出院居家安全指導提升老人跌倒預防之成效探討
中文摘要
跌倒是老人重要的健康議題，本研究係探討居家安全指導對出院後老人居家環境危險因素、避免跌
倒自我效能及預防跌倒行為改善之成效。採類實驗研究設計，以北部某醫學中心 65 歲以上老年病 患為研究對象，共收集實驗組 37 位、對照組 38 位個案。研究工具包括「居家內、外在環境評估 表」、「避免跌倒自我效能量表」及「預防跌倒行為量表」，以居家訪視評估及問卷調查方式，了 解出院居家安全指導對提升老人跌倒預防之成效。
研究對象平均年齡為 75.47 歲（ SD = 6.23 ）、男女性分布相當、以不識字及三代同堂居住者為多
， 77.33﹪ 的長者罹患一種以上之慢性病、平均為 1.24 種、 70.67﹪ 有長期使用藥物、平均使用 1.1 1 類藥物、 60﹪ 在日常生活上能夠完全自理、 95.0﹪ 之認知功能為正常，在過去一年及二個月分 別有 34.7﹪ 及 20.0﹪ 個案有跌倒經驗；兩組在上述之基本資料除教育程度、平均罹病數及用藥種 類，實驗組明顯高於對照組外，其他皆具同質性。
研究介入兩個月後，以 Paired-t 檢定發現，實驗組在避免跌倒自我效能得分，由 6.91 分提升至 8.96 分（ paired-t = 4.32, p < .001 ）、對照組由 7.76 分提升至 7.73 分（ paired-t = -0.08, p = .940 ），在 預防跌倒行為變項，實驗組由 3.04 分降低至 3.69 分（ paired-t = 8.78, p < .001 ）、對照組由 3.12 分 提升至 3.50 分（ paired-t = 3.36, p < .01 ），於兩個月跌倒發生頻率變項，實驗組由 0.86 次降至 0.06 次（ paired-t = -2.50, p < .05 ）、對照組由 0.19 次升高為 0.46 次（ paired-t = 2.25, p < .05 ），實驗 組個案之居家環境危險數量，介入前為 5.49 個，實驗後減為 3.37 個（ paired-t = -4.90, p < .0001 ）
；以 t 檢定在後測時，比較兩組得分發現，實驗組不論在避免跌倒自我效能（ t = 3.19, p < .01 ）、
預防跌倒行為 ( t = 2.40, p < .05) 、及兩個月跌倒發生頻率（ t = -3.13, p < .01 ），均明顯較對照組改 善，顯示居家安全指導對於跌倒相關危險因子及跌倒頻率之改善均有其成效。期望此結果，除作為 日後相關預防跌倒研究之參考外，亦提供護理人員在臨床及社區工作中，於老人出院準備服務及跌 倒預防指導之參考，同時建議護理教育設計時，能將老人居家環境危險評估納入護理人員養成教育 之學習項目。
The Effect of Home Safety Guidance Program for Elderly Fall Prevention
英文摘要
Fall is a major issue for elderly health. This study was to examine the effect of home safety guidance progr am for elderly fall prevention through decreasing subjects’ home environment hazards, improving fall avoi dance self-efficacy and falling prevention behavior. The quasi-experimental design was adopted, subjects who were 65 years old and over were invited from an acute medical center, a total of 37 in the experimenta l group and 38 in the control group were recruited. The research instruments used including “Inside/Outsid e Home Environmental Hazard Evaluation Scale”, “Fall self-efficacy Scale” and “Falls Behavior (FaB) Sca le”. Home visit and questionnaire were used for data collection.
The subjects’ mean age was 75.47 years old (SD=6.23), male and female were equally distributed. Most of them were illiterate and live with family including grandkids. 77.33 of them suffered from one to several ﹪ kinds of chronic disease(s) (M= 1.24); 70.67 of them were under long-term medical treatment and used i﹪ n average 1.11 types of medications. Based on functional evaluation, 60 of the subjects were independent ﹪ and 95.0% were normal in cognition. 34.7 and 20 of them experienced falling incident one year and tw﹪ ﹪ o months previous to home visiting respectively. In comparing 2 groups’ homogenous, higher educational l evel, more underlined diseases and regular controlled medicines were noted in experimental group.
Two months after the home safety guidance program intervention, results indicated that the experimental g roup improves from 6.91 to 8.96 in Fall self-efficacy (paired-t = 4.32, p < .001), 3.04 to 3.69 in FaB (paire d-t = 8.78, p < .001) and 0.86 to 0.06 times in fall frequency (paired-t = -2.50, p < .05); compared to 7.76 t o 7.73 (paired-t = -0.08, p = .940), 3.12 to 3.50 (paired-t = 3.36, p < .01), and 0.19 to 0.46 (paired-t = 2.25, p < .05) in control group respectively. There was a significantly improvement for intervention group in avo iding fall self-efficacy ( t = 3.19, p < .01), preventing falls behavior ( t = 2.40, p < .05) and two month’s fal ling frequency( t = -3.13, p < .01) using t test analyses in post test. Based on results of this study, the follo wing strategies will be recommended in research, clinical practice and nursing educations.
