探討失能老年患者跌倒之影響因子

Fall Risk Factors of Aging Patients with Physical Disabilities

根據醫療院所異常事件通報統計，以住院病患跌倒比率最高，其中又以神經系統疾病相關病患佔多數，造成跌倒之內外在因素包括個人、疾病、藥物，主要照顧者的能力，以及醫療環境的安全設備等。本研究藉由文獻參考與彙集國內各醫療院所使用的評估表，重新整合、建立具敏感性及特異性之跌倒高危險群篩選表，並藉由對患者跌倒與非跌倒之影響因子分析，探討健康問題類別與跌倒之相關性。研究結果顯示，當篩選表的內在因子8個項目中若有5項及5項以上，或外在因子23個項目中若有12項及12項以上的答覆為“是”（敏感性=76.67%or73.33%，特異性=40.18%or28.57%），就表示他／她是屬於跌倒高危險群患者；而在健康問題之類別與跌倒之相關性，則以視力及聽力的問題呈現顯著的正面相關性。跌倒事件雖無法百分之百預防，但明確界定屬於跌倒高危險群影響因子的項數，將有助於臨床護理人員快速辨識跌倒高危險群患者，並針對個別性儘早介入預防措施，期望降低跌倒事件的發生，確保病患之安全。

According to reported statistics of unusual incidents from medical institutions, slip and fall from hospitalized patients have been ranked as the most numberous among accidents, and it occurs most frequently to the patients with neurologic problems. The factors include personal issues, diseases, drugs, the capacity of primary caregivers, and safety equipment of the medical environment, etc. This study applies the evaluation score table, the ROC curves and the area under the curve (the “AUC”) generally used by medical institutions in Taiwan and analyzes the internal and external factors through literature review, to re-organize and re-establish the screening sheet of falling, thus indicating sensitivity and particularity for high-risk fall groups. In the study, we provide the analysis of the relationship between categories of health issues and falling. The results showed that she/he would be considered as the patient of high-risk falling group if there were five or more “yes” responses (sensitivity = 76.67% or 73.33%, specificity = 40.18% or 28.57%) to 8 inquiries among internal factors and 12 or more “Yes” to 23 inquiries among external factors. In addition, the results also showed that vision and hearing ability have significant positive correlation with slip and fall accidents. It is impossible to thoroughly prevent slip or fall accidents, but defining and identifying the factors causing slip and fall accidents could help the nurses identity the patients with high risk of fall, provide preventive procedures as early as possible, decrease slip and fall accidents, and improve patients’ safety.