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預防老人跌倒

Hui-Chi Huang

DNSc. RN.

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can absorb the shaving power and ventricular impact force

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Introduction Increase in life expectancy. Age is related to changes in the

musculoskeletal and neuromuscular system.

An impact on the complex motor performance.

Approximately 30% of older peoplesuffer from a fall each year.

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Figure: Determining a good outcome by considering explicitly the patient population. A desirable outcome for patients with a permanent disability of acute onset (e.g. head trauma, myocardial infraction) might seek realistically to enhance functional status to a stable and higher level of function from treatment initiation (left-hand side). In contrast, rehabilitation for those have a chronic progressive disease might seek to extend baseline function (right-hand side).

Optimal rehabilitation

Optimal rehabilitationAverage rehabilitation

Average rehabilitationRestricted rehabilitation

Restricted rehabilitation

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老人跌倒的危險因子影響跌倒的危險因子中 使用輔具者 下肢無力的跌倒風險為最高 ( 約五倍 ) ， 有步態及平衡困難者的跌倒風險 ( 約三倍 ) 。 疾病 藥物 環境障礙 ( 如：鬆滑的地毯、不足的光線、易滑的地面 ) 穿著 ( 衣服脫垂 ) 鞋子 ( 無止滑墊、不是包鞋、無鞋邊緣 ) 害怕跌倒 多重因子間有加成交互作用 當危險因子越多時，跌倒的風險便越大

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Etiologies of Gait Disturbances in the Elderly

Parkinson’s disease White matter ischemic injury Normal pressure hydrocephalus Cervical spondylosis Lumber spondylosis Cerebellar disease Peripheral neuropathy Myelopathy Hemiparesis Myopathy Vestibulopathy Impaired vision Arthritis of lower extremities Hip replacement surgery Foot disease

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跌倒者之理學檢查平衡評估：可用最簡易的「站起來及行走試驗」 (Get up and

go test) 、或進行步態觀察，或應用觀察表。站起來及行走試驗 (Get up and go test)：在地上標示 3(10)公尺的距離，一端放置無扶手之椅子，請老人在椅子上坐，計算自他起來行走至 3(10)公尺標示處，再轉身走回來並坐回椅子上所花的總時間，若少於 10(25)秒者，可界定為無限制的活動能力 , 若在 20秒內者屬大部分非依賴程度 , 若在 20秒至 29秒間者，屬變異性的活動能力，另若超出 29秒者，則可界定為顯著活動障礙。

請老人試著邊走邊說，如果他必須停下來才能說話，他便有跌倒的危險。

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Table: Simple Tests to lower extremities: Strength, Balance, Gait, and Fall RiskTest Time to

administerComments

Get-up and Go ＜ 1 minute Sensitivity 88%, specificity 94% compared to geriatrician's evaluation using cut point ＞ 15 seconds

Office-based maneuvers

2-3 minutes Some are part of Performance-oriented assessment of mobility

1.Observed gait

2.Resistance to nudge

3.Tandem/semitandem stand

4.Rising from chair

5.360° turnFunctional reach 2 minutes Adjusted odds ratios for ＞ 2 falls within 6

months

* 8.1 if unable reach

*4.0 if reach 6"

*2.0 if reach 6" but <10"

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Standing Position

Functional Reach Ending Position

Figure 3.6: Functional Reach(Available from www.mayo.edu/geriatrics etc., Accessed 19 December 2003).

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Fall Risk Increasing Drugs: The Effect on Injuries of the Frail Elderly Estimated from Administrative Data.

The empirical results suggest that antidepressants, anxiolytics, hypnotics and sedatives, anti-arrhythmics, and drugs from the Priscus-list have a significant positive effect on the number of injuries, while anti-hypertensives and anti-parkinsonian agents show no and neuroleptics a significant negative effect.

(Bauer, T. K., Lindenbaum, K., Stroka, M. A., Engel, S., Linder, R. and Verheyen, F. (2012), Fall risk increasing drugs and injuries of the frail elderly — evidence from administrative data. Pharmacoepidem. Drug Safe., 21: 1321–1327. doi: 10.1002/pds.3357)

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A checklist to assist in assessment of risk of falling in older people

Hui-chi Huang

DNSc. RN.

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Introduction Falls are associated with many risk

factors. It is proposed to identify the high-risk group for possible prevention or protection measures.

A checklist has been developed using the Delphi technique (Huang, 2000).

Purpose The purpose of this study was to estimate

the risk factors for falls of older adults using the checklist.

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Variable B S.E. Odds p

Arthritis 2.21 1.15 9.15 .05

Hearing impairments 1.93 .94 6.89 .04

Cardiovascular accident / year 3.13 1.78 22.77 .08 a

Sleeping tables 3.08 1.26 21.83 .01

Get-up and Go test (seconds) .05 .02 1.05 .03

Table. Logistic Regression by the Enter Method for the Risk Rate of Falls (N=103)

Sample ： 103 位機構失能老人

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Predictors of ModelPredictors: assistance provision, cigarette smoking, sleep disturbances, polished bedroom floor, four or more medications daily, son visiting, single shopping.

 

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Objectives Can checklists predict falls in older people?

Can checklists identify a high-risk group?

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Location Fall group Non- fall group

Total

Sheltered houses projects A 50 51 101

Sheltered houses projects B 50 51 101

Sheltered houses projects C 50 50 100

District 52 51 103

Total 202 203 405

Table 1.Participants Came from Three Sheltered Housing and One District in

Taipei City (N = 405)

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Variables B* StandardError

Odds p

Assistance provision .69 .24 2.00 .004Urinary frequency or incontinence

.76 .36 2.13 .04

Get-up and Go test (seconds)

.03 .01 1.03 .0007

Kitchen (light dim) a 3.09 1.51 22.02 .04Front door or backyard (clutter)

2.62 1.25 13.66 .04

Getting in and out of bed 1.22 .51 3.39 .02

Table.Logistic Regression Showing the Risk Rate of Falls (N = 405)

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Discussion and Recommendations Social support and Chinese culture. Older people used assistance provision, had cigarette

smoking and sleep disturbances, polished bedroom floor, took four or more medications daily, less frequency son visiting, and being careful to avoid or decrease simple shopping that may be a warning of high risk for falls.

Falls are multi factorial. Interventions need to developed to prevent falls.

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The High-risk Factors for the Elderly Fall

Age, lack of exercise, living alone Illness: diabetes mellitus, hypertension Medicine: taking sleeping pills Taking longer time to finish the test of Get-up and Go Lower score of cognitive function Environment: having a rug in the bathroom, no

railing in the toilet, and other factors. Fear of falling

(Huang, Gau, Lin, & Kernohan, 2003)

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Community Based Nursing Interventions to Reduce the Risk of Falling Among Older Adults in Taiwan

Hui-Chi Huang, DNSc. RN.

Associate Professor

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Literature Review

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Health education

Health prevention Health protection

Figure : Health Promotion Model developed by Tannahill, A. (1985).

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Fall Risk Pyramid – Which Subset of the Population Should Receive Multifactorial Interventions?

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The purpose

This study aimed to provide an exercise and knowledge program to decrease the risk of falls in older adults.

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Knowledge Programme (1) Teaching take medicine safely and the notice side

effects of medication.(2) Appropriate nutrition for older adults.(3) Maintaining inside environment safely: keeping kitchen and toilet lightly and dry, keeping stairs well-lit and clean, moving small rugs from door risers, and being

careful when crossing raised high door saddle. (4) Maintaining outside environment safely:

avoiding dim light, slippery surfaces, removing doormat

(5) Choosing correct and appropriate shoes: Ridges soles .

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Tai Chi Chuan Exercise

Figure 2: An example of a typical Tai Chi Chuan exercise:

push down and stand on one leg; the sequential motions are performed in semi-squatting posture.

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Illness

Fear of Falling

Medicine

Balance Measurement

Demographics

Social support

Nutrition

Environment

Short Portable Mental Status Questionnaires

Footwear

Health EducationInterventions

Health Protection Community services

and policy

Health PreventionRisk factors checklist

Fall or Non-fall

in older people

1.Exercise: Tai Chi2.Knowledge programmes: knowledge of taking medicine safely and nutrition appropriately, maintaining inside and outside environment safely, choosing correct shoes3.Exercise Knowledge programmes4.Control group

Outcomes:reduction in risk factors

Intrinsic risk factors

Extrinsic risk factors

Figure3: Theoretical framework for this study

(Developed by researcher and based on literature review, expert suggestions, the Health Promotion Model of Tannahill in 1985.)

33Figure 1: CONSORT checklist of study design

Five-month period

Randomized selection of 4 villages

A district in a Taiwan City

(4,695 older people in 55,889 residents)

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15 villages

Exclude 4 villages in mountain area due to difficulty of access

A village(274)

B village (88)

C village (96)

D village (50)

A village (96)

Exclude residents who live elsewhere.

Education Tai Chi(85)

Exclude bed bound-residents, ambulant residents

Completed the pre-test

9 residents in hospital, moved, and died

5 residents in hospital, moved, and died

4 residents in hospital, moved, and died

3 residents in hospital, moved, and died

B village(376)

C village(198)

D village(311)

Tai Chi (65)

Education (61)

Control (50)

Education (38)

Education (29)

Tai Chi (36)

Tai Chi (31)

Education Tai Chi(60)

Education Tai Chi(56)

Control (50)

Control (47)

Randomly selected one from seven districts

Randomization

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Conclusions The relevance to clinical practice of this study is that the

results suggest that prevention of falls among the older people

seems to needs multiple interventions. Education plus Tai Chi Chuan had both an immediately and

a long-term effect and it is possible that a shorter intervention period such as five month using this approach would also be successful.

This study involved a true experimental research design and the study had enough statistical power to answer the questions

posed; therefore, the results can be generalised to other groups of individuals undergoing similar interventions.

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Hip protectors: a Pilot Study of for the Elderly in Taiwan

Hui-Chi Huang

RN., DNSc.

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Chance of Injury Not every fall may result in injury or

fracture, but in the elderly there is a 22% chance of injury after a fall.

( Chu, et al., 1999 )

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Hip Fracture After hospital discharge, but their function of

mobility is worse than before the operation, and this influences

1. their quality of life2. the ability of self-care3. later, 50% of the elderly became more

dependent (Lin, 2001; National Osteoporosis Foundation, 1998; Simpson,

2002).

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To Prevent Falls

Preventing fall is not a single and absolutely way.

Preventing fall from intervention, only decrease 40 % chance to fall.

(Tinetti & Williams, 1997)

40Figure: Hip protectors (www.impactwear.co.nz)

Nabhani 和Bamford (2002) 對於髖部保護墊的材質力學實驗發現，施予保護墊 120焦耳的撞擊力，保護墊確實能有效吸收地板的能量，同時可以減少髖部所承受的壓力在 2500 牛頓以下，因而避免了髖骨骨折。

Mills (1996) 的研究，跌倒時若髖骨承受 2500 牛頓以上的撞擊力時可導致髖骨骨折。

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1. many small hexagon-like honeycombs

2. can absorb the impact force then compress it to look like one line.

Made from a special material (such as polypropylene or polyethylene)

Figure 2 ： Hip protectors in underwear (www.impactwear.co.nz)

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感謝 聆聽敬請 指教