探討社區長者跌倒經驗與健康相關生活品質(SF-8)之關係： 恐懼跌倒與三面向衰弱作為中介因素

Abstract

研究背景與目的： 根據世界衛生組織及聯合國報告，全球人口老化趨勢明顯，台灣亦受其影響，老年人口比例逐年攀升，跌倒作為老年人常見之健康議題之一，不僅對生理造成損害，更可能引發恐懼跌倒等心理問題，甚至導致衰弱狀態，影響健康生活品質。跌倒後續引起的生理、心理及社會因素對長者健康生活品質具有重要影響，然而目前較少研究將生理、心理及社會層面的影響因子共同探討。因此本研究旨在探討台灣長者經歷跌倒後，恐懼跌倒與三面向衰弱(身體、心理、社會衰弱)是否作為中介變項影響長者的健康生活品質。

研究方法： 為次級資料分析，資料來自於陳端容博士於2019年主持的國科會【研究計畫：減緩老化衰弱的社會因素：「社會衰弱」(social frailty)的測量、變化趨勢及預測效果(109-2410-H-002-054-SS2)】。研究樣本為全台多個地區的65歲以上長者(n=1526)，以了解跌倒經驗與健康生活品質之關係，同時分析恐懼跌倒與三面向衰弱(身體、心理、社會衰弱)的中介角色。

研究結果： 過去3個月內曾經跌倒、一年內重複跌倒及一年內跌倒就醫次數對健康生活品質的總效果均顯示統計顯著的負相關性。其中，僅過去3個月內曾經跌倒對健康生活品質具有顯著的直接影響，效果百分比為29.06%；僅過去3個月內曾經跌倒(效果百分比70.94%)及一年內跌倒就醫次數(效果百分比76.20%)對健康生活品質具有顯著的總間接效果，且總間接效果遠大於直接效果。在所有間接效果路徑中，恐懼跌倒的中介影響效果最大，身體衰弱和社會衰弱次之。心理衰弱作為中介變項的影響最小。

研究結論： 本研究發現跌倒經驗在不同時間跨度、跌倒次數和影響程度上各異，並通過增加恐懼跌倒、身體和社會衰弱影響健康生活品質。恐懼跌倒是最顯著的中介因素，而心理衰弱未顯示顯著影響。研究建議，應重視有跌倒經驗長者的綜合護理，提升其跌倒自我效能和身體功能，減少恐懼跌倒及社會衰弱，以維持和改善健康生活品質。

Background and purpose： According to reports from the World Health Organization and the United Nations, the global trend of population aging is evident, and Taiwan is no exception, with the proportion of elderly people increasing annually. Falls are a common health issue among the elderly, causing not only physical harm but also psychological problems such as fear of falling, and potentially leading to frailty, thereby impacting their quality of life. The subsequent physiological, psychological, and social factors triggered by falls significantly affect the quality of life of the elderly. However, current research rarely explores these factors comprehensively. Therefore, this study aims to investigate whether fear of falling and the three dimensions of frailty (physical, psychological, and social frailty) act as mediating variables affecting the quality of life of elderly individuals in Taiwan who have experienced falls.

Methods： For secondary data analysis, the data are derived from a research project led by Dr. Duan-Rung Chen in 2019, funded by the National Science and Technology Council："Social Factors Associated with Reducing Frailty in Older Adults: the Measurements, Trajectory and Predictor Power of Social Fraility" (Project No. 109-2410-H-002-054-SS2). The study sample consisted of elderly individuals over 65 years old (n=1526) from various regions in Taiwan. The aim was to understand the relationship between fall experiences and health-related quality of life, and to analyze the mediating roles of fear of falling, as well as the three dimensions of frailty (physical, psychological, and social frailty).

Results： Experiencing a fall in the past three months, repeated falls within a year, and the number of falls requiring medical attention within a year all show statistically significant negative correlations with health-related quality of life. Among these, only experiencing a fall in the past three months has a significant direct impact on health-related quality of life, with an effect percentage of 29.06%. Experiencing a fall in the past three months (effect percentage of 70.94%) and the number of falls requiring medical attention within a year (effect percentage of 76.20%) have significant total indirect effects on health-related quality of life, with the total indirect effects being much greater than the direct effects. Among all indirect effect pathways, fear of falling has the largest mediating effect, followed by physical frailty and social frailty. Psychological frailty has the smallest mediating effect.

Conclusions： This study found that the experience of falls varies across different time spans, frequencies, and severities, and negatively impacts health-related quality of life through increased fear of falling, physical frailty, and social frailty. Fear of falling was identified as the most significant mediating factor, while psychological frailty did not show a significant mediating effect. The study suggests that comprehensive care for older adults with a history of falls should be emphasized, including enhancing their self-efficacy in fall prevention, improving physical function, and reducing fear of falling and social frailty to maintain and improve their health-related quality of life.