社區長者身、心、社會衰弱指標與跌倒及恐懼跌倒關係

Abstract

導論：本研究將衰弱的定義從傳統的身體層面，擴大到涵蓋身體、心理與社會層面，並加以闡明長者衰弱與跌倒及恐懼跌倒的關係。方法：本研究為橫斷研究採方便取樣收案，研究對象為居住或生活於臺北市中正區65歲以上長者(N= 693)，以迴歸分析控制相關變項後，探討跌倒及恐懼跌倒與衰弱的關係。結果：心理及社會衰弱期與跌倒顯著相關，而身體衰弱期僅在未控制心理及社會衰弱變項下，才與跌倒顯著相關。另各衰弱前期中，僅心理衰弱前期與恐懼跌倒顯著相關，而各衰弱期(身體、心理及社會)皆與恐懼跌倒顯著相關。討論：心理或社會衰弱者，即使無身體衰弱狀況，仍需針對其心理或社會衰弱情形進行介入，以降低跌倒發生的機率，又身體衰弱者除可進行體能訓練介入外，也可藉由改善心理及社會衰弱情形，來預防跌倒。另心理衰弱者需從衰弱前期即進行恐懼跌倒防治。本研究指出心理及社會衰弱與身體衰弱不同，評估時須各別考慮身體、心理與社會衰弱情形，以全面檢視長者衰弱狀況。

Background: This study expanded the definition of frailty from the traditional physical aspect to cover physical, psychological, and social aspects, and attempted to clarify the relationships between frailties and falling and fear of falling in the elderly. Method: It was a cross-sectional study with convenience sampling. The subjects of the study were the elderly over 65 years old (N=693) who resided in Zhongzheng District, Taipei City, Taiwan. After controlling for the related variables by the regression analysis, we explored the relationships between frailties (physical, psychological, and social aspects) and falling and fear of falling. Results: Psychological and social frailties were significantly associated with falls, while physical frailty were only significantly associated with falls when psychological and social frailty variables left uncontrolled. In pre-frailty, only the psychological pre-frailty was significantly associated with fear of falling, while each aspects of frailty (physical, psychological and social) was significantly associated with fear of falling. Conclusion: People who are in the state of psychological or social frailty, even if they are not physically frail, still need to receive the interventions for improving psychological or social frailty to reduce the probability of falling. In addition to the physical training interventions, the elderly with physical frailty can also prevent falls by improving their psychological or social frailty status. Moreover, people with psychological frailty need to prevent fear of falls as early as in the pre-frailty stage. This study indicated that psychological and social frailties were different from physical frailty, and physical, psychological and social frailties must be considered separately in the assessment of frailty in order to evaluate the health status of the elderly comprehensively.