長期照護機構住民的跌倒預防

Falls Prevention for Residents in Long Term Care Facilities

長期照護機構中的住民跌倒發生率約為社區居民的三倍，因為跌倒發生率高又可能造成住民嚴重傷害，且20-30%的長照機構跌倒事件可被預防，所以值得主管與所有工作同仁一起努力預防。大多數長照機構住民擁有一個以上的跌倒危險因子，所以一入住就應接受跌倒風險評估。Morse Fall Scale 與Downton Index 都是常用來評估機構住民跌倒風險的工具。對於高跌倒風險住民，應以多因子介入方式減少未來跌倒風險，包括工作人員教育、環境調整、個人化住民保護、適當輔具選擇與使用指導、運動課程、失禁治療、用藥回顧與調整、骨質疏鬆防治、維生素D 補充都是應該著力的方向。若是住民跌倒，應進行詳細的病史詢問與身體檢查，以確保無嚴重受傷，並找出可以預防再跌倒的方法。

The incidence of falls in long term care facility (LTCF) residents is three times higher than that among community-dwelling older people. Because of the high incidence, potential severe injurious falls and 20-30% preventable falls, it is worthy for all LTCF staffs to strive for fall prevention. Most residents in LTCF have more than one risk factor of falls, it is important to perform a falls risk assessment soon after their admission. Morse Fall Scale and Downton Index are both common fall risk assessment tools in LTCF. A multi-factorial intervention is necessary for high risk residents. It includes staff education, environment modification, personalized protection, appropriate assisted devices and instruction, exercise program, incontinence treatment, medication review and adjustment, osteoporosis prevention and vitamin D supplement. A comprehensive fall history-taking and physical examination in fallers are the key steps to detect severe injury and prevent future falls.