以復健為主之聯合照護模式降低長者之髖骨骨折術後死亡率

Reduction of Postoperative Mortality Rate in Hip Fracture by a Rehabilitation-Based Cohesive Care Model in Elderly

台灣老年口比例逐年增加，65歲以上人口佔宜蘭縣總人口數的13.83%，相較高於台灣老年人口比10.75%。國內健保每年花在老人髖部骨折之住院費為13億，佔所有骨折的1 / 5，每年約增加2.8%髖部骨折人口，加上老年人髖部骨折後一年內的死亡率高達8.4-36%，相關研究顯示跌倒後80%病患無法自理生活，30%病患必須長期臥床，嚴重影響老年人的生活品質，因此髖部骨折患者的高齡照護為重要的議題。回溯國立陽明大學附設醫院高齡髖部骨折長者接受整合型復健照護計畫後之成效，收案對象為因跌倒而發生髖部骨折的65歲以上患者，並排除因外力而造成之骨折，以結構式問卷作資料收集內容包括：1）個人基本資料；（2）老年人精神抑鬱量表；（3）自我照顧認知量表；（4）環境安全評估量表；（5）老人活動量表、步態及平衡評估量表：（6）日常生活功能量表及工具性E常生活活動量表。個案接受以復健為主之多專業醫療團隊的骨折聯合照護服務後，其老年人精神抑鬱量表、日常生活功能量表、老人活動量表、步態及平衡評估量表及居家自我照顧認知分數有顯著進步。在台灣，髖部骨折患者的術後一年內的死亡率約為14.6%，而接受本照護服務的患者，其術後一年內的死亡率僅4%。本研究結果顯示透過跨團隊成員提供高齡髖部骨折患者整合型照護，藉由加強提供術後復健活動指導的介入措施，評估環境安全與提供環境改善之建議，確能有效提升高齡髖部骨折患者出院後的術後活動力，並降低術後一年內之再跌倒率骨折率與死亡率。

Abstract: The proportion of older adults in Taiwan increases annually. Adults over 65 years old account for 13.83% of the overall population in Yilan County, which is higher than the 10.75% for the entirety of Taiwan. Taiwan’s National Health Insurance spends NT$1.3 billion annually on hospitalization expenses for older adults with hip fractures, which accounts for 1/5 of the expenses for all fractures. Each year, the number of people with hip fractures increases by 2.8%. The mortality rate for older adults within the first year after hip fracture is 8.4%-36%. Studies have shown that 80% of older adults who have experienced falls are not able to live independently and 30% require long-term bed rest, which severely affects quality of life. Therefore, care for older adult patients with hip fractures is an important issue. This study examined the effects of integrated rehabilitation care provided to older adults with hip fractures. The participants in this study were patients who were aged 65 years or older and had suffered hip fractures caused by a fall. Any patients with fractures caused by external force were excluded. Data was collected using structured questionnaires that included (1) basic personal information, (2) the Geriatric Depression Scale, (3) a self-care knowledge scale, (4) an environmental safety evaluation scale, (5) a physical activity scale and gait and balance evaluation scale, and (6) the activities of daily living scale (ADL) and instrumental activities of daily living scale (IADL). A survey including environmental safety evaluation scale, physical activity scale, gait and balance evaluation scale, ADL, and IADL was conducted at participants’ homes one week after discharge and one month and six months after returning home in order to evaluate participants’ activity recovery after surgery. The participants in this fracture liaison service showed a significant progress in their scores in GDS, ADL, physical activity, gait and balance evaluation, and self-care knowledge after receiving rehabilitation-based care services from a multidisciplinary medical team. In Taiwan, the one-year mortality rate for older adults with hip fractures after surgery is 14.6%. The corresponding mortality rate for the elderly in this study was only 4%. The results of this study illustrate the integrated post-surgery intervention provided by a multidisciplinary medical team to older adults with hip fractures. Evaluation of environmental safety and provision of recommendations regarding environmental improvement effectively improved post-discharge physical activity of hip fracture patients and reduced the risk of recurrent falls, fracture incidence, and mortality rate for the first year after surgery.