁315-330 |
分類號 | 412.86 |
關鍵詞 | 跌倒; 多面向介入; 跌倒風險; Fall; Multifaceted fall intervention; Fall risk; |
語 文 | 中文(Chinese) |
中文摘要 | 背景與目的:台灣人口快速老化,跌倒盛行率與死亡率隨年齡增加而提升,造成龐大的醫療支出與社會負擔。文獻指出具跌倒風險者其未來一年跌倒發生率高達45-68%。本研究探討多面向介入對於不同跌倒風險老人之跌倒預防成效。方法:自台北、台南社區及醫院門(急)診,篩檢具跌倒風險之老年人參與多面向防跌介入,依據跌倒風險等級分層隨機分為介入組及對照組。介入組接受為期八週、每週一次的小團體運動指導課程、防跌衛教課程、居家環境改善建議及用藥、視力轉介;對照組則給予防跌衛教及居家環境改善手冊。身體功能成效評量於八週介入前後執行,包含問卷及跌倒風險評估(含視差、肌力、反應時間、平衡和本體成覺)等檢測,且每月電訪追蹤一年內跌倒情形。使用Kaplan-Meier存活分析比較兩組一年內累積跌倒發生率,並採用重複量數二因子變異數分析比較兩組身體功能變化(α-level=.05),所有資料均採用意向分析(intention-to-treat analysis)處理。結果:共蒐集有效樣本411位、平均年齡77±7歲。介入組與對照組之一年累積跌倒發生率無顯著差異皆為29%。以跌倒風險進行次族群分析, 發現兩組之跌倒機率在各風險等級亦無顯著差異;低風險(19%:27%, p=.358)、中風險(40%:24%, p=.078)、高風險(28%:35%, p=.327 )。介入組追蹤期間的跌倒機率由過去一年的48.1% 顯著降低為28.6%(p<.001);而對照組由過去一年的36.3%微幅降低為28.9%(p=.101)。身體功能結果顯示不論是低、中、高跌倒風險者經過八週介入後兩組在多數項目都有明顯進步(p<.05),尤其是中、高風險族群,但介入與對照兩組之進步幅度大多未呈明顯組間差異。結論:本研究介入與對照組之一年累積跌倒發生率皆為29%;但介入組追蹤一年的跌倒機率由過去的48.1%顯著降低為28.6%,顯示多面向介入計畫仍有潛力可降低老年人跌倒機率。具跌倒風險老人可透過跌倒風險篩檢、衛教諮詢建議與每月電話追蹤提醒,改善其跌倒機率及身體功能;但若要突顯兩組差異可能須增加運動介入之劑量、強度或頻率。 |
英文摘要 | Background: Falls are the leading cause of morbidity and mortality among people aged 65 years and older, resulting in marked costs and social burden. The purpose of this study was to evaluate the effect of multifaceted fall prevention program on community-dwelling elderly of different fall risks. Methods: Community-dwelling elderly aged 65 and older who met our fall screening criteria were recruited to participate in a stratified randomized controlled fall-prevention trial. Multifaceted intervention included exercise program, fall prevention education courses, recommendations for home hazards modification, as well as referrals for medication or vision check-up. The control group got recommendation and referrals without direct exercise intervention. Primary outcome was incidence of falls in 12 months. Secondary outcomes were PPA battery (including vision, muscular strength, reaction time, balance and proprioception), timed up-and-go (TUG), Taiwan version of International Physical Activity Questionnaire (IPAQ), EuroQoL-5D, and Fall Efficacy Scale (FES). Results: This study recruited 411 older participants with mean age of 77±7 years from hospital outpatient clinics or communities. The fall incidence within I-year for IG (29%) and CG (29%) showed no significant difference. Subgroup analyses stratified by PPA risk-level found that there was no significant difference in fall incidences of both groups among any stratum of fall-risk: low risk (IG: CG= 19%: 27%, p= .358), moderate risk (IG: CG=40%; 24%, p=.078), and marked risk (IG: CG=28%: 35%, p=.327). The fall incidence during the I-year follow-up period significantly decreased from 48.1 % to 28.6%, (p<.001) in IG, while no significant decrease in CG (36.3%→28.9%, p=.101). Both IG and CG improved significantly in most secondary outcomes after intervention, especially for those with moderate or marked fall risk; however, it revealed no significant within-group difference. Conclusion: The findings of 29% fall incidence in both groups during the I-year follow-up period along with the significant decrease of fall incidence from 48.1% to 28.6% in IG might suggest the potential role of the multifaceted fall-prevention program. Interventions including recommendation and referrals seemed to take some effects on improving physical functions of the elderly, especially to the moderate or marked risk group. Whether higher-intensity of longer duration exercise program is required to significantly decrease the fall incidence warrants further study. |
本系統中英文摘要資訊取自各篇刊載內容。