進階搜尋


下載電子全文  
系統識別號 U0026-1601201315502500
論文名稱(中文) 分析急診就醫老年人反覆跌倒之危險因子
論文名稱(英文) The risk factors of recurrent fall in the elderly presenting to the emergency department
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 101
學期 1
出版年 102
研究生(中文) 林鈺舒
研究生(英文) Yu-Shu Lin
學號 t26991014
學位類別 碩士
語文別 中文
論文頁數 59頁
口試委員 指導教授-陳清惠
召集委員-張家銘
口試委員-施欣怡
中文關鍵字 急診  反覆跌倒  老年人  危險因子 
英文關鍵字 emergency department  recurrent fall  elderly  risk factors 
學科別分類
中文摘要 背景:老年人跌倒已是全球性的健康議題,跌倒的後續影響不僅是醫療費用的支出,更易造成老年人失能、憂鬱,甚至死亡,也增加了照顧者的負擔。急診為老年緊急醫療的第一線,超過ㄧ半的老年人跌倒至急診就醫治療後即出院,往往因潛在的跌倒風險而再度跌倒就醫,甚至因跌倒造成的合併症需住院治療。若能在急診第一線即進行跌倒危險因子評估,並可提供介入措施,預防反覆跌倒的情形。
目的:分析反覆跌倒的危險因子,作為急診跌倒評估與預防措施之參考。
方法:以南部某醫學中心的急診就醫病歷為收案來源,採回溯性病歷回顧,以自擬式結構問卷包括人口學資料、跌倒史、醫療、藥物及社會層面進行資料登錄。為了資料的完整性,另向個案或家屬以電話訪談蒐集資料。
研究結果與臨床應用:多數老年人跌倒後至急診就醫,無論是反覆跌倒或單次跌倒,其共同診斷以頭部創傷、暈眩為主。數據顯示超過ㄧ半以上的老年人接受治療後即出院返家,並未經過危險因子評估或轉介諮詢。75%反覆跌倒的老年人於離院後六個月再度入院,而反覆跌倒的老年人比單次跌倒、無跌倒經驗者需支付更高的醫療費用。其主要的危險因子為心血管、神經系統疾病、步態不穩、鎮靜安眠藥物。此結果可提供臨床醫護人員ㄧ個跌倒評估參考,篩檢反覆跌倒的高危險群,以減少老年人反覆跌倒再入院機率。
英文摘要 Background: Falls are a global health concern in the elderly population. The results of falls include increasing in healthcare spending and caregivers’ burdens, functional disability, depression and even death. Though emergency departments(EDs)are the initial places to provide medical management, lack of enough high risks assessments and interventions at the ED frequently resulted in more falls after discharge. Furthermore, risk factors among those elderly persons presenting to EDs with recurrent fall were not well developed before.
Purpose: The study is designed to determine risk factors for elderly patients with recurrent fall within one year presenting to emergency room.
Method: A retrospective chart review was conducted for elderly patients who presented to the ED of a medical center in southern Taiwan with recurrent fall within one year from 2010 through 2012. Structure questionnaires were developed to collect data, which includes demographic characteristics, underlying diseases, medication, fall history and social factors. Telephone interviews were conducted to have more complete information if needed.
Results and future implication: The most common diagnoses for elderly individuals presenting to the ED were head injury and dizziness. Seventy-five percent of the elderly patients with recurrent fall returned to the ED after the six months following the frequency of readmission. The cost for fall-related injuries for elderly with recurrent fall was much more than that for elderly with single fall event and elderly who have never fell before within 6 months. Most patients discharged directly from the ED did not receive fall-related risk factors assessment or preventing education. The risk factors of recurrent fall were cardiac vascular disease, neurological disease, unsteady gait, and sedative drugs. The information can be helpful to screen high risk multiple falls elderly and the more fall interventions are necessary to conduct for reducing the further events at the ED.
論文目次 中文摘要 I
Abstract II
致謝 III
目錄 V
圖目錄 VII
表目錄 VIII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 4
第三節 研究問題 4
第四節 研究假設 4
第二章 文獻查證 4
第一節 老年人跌倒的危險因子與篩檢重點 4
第二節 老年人反覆跌倒之危險因子 7
第三節 反覆跌倒的後遺症 7
小結 8
第三章 研究方法 11
第ㄧ節 研究架構 11
第二節 名詞定義 13
第三節 研究設計 14
第四節 研究對象及樣本數估計 14
第五節 研究工具 15
第六節 研究過程 16
第七節 統計分析 18
第四章 研究結果 20
第一節 人口學特性資料、臨床表現及預後 20
第二節 跌倒史與反覆跌倒、單次跌倒之間的差異 25
第三節醫療層面與反覆、單次及無跌倒之間的差異 27
第四節藥物層面與反覆、單次及無跌倒之間的差異 29
第五節社會層面與反覆、單次及無跌倒之間的差異 32
第六節 反覆、單次跌倒及跌倒的危險因子 32
第五章 討論 35
第一節 老年人前來急診就醫的臨床表現、預後及跌倒相關層面之探討 35
第二節 老年人反覆跌倒的危險因子 37
第三節 老年人單次跌倒的危險因子 37
第四節 急診就醫老年人的跌倒危險因子 38
第五節 反覆、單次及無跌倒老年人的醫療費用支出 38
第六章 結論與建議 39
第一節 結論 39
第二節 研究結果之應用與建議 40
第三節 研究限制 40
參考文獻 42
附件一、急診老年人跌倒之問卷 50
附件二、電話訪談大綱 52
參考文獻 行政院經濟建設委員會(2010)‧2010年至2060年台灣人口推計‧民100年5月20日取自 http://www.doh.cepd.gov.tw/
行政院衛生署(2010)‧衛生署統計系列(一)98年度死因統計‧民100年5月20日取自http://www.doh.gov.tw/CHT2006/index_populace.aspx
行政院衛生署統計資訊網(2006)‧2005-2006年國民醫療保健支出‧民101年11月30日取自http://www.bhp.doh.gov.tw/BHPNet/Portal/File/ThemeDocFile/20111021
吳錦蓉(2010)‧急診醫療專業人員對老年人跌倒評估及處置之認知與現況分析(未發表的碩士論文)‧成功大學醫學院護理研究所,台南市。
林茂榮 、蔡素蘭 、陳淑雅 、曾信嘉(2002)‧台灣中部某鄉村社區老人跌倒之危險因子‧台灣衛誌,21,73-82。
林茂榮、王夷暐(2004)‧社區老人跌倒的危險因子與預防‧臺灣公共衛生雜誌,23(4),259-271。
國家衛生研究院(2007)‧電子報:1999年與2005年台灣地區老人跌倒狀況之比較‧民101年5月26日取自http://enews.nhri.org.tw/
張念慈、楊南屏、李建賢、周碧瑟(2008)‧單次跌倒與反覆跌倒之盛行率與相關因素探討-以都會區老人為例‧台灣衛誌,27(4),330-340。
張哲誌、周騰達(1994)‧老人跌倒的預防(上)‧基層醫學,9(9),170-174。
陳玉枝、林麗華、簡淑芬(2002)‧住院病患傷害性跌倒的影響因素與其醫療資源耗用之相關性‧慈濟護理雜誌,1,66-77。
Abreu, N., Hutchins, J., Maston, J., Polizzi, N., & Seymour, C. J. (1998). Effect of group versus home visit safety education and prevention strategies for falling in community-dwelling elderly persons. Home Health Care Management & Practice, 10(4), 57-63.
American Geriatrics Society, British Geriatrics Society, American Academy of Orthopedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. Journal of American Geriatric Society, 49, 664–672.
Baraff, L. J., Lee, T. J., Kader, S., & Della, P. R. (1999). Effect of a practice guideline for emergency department care of falls in elder patients on subsequent falls and hospitalizations for injuries. Academic Emergency Medicine, 6, 1224–1231.
Baraff, L. J., Penna, R. D., Williams, N., & Sanders, A. (1997). Practice Guideline for the ED Management of Falls in Community-Dwelling Elderly Persons. Annals of Emergency Medicine, 30(4), 480-492.
Bath, P. A., & Morgan, K. (1999). Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK. European Journal of Epidemiology, 15, 65-73.
Bell, A., Talbot-Stern, J., & Hennessy, A. (2000). Characteristics and outcomes of older patients presenting to the emergency department after a fall: A retrospective analysis. Medical Journal of Australia, 173(4), 179-182.
Carpenter, C. R., Scheatzle, M. D., D’Antonio, J. A., Ricci, P. T., & Coben, J. H. (2009). Identification of fall risk factors in older adult emergency department patients. Academic Emergency Medicine, 16, 211–219.
Centre for Disease Control and Management. (2001). Public health and ageing: nonfatal injuries among older adults treated in hospital emergency departments-United States. MMWR Morb Mortal Wkly Rept. 2003;52:1019-1022.
Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M. J., ... Shekelle, P. G. (2004). Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomized clinical trials. British Medical Journal, 328 (7441), 680-683.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Clinical Epidemiology, 40(5), 373-383.
Clapperton, A. (2005). Unintentional (Accidental) Hospital-Treated Injury in Victoria. Melbourne: Monash University Accident Research Centre Victorian Injury Surveillance Unit, 2007.
Close, J., Hooper, R., Glucksman, E., Jackson, S. H., & Swift, C. G. (2003). Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET). Emergency Medicine Journal, 20, 421–425.
Close. J., Ellis, M., & Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (1999). Prevention of falls in the elderly trial (PROFET): a randomized controlled trial. Lancet, 353, 93-97.
Cohen, J. (1969). Statistical power analysis for the behavioral sciences (1st edition). New York: Academic Press.
Cumming, R. G. (1998). Epidemiology of medication-related falls and fractures in the elderly. Drug s Aging, 12(1), 43-53.
Donald, I. P., & Bulpitt, C. J. (1999). The prognosis of falls in elderly people living at home. Age and Ageing, 28, 121-125.
Downing, A., Wilson, R. (2005). Older people's use of Accident and Emergency services. Age and Ageing, 34(1), 24-30.
Dunn, J. E., Rudberg, M. A., Furner, S. E., & Cassel, C. K. (1992). Mortality, disability, and falls in older persons: the role of underlying disease and disability. American Journal of Public Health, 82(3), 395-400.
Ganz, D. A., Bao, Y., Shekelle, P. G., & Rubenstein, L. Z. (2007). Will my patient fall? Journal of American Medical Association, 297, 77–86.
Graafmans, W. C., Ooms, M. E., Hofstee, H. M., Bezemer, P. D., Bouter, L. M., & Lips, P. (1996). Falls in the elderly: a prospective study of risk factors and risk profiles. American Journal of Epidemiology, 143, 1129-1136.
Hensbroek, P. B., Dijk, N., Breda, F., Scheffer, A. C., Cammen, T. J., Lips, P., ...Rooij, S. (2009). The CAREFALL Triage instrument identifying risk factors for recurrent falls in elderly patients. American Journal of Emergency Medicine, 27(1), 23-36.
Huang, T. T. (2005). Home environmental hazards among community-dwelling elderly persons in Taiwan. Journal of Nursing Research, 13(1), 49-57.
Kalula, S., de Villiers, L., Ross, K., & Ferreira, M. (2006). Management of older patients presenting after a fall-an accident and emergency department audit. South African Medical Journal, 96, 718–721.
Li, W., Keegan, T. H., Sternfeld, B., Sidney, S., Quesenberry, C. P., & Kelsey, J. L. (2006). Outdoor falls among middle-aged and older adults: A neglected public health problem. American Journal of Public Health, 96(7), 1192-1200.
Lord, S. R., Ward, J. A., Williams, P., & Anstey, K. J. (1994). Physiological factors associated with falls in older community dwelling women. Journal of American Geriatrics Society, 42, 1110-1117.
Macdonald, G. (1998). Development of a social support scale: An evaluation of psychometric properties. Research on Social Work Practice, 8(5), 564-576.
Manitoba Health. (2005). Preventing falls and fall-related injuries in Manitoba: a review of best practices. Impact, 18–30.
Masud, T., & Morris, R. (2001). Epidemiology of fall. Age and Ageing, 30, 3-7.
Miller, E., Wightman, E., Rumbolt, K., McConnell, S., Berg, K., Devereaux, M., & Campbell, F. (2009). Management of fall-related injuries in the elderly: a retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital. Physiotherapy Canada, 61, 26-37.
Murray, K. J., Hill, K., Phillips, B., & Waterston, J. (2005). A pilot study of falls risk and vestibular dysfunction in older fallers presenting to hospital Emergency Departments. Disability & Rehabilitation, 27(9), 499-506.
Oswald, A. E., Pye, S. R., O’Neill, T. W., Bunn, D., Marshall, T., Silman, A. J., & Symmons, D. P. (2006). Prevalence and associated factors for falls in women with established inflammatory polyarthritis. Journal of Rheumatology, 33, 690-694.
Perell, K. L., Nelson, A., & Goldman, R. L. (2001). Fall risk assessment measures: an analytic review. Journal of Gerontology: MEDICAL SCIENCES, 56, 761–766.
Pluijm, S. M., Smit, J. H., Tromp, E. A., Stel, V. S., Deeg, D. J., Bouter, L. M., & Lips, P. (2006). A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporosis International, 17(3), 417-425.
Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35, 37-41.
Rubenstein, L. Z., & Josephson, K. R. (2002). The epidemiology of falls and syncope. Clinics in Geriatric Medicine, 18(2), 141-158.
Russell, M. A., Hill, K. D., Blackberry, I., Day, L. L., & Dharmage, S. C. (2006). Falls Risk and Functional Decline in Older Fallers Discharged Directly From Emergency Departments. Journal of Gerontology: MEDICAL SCIENCES, 61(10), 1090–1095.
Russell, M. A., Hill, K. D., Day, L. M., Blackberry, I., Gurrin, L. C., & Dharmage, S. C. (2009). Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool. Age and Ageing, 38(1), 40-46.
Sattin, R. W. (1992). Falls among older persons: a public health perspective. [Review] [105 refs]. Annual Review of Public Health, 13, 489-508.
Sattin, R. W., Lambert, H. D. A., DeVito, C. A., Rodriguez, J. G., Ros, A., Bacchelli, S., …Waxweiler, R. J. (1990). The incidence of fall injury events among the elderly in a defined population. American Journal of Epidemiology, 131(6), 1028-1037.
Stalenhoef, P. A., Diederiks, J. P., Knottnerus, J. A., Kester, A. D., & Crebolder, H. F. (2002). A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. Journal of Clinical Epidemiology, 55, 1088–1094.
Stevens, J., & Sogolow, E. (2005). Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevent, 11, 115–119.
Tromp, A. M., Pluijm, S. M., Smit, J. H., Deeg, D. J., Bouter, L. M., & Lips, P. (2001). Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. Journal of Clinical Epidemiology, 54, 837–844.
World Health Organization. (1977). Manual of the international classification of diseases, injuries, and the causes of death. Ninth revision, 1.
Worster, A., & Haines, T. (2004). Advanced statistics: understanding medical research review (MRR) studies. Academic Emergency Medicine, 11, 187-192.
Yardley, L., & Smith, H. (2002). A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist, 42, 17-23.
Zijlstra, G. R., Haastregt, J. C. M., Rossum, E., Eijk, J. M., Yardley, L., & Kempen, G. M. (2007). Interventions to reduce fear of falling in community-living older people: A systematic review. Journal of the American Geriatrics Society, 55, 603-615. doi: 10.1111/j.1532-5415.2007.01148.x.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2014-01-10起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2014-01-10起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw