機構老人跌倒預防課程介入之過程及衝擊評價研究

Abstract

摘 要 跌倒是影響老年人健康及獨立生活之重要危險因子，老人跌倒會造成自信喪失及害怕再跌倒的心理傷害，因而自我限制行動，導致身體功能與獨立活動能力逐漸喪失，增加罹病率及死亡率。跌倒亦會增加社會醫療費用與家庭照顧成本的負擔，隨著台灣進入高齡化社會，跌倒的預防已成為現代預防醫學及家庭健康照護之重要課題。 本研究主要是針對機構老人設計一「跌倒預防多元介入」課程，並進而探討「跌倒預防多元介入」對機構老人對跌倒預防之「知識」、「信念」與「自我效能」的影響成效。本研究採準實驗設計，以台北市某公辦民營老人安養中心機構老人共40人為研究對象，另一所安養機構則為對照組，實驗組實施十六週「跌倒預防」的多元介入課程，對照組則不予任何介入。 本研究於研究期間對實驗組進行十六週的多元介入課程，每周上課一次，每次90分鐘，分別包含30分鐘衛生教育課程及60分鐘運動課程（分為二段各30分鐘）、媒體運用（教材、講義、學習護照）等多元介入方式，對照組僅針對其進行前後測問卷，而無任何介入活動。 「跌倒預防介入」兩組皆實施前後測，實驗組在後測同時一併實施教學過程評量，在課程結束時抽樣七位個案進行深度訪談，以了解跌倒預防多元介入的成效。本研究結論可歸納如下： 一、跌倒預防多元介入後，在控制前測成績下，實驗組對預防跌倒的「知識」得分高於對照組，且達顯著性差異。 二、跌倒預防多元介入後，在控制前測成績下，實驗組對預防跌倒的「信念」得分高於對照組，共變數分析無顯著差異，但實驗組介入後信念得分顯著高於介入前得分。 三、跌倒預防多元介入後，在控制前測成績下，實驗組對預防跌倒的「自我效能」的得分高於對照組，共變數分析無顯著差異，但實驗組介入後自我效能得分顯著高於介入前得分。 四、跌倒預防多元介入後，受測者在預防跌倒行為的卡方檢定有顯著，亦即實驗組與對照組在介入期間跌倒發生率有明顯的差異。 五、超過九成的實驗組老人滿意此次跌倒預防多元介入的課程設計，而八成以上的人認為各教學單元對跌倒預防是有幫助的。 六、研究對象對於跌倒預防多元介入大都持有正向的評價。 本研究的貢獻可提供機構老人在「跌倒預防」多元介入的參考建議，未來研究者可在本研究的基礎下，進一步以更嚴謹的縱貫性研究來進行介入，以探討其適用範圍與成效。Abstract Falls which affect the elders’ health and independent life are important dangerous factors. These will cause self-confidence losing as well as psychological harm of falling again scaring, and that brings about self-limited action, which will lead to gradually loss of body functions and independent moving ability, increasingly rate of suffering illness and death. Falls will also increase the burden of social treatment expenses and family caring cost. As time goes on to aged-society in Taiwan, the prevention of falls has become important issues of nowadays preventive medicine and family health nursing. The study was mainly to design lessons of “Falls Prevention Education Intervention” for institution elders, and then explored the effected results of knowledge, belief and self-efficiency of lessons. The study employed quasi-experimental design, a target of 40 persons in private management of public management elder nursing center institution in Taipei with 16 “falls prevention” education intervention lessons, and applied to another nursing institution as the contrast groupwith no intervention. The experimental group in the study was divided into two: the experimental group and the contrast. To conduct multi-intervention for 16 weeks, once a week of 90 minutes for each class with hygiene education for 30 minutes and exercise for 60 minutes, and media applied (teaching material, hand outs and learning proves), and none for the contrast. The two, the experimental group and the contrast, are all applied pre- and post-test, and the experimental group are employed teaching process evaluation as well. The study casually sampled 7 cases and directed in-depth interviewing to investigate the results of educationintervention. The main results of study were summarized as followed: 1. The scores of the experimental group on “knowledge” are significantly different and higher than the contrast, under the control of pre-test scores, after the intervention of falls prevention education. 2. The scores of the experimental group on “belief” are significantly higher than the contrast, no significance on ANCOVA, significance difference on t-test, under the control of pre-test scores, after the intervention of falls prevention education. 3. The scores of the experimental group on “self-efficiency” are significantly higher than the contrast, no significance on ANCOVA, significance difference on t-test, under the control of pre-test scores, after the intervention of falls prevention education. 4. More than 90% of the elders of the experimental group were satisfied with the falls prevention education intervention design, and more than 80% of them considered the lessons applied helpful. 5. The experimental group in this study mostly had positive evaluation to falls prevention education intervention. The contribution of the study lies in providing suggestions for “falls intervention” to institution elders, and being the basis of future advanced study with vertically intervention research.