社區與住院老人跌倒的危險因子與預防

隨著世界人口的高齡化，老年人的跌倒預防已是世界公共衛生重要議題之一。社區老人跌倒的危險因子包括年齡相關之退化、跌倒病史、姿勢性低血壓、慢性疾病、認知功能、藥物使用、居家環境因素、足部保護措施等，住院老人的危險因子有些與社區老人相似但有較高盛行率，另外病人與護理人員比例增加、病人與護理人員、家屬之間的溝通不良也是危險因子之一。要預防跌倒，事前完善的評估是必要的，社區老人可藉由詢問跌倒史加上簡單步態平衡測試，找出跌倒高危險群，住院老人因為多合併其他內科疾病，且較高比例有行動不便、認知功能減退的現象，較仔細的周全評估是需要的。社區老人跌倒的介入方式以多重因子介入最有效，其他單一因子如太極運動能減少跌倒的機率、足夠劑量的維他命D 補充能降低跌倒危險性。住院老人跌倒的預防也以多重因子介入有較理想結果，其他單一因子如髖部保護措施等則未有明顯效果。院內老人防跌仰賴醫護人員、病人與家屬之良好的溝通，經由不斷監測、改善、落實跌倒預防作業及病人、家屬積極的參與，才能落實防跌作業流程，進而減少院內跌倒的發生率。

As population ages, fall prevention in older people has became one of the most important public health issues in the world. Risk factors for falls among community-dwelling older people include age-related organ degeneration, past history of falls, postural hypotension, chronic diseases, cognitive impairment, medication use, environmental factors, and foot wear. Risk factors for falls among elderly patients in hospital are similar to those in the community. However, the prevalence of these risk factors is usually higher. An increased patient to nurse ratio and poor communication among patients, family members and medical staffs are also associated with increased risk of falls. A complete assessment to identify older people at risk for falls is essential for fall prevention. In the community, information about previous falls and functional balance and mobility tests can help us identify those at risk. In the hospital, owing to the high proportion of comorbid conditions, mobility impairment and cognitive decline of the elderly patients, a comprehensive geriatric assessment is warranted. Multifactorial interventions are the most effective way to prevent future falls in community setting. Other effective interventions include Tai Chi and adequate vitamin D intake. Multifactorial interventions are also effective in preventing falls in the hospital. Single measures such as hip protector failed to demonstrate significant preventive effect. Good communication between nursing staffs, patients and families plays a crucial role in a successful hospital fall prevention program. Fall prevention in hospitals can ultimately be achieved by implementing a fall prevention program, continuous monitoring and auditing, plus active participation of patients and families.