研究生: |
楊婷婷 Yang, Ting-Ting |
---|---|
論文名稱: |
老人跌倒預防介入計畫在預防跌倒相關傷害上之效果:探索性統合分析之應用 The preventive effects on fall related injuries of elderly fall prevention programs: an exploratory meta-analysis |
指導教授: |
郭鐘隆
Guo, Jong-Long |
學位類別: |
碩士 Master |
系所名稱: |
健康促進與衛生教育學系 Department of Health Promotion and Health Education |
論文出版年: | 2016 |
畢業學年度: | 104 |
語文別: | 中文 |
論文頁數: | 93 |
中文關鍵詞: | 跌倒預防介入計畫 、統合分析 、相關傷害 、效果量 |
英文關鍵詞: | prevention program, meta-analysis, injury, effect size |
DOI URL: | https://doi.org/10.6345/NTNU202203800 |
論文種類: | 學術論文 |
相關次數: | 點閱:305 下載:42 |
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目的:在老人許多的健康問題中,跌倒是影響老年人健康及獨立生活之重要危險因子,過去關於跌倒預防介入計畫的研究已有證據指出實施多元計畫較單一計畫有效,但相關研究皆偏重在於降低跌倒發生率,忽略了實施老人跌倒預防計畫後是否有效降低跌倒發生後的相關傷害。本研究期望評值跌倒預防介入計畫對於預防跌倒後相關傷害之成效,並探討預防介入計畫的特徵變項對效果量的影響。
方法:本研究運用探索性統合分析,自西元1996年至西元2016年以英文發表之期刊為研究對象,計算跌倒預防介入計畫的綜合效果及在相關傷害上的預防效果。
結果:確認跌倒預防介入計畫對預防跌倒相關傷害有顯著效果(Effect size=0.855;95% CI=0.753~0.971;Z=-2.417;p=0.016),但對預防骨折卻無顯著效果(Effect size=0.802;95%CI=0.627~1.025;Z=-1.766; p=0.077)。其預防介入計畫的研究特徵中,高品質的研究有顯著效果量;樣本特徵中:男女皆含、跌倒史大於15%、跌倒傷害史小於30%、獨居大於50%的研究有顯著的效果量;介入特徵中:研究地點為社區、介入時數≦11小時及12~100小時、多元介入方式、有醫療專業背景介入皆有顯著效果量。特徵項目與相關傷害之相關性可提供給後續決策者、臨床工作者及研究者進行介入時的參考方向,並可減少相同研究的複製及節省介入規劃投入的成本、時間與精力。
Purpose:
Among various health issues, falls have become a critical risk factor that influence health and independent living for elderly. Previous studies suggested that multidisciplinary prevention programs be more effective than single dimensional ones. Reduction of fall incidence was generally emphasised in earlier research, the effectiveness of reducing fall-related injuries after the implementation of elderly fall-prevention intervention, however, was ignored. The objective of this study was to evaluate the effectiveness of fall-prevention intervention on related injuries cuased after falling, then to determine characteristics variables effects of prevention program on effect size.
Method:
An exploratory meta-analysis was applied on the English-published paper reported during 1996-2016. Summary effect of fall-prevention programs and preventive effect of on related injuries were computed.
Results:
This study confirmed that fall-prevention intervention programs had significant effect on related injuries caused after falling(Effect size=0.855;95% CI=0.753~0.971;Z=-2.417;p=0.016), but no effect on fracture(Effect size=0.802;95%CI=0.627~1.025;Z=-1.766; p=0.077). Regarding the research characteristic of the fall prevention programs, the papers with high quality obtained significant effect size; in terms of sample characteristic, research with both gender included, a falling history larger than 15%, traumatizing falling history less than 30%, and independent living rate more that 50% were found to have significant effect size; concerning intervention characteristic, studies conducted in the communities, with intervention duration less than or equal to 11 hours or between 12 to 100 hours, multidisciplinary intervention approaches, and with medical background all secured a significant effect size. The relationship between characteristic variables and injuries followed by falling were found and could be served as reference for future intervention. Replication of similar studies could be reduced and cost and effort put into intervention planning could be saved.
參考文獻
中文部份
李亞芸、吳英、蔡亦為、李雪楨、王瑞瑤、楊雅如 (2006)。 運動訓練對預防老年女性跌倒之效益: 統合分析。物理治療, 31(5), 273-284。
李宗育、陸鳳屏、詹鼎正 (2014)。老年人跌倒之危險因子、評估、及預防。內科學誌, 25(3),137-142。
李茂能(2015)。傳統整合分析理論與實務:ESS&EXCEL。臺北市:五南圖書出版公司。
林正祥、劉士嘉 (2013)。 台灣老人成功與活躍老化之健康餘命探討。臺灣公共衛生雜誌, 32(6),562-575。
林茂榮、王夷暐 (2004)。 社區老人跌倒的危險因子與預防。臺灣公共衛生雜誌, 23(4),259-271。
林茂榮、黃慧芬 (2008)。 老人跌倒之預防介入策略。臺灣公共衛生雜誌, 27(6),447-462。
林碧珠(2001)。髖骨骨折跌倒相關特性及其對老人影響之研究。公共衛生,28(1),49-60。
行政院衛生福利部:衛生福利統計專區(2016)。103年度死因統計。2016年07月01日,取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5488
徐慧娟、張明正 (2004)。臺灣老人成功老化與活躍老化現況:多層次分析。台灣社會福利學刊,3(2),1-36。
張念慈、楊南屏、李建賢、周碧瑟 (2008)。單次跌倒與反覆跌倒之盛行率與相關因素探討-以都會區老人為例。臺灣公共衛生雜誌, 27(4), 330-340。
張哲誌、周騰達 (1991)。 老人跌倒的預防(上)。 基層醫學,9(9),170-174
梁偉成、紀煥庭、胡名霞、林茂榮 (2005)。社區老人跌倒機轉與傷害嚴重度。物理治療, 30(3), 105-115。
郭鐘隆、張鈞恵、林靜兒、蔡益堅 (2009)。16 週跌倒預防介入對社區及安養機構老人之成效初探• 健康生活與成功老化學刊, 1 (1), 53-67。
陳美芳、林家綾、蔡宗廷、朱素鳳、洪淑玲、顏碧汝等人 (2013)。 以系統性文獻回顧探討台灣居家老年人跌倒之相關或危險因素。臺灣公共衛生雜誌, 32(5), 403-423。
曾雅梅、余承萍、賴冠郎、高森永 (2012)。長期照護機構高風險群老人跌倒因素與防跌課程介入成效之探討。臺灣公共衛生雜誌, 31(3),263-276。
國民健康署(2014)。2014國健署中文年報。2016年07月01日,取自http://www.hpa.gov.tw/BHPNet/Portal/file/FormCenterFile/201410240949220444/2014國健署中文年報.pdf
黃子庭、廖秀珠(1993)。台北市北投區社區居家老人跌倒的情形及其相關因素之探討。公共衛生,20,234-45。
黃少君、陳曾基、周碧瑟 (2005)。石牌地區老年人跌倒累積發生率及其相關因素之探討。臺灣公共衛生雜誌, 24(2),136-145。
黃寶園 (2006)。 心理與教育研究法。台北市: 華立圖書。
葉兆斌、周明智、林榮一、王世名 (2003)。跌倒意外事件的流行病學分析。中華民國重症醫學雜誌,5(2),96-109。
詹莉君 (2004)。 老人跌倒的危險因子: 長期追蹤研究(未出版之碩士論文)。亞洲大學健康管理學系,台中市。
鄒曉婷、郭冠良、何清幼、吳岱穎、陳淑廷、周佑霖 (2016)。 獨居與非獨居長者健康狀況之比較。北市醫學雜誌, 13(1), 47-60。
蔡素蘭、林茂榮 (2002)。跌倒對台灣鄉村社區老人日常生活活動能力衰退與害怕跌倒心理的影響。物理治療, 27(4),155-164。
蔡鎰隆、劉胤廷、張宏博 (2004)。 整合分析之探討與應用-文獻回顧。中華民國齒顎矯正學雜誌, 16(1),頁 36-40。
衛生福利部台灣病人安全資訊網。台灣病人安全通報系統2015年TPR年報。2016年08月10日,取自
http://www.patientsafety.mohw.gov.tw/Content/Downloads/list01.aspx?&SiteID=1&MenuID=621273303702500244&SSize=10&CatID=621304160331571433
英文部份
Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American journal of public health, 82(7), 1020-1023.
Aschkenasy, M. T., & Rothenhaus, T. C. (2006). Trauma and falls in the elderly. Emergency medicine clinics of North America, 24(2), 413-432.
Barker, A., Morello, R., Wolfe, R., Brand, C., Haines, T., Hill, K., . . . Livingston, P. (2016). 6-PACK programme to decrease fall injuries in acute hospitals: Cluster randomised controlled trial.
Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community‐based group exercise improves balance and reduces falls in at‐risk older people: a randomised controlled trial. Age and ageing, 32(4), 407-414.
Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., Walter-Jung, B., & Nikolaus, T. (2003). Effectiveness of a multifaceted intervention on falls in nursing home residents. Journal Of The American Geriatrics Society, 51(3), 306-313.
Borenstein, M., Cooper, H., Hedges, L., & Valentine, J. (2009). Effect sizes for continuous data. The handbook of research synthesis and meta-analysis, 2, 221-235.
Campbell, A. J., Robertson, M. C., La Grow, S. J., Kerse, N. M., Sanderson, G. F., Jacobs, R. J., . . . Hale, L. A. (2005). Randomised controlled trial of prevention of falls in people aged≥ 75 with severe visual impairment: the VIP trial. British Medical Journal, 331(7520), 817.
Chinn, S. (2000). A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in medicine, 19(22), 3127-3131.
Chu, Y.-H., Tang, P.-F., Peng, Y.-C., & Chen, H.-Y. (2013). Meta-analysis of type and complexity of a secondary task during walking on the prediction of elderly falls. Geriatrics & Gerontology International, 13(2), 289-297. doi:10.1111/j.1447-0594.2012.00893.x
Close, J., Ellis, M., Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (1999). Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet, 353(9147), 93-97.
Cumming, R. G., Sherrington, C., Lord, S. R., Simpson, J. M., Vogler, C., Cameron, I. D., & Naganathan, V. (2008). Cluster Randomised Trial of a Targeted Multifactorial Intervention to Prevent Falls among Older People in Hospital. British Medical Journal, 758-760.
Cohen, J. (1977). Statistical power analysis for the behavioral sciences (revised ed.): New York: Academic Press.
Davison, J., Bond, J., Dawson, P., Steen, I. N., & Kenny, R. A. (2005). Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial. Age and ageing, 34(2), 162-168.
Dyer, C. A., Taylor, G. J., Reed, M., Dyer, C. A., Robertson, D. R., & Harrington, R. (2004). Falls prevention in residential care homes: a randomised controlled trial. Age and ageing, 33(6), 596-602.
El-Khoury, F., Cassou, B., Charles, M.-A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. British Medical Journal, 347.
Elley, C. R., Robertson, M. C., Garrett, S., Kerse, N. M., McKinlay, E., Lawton, B., . . . Campbell, A. J. (2008). Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults. Journal Of The American Geriatrics Society, 56(8), 1383-1389.
Fitzharris, M. P., Day, L., Lord, S. R., Gordon, I., & Fildes, B. (2010). The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates. Age and ageing, 39(6), 728-733. doi:10.1093/ageing/afq109
Gates, S., Fisher, J. D., Cooke, M., Carter, Y., & Lamb, S. (2008). Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. British Medical Journal, 336(7636), 130-133.
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H.(2009).Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2.
Glass, G. V., Smith, M. L., & McGaw, B. (1981). Meta-analysis in social research: Sage Publications, Incorporated.
Greubel, D., Stokesberry, C., & Jelley, M. (2002). Preventing costly falls in long-term care. The Nurse Practitioner, 27(3), 83.
Guo, J. L., Tsai, Y. Y., Liao, J. Y., Tu, H. M., & Huang, C. M. (2014). Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta‐analysis. International Journal Of Geriatric Psychiatry, 29(7), 661-669.
Haines, T. P., Hill, A., Hill, K. D., & et al. (2011). Patient education to prevent falls among older hospital inpatients: A randomized controlled trial. Archives of Internal Medicine, 171(6), 516-524.
Hendriks, M. R., Bleijlevens, M. H., Van Haastregt, J., Crebolder, H. F., Diederiks, J. P., Evers, S. M., . . . Ruijgrok, J. M. (2008). Lack of Effectiveness of a Multidisciplinary Fall‐Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial. Journal Of The American Geriatrics Society, 56(8), 1390-1397.
Hill-Westmoreland, E. E., Soeken, K., & Spellbring, A. M. (2002). A Meta-Analysis of Fall Prevention Programs for the Elderly: How Effective Are They? Nursing Research, 51(1), 1-8.
Hill, A.-M., Etherton-Beer, C., & Haines, T. P. (2013). Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge—a pilot randomized controlled trial. PLoS ONE, 8(5), e63450.
Ho, S. C., Woo, J., Chan, S. S., Yuen, Y., & Sham, A. (1996). Risk factors for falls in the Chinese elderly population. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 51(5), M195-M198.
Hubacher, M., & Wettstein, A. (2001). Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, 12(9), 794-799.
Hunter, J. E., Schmidt, F. L., & Jackson, G. B. (1982). Meta-analysis: Cumulating research findings across studies (Vol. 4): Sage Publications, Inc.
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled clinical trials, 17(1), 1-12.
Jensen, J., Lundin-Olsson, L., Nyberg, L., & Gustafson, Y. (2002). Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Annals Of Internal Medicine, 136(10), 733-741.
Jensen, J., Nyberg, L., Gustafson, Y., & Lundin-Olsson, L. (2003). Fall and injury prevention in residential care--effects in residents with higher and lower levels of cognition. Journal Of The American Geriatrics Society, 51(5), 627-635.
Kannus, P., Parkkari, J., Koskinen, S., Niemi, S., Palvanen, M., Järvinen, M., & Vuori, I. (1999). Fall-induced injuries and deaths among older adults. Jama, 281(20), 1895-1899.
Karinkanta, S., Kannus, P., Uusi-Rasi, K., Heinonen, A. R. I., & SievÄNen, H. (2015). Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study. Age & Ageing, 44(5), 784-789. doi:10.1093/ageing/afv064
Karinkanta, S., Kannus, P., Uusi-Rasi, K., Heinonen, A. R. I., & SievÄNen, H. (2015). Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study. Age & Ageing, 44(5), 784-789. doi:10.1093/ageing/afv064
Kerse, N., Butler, M., Robinson, E., & Todd, M. (2004). Fall prevention in residential care: a cluster, randomized, controlled trial. Journal Of The American Geriatrics Society, 52(4), 524-531.
Kim, H., Yoshida, H., & Suzuki, T. (2014). Falls and fractures in participants and excluded non-participants of a fall prevention exercise program for elderly women with a history of falls: 1-year follow-up study. Geriatrics & Gerontology International, 14(2), 285-292.
Lange, M. (1996). The challenge of fall prevention in home care: a review of the literature. Home healthcare nurse, 14(3), 198-206.
Logan, P. A., Coupland, C. A., Gladman, J. R., Sahota, O., Stoner-Hobbs, V., Robertson, K., . . . Avery, A. J. (2010). Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. British Medical Journal, 340, c2102.
Lord, S. R., Tiedemann, A., Chapman, K., Munro, B., Murray, S. M., Gerontology, M., . . . Sherrington, C. (2005). The Effect of an Individualized Fall Prevention Program on Fall Risk and Falls in Older People: A Randomized, Controlled Trial. Journal Of The American Geriatrics Society, 53(8), 1296-1304.
McMurdo, M. E., Millar, A. M., & Daly, F. (2000). A randomized controlled trial of fall prevention strategies in old peoples’ homes. Gerontology, 46(2), 83-87.
Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Järvinen, M. (2014). Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomised controlled trial. Injury, 45(1), 265-271.
Patil, R., Uusi‐Rasi, K., Tokola, K., Karinkanta, S., Kannus, P., & Sievänen, H. (2015). Effects of a Multimodal Exercise Program on Physical Function, Falls, and Injuries in Older Women: A 2‐Year Community‐Based, Randomized Controlled Trial. Journal Of The American Geriatrics Society, 63(7), 1306-1313.
Pekkarinen, T., Löyttyniemi, E., & Välimäki, M. (2013). Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women. Osteoporosis International, 24(12), 2983-2992.
Rekeneire, N., Visser, M., Peila, R., Nevitt, M. C., Cauley, J. A., Tylavsky, F. A., . . . Harris, T. B. (2003). Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. Journal Of The American Geriatrics Society, 51(6), 841-846.
Robertson, M. C., Devlin, N., Gardner, M. M., & Campbell, A. J. (2001). Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. Bmj, 322(7288), 697.
Rosenthal, R. (1991). Meta-analytic procedures for social research (Vol. 6): Sage Publications, Incorporated.
Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35(suppl 2), ii37-ii41.
Russell, M. A., Hill, K. D., Day, L. M., Blackberry, I., Schwartz, J., Giummarra, M. J., . . . Dharmage, S. C. (2010). A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments. Journal Of The American Geriatrics Society, 58(12), 2265-2274.
Salminen, M. J., Vahlberg, T. J., Salonoja, M. T., Aarnio, P. T., & Kivelä, S. L. (2009). Effect of a Risk‐Based Multifactorial Fall Prevention Program on the Incidence of Falls. Journal Of The American Geriatrics Society, 57(4), 612-619.
Sanders, K. M., Stuart, A. L., Williamson, E. J., Simpson, J. A., Kotowicz, M. A., Young, D., & Nicholson, G. C. (2010). Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. Jama, 303(18), 1815-1822.
Scott, V., Bawa, H., Votova, K., Rajabali, F., Han, G., Swan, L., & Gallagher, E. (2006). Strategies and action for independent living (SAIL) 2: The effectiveness of a multifaceted prevention program for the reduction of falls and injury among home support clients. Vancouver, BC: British Columbia Injury Research and Prevention Unit.
Scuffham, P., Chaplin, S., & Legood, R. (2003). Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of epidemiology and community health, 57(9), 740-744.
Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landendoerfer, P., . . . Blank, W. A. (2016). Fall Prevention in a Primary Care Setting: The Effects of a Targeted Complex Exercise Intervention in a Cluster Randomized Trial. Deutsches Ärzteblatt International, 113(21), 365.
Spice, C. L., Morotti, W., George, S., Dent, T. H., Rose, J., Harris, S., & Gordon, C. J. (2009). The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age and ageing, 38(1), 33-40.
Stel, V. S., Smit, J. H., Pluijm, S. M., & Lips, P. (2004). Consequences of falling in older men and women and risk factors for health service use and functional decline. Age and ageing, 33(1), 58-65.
Talbot, L. A., Musiol, R. J., Witham, E. K., & Metter, E. J. (2005). Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health, 5(1), 1.
Tinetti, M. E. (1994). Prevention of falls and fall injuries in elderly persons: a research agenda. Preventive Medicine, 23(5), 756-762.
Tinetti, M. E. (2003). Preventing falls in elderly persons. New England Journal of Medicine, 348(1), 42-49.
Tinetti, M. E., Doucette, J. T., & Claus, E. B. (1995). The Contribution of Predisposing and Situational Risk Factors to Serious Fall Injuries. Journal Of The American Geriatrics Society, 43(11), 1207-1213.
Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk Factors for Falls among Elderly Persons Living in the Community. New England Journal of Medicine, 319(26), 1701-1707.
Vassallo, M., Vignaraja, R., Sharma, J. C., Hallam, H., Binns, K., Briggs, R., . . . Allen, S. (2004). The effect of changing practice on fall prevention in a rehabilitative hospital: the Hospital Injury Prevention Study. Journal Of The American Geriatrics Society, 52(3), 335-339.
Verma, S. K., Willetts, J. L., Corns, H. L., Marucci-Wellman, H. R., Lombardi, D. A., & Courtney, T. K. (2016). Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States. PLoS ONE, 11(3), 1-14. doi:10.1371/journal.pone.0150939
Vind, A. B., Andersen, H. E., Pedersen, K. D., Jørgensen, T., & Schwarz, P. (2009). An Outpatient Multifactorial Falls Prevention Intervention Does Not Reduce Falls in High-Risk Elderly Danes. Journal Of The American Geriatrics Society, 57(6), 971-977.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., . . . Milisen, K. (2015). Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials. Journal Of The American Geriatrics Society, 63(2), 211-221. doi:10.1111/jgs.13254
Weir, E., & Culmer, L. (2004). Fall prevention in the elderly population. Canadian Medical Association Journal, 171(7), 724-724