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研究生: 張毓芬
Chang, Yu-Fen
論文名稱: 跌倒風險篩檢簡表應用於社區中老年人之研究
A short-form fall-risk screening tool for community- dwelling
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: 2011
畢業學年度: 99
語文別: 中文
論文頁數: 60
中文關鍵詞: 跌倒風險篩檢簡表信度效度
英文關鍵詞: fall-risk, screening tool, Reliability, Validity
論文種類: 學術論文
相關次數: 點閱:139下載:17
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  • 本研究目的是透過跌倒風險篩檢簡表應用於社區中老年人之研究,用於篩檢『中老人年跌倒的風險』,並探討其信度與效度,而決定最佳切點分數,並區辨具有跌倒風險的社區中老年人。
    研究對象為臺灣29個社區的保命防跌班學員,總計為669位50歲以上中老年人,本研究的跌倒風險篩檢簡表共有14題,總分範圍為0-14分,若得分越高,表示跌倒的可能性越高。
    研究結果發現,跌倒風險篩檢簡表之信度檢定,內部一致性良好。可以有效預測跌倒組與未跌倒組,4分為最佳切點分數,兼具敏感性及特異性。應用重複跌倒個案的篩選,4到6分敏感性與特異性均達70%以上,若用4分或5分當作切點分數,其敏感性均達9成以上,但5分特異性較高,達84.68%。若欲進一步減少人力評估或檢查,則切點分數可提高至6分,雖然敏感性70%,但特異性達88.5%。
    本研究工具簡單易操作,可供衛生專業人員利用短時間篩檢出跌倒高危險族群,利於公共衛生上推廣。

    Through application of a short-form fall-risk screening tool for community-dwelling elderly people, this study aims to carry out fall-risk screening for community-dwelling elderly people and discuss its reliability and validity so that the best cut-off point can be determined and the community-dwelling elderly people with fall risk can be identified.
    The research subjects are 669 elderly people who are over 50 years of age from 29 communities’ life-saving and anti-fall classes in Taiwan. The short-form fall-risk screening tool in this study has 14 questions with score between 0 and 14; the higher score represents higher probability of falling.
    The research results show that the short-form fall-risk screening tool’s reliability test has good internal consistency. It is able to effectively predict the falling group and non-falling group. The score of 4 is the best cut-off point with sensitivity and specificity. With the application of repeat falling case, both sensitivity and specificity are over 70% for score between 4 and 6. If we use the score of 4 or 5 as cut-off point, the sensitivity is over 90%; however, the score of 5 has higher specificity with 84.68%. For the purpose of reducing assessment or inspection manpower, the cut-off point can be increased to score of 6, with sensitivity of 70% and high specificity of 88.5%.
    The tool used in this study is easy to operate and it can help the health and care professionals to identify the high fall-risk group in a timely manner so that it is also conductive to the promotion of public health.

    摘要…………………………………………………………………………i Abstract………………………………………………………………… ii 目次 ………………………………………………………………………iii 表次……………………………………………………………………v 圖次 ………………………………………………………………………vi 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……………………………………………… 3 第三節 研究問題與研究假設……………………………… 4 第四節 名詞解釋……………………………………………… 5 第五節 研究限制……………………………………………… 6 第二章 文獻探討………………………………………………… 7 第一節 老人跌倒的危險因子……………………………… 7 第二節 各跌倒相關介入研究中所應用的篩檢工具………… 9 第三節 跌倒篩檢工具於研究中之發現……………………… 16 第四節 篩檢工具的評價……………………………………… 25 第三章 研究設計………………………………………………… 28 第一節 研究對象……………………………………………… 28 第二節 研究工具……………………………………………… 30 第三節 研究步驟 ……………………………………………… 31 第四節 資料處理與統計分析………………………………… 32 第四章 研究結果與討論………………………………………… 34 第一節 研究對象之社會人口學變項在跌倒發生的差異…… 34 第二節 跌倒風險篩檢簡表之效度分析………………… 39 第三節 跌倒風險篩檢簡表之信度分析…………………… 47 第五章 結論與建議……………………………………………… 49 第一節 結論………………………………………………… 49 第二節 建議……………………………………………… 51 參考文獻 ……………………………………………………… 53 附錄 ……………………………………………………………… 60 附錄一:跌倒風險篩檢簡表……………………………………… 60

    一、中文部分
    林茂榮(2003)。社區跌倒老人健康的變化與再跌倒的預防,行政院衛生署國民健康局研究計畫書,未出版。
    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。
    秦毛漁、盧得發、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。
    唐美蓮(2007)。預防老人跌倒居家環境改善之成本效益分析。亞洲大學長期照護研究所碩士論文,未出版,臺中市。
    徐慧娟、吳淑瓊、江東亮(1996)。跌倒對社區老人健康生活品質的影響,中華公共衛生雜誌,15(6),525-532。
    曹昭懿(2009)。老人跌倒整合預防保健介入模式建置先驅研究,行政院衛生署國民健康局研究計畫書,未出版。
    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。
    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,臺灣衛誌,24(2),136-145。
    黃惠璣、林季宜、王寶英(2007)。老人或失智老人跌倒危險因子之初探,臺灣老人保健學刊,3(1),1-13。
    楊月嬌(20004)。雲嘉南地區住院病人跌倒及其造成傷害意外事件之監測與通報及落實有效跌倒防範措施,行政院衛生署九十三年度科技研究計畫,未出版。
    詹莉君(2004)。老人跌倒的危險因子:長期追蹤研究。臺中健康暨管理學院健康管理研究所碩士論文,未出版,臺中市。
    葉錦瑩、陳怡樺、王豊裕(2009)。流行病學(第四版)。臺北市:台灣愛思唯爾。
    蔡益堅、葉純志、藍祚韻、張文瓊、曾德運(2007)。1999年與2005年台灣地區老人跌倒狀況之比較-20005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,1-15。
    黎家銘、陳晶瑩(2005)。老人跌倒因素的評估與預防,臺灣醫學,9(2),277-284。
    魏大森(2008)。老年人跌倒的篩檢與評估,台灣老年醫學暨老年學雜誌,3(2),91-105。

    二、英文部分
    Alessi, C. A., Josephson, K. R., Harker, J. O., Pietruszka, F. M., Trinidad-Hoyl, M., & Rubenstein, L.Z.(2003). The yield, reliability, and validity of a postal survey for screening community-dwelling older people. Journal American Geriatrics Society, 51, 194-202.
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    Flemming, P.J. (2006). Utilization of a screening tool to identify homebound older adults at risk for falls: Validity and reliability. Home Health Care Services Quarterly, 25(3/4),1-22.
    Hendrich , A. L., Bender, P.S., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16, 9–21.
    Hill, K., & Schwarz J. (2004). Assessment and management of falls in older people. Internal Medicine Journal, 34, 557-564.
    Hung, H.C.(2004). A Checklist for Assessing the Risk of Falls among the Elderly. The Journal of Nursing Research,12(2),131-142。
    Oliver, D., Britton, M., Seed, P., Martin, F.C., & Hopper, A.H. (1997). Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. British Medical Journal, 315, 1049-1053.
    Oliver, D., Daly, F., Martin, F.C., & McMurdo, M. E. T.(2004). Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and Ageing ,33, 122-30.
    Perell, K. L., Nelson, A., Goldman, R. L., Luther, S. L., Prieto-Lewis, N., & Rubenstein, L. Z.(2001). Fall risk assessment measures: an analytic review. Journals of Gerontology: Medical Sciences, 56A(12), M761–M766.
    Pluijm, S. M. F., Smit, J. H., Tromp, E. A. M., Stel, V. S., Deeg, D. J. H., Boute, L. M., & Lips, P. (2006). A risk profile to identify community-dwelling elderly at high risk for recurrent falling: results of a three-year prospective study. Osteoporos International, 17(3), 417–425.
    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., Gurrin, L. C., & Dharmage, S. C.(2009). Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool. Age and Ageing, 38, 40-46.
    Russell, M. A., Hill, K.D., Blackberry, I., Day, L. M., & Dharmage S.C.(2008). The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age and Ageing, 37, 634-639.
    Salameh, F., Cassuto, N.,& Oliver, A. (2008). A Simplified Fall-Risk Assessment Tool for Patients Hospitalized in Medical Wards. Fall RISK on Medical Wards,10, 125-129.
    Scott, V., Votova, K., Scanlan. A., & Close, J.(2007). Multifactorial and functional mobility assessment tool for fall risk among older adults in community, home-support, long-term and acute care settings. Age and Ageing, 36, 130-139.
    Stalenhoef, P. A., Diederiks, J. P., Knottnerus, J. A., Witte, L. P.,& Crebolder, H.F.(2000). The construction of a patient record-based risk model for recurrent falls among elderly people living in the community. Family Practice, 17(6),490-496.
    Tinetti, M. E.(2003). Preventing falls in elderly persons. New England Joural of Medcine, 348(1), 42-49.
    Tromp A. M.,Pluijm ,S. M. F., Deeg, D. J. H., Bouter, L. M, Lips, P.(2001). Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly. Journal of Clinical Epidemiology,54, 837-844.
    Woo, J., Leung, J., Wong, T.K., Lee, J.,& Lynn, H.(2009). Development of simple scoring tool in the primary care setting for prediction of recurrent falls in men and women aged 65 years and over living in the community. Journals of Clinical Nursing, 18,1038-1048.
    World Health Organization.(2010). Falls. Retrieved July 25, 2011, from the World Wide Web: http://www.who.int/mediacentre/factsheets/fs344/en/

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