簡易檢索 / 詳目顯示

研究生: 洪麗玲
Li-Ling, Hung
論文名稱: 社區老人跌倒相關因素模式之研究
A Model of Fall Correlates in Community-Dwelling Older Adults
指導教授: 郭鐘隆
Guo, Jong-Long
學位類別: 博士
Doctor
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: 2011
畢業學年度: 99
語文別: 中文
論文頁數: 143
中文關鍵詞: 社區老人PRECEDE模式跌倒模式環境支持跌倒預防行為效能
英文關鍵詞: community-dwelling older adult, PRECEDE model, fall model, environmental support, self-efficacy of fall prevention
論文種類: 學術論文
相關次數: 點閱:236下載:68
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 高齡化社會的來臨,跌倒是影響社區老年人健康及失能之重要因素,因此,老人跌倒是公共衛生重要議題。本研究係以社區為基礎的橫斷性調查研究,主要目的係應用PRECEDE模式為架構,探討社區老人跌倒現況及建構與驗證社區老人的跌倒模式。
    方法:研究對象採立意取樣,以台灣地區各縣市參與保命防跌計畫班的65歲以上老年人為主,自2008年3月至6月收集資料,總共來自42個社區,計904名社區老人為研究樣本。應用PRECEDE模式,配合結構式問卷及身體功能檢測,進行社會人口學變項、跌倒預防知識、信念、行為效能、環境支持、身體功能及跌倒相關資訊等資料收集。主要統計分析方法包括統合分析、邏輯斯廻歸分析及結構方程模式分析,建立及驗證社區老人跌倒相關因素模式。
    結果:主要研究結果分為四部份:第一部份,社區老年人過去一年跌倒發生率為16.92%。第二部份統合分析(社區來源)結果顯示,增強因素中「慢性病」及「輔助器使用」與過去一年跌倒發生率間的成效值介於微弱和中等效果之間。第三部份邏輯斯迴歸分析結果顯示素質因素之「跌倒預防知識」;使能因素之「行為效能」、「支持性環境」、「反應時間」、「二十尺行走距離時間」及增強因素之「獨居」、「輔助器使用」及「慢性病」等為社區老人跌倒重要預測因子;判別分析整體預測分類的百分比為82.9%。第四部份,本研究模式經修正後與資料的適合度良好,參數估計結果與關係的方向性皆與理論相符合。潛在變項「增強因素」對潛在依變項「跌倒狀況」的解釋力最大,且其徑路係數達顯著水準;其次為「素質因素」;最後則為「使能因素」。
    結論:社區老人跌倒是多重因素結構,本研究嘗試以PRECEDE模式之架構及結構方程模式分析,測試社區老人跌倒相關因素模式的研究,模式經修正後與資料的適合度良好,「增強因素」是社區老人最重要結構因素,研究結果可應用在老人跌倒預防計畫及政策擬定之依據。

    關鍵字:社區老人、PRECEDE模式、跌倒模式、環境支持、跌倒預防行為效能

    With the advent of an aging society, falls are the most common and serious public health issue for older adults. Along with significant health and disability impacts, Moreover, falls are leading cause of injury-related death among the elderly. The aims of this study were to investigate the incidences of falling and test a model that explains the relationships between the correlates of falling among the community-dwelling elderly within the framework of the PRECEDE model, through a community- base and by using a cross-sectional survey.
    Method: Purposive samples of older adults were living in 42 communities in Taiwan were selected to participate in the fall prevention program, A total of 904 subjects aged 65 years and above. Based upon PRECEDE model and used structured questionnaires, including personal profiles and scales to obtain data on the knowledge, health beliefs, self-efficacy of fall prevention, environmental support, and physical function. Meta-analysis, logistic regression, and structural equation modeling analysis were performed as the main statistical methods.
    Results: The main findings were divided into four sections: First, 16.92% of the subjects had suffered from falls in the past year. Second, the meta-analysis (Community sources) showed that “chronic disease” and “use of assistive devices” were the major relevant factors among the reinforcing factors are significantly related to incidences of falls in the preceding year; the effect sizes r value was between small and medium. Third, logistic regression identified the following significant predictors of falls were: “knowledge of fall prevention” among the predisposing factor; “self-efficacy of fall prevention,” “supportive environment,” “reaction time,” “20-meters walking test, ” among the enabling factors; and “living alone,” “use of assistive devices, ” and “chronic disease” among the reinforcing factors. Discriminant analysis showed that classified the percentage of the overall prediction was 82.9%. Fourth, after model modefication, the results indicated a good model fit, and parameter estimates and the direction of the relationship were consistent with the theory. The significant path coefficients with “reinforcing factor,” followed by “prediposing factor,” and finally “enabling factor.”
    Conclusion: The above model had a multifactor structure. This study is base upon PRECEDE model framework and uses structural equation modeling to explain the fall model. The results indicated a good model fit . Thus, future programs and policies can apply this model to prevent falls.
    Keywords: community-dwelling older adult, PRECEDE model, fall model, environmental support, self-efficacy of fall prevention

    誌 謝 I 摘 要 II ABSTRACT IV 目 錄 VI 圖表目錄 IX 第一章 緒論 1 第一節 研究動機與重要性 1 第二節 研究目的 5 第三節 研究問題 5 第四節 研究假設 6 第五節 名詞界定 6 第二章 文獻探討 9 第一節 老人跌倒流行病學分析 9 第二節 跌倒對老人的影響 16 第三節 PRECEDE模式及其應用 22 第四節 社區老人跌倒的相關影響因素 27 第三章 研究方法 45 第一節 研究設計 45 第二節 研究架構 45 第三節 研究對象 47 第四節 研究工具 48 第五節 研究流程 53 第六節 資料處理與分析 56 第四章 研究結果 63 第一節 社區老人的社會人口學變項、跌倒相關變項及過去一年跌倒的狀況 63 第二節 以統合分析方法分析素質因素、使能因素、增強因素與過去一年跌倒發生率間的關係 68 第三節 社區老人過去一年跌倒發生率預測之邏輯斯迴歸及判別分析 84 第四節 以結構方程模式驗證理論模式 88 第五章 討 論 95 第一節 社區老人的社會人口學變項、跌倒相關變項及過去一年跌倒的狀況 95 第二節 社區層次社區老人之素質、使能、增強因素與過一年跌倒發生率間之關係 97 第三節 社區老人之素質、使能、增強因素對過去一年跌倒發生之預測 101 第四節 社區老人之素質、使能、增強因素對過一年跌倒發生率之模式驗證 108 第五節 研究限制 110 第六章 結論與建議 113 第一節 結論 113 第二節 建 議 115 參考文獻 119 中文部份 119 英文部份 125

    中文部份
    內政部統計處(2010)。重要參考指標。2011年3月15日,取自http://sowf.moi.gov.tw/stat/indices/list.xls#Sheet1!R3C2
    王秀媞、王瑞霞(2000)。以PRECEDE模式探討五專生愛滋病預防行爲意圖。護理研究,8(3),349-361。
    王國川(1997)。從PRECEDE模式中教育與行為診斷來探討青少年事故傷害發生之影響因素。台灣師範大學學報,42,75-93。
    行政院經濟建設委員會(2008年,8月)。中華民國臺灣97年至145年人口推計報告。2010年6月15日,取自http://www.cepd.gov.tw/
    行政院衛生署(2009)。衛生統計資訊網。2009年10月20日,取自 http://www.doh.Gov.tw//statistic/data/生命統計/97/97年衛生統計-生命統計.pdf
    行政院衛生署國民健康局(2007)。1999年與2005年台灣地區老人跌倒狀況之比較。2010年8月25日,取自http://www.bhp.doh.gov.tw/bhpnet/portal/file/ThemeDocFile/200712271149147557/成果報告—研究簡訊—1999年與2005年台灣地區老人跌倒狀況之比較.pdf
    吳文琪、李蘭(2001)。台北市國中生之暴力行為與溝通技巧的關係。台灣公共衛生雜誌,20(4),485-494。
    吳淑瓊,莊坤洋(2001)。在地老化:臺灣二十一世紀長期照護的政策方向。台灣公共衛生雜誌,20(3),192-201。
    李蘭、晏涵文(2002)。健康教育與健康促進。陳拱北預防醫學基金會主編:公共衛生學(下冊)。修訂二版。台北:巨流圖書。
    林茂榮、王夷暐(2004)。社區老人跌倒的危險因子與預防。台灣公共衛生雜誌,23(4),259-271。
    林茂榮、胡名霞、曹昭懿、李世代、張淑惠、王慧如(2004)。社區老人的平衡測量、跌倒後處理、與運動。國家科學委員會專題研究計畫成果報告。
    林茂榮、黃慧芬(2008)。老人跌倒之預防介入策略。台灣公共衛生雜誌,27(4),447-462。
    林茂榮、蔡素蘭、陳淑雅、曾信嘉(2002)。台灣中部某鄉村社區老人跌倒危險之因子。台灣公共衛生雜誌,21(4),73-82。
    林淑芬、高毓秀(2008)。機構高血壓老人預防跌倒行爲相關因素之探討。健康促進與衛生教育學報,29,99-171。
    林莉茹、李蘭、莊莉菁、郭寶貞、白璐(2010)。運用PRECEDE模式評估某社區之事故傷害問題。台灣公共衛生雜誌,29(4),314-325。
    林碧珠(2004)。髖部骨折老人出院過渡期主要照顧者照顧經驗之探討。新臺北護理期刊,6(1),57-67。
    邱啟潤、吳瓊滿、王瑞霞、李淑婷(1999)。以PRECEDE模式分析老人健康檢查的行為。The Kaohsiung Journal of Medical Sciences,15(6),348-358。
    邱皓政(2003)。青少年自我概念向度與成份雙維理論之效度檢驗與相關因素研究。教育與心理研究,26(1),85-131。
    邱寶萱(2003)。預防社區老人跌倒介入研究之前驅研究:城鄉之比較。國立臺灣師範大學衛生教育研究所碩士論文,未出版。台北。
    唐美蓮(2008)。預防老人屌居家環境改善之成本效益分析。亞洲大學長期照護研究所學位論文,未出版,台中。
    夏語婷(2009)。南台灣某鄉三個社區中老年人跌倒相關因素之長期追蹤研究。國立台灣師範大學健康促進與衛生教育學系碩士論文,未出版。台北。
    徐慧娟、張明正(2004)。台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。
    徐慧娟、詹莉君(2008)。台灣老人跌倒危險因子之探討。台灣老年醫學暨老年學雜誌,3(2),141-151。
    秦毛漁、盧德發、吳美惠(2008)。社區老人跌倒相關因素之探討。護理雜誌,55(3),39-48。
    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。台灣公共衛生雜誌,27(4),330-340。
    張鳳琴、蔡益堅、吳聖良(2003)。台灣地區非致命事故傷害狀況。台灣公共衛生雜誌,22(6),492-500。
    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。
    梁章國(2010)。社區跌倒高風險老人之影響因素與介入課程之成效探討。國防醫學院公共衛生學研究所碩士論文,未出版,台北市。
    郭鐘隆、張鈞惠、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。
    陳正昌、程炳林、陳新豐、劉子鍵(2009)。多變量分析方法-統計軟體應用(四版)。臺北:五南。
    陳玉枝、林麗華、簡淑芬(2003)。跌倒危險因子。醫院,36(5),42-53。
    陳怡如(2006)。台北市老人身體活動、功能性體適能與跌倒之模式分析。國立台北大學醫學院護理學研究所博士論文,未出版,台北市。
    陳怡如、黃璉華、鄭舜平(2005)。預防老人跌倒之運動訓練研究趨勢探討。台灣公共衛生雜誌,24(2),93-102。
    陳施妮、孫嘉玲(2008) 。獨居老人健康、生活功能與跌倒概況分析。長期照護雜誌,12(3),249-265。
    傅麗蘭、楊政峰(1999)。獨居老人跌倒情形、步態、居家環境及身體功能評估。中華民國物理治療學會雜誌,24(2),53-62。
    游斯湟、卓俊伶、吳姿瑩、林靜兒(2007)。從限制觀點看老年人跌倒及其預防策略。中華體育季刊,21(1),18-32。
    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性之探討。台灣公共衛生雜誌,24(2),136-145。
    黃荷瑄(2008)。感官與走路功能對老人跌倒之因果關係性研究。中山醫學大學公共衛生研究所碩士論文,未出版,台中市。
    楊文傑、林桑伊(2009)。影響社區居住老人活動相關之跌倒關注程度的因子。物理治療,34(5),288-296。
    劉文良(1999)。老人研究跌傷的多重因子長期追蹤(第三年計畫)。行政院衛生署八十八年度科技研究發展計畫研究報告(報告编:DOH88-TD-1094)。台北:行政院衛生署病病管制局。
    蔡益堅、葉純志、藍祚運、張文瓊、曾德運(2007)。1999年與2005年臺灣地區老人跌倒狀況之比較-2005年國民健康訪問暨藥物濫用調查結果。國民健康訪問調查研究簡訊,9,1-15。
    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的心理的影響。物理治療,27(4),155-164。
    黎家銘、陳晶瑩(2005)。老人跌倒因素的評估與預防。台灣醫學,9(2),277-284。
    賴玫娟(2006)。運用PRECEDE 模式分析老人生活滿意度之多重因素結構。國立臺灣師範大學衛生教育研究所碩士論文,未出版。台北。
    聯合國(2006)。2002年國際人口老化行動策略。2008年10月21日,取自http://www.who.int/hpr/ageing/Active Ageing Policy Frame.pdf
    韓玉柑(2004)。吸菸與不吸菸高職進修學校女學生吸菸行為之探討。國立台北護理學院教育研究所碩士論文,未出版,台北。

    英文部份
    Adams, C. K., Cotton, L. M., O’Connell, J., & O’Connell, D. (2007). Performance- orientated mobility assessment in those with mental retardation living in an institutional facility. Topics in Geriatric Rehabilitation, 23(2), 95-101.
    American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. Journal of American Geriatrics Society, 49(5), 664-672.
    Bagozzi, R. P., & Yi., Y. (1988).On the evaluation of structural equation models. Academic of Marketing Science,16,76-94.
    Ballard, J., McFarland, C., Wallace, L., Holiday, D., & Roberson, G. (2004). The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years. Journal Of The American Medical Women's Association, 59(4), 255-261.
    Bandura, A. (1997). Self-efficacy: the exercise of control. New York: Freeman.
    Bath, P. A., & Morgan, K. (1999). Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham. UK. European Journal of Epidemiology, 5(1), 65-73.
    Beard, J., Rowell, D., Scott, D., van Beurden, E., Barnett, L., & Hughes, K. (2006). Economic analysis of a community-based falls prevention program. Public Health, 120(8), 742-751.
    Belgen, B., Beninato, M., Sullivan, P. E., & Narielwalla K.(2006). The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke, The American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation, 87(4), 554-561.
    Bergland, A., & Wyller, T. (2004). Risk factors for serious fall related injury in elderly women living at home. Injury Prevention: Journal Of The International Society For Child And Adolescent Injury Prevention, 10(5), 308-313.
    Biderman, A., Cwikel, J., Fried, A. V., & Galinsky, D. (2001). Deppression and falls aming community dwelling elderly people: A research for common risk factors. Journal of Epidemiology and Community Healt, 56(8), 631-636.
    Binda, S. M., Culham, E. G., & Brouwer, B. (2003). Balance, muscle strength, and fear of falling in older adults. Experimental Aging Research, 29(2), 205-19.
    Blake, A. J., Morgan K, Bendall M. J., et al.(1988). Falls by elderly people at home: prevalence and associated factors. Age and Ageing, 17(6), 365-72.
    Borenstein, M., Hedges L. & Rothstein, H.(2007). Introduction to Meta-Analysis. [online]. Retrieved Jul 5, 2011, from http://www.meta-analysis.com/downloads/Meta%20Analysis%20Fixed%20vs%20Random%20effects.pdf
    Boulgarides, L.K., McGinty, S. M., Willett, J. A., & Barnes, C. W. (2003). Use of clinical. and impairment-based tests to predict falls by community-dwelling older adults. Physical Therapy, 83(4), 329-339.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2008). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved Dec 5, 2010, from http://www.cdc.gov/ncipc/wisqars.
    Centers for Disease Control and Prevention.(2010). Falls Among Older Adults: An Overview. Retrieved Jun 5, 2011, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
    Chan, K., Pang, W., Ee, C., Ding, Y., & Choo, P. (1997). Epidemiology of falls among the elderly community dwellers in Singapore. Singapore Medical Journal, 38(10), 427-431.
    Cheal, B., & Clemson, L.(2001). Older people enhancing self-efficacy in fall-risk situations. Australian Occupational Therapy Journal, 48(2), 80-91.
    Chiang, L., Huang, J., Yeh, K., & Lu, C. (2004). Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children. The Journal of Asthma, 41(2), 205-215.
    Chu, L. W., Chi, I., & Chiu, A. Y. Y. (2005). Incidence and predictors of falls in the Chinese elderly. Annals Academy of Medicine Singapore, 34(1), 60-72.
    Chu, L. W., Chiu, A. Y. Y., & Chi, I. (2008). Falls and subsequent health service utilization in community-dwelling Chinese older adults. Archives of Gerontology and Geriatrics, 46(2), 125-135.
    Classen, S., Garvan, C.W., Awadzi, K., Sundaram, S., Winter, S., Lopez, E.D.S., & Ferren, N. (2006). Systematic literature review and model for older driver safety. Topics inGeriatric Rehabilitation, 22(2), 87-98.
    Cohen, J. (1977). Statistical power analysis for the behavioral sciences (revised edition). New York: Academic Press.
    Commodore, D. I. (1995). Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies. Rehabilitation Nursing, 20(2), 84-89.
    Connell, B., & Wolf, S. (1997). Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group. Archives of Physical Medicine and Rehabilitation, 78(2), 179-186.
    Cooper, H. M. (1989). Integrating research: A guide for literature review (2nd ed.). CA: Sage.
    Cornoni-Huntley, J. C., Foley, D. J., & Guralnik, J. M. (1991). Comorbidity analysis: a strategy for understanding mortality, disability and use of health care facilities of older people. International Journal of Epidemiology, 20(1), 8-17.
    Cumming, R. G., Salkeld, G., Thomas, M., & Szonyi, G. (2000). Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55(5), 299-305.
    Daubney, M.F., & Culham, E.G.(1999). Lower extremity muscle force and balance performancein adults aged 65 years and older. Physical Therapy, 79(12), 1177-1185.
    Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. BMJ (Clinical Research Ed.), 325(7356), 128.
    Delbaere, K., Close, J. C., Heim, J., Sachdev, P., Brodaty, H., Slavin, M. J., Kochan, N. A. & Lord, S. (2010). A multifactorial approach to understanding fall risk in older people. Journal of the American Geriatrics Society, 58(9), 1679-1685.
    DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177-188.
    Donald, I. P., & Bulpitt, C. J. (1999). The prognosis of falls in elderly people living at home. Age and Ageing, 28(2), 121-5.
    Duncan, P. W., Weiner, D. K., Chadler, J., & Studenski, S. (1990). Functional reach: a new clinical measure of balance. Journal of Gerontology: Medical Sciences, 45(6), 192-M197.
    Faber, M. J., Bosscher, R. J., & van Wieringen, P. C. (2006). Clinimetric properties of the performance orientated mobility assessment. Physical Therapy, 86(7), 944-954.
    Faulkner, K., Cauley, J., Zmuda, J., Landsittel, D., Nevitt, M., Newman, A., & Redfern, M. (2005). Ethnic differences in the frequency and circumstances of falling in older community-dwelling women. Journal of The American Geriatrics Society, 53(10), 1774-1779.
    Fletcher, P. C., & Hirdes, J. P. (2002). Risk factors for falling among community-based seniors using home care services. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(8), 504-510.
    Fletcher, P. C., & Hirdes, J. P. (2004). Restriction in activity associated with fear of falling among community-based seniors using home care services. Age and Ageing, 33(3), 273-9.
    Ford, C. L., Miller, W. C., Smurzynski, M., & Leone, P. A. (2007). Key Components of A Theory-Guided HIV Prevention Outreach Model: Pre-Outreach Preparation, Community Assessment, and a Network of Key Informants. AIDS Education and Prevention, 19(2), 173-186.
    Friedman, S. M., Munoz, B., West, S. K., Rubin, G. S., & Fried, L. P. (2002). Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society, 50(8), 1329-1335.
    Gassmann, K. G., Rupprecht, R., & Freiberger, E. (2009). Predictors for occasional and recurrent falls in community-dwelling older people. Zeitschrift Fur Gerontologie Und Geriatrie, 42(1), 3-10.
    Gates, S., Smith, L., Fisher, J., & Lamb, S. (2008). Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. Journal of Rehabilitation Research & Development, 45(8), 1105-1116.
    Gehlsen, G. M., & Whaley, M.H. (1990). Falls in the elderly: Part I, Gait. Archives of Physical. Archives of Physical Medicine & Rehabilitation, 71(10), 735-8.
    Gibson, M., Andres, R., Isaacs, B., Radebaugh, T., & Worm-Petersen, J. (1987). The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Danish Medical Bulletin, 34(4), 1-24.
    Gielen, A., McDonald, E., Wilson, M., Hwang, W., Serwint, J., Andrews, J., & Wang, M. (2002). Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial. Archives of Pediatrics & Adolescent Medicine, 156(1), 33-40.
    Gill, T., Taylor, A. W., & Pengelly, A. (2005). A population-based survey of factors relating to the prevalence of falls in older people. Gerontology, 51(5), 340-345.
    Gillespie, L. D., Gillespie, W. J., Robertson, M. C., Lamb, S. E., Cumming, R. G., & Rowe, B. H. (2003). Interventions for preventing falls in elderly people. Cochrane Database System Review (4): CD000340.
    Gillett, P. A., White, A. T., & Caserta, M. S. (1996). Effect of exercise and/or fitness education of fitness in older, sedentary, obese women. Journal of Aging and Physical Activity, 4(1), 42-55.
    Glanz, K., Lewis, F. M., & Rimer, B.K. (2002). Health Behavior and Health Education (3rd Ed). San Francisco: Jossey-Bass.
    Green, L. W., & Kreuter, M. S. (1992).CDC’s planned approach to
    Community health as an application of PRECEDE and an inspiration for PROCEED. Journal of Health Education,23(3), 140-144.
    Green, L. W., & Kreuter, M. S. (1999). Health promotion planning : an Educational and ecological approach (3rd ed.). Mountain View, CA: Mayfield.
    Grimley-evans (1990). Fallers, non-fallers and Poisson. Age and Ageing, 19, 268-269.
    Hanlon, J. T., Landerman, L. R., Fillenbaum, G. G., & Studenski S. (2002). Fall in African American and white community-dwelling elderly residents. The Jourals of Gerontology, 75A(7), 473-478.
    Harris, J. E., Eng, J. J., Marigold, D. S., Tokuno, C. D., & Louis, C. L. (2005). Relationship of balance and mobility to fall incidence in people with chronic stroke. Physical Therapy, 85(2), 150-158.
    Hauer, K., Lamb, S.E., Jorstad, E.C., Todd, C., & Becker, C.(2006). Systematic Medicine and Rehabilitation, 71 (10), 735-738.
    Hausdorff, J. M., Rios, D. A., & Edelberg, H. K. (2001). Gait variability and fall risk in community-living older adults: A 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82(8), 1050-1056.
    Hawk, C., Hyland, J., Rupert, R., Colonvega, M., & Hall, S. (2006). Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropractic & Osteopathy, 14(1), 3-10.
    Ho, K., O'Sullivan, A., Weissberger, A., & Kelly, J. (1996). Sex steroid regulation of growth hormone secretion and action. Hormone Research, 45(1-2), 67-73.
    Howland, J., Lachman, M. E., Peterson, E. W., Cote, J., Kasten, L., & Jette, A. (1998). Covariates of fear of falling and associated activity curtailment. Gerontologist, 38(5), 549-555.
    Huang, H. C. (2004). A checklist for Assessing the Risk of falls among the Elderly. The Journal of Nursing Research, 12(2), 131-141.
    Huang, T. T. (2005). Home environmental hazards among community-dwelling elderly in Taiwan. The Journal of Nursing Research, 13(1), 49-57.
    Huang, T. T., & Acton, G. J. (2004). Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: Randomized trial. Public Health Nursing, 21(3), 247-256.
    Kario, K., Tobin, J. N., Wolfson, L. I., Wipple, R., Derby, C., Singh, D., Marantz, P. R., & Wassertheil-Smoller, S. (2001). Lower standing systolic blood pressure as a predictor of falls in the elderly: A community-based prospective study. Journal of the American College of Cardiology, 38(1), 246-252.
    Kelly, K. D., Pickett, W., Yiannakoulias, N., Rowe, B. H., Schopfloches, D. P., & Svenson, L. (2003). Medication use and falls in community-dwelling older persons. Age and Ageing, 32(5), 503-509.
    Kline, R. B. (1998). Principles and practice of structure equation modeling. New York: Guilford Press.
    Kreft, I. G. G.& Leeuw, J. D.(1998). Introducing Multilevel Modeling. Newbury Park, CA: Sage
    Kwan, M., Close, J. T., Wai, & Lord, S. R. (2011). Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. Journal of the American Geriatrics Society, 59(3), 536-543.
    Lachman, M. E., Howland, J., Tennstedt, S., Jette, A., Assmann, S., & Peterson, E. W. (1998). Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53(1), 43-50.
    Lamb, S. E., Ferrucci, L., Volapto, S., Fried, L. P., & Guralnik, J. M. (2003). Risk factors for falling ing home-dwelling older women with stroke:The women’s health and study. Stroke, 34(2), 494-501.
    Landi, F., Onder, G., Cesari, M., Zamboni, V., Russo, A., Barillaro, C., & Bernabei, R. (2006). Functional decline in frail community-dwelling stroke patients. European Journal of Neurology: The Official Journal of the European Federation of Neurological Societies, 13(1), 17-23.
    Lee, J. S., Kwok, T., Leung, P. C., & Woo, J. (2006). Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age and Ageing, 35(3), 246-51.
    Legters, K. (2002). Fear of falling. Physical Therapy, 82(3), 264-272.
    Leveille, S. G., Bean, J., Bandeen-Roche, K., Jones, R., Hochberg, M., & Guralnik, J. M. (2002). Musculoskeletal pain and risk for falls in older disabled women living in the community. Journal of the American Geriatrics Society, 50(4), 671-678.
    Li, F. Z., McAuley, E., Fisher, K. J., ,Harmer, P., Chaumeton, N., & Wilson N. (2002). Self-efficacy as a mediator between fear of falling and functional ability in the elderly. Jounal of Aging Health, 14(4), 452-466.
    Li, Y., Cao, J., Lin, H., Li, D., Wang, Y., & He, J. (2009). Community health needs assessment with precede-proceed model: a mixed methods study. BMC Health Services Research, 9(181),1-14.
    Lord, S. R., Ward, J. A., Williams, P., & Anstey, K. J. (1994). Physiological factors associated with falls in older community-dwelling women. Journal of the American Geriatrics Society, 42(10), 1110-7.
    Mackintosh, S. F., Goldie, P., & Hill, K. (2005). Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (> 1 year after stroke) and matched controls. Aging Clinical and Experimental Research, 17(2), 74-81.
    Magini, A., & Lowenthal, D. T. (1998). Drugs and the elderly: how "starting low and going slow" can help avert reactions and interactions. Consultant, 38(5), 1311-4.
    Mann, R., Birks, Y., Hall, J., Torgerson, D. & Watt, I. (2006). Exploring the relationship between fear of falling and neuroticism: a cross-sectional study in community-dwelling women over 70. Age and Ageing, 35(2), 143-7.
    Means, K. M., Rodell, D. E., & O'Sullivan, P. S. (2005). Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. American Journal of Physical Medicine & Rehabilitation. Association of Academic Physiatrists, 84(4), 238-250.
    Michaud, C. M., Murray, C. J. L., & Bloom, B. R. (2001). Burden of Disease-Implications for Future Research. Journal of the American Medical Association, 285(5), 535-539.
    Milisen, K., Detroch, E., Bellens, K., Braes, T., Dierickx, K., & Smeulders, W. (2004). Fall among community-dwelling elderly:a pilot study of prevalence,circumstances and consequences in Flanders. Tijdschr Gerontol Geriatr, 35(1), 15-20.
    Mo, P. H., & Mak, W. S. (2008). Application of the PRECEDE Model to Understanding Mental Health Promoting Behaviors in Hong Kong. Health Education & Behavior, 35(4), 574-587.
    Moretti, R., Torre, P. Antonello, R. M., Cazzato, G., Griggio, S., & Bava, A. (2003). Olanzapine as a treatment of neuropsychiatric disorders of Alzheimer’s disease and other dementias : a 24 month follow-up of 68 patients. American Journal Alzheimers Disease & Other Dementias, 18(4), 205-214.
    Morris, M., Osborne, D., & Hill, K. (2008). Predisposing factors for occasional and multiple falls in older Australians who live at home. Aust Physiother, 50(3), 153-159.
    Nevitt, M. C., Cummings, S. R., & Hudes, E. S. (1991). Risk factors for injurious falls: a prospective study. Journals of Gerontology, 46(5), 164-170.
    Nevitt, M., Cummings, S., Kidd, S., & Black, D. (1989). Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA: The Journal Of The American Medical Association, 261(18), 2663-2668.
    Niino, N., Kozakai, R., & Eto, M. (2003). Epidemiology of falls community-dwelling elderly people. Nippon Ronen Igakkai Zasshi. Japanese Journal of geriatrics,, 40(5), 484-486.
    Nitz, J, C. & Choy, N. L. (2004). The efficacy of a specific balance-strategy training programme for preventing falls among older people:a pilot randomized controlled trial. Age and Ageing, 33(1), 52-58.
    Northridge, M. E., Nevitt, M. C., Kelsey, J. L., & Link, B. (1995). Home hazards and falls in the elderly: the role of health and functional status. American Journal of Public Health, 85(4), 509-515.
    Ory, M. G., Schechtman, K. B., Miller, J. P., Hadley, E. C., Fiatarone, M. A., Province, M. A., Arfken, C. L., Morgan, D., Weiss, S., & Kaplan M. (1993). Frailty and injuries in later life: the FICSIT trials. Journal of the American Geriatrics Society, 41(3), 283-296.
    Pavol, M. J., Owings, T. M., Foley, K. T., & Grabiner, M. D. (1999). Gait characteristics as risk factors for falling from trips induced in older adults. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 54A(11), 583-90.
    Perracini, M. R. & Ramos, L. R. (2002). Fall-related factors in a cohort of elderly community residents. Revista de Saude Publica, 36(6), 708-716.
    Petrella, R. J., Payne, M., Myers, A., Overend, T., & Chesworth, B. (2000). Physical function and fear of falling after hip fracture rehabilitation in the elderly. American Journal of Physical Medicine & Rehabilitation, 79(2), 154-60.
    Raiche, M., Hebert, R., Prince, F., & Corriveau, H. (2000). Screening older adults at risk of falling with the Tinetti balance scale. The Lancet, 356(16), 1001-1002.
    Rao, S. (2005). Prevention of fall in older patients. American Family Physician, 72(1), 81-88.
    Robltalle, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., & Corriveau, H. T. (2005). Moving forward in fall prevent :An intervention to improve balance among older adults in real-world setting. American Journal of Public Health, 95(11), 2049-2056.
    Rosenthal, R. (1991). Meta-analytic procedures for social research. Newbury Park, CA: Sage.
    Rowe, J.W. , Kahn, R.L. (1997). Successful aging. Gerontologist, 37, 433-440.
    Rubenstein, L. Z.(2006). Falls in older people:epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(2), 37-41.
    Rubenstein, L. Z., & Josephson, K. R. (2002). Risk factors for falls: A central role in prevention. Generations, 26(4), 15-21.
    Sai, A., Gallagher, J., Smith, L., & Logsdon, S. (2010). Fall predictors in the community dwelling elderly: a cross sectional and prospective cohort study. Journal of Musculoskeletal & Neuronal Interactions, 10(2), 142-150.
    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.
    Shubert, T. E., Schrodt, L. A., Mercer, V. S., Busy, W. J., & Giuliani, C.A. (2006). Are score on balance screening tests associcated with mobility in older adults. Journal of Geriatric Physical Therapy, 29(1), 33-39.
    Shumway, C. A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy, 80(9), 896-903.
    Shumway, C. A., Ciol, M. A., Gruber, W., & Robinson, C. (2005). Incidence of and risk factors for falls following hip fracture in community-dwelling older adults. Physical Therapy, 85(7), 648-55
    Skelton, D. A., Kennedy, J., & Rutherford, O. M. (2002). Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age and Ageing, 31(2), 119-125.
    Stalenhoef, P. A., Diederiks, J. P., Knitterus, J.A., Kester, A. D., & Crebolder, H. F. (2002). A risk model for the prediction of recurrent falls in community-dwelling elderly:A prospective cohort study. Joural of Clinical Epidermiology, 55(11), 1088-1094.
    Steinweg, K. K. (1997). The changing approach to falls in the elderly. American Family Physician, 56(7), 1815-1823.
    Stevens, J. A., Corso, P. S., Finkelstein, E. A., & Miller, T. R. (2006). The costs of fatal and non-fatal falls among older adults. Injury Prevention, 12(5), 290-295.
    Stevens, J. A., Mack, K. A., Paulozzi, L. J., & Ballesteros, M. F. (2008). Self-reported falls and fall-related injuries among persons aged >= 65 years-United States, 2006. Journal of Safety Research, 39(3), 345-349.
    Stevens, J. A. & Olson, S. (2000). Reducing falls and resulting hip fractures among older women. Morbidity and Mortality Weekly Report Recommendations Reports, 49(RR-2), 3-12.
    Stevens, J., & Sogolow, E. (2005). Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention, 11(2), 115-119.
    Taaffe, D., & Galvao, D.(2003).Muscle strength but not functional
    performance is associated with falls self-efficacy in older men
    and women. Journal of Science and Medicine in Sport,6(4), 31.
    Tait, C. (1998). Living chemistry sets: how pharmacology and physiology interact in elderly patients. Journal of Emergency Medical Services, 23(11), 56-60.
    Thapa, P. B., Gideon, P., Cost, T.W., Milam, A.B., & Ray, W.A. (1998). Antidepressants and the risk of falls among nursing home resident. New England Journal of Medicine, 339(13), 875-882.
    Tinetti, M. E. & Speechley, M. (1989). Prevention of falls among the elderly. New England Journal of Medicine, 320(16), 1055-9.
    Tinetti, M. E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34(2), 119-126.
    Tinetti, M. E. (2003). Preventing falls in elderly persons. New England Journal of Medicine, 348, 42-49.
    Tinetti, M. E., Doucette, J., Claus, E., & Marottoli, R. (1995). Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatrics Society, 43(11), 1214-21.
    Tinetti, M. E., Doucette, J.T., Claus, E., & Marottoli. (1988). Risk factors for serious injury during falls by older persins in the community. The New England Journal of Medicine, 319,(26) 1701-1707.
    Tinetti, M. E., Mendes, de Leon C. F., Doucette, J. T., & Baker, D.I. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journals of Gerontology, 49, 140-147.
    Tinetti, M. E., Speechley, M., & Ginter, S.F. (1988). Risk factors for fall among elderly persons living in the community. New England Journal of Medicine, 319(26), 1710-1717.
    Tinetti, M. E., & Williams, C. S. (1998). The effect of falls and fall injuries on functioning in community-dwelling older persons. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 53(2), 112-9.
    Trifiletti, L., Gielen, A., Sleet, D., & Hopkins, K. (2005). Behavioral and social sciences theories and models: are they used in unintentional injury prevention research?. Health Education Research, 20(3), 298-307.
    Tromp, A. M., Pluijm, S. M., Smit, J. H., Deeg, D. J., Bouter, L. M., & Lips, P. (2001). Fall-risk screening test: A prospective study on predixtors for falls in community-dwelling elderly. Journal of Clinical Epidemiology, 54(8), 837-844.
    Ueno, M., Kawai, S., Mino, T., & Kamoshita, H. (2006). Systematic review of fall-related factors among the house-dwelling elderly in Japan. Nippon Ronen Igakkai Zasshi. Japanese Journal Of Geriatrics, 43(1), 92-101.
    Vaapio, S., Salminen, M., Ojanlatva, A., & Kivelä, S. (2009). Quality of life as an outcome of fall prevention interventions among the aged: a systematic review. European Journal of Public Health, 19(1), 7-15.
    VanSwearingen, J., & Brach, J. (2001). Making geriatric assessment work: selecting useful measures. Physical Therapy, 81(6), 1233-1252.
    Weatherall, M. (2004). Multifactorial risk assessment and management programmes effectively falls in the elderly. Evidence-Based Healthcare and Public Health, 8, 270-272.
    Whitehead, C. H., Wundke, R., & Crotty, M.(2006). Attitudes to falls
    and injury prevention: what are the barriers to implementing falls
    prevention strategies? Clinical Rehabilitation, 20(6), 536-542.
    Wolfson, L., Judge, J., Whipple, R., & King, M.(1995). Strength is a major factor in balance, gait and the occurrence of falls. Journal of Gerontology Series A-Biological Sciences & Medical Sciences, 50,64-67.
    Woollacott, M.H., & Tamg, P.F.(1997). Balance control curing walking in the older adult: research and its implications. Physical Therapy, 77(6), 646-660.
    World Health Organization. (1984). The uses of epidemiology in the study of the elderly.Report of a WHO Scientific Group on the Epidemiology of Aging. World Health Organization Technical Report Series, 706, 1-84.
    Yardley, L., & Smith, H. (2002). A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist, 42(1), 17-23.
    Yardley, L., Donovan-Hall, M., Francis, K., & Todd, C. (2007). Attitudes and beliefs that predict older people’s intention to undertake strength and balance training. The Journal of Gerontology: Psychological Sciences, 62(2), 119-125.
    Yasumura, S., Haga, H., & Niino, N. (1996). Circumstances of injurious falls leading to medical care among elderly people living in a rural community. Archives of Gerontology and Geriatrics, 23(2), 95-109.
    Yates, S. M., & Dunnagan, T. A. (2001). Evaluating the Effectiveness of A Home-Based Fall Risk Reduction Program for Rural Community- Dwelling Older Adults. The Journals of Gerontology, 56A(4), 226-230.
    Yiannakoulias, N., Row, B. H.,Svenson, L. W., Schopflocher, D. P., Kelly, K., Voaklander, D. C. (2003). Zones of prevention:the geography of fall injuries in the elderly. Social Science & Medicine, 57(11), 2065-73.
    Zijlstra, G. A., Haastregt, J. C., Eijk, J. T., Rossum, E., Stalenhoef, P. A., & Kempen, G.I. (2007). Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing, 36(3), 304-309.

    下載圖示
    QR CODE