Transcript 老人跌倒的危險因子

預防老人跌倒
Hui-Chi Huang
DNSc. RN.
1
can absorb
the shaving
power and
ventricular
impact force
2
Introduction




Increase in life expectancy.
Age is related to changes in the
musculoskeletal and neuromuscular
system.
An impact on the complex motor
performance.
Approximately 30% of older people
suffer from a fall each year.
3
Optimal rehabilitation
Optimal rehabilitation
Average rehabilitation
Average rehabilitation
Restricted rehabilitation
Restricted rehabilitation
Figure: Determining a good outcome by considering explicitly the patient
population. A desirable outcome for patients with a permanent disability of
acute onset (e.g. head trauma, myocardial infraction) might seek realistically to
enhance functional status to a stable and higher level of function from
treatment initiation (left-hand side). In contrast, rehabilitation for those have a
chronic progressive disease might seek to extend baseline function (right- 4
老人跌倒的危險因子
影響跌倒的危險因子中
 使用輔具者
 下肢無力的跌倒風險為最高(約五倍)，
 有步態及平衡困難者的跌倒風險(約三倍)。
 疾病
 藥物
 環境障礙(如：鬆滑的地毯、不足的光線、易滑的地面)
 穿著(衣服脫垂)
 鞋子(無止滑墊、不是包鞋、無鞋邊緣)
 害怕跌倒
 多重因子間有加成交互作用
 當危險因子越多時，跌倒的風險便越大
5
Etiologies of Gait Disturbances in
the Elderly















Parkinson’s disease
White matter ischemic injury
Normal pressure hydrocephalus
Cervical spondylosis
Lumber spondylosis
Cerebellar disease
Peripheral neuropathy
Myelopathy
Hemiparesis
Myopathy
Vestibulopathy
Impaired vision
Arthritis of lower extremities
Hip replacement surgery
Foot disease
6
跌倒者之理學檢查
平衡評估：可用最簡易的「站起來及行走試驗」(Get up and
go test)、或進行步態觀察，或應用觀察表。
 站起來及行走試驗(Get up and go test)：在地上標示
3(10)公尺的距離，一端放置無扶手之椅子，請老人在椅子
上坐，計算自他起來行走至3(10)公尺標示處，再轉身走回
來並坐回椅子上所花的總時間，若少於10(25)秒者，可界
定為無限制的活動能力,若在20秒內者屬大部分非依賴程度,
若在20秒至29秒間者，屬變異性的活動能力，另若超出29
秒者，則可界定為顯著活動障礙。
 請老人試著邊走邊說，如果他必須停下來才能說話，他便
有跌倒的危險。
7
Table: Simple Tests to lower extremities: Strength,
Balance, Gait, and Fall Risk
Test

Get-up and Go
Office-based
maneuvers
1.Observed gait

Time to
administer
＜1 minute
2-3 minutes
Comments
Sensitivity 88%, specificity 94% compared to
geriatrician's evaluation using cut point ＞15
seconds
Some are part of Performance-oriented
assessment of mobility
2.Resistance to nudge
3.Tandem/semitandem stand
4.Rising from chair
5.360° turn

Functional reach
2 minutes
Adjusted odds ratios for ＞2 falls within 6
months
* 8.1 if unable reach
*4.0 if reach  6"
*2.0 if reach  6" but <10"
8
Functional Reach
Ending Position
Standing
Position
Figure 3.6: Functional Reach
(Available from www.mayo.edu/geriatrics etc., Accessed 19 December 2003).
9
10
11
Fall Risk Increasing Drugs: The Effect on
Injuries of the Frail Elderly Estimated from
Administrative Data.


The empirical results suggest that
antidepressants, anxiolytics, hypnotics
and sedatives, anti-arrhythmics, and
drugs from the Priscus-list have a
significant positive effect on the number of
injuries, while anti-hypertensives and antiparkinsonian agents show no and
neuroleptics a significant negative effect.
(Bauer, T. K., Lindenbaum, K., Stroka, M. A., Engel, S., Linder, R. and Verheyen, F. (2012), Fall
risk increasing drugs and injuries of the frail elderly — evidence from administrative data.
Pharmacoepidem. Drug Safe., 21: 1321–1327. doi: 10.1002/pds.3357)
12
13
A checklist to assist in assessment
of risk of falling in older people
Hui-chi Huang
DNSc. RN.
14
Introduction


Falls are associated with many risk
factors. It is proposed to identify
the high-risk group for possible
prevention or protection measures.
A checklist has been developed
using the Delphi technique (Huang,
2000).
15
Purpose

The purpose of this study was to estimate
the risk factors for falls of older adults using
the checklist.
16
Sample：103位機構失能老人
Table. Logistic Regression by the Enter Method for the Risk Rate
of Falls
(N=103)
Variable
B
S.E.
Odds
p
Arthritis
2.21
1.15
9.15
.05
Hearing impairments
1.93
.94
6.89
.04
Cardiovascular accident / year
3.13
1.78
22.77
.08 a
Sleeping tables
3.08
1.26
21.83
.01
.05
.02
1.05
.03
Get-up and Go test (seconds)
17
Predictors of Model
Predictors:
 assistance provision,
 cigarette smoking,
 sleep disturbances,
 polished bedroom floor,
 four or more medications daily,
 son visiting,
 single shopping.
18
Fear of falling and re-falling
Fall
Mental effect
Restrict external activity
Physical effect
19
20
Objectives

Can checklists predict falls in older people?

Can checklists identify a high-risk group?
21
Table 1.
Participants Came from Three Sheltered Housing and One District in
Taipei City (N = 405)
Location
Fall group
Non- fall
Total
group
Sheltered houses projects A
50
51
101
Sheltered houses projects B
50
51
101
Sheltered houses projects C
50
50
100
District
52
51
103
Total
202
203
405
22
Table.
Logistic Regression Showing the Risk Rate of Falls (N = 405)
Variables
B* Standard Odds
p
Error
Assistance provision
.69
.24
2.00 .004
Urinary frequency or
.76
.36
2.13
.04
incontinence
Get-up and Go test (seconds)
.03
.01
1.03 .0007
Kitchen (light dim) a
Front door or backyard
(clutter)
Getting in and out of bed
3.09
2.62
1.51
1.25
22.02
13.66
.04
.04
1.22
.51
3.39
.02
23
Discussion and Recommendations




Social support and Chinese culture.
Older people used assistance provision, had cigarette
smoking and sleep disturbances, polished bedroom
floor, took four or more medications daily, less
frequency son visiting, and being careful to avoid or
decrease simple shopping that may be a warning of
high risk for falls.
Falls are multi factorial.
Interventions need to developed to prevent falls.
24
The High-risk Factors for the Elderly
Fall







Age, lack of exercise, living alone
Illness: diabetes mellitus, hypertension
Medicine: taking sleeping pills
Taking longer time to finish the test of Get-up and Go
Lower score of cognitive function
Environment: having a rug in the bathroom, no
railing in the toilet, and other factors.
Fear of falling
(Huang, Gau, Lin, & Kernohan, 2003)
25
Community Based Nursing Interventions
to Reduce the Risk of Falling Among
Older Adults in Taiwan
Hui-Chi Huang, DNSc. RN.
Associate Professor
26
Literature Review
Health education
5
2
1
Health prevention
7
4
3
6
Health protection
Figure : Health Promotion Model developed by Tannahill, A. (1985).
27
Fall Risk Pyramid – Which Subset of the Population
Should Receive Multifactorial Interventions?
28
The purpose
This study aimed to provide an exercise and
knowledge program to decrease the risk of
falls in older adults.
29
Knowledge Programme
(1) Teaching take medicine safely and the notice side
effects of medication.
(2) Appropriate nutrition for older adults.
(3) Maintaining inside environment safely:
keeping kitchen and toilet lightly and dry,
keeping stairs well-lit and clean,
moving small rugs from door risers, and being
careful when crossing raised high door saddle.
(4) Maintaining outside environment safely:
avoiding dim light, slippery surfaces, removing
doormat
(5) Choosing correct and appropriate shoes: Ridges
soles .
30
Tai Chi Chuan Exercise
Figure 2: An example of a typical Tai Chi Chuan exercise:
push down and stand on one leg; the sequential motions are
performed in semi-squatting posture.
31
Health Prevention
Health Protection
Risk factors checklist
Health Education
Community services
and policy
Interventions
Demographics
Illness
Medicine
Intrinsic
risk
factors
Balance
Measurement
Nutrition
Fall or Nonfall
in older
people
Short Portable
Mental Status
Questionnaires
Fear of Falling
Extrinsic
risk
factors
Outcomes:
reduction in risk factors
1.Exercise: Tai Chi
2.Knowledge programmes:
knowledge of taking
medicine safely and
nutrition appropriately,
maintaining inside and
outside environment safely,
choosing correct shoes
3.Exercise  Knowledge
programmes
4.Control group
Environment
Footwear
Social support
Figure3: Theoretical framework for this study
(Developed by researcher and based on literature review, expert suggestions, the Health Promotion
Model of Tannahill in 1985.)
32
A district in a Taiwan
City
(4,695 older people
in 55,889 residents)
)
Randomly selected one from
seven districts
Exclude 4 villages in mountain
area due to difficulty of access
15 villages
Randomized selection of
4 villages
Exclude
residents who
live elsewhere.
Exclude bed
bound-residents,
ambulant
residents
Randomization
Completed
the pre-test
Fivemonth
period
C village
(198)
A village
(274)
B village
(376)
A village
(96)
B village
(88)
Education
(61)
Tai Chi
(65)
Education  Tai Chi
(85)
Control
(50)
Education
(38)
Tai Chi
(36)
Education  Tai Chi
(60)
Control
(50)
9 residents in
hospital, moved,
and died
Education
(29)
5 residents in
hospital, moved,
and died
Tai Chi
(31)
D village
(311)
D village
(50)
C village
(96)
4 residents in
hospital, moved,
and died
3 residents in
hospital, moved,
and died
Education  Tai Chi
(56)
Figure 1: CONSORT checklist of study design
Control
(47)
33
34
Conclusions
The relevance to clinical practice of this study is that the
results suggest that prevention of falls among the older people
seems to needs multiple interventions.
 Education plus Tai Chi Chuan had both an immediately and
a long-term effect and it is possible that a shorter intervention
period such as five month using this approach would also be
successful.
 This study involved a true experimental research design and
the study had enough statistical power to answer the questions
posed; therefore, the results can be generalised to other groups
of individuals undergoing similar interventions.

35
Hip protectors: a Pilot Study of
for the Elderly in Taiwan
Hui-Chi Huang
RN., DNSc.
36
Chance of Injury
Not every fall may result in injury or
fracture, but in the elderly there is a
22% chance of injury after a fall.
( Chu, et al., 1999 )
37
Hip Fracture

1.
2.
3.
After hospital discharge, but their function of
mobility is worse than before the operation,
and this influences
their quality of life
the ability of self-care
later, 50% of the elderly became more
dependent
(Lin, 2001; National Osteoporosis Foundation, 1998; Simpson,
2002).
38
To Prevent Falls


Preventing fall is not a single and absolutely
way.
Preventing fall from intervention, only
decrease 40 % chance to fall.
(Tinetti & Williams, 1997)
39
Nabhani 和
Bamford (2002)
對於髖部保護墊
的材質力學實驗
發現，
施予保護墊120焦
耳的撞擊力，保
護墊確實能有效
吸收地板的能量，
同時可以減少髖
部所承受的壓力
在2500牛頓以下，
因而避免了髖骨
骨折。
Mills (1996) 的研究，
跌倒時若髖骨承受
2500牛頓以上的撞
擊力時可導致髖骨
骨折。
Figure: Hip protectors (www.impactwear.co.nz)
40
Made from a
special material
(such as
polypropylene or
polyethylene)
1. many small
hexagon-like
honeycombs
2. can absorb
the impact
force then
compress it
to look like
one line.
Figure 2：Hip protectors in underwear
(www.impactwear.co.nz)
41
感謝 聆聽
敬請 指教
42