精神科住院病患跌倒因素之探討

The Factors of Fall-Related Among Psychiatric Inpatients

本研究之目的在探討精神科住院病患跌倒事件之相關因素。採用回溯性個案控制的方法，以某區域醫院精神科病房92年1月至93年5月期間內，有正式跌倒紀錄之住院病人為跌倒組，依性別、年齡、跌倒事件發生時之住院天數、以及精神疾病診斷等控制變項，於出院病人中進行電腦非跌倒組的配對，共計配對34對（68位）。研究工具包括跌倒組與非跌倒組之登錄表，內容包括基本資料、入院資料、跌倒前一天之生理狀態、內科疾病嚴重度以及服用的藥物等。研究結果呈現跌倒組與非跌倒組在生理方面的病人獨立活動能力、內科疾病嚴重度達顯著差異，服用的藥物在抗憂鬱劑、血管擴張劑以及多重用藥等方面，在統計上有顯著差異（p＜.05），以逐步回歸方式進一步做分析，在跌倒的預測力方面以病人之獨立活動能力的83.9%最高、服用抗憂鬱劑有3.8%、內科疾病嚴重度有1.7%以及多重用藥有1.3%的解釋力。本研究結果可提供監測精神病人跌倒趨勢的指標，作為防範跌倒有效因應措施之參考。

The purpose of this study was to explore the fall-related factors among psychiatric inpatients. This was a retrospective case-control study from Jan. 1, 2003 to May 31, 2004 in a community hospital. The inpatients were reported to have fallen as the fall group, while the discharged patients were selected from the computer as the non-fall group. Two groups were matched by controlled variances such as gender, age, length of stay at hospital for the fall event and psychiatric diagnosis. The total pairing consisted of 34 pairs (68 subjects). The study tools included the registration forms of the two groups, containing basic data, admission data, pre-day physical status of the fall event, Charlson Comorbidity Score and the use of medications. The results of the study indicated activity dependent ability, Charlson Comorbidity Score in physical status, and the use of medications such as antidepressant agents, vasodilator agents and polypharmacy to be significantly different between the two groups (p<.05). Using regression for further analysis, patient’s activity dependent ability as 83.9% is proved most important as predictive variables for falls. The use of antidepressant agents as 3.8%, polypharmacy 1.3%, and Charlsom Comorbidity Score 1.7% could explain variances for falls. From this study, the results can provide indicators to predict falls among the psychiatric patients and develop coping strategies for fall prevention.