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系統識別號 U0026-0702201019361700
論文名稱(中文) 健康照護專業人員對老年人跌倒知識及處理之調查
論文名稱(英文) Knowledge and Management of Elderly Falls among Health Care Professionals
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 98
學期 1
出版年 99
研究生(中文) 呂育陞
研究生(英文) Yu-Sheng Lu
學號 TC697403
學位類別 碩士
語文別 中文
論文頁數 97頁
口試委員 指導教授-張家銘
口試委員-楊宜青
口試委員-官大紳
中文關鍵字 老年人跌倒  健康照護專業人員  跌倒處理  跌倒知識 
英文關鍵字 elderly falls  health care professionals  falls management  falls knowledge 
學科別分類
中文摘要 老年人的跌倒導致整體活動功能及生活品質的下降、預期生命的縮短、增加整體醫療資源的支出,也造成長期照護的負擔。在目前,老年人如因跌倒造成損傷進入醫療院所時,第一線健康照護專業人員大多只有損傷處理並執行基本的理學檢查,以及使用影像檢查了解有無因跌倒而造成出血、骨折或軟組織傷害,最多只照會因跌倒所造成損傷之相關專科醫師,但對於引起跌倒原因的評估、預防及處理卻極其有限。對於跌倒的處理其實是需要具備廣泛且全面的認識;同時因專業人員所照護的對象也大多為老年族群,因此這種對於老年人跌倒的知識,應該是所有專業人員都需要瞭解的。本研究旨在調查南臺灣健康照護專業人員對於老年人跌倒處理及知識的現況,並瞭解健康照護專業人員對於老年人跌倒知識缺乏的部份,以做為將來安排防跌教育的參考依據。
本研究為一橫斷性研究,採用研究者自擬的「健康照護專業人員對老年人跌倒處理現況、知識及概念調查問卷」,分別依「老年人跌倒處理」、「跌倒的定義」、「老年人跌倒危險因子」、「老年人跌倒預防方式」及「老年人跌倒後所造成的影響及治療」等五個面向來進行施測,後三個面向依答對題數比例採百分比計分方式。經由專家效度進行問卷修改,取34 位非母群體之研究對象進行前驅研究,得Cronbach's α 值為0.63。以SPSS 17.0
進行分析,處理現況採複選題集群分析,知識現況分別採單變項分析及多因子迴歸方式進行分析。
正式施測時取樣313 位專業人員,研究結果顯示,在處理老年人跌倒無外傷時,以意外事件通報最多(91.4%),有外傷時以處理外傷為主 (97.4%)。如有外傷時,照會骨、外科之比例較無外傷時明顯高出許多,無外傷評估項目較多以神經學檢查(25.6%)及環境評估(24.9%)為主。整體而言,所有專業人員在預防跌倒知識平均得分最高(89.8 分),以外在因子-輔具知識平均得分最低(51.6 分),跌倒定義醫師答對比例較高(72.6%),自評對骨質疏鬆症藥物大多不清楚(74.7%)。在內在危險因子的知識方面,受測專業人員的基本資
料並無統計上顯著差異及相關,但整體在危險因子為女性(6.7%)及憂鬱症(25.9%)二項目答對較少。
對知識現況,資深的專業人員對外在因子-藥物及髖關節骨折後的影響知識較為瞭解;外科系專業人員對外在因子-環境的知識較為瞭解;自評對老年人跌倒瞭解程度高者,多數對外在因子-環境及預防跌倒較為瞭解;遇過跌倒次數較多者,在整體外在因子及外在因子-藥物的知識較為瞭解。而在職別與知識方面,醫師較缺乏的知識為輔具的知識;護理人員較缺乏的知識為輔具、跌倒後併發症、髖關節骨折後的影響及骨質疏鬆症的知識;復健治療師較缺乏的知識為藥物、髖關節骨折後的影響知識及骨質疏鬆症的知識;預防跌倒的知識與職別並無相關。
在處理老年人跌倒時需從跌倒原因來思考,並應要有更周全的評估和多照會神經內科、復健科或是老年醫學科之專業人員。另外宜針對不同照護專業人員員對於老年人跌倒知識不足的部份,提供不同的防跌教育知識,期能當老年人跌倒時,專業人員能適時提供給跌倒老年人必要的協助。
英文摘要 Falls in the elderly people will result in functional decline, reduced quality of life, shortened life expectancy, increased expenditure of medical care and increased burden of long term care. Currently, when elderly people were sent to medical institutions because of fall-related injuries, the first-line health care professionals (HCPs) usually take care of injuries and perform basic
physical examination, as well as imaging studies to confirm fall-related hematoma, fractures or soft-tissue injuries. Sometimes the trauma-related specialists will be consulted. However, little was conducted in assessment, prevention and management of falls in the elderly. Comprehensive knowledge is needed to managing falls in the elderly. As the elderly are the major subjects of medical care, it is necessary that every HCP should know how to manage elderly falls. This
study is to investigate current situation of the knowledge and management of elderly falls among the HCPs in southern Taiwan, and to investigate if there is any deficiency in the knowledge about elderly falls, which can be the base for designing education of the falls prevention education planning in the future.
This is a cross-sectional study. "The Questionnaire of Knowledge and Management of Elderly Falls among Health Care Professionals", composed of questionnaire of elderly falls
management, definition, risk factors, prevention, as well as impact and treatment of elderly falls, was designed by the researcher. Questionnaire was revised according to the validity assessment by four experts. Thirty-four professionals not enrolled in the study were sampled for pilot study to test the reliability of questionnaire (Cronbach’s α=.63). SPSS 17.0 for Windows was used to
statistic analysis. “Management status” was evaluated using multiple-choice grouping, and “Knowledge status” was evaluated using univariate analysis and multi-variate regression. A total of 313 professionals were enrolled in this study. As to management of elderly falls
without injuries, accident notification (91.4%) was the most common action that HCPs took. If there were visible injuries after falls, the focus was on the treatment of fall-related injuries (97.4%). The percentage of orthopedic and surgical consultation was much higher among theelderly falls with injuries than those without injuries. As to assessment of elderly falls without injuries,, HCPs tended to focus on neurological examination (25.6%) and environmental assessment (24.9%). Overall, HCPs got highest scores in “prevention of falls” (89.8%), and the lowest scores in “assistive device” of extrinsic factors (51.6%). Definition of falls was answered correctly among most HCPs, especially the physicians(72.6%). Most of HCPs thought they were not familiar to osteoporosis medications (74.7%). There was no significantly statistic association between the overall knowledge of intrinsic risk factors and characteristics of HCPs, but HCPs answered less correctly in the two items of intrinsic risk factors, "female" (6.7%) and "depression" (25.9%).
As to the knowledge of the elderly falls, senior HCPs understood better in “medications” and “impact of hip fracture” of extrinsic risk factors. Surgical HCPs understood better in “environment” of extrinsic risk factors. HCPs who had a higher self-rated degree of knowledge of elderly falls also understood better in “environment” and “falls prevention". HCPs who had
more experiences in managing falls understood better in “extrinsic factors” and “medications”.
As to the association between occupation and knowledge, physicians knew less about the assistive devices. Nurses knew less about the assistive devices, complications after falls, impact of hip fracture and osteoporosis. Rehabilitation therapists knew less about the medications,
impact of hip fracture and osteoporosis. There was no association between knowledge of fall prevention and types of occupation.
When HCPs managing elderly falls, the causes of falls,should be assessed. A comprehensive assessment and more consultions of neurologial, rehabilitation, or geriatric professionals should be addressed. In addition, different education curriculum of fall prevention should be provided based on different HCPs insufficient backgrounds. We hope that HCPs can provide optimal assistance for the elderly that fall down.
論文目次 中文摘要-Ⅰ
英文摘要-Ⅲ
致謝-Ⅴ
第一章緒論-1
第一節 研究背景-1
第一項 老年人跌倒議題的重要性-1
第二項 老年人跌倒的盛行率:國內外之比較-2
第三項 老年人跌倒的死亡率及醫療費用-3
第四項 小結-3
第二節 研究重要性、動機、目的及問題-4
第一項 研究重要-4
第二項 研究動機、目的及問題-4
第二章文獻探討-6
第一節 跌倒的定義-6
第二節 老年人跌倒的危險因子-8
第一項 內在因子-8
第二項 外在因子-9
第三節 預防老年人跌倒-10
第四節 老年人跌倒的併發症-11
第一項 生理-11
第二項 心理-害怕再次跌倒-12
第五節 預防老年跌倒所造成的損傷-13
第一項 骨質疏鬆症及髖關節骨折-13
第二項 預防跌倒損傷之器具-15
第六節 老年人跌倒相關知識與認知的調查-15
第三章 研究方法-19
第一節 名詞定義-19
第二節 研究流程-20
第三節 研究架構-21
第四節 研究設計-21
第一項 研究場所-21
第二項 研究對象-22
第三項 抽樣方式及樣本數大小-22
第五節 研究工具-23
第一項研究工具內容-23
第二項研究工具之信度、效度-26
第三項資料處理及分析-30
第四章 研究結果-33
第一節 健康照護專業人員基本資料-30
第二節 健康照護專業人員對老年人跌倒處理現況-36
第三節 健康照護專業人員對老年人跌倒知識現況-42
第四節 健康照護專業人員基本資料與老年人跌倒知識現況的關係-43
第五章 討論-62
第一節 健康照護專業人員如何處理老年人跌倒-62
第二節健康照護專業人員對老年人跌倒知識的現況及相關性-64
第六章結論與建議-70
第一節 結論-70
第二節 研究限制-72
第三節 應用與建議-73
第七章 參考文獻-74
附件
附件一 專家效度名單-80
附件二致專家效度鑑定函-81
附件三問卷評核表-84
附件四「健康照護專業人員對老年人跌倒處理現況、知識及概念」調查問卷-91
附件五一般審查受試者同意書-95
附件六同意臨床試驗證明書-96
附件七成大研究生申請研究論文回覆函-97
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