中高齡住院病人跌倒風險評估

背景與目的：醫療機構降低住院病人跌倒發生率，能降低醫療成本且提昇醫療品質。有效的跌倒預防與介入，有賴進行完善的跌倒風險評估。了解住院病人常見的跌倒風險因子，有助於醫療機構發展有效的防跌措施。本研究目的是希望以周全性的風險因子評估量表進行住院病人跌倒風險因子的調查。方法：本研究是觀察性研究，研究對象為台北市某醫學中心高齡友善病房年滿50歲住院病人，以立意取樣的方式選取樣本於病人入院三日內及出院前進行調查。研究工具是台灣版高齡住院病人跌倒風險因子評估表（Tw-FRHOP），本量表包含11個面向共21個評估項目。比較各項跌倒風險因子的盛行率及風險分數，並比較前測與後測時各項風險因子的改變程度。統計方法使用描述性分析、Wilcoxon signed-rank分析與kappa一致性檢定。結果：本研究共收案200人，平均年齡為65.6±10.8歲，54.5%為男性，94%為內科病人。Tw-FRHOP前測總分平均為12.61±5.71，後測分數降低為9.11±5.83（p＜0.001）。入院時平均分數較高的風險因子為鞋子問題（2.44±1.12）、藥物使用（2.17±1.06）、平衡不良（1.41±1.35）、體重下降（1.14±1.33）、服用高風險藥物（1.09±0.89）；盛行率較高者為藥物使用（90.5%）、鞋子問題（84.5%）、服用高風險藥物（75.0%）、平衡不良（57.5%）。出院前，個案的Tw-FRHOP量表跌倒風險總分以及絕大部分的風險因子分數有明顯下降，而鞋子問題風險因子盛行率有明顯改善。結論：本研究調查某醫院高齡友善病房住院病人的入院時與出院前跌倒風險因子的盛行率與風險程度，多重用藥、鞋子問題、服用高風險藥物、平衡不良、體重下降為較主要之風險因子。Background and objective: Preventing patients from falls can reduce medical cost and increase quality of care. A comprehensive fall risk assessment, essential for hospital fall prevention, provides information about prevalence and severity of risk factors of falls to help healthcare professionals develop effective prevention strategies. This study used a comprehensive risk assessment tool to investigate the fall risk factors of middle-aged and elderly patients admitted to an acute care ward. Method: This observational study performed a fall risk assessment on patients aged over 50 years old and admitted to a geriatric ward. The assessment was completed within 3 days after admission and before discharge, using the Falls Risk for Hospitalized Older People - Taiwan version (Tw-FRHOP) incorporating 21 items divided into 11 domains. The study investigated the prevalence and severity of each factor and compared the changes between pre- and posttest. The statistical analysis included descriptive analysis, Wilcoxon sign rank, and kappa coefficient. Results: A total 200 patients were enrolled. 54.5% were male. The average age was 65.6±10.8 years. The mean of Tw-FRHOP total score was 12.61±5.71 in pre-test and 9.11±5.83 in posttest (p＜0.001). Footwear problems, multiple medications, balance problems, weight loss, and high-risk medications were marked with higher scores in Tw-FRHOP. Risk factors showing a higher prevalence included multiple medications, footwear problems, high-risk medications, and balance problems. The total score and the individual scores of most of the risk factors decreased significantly before discharge. Conclusion: This study investigated the prevalence and severity of falls risk factors of patients. The identified major risk factors included multiple medications, footwear problems, high-risk medications, balance problems, and body weight loss. Further research is encouraged to examine this issue in greater detail.