肌力與高齡者髖部骨折相關性、評估與處置

Assessment and Treatment of Muscle Strength with Hip Fracture in Elderly Patients

全球人口老化，高齡社會面臨年長者醫療照護需求增加。2017年台灣老人十大死因第十名為事故傷害，老化造成的肌力下降為老人跌倒主因，跌倒所造成的骨折則以髖部骨折為大宗，老人髖部骨折已成為我國重要的公共衛生議題。肌力強弱是老年人執行日常生活功能的一項重要指標，手部握力為評估肌力的主要方式之一，且手部握力可作為接受髖部骨折手術之年長者術後半年功能回復之獨立指摽。肌力的客觀評估工具有計時五次坐站測試、徒手肌力測試以及手部握力，主觀評估工具則可用巴氏量表評估老人獨立執行日常生活功能情形。高齡髖部骨折患者建議在骨折後48小時內接受手術，以降低併發症及死亡率。術後護理措施重點為協助病患恢復身體功能，預防活動功能障礙之惡化。針對老人肌少症在營養方面應補充蛋白質及維生素D，並設計適合老人的肌力訓練運動以增加肌肉量並可預防跌倒。本文期望提供醫療人員在照顧肌力衰減年長者之參考，對有肌少症的老人應早期提供預防性衛教與適當的措施，以減少老人髖部骨折發生率。

As the global population is aging, demand for medical care among the elderly is increasing. Falling accidents were the tenth most common cause of death for the geriatric population of Taiwan in 2017. The agerelated decline in muscle strength is one of the major causes of such falling, which causes hip fracture. The number of hip fractures is also increasing as the population ages, highlighting the importance of associated medical costs and prevention programs. Muscle strength is an important indicator of the quality of life of the elderly. Hand grip strength, which reflects muscle strength more generally, is an independent factor that predicts the functional recovery of elderly patients following hip fracture surgery. An objective assessment of muscle strength involves timed five-chair standing (TCS), the manual muscle power test (MMT) and the assessment of hand grip strength; methods of subjective assessment include use of the Barthel index to evaluate independent everyday activities of the geriatric population. Additionally, geriatric patients are recommended to receive hip surgery within 48 hours following hip fracture to reduce their mortality and complications. Post-operative nursing care should accelerate reablement to prevent decline in everyday activity. Nutritional supplements with protein and vitamin D along with resistance training exercise to improve muscle strength can prevent falling accidents among the elderly. Therefore, this review article discusses the correlations among muscle strength, hand grip strength and recovery following hip fracture in the aging population, providing a reference for evaluating the attenuation of muscle strength and its relationship with outcomes for the elderly following hip fracture.