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研究生: 王譽堤
Wang, Yu-Ti
論文名稱: 跌倒風險中高齡者與其照顧者對跌倒之經驗與因應
The Experiences and Coping of Falls among Middle-Aged and Older Adults with Risk of Falling and Their Caregivers
指導教授: 范聖育
Fan, Sheng-Yu
學位類別: 碩士
Master
系所名稱: 醫學院 - 老年學研究所
Institute of Gerontology
論文出版年: 2024
畢業學年度: 112
語文別: 中文
論文頁數: 87
中文關鍵詞: 照顧者跌倒中高齡者對偶資料主題分析法
外文關鍵詞: Caregivers, Falls, Middle-Aged and Older Adults, Paired Data, Thematic Analysis
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  • 跌倒是高齡照護的重要議題。高齡者的跌倒會增加頭頸部受傷、髖部骨折的風險,亦會造成日常生活不便、後續害怕跌倒的心理障礙。高齡者進而減少行動以避免發生跌倒,繼而造成行動能力下降與社交困擾。此外,家庭成員需要承擔照顧壓力,使得其原本的生活受到影響。本研究之目的為探索有跌倒風險之中高齡者與照顧者對於跌倒的經驗與因應方式。
    研究分別針對有跌倒風險的中高齡者與其照顧者進行深度訪談,中高齡者納入 條件為 55 歲以上中高齡者,且有以下兩項標準其中之一,(1)醫師臨床評估有跌倒風險者,病情穩定並可下床活動者,或(2)一年內有跌倒經驗。照顧者納入條件為與中高齡者有血緣或婚姻關係者,且有照顧事實、或熟悉中高齡者日常生活狀況者。使用半結構式訪談大綱進行中高齡者資料收集,包括中高齡者自覺行走狀況與困擾、跌倒經驗、地點、居住環境的跌倒危險因子、及跌倒後的因應。針對照顧者,探詢其對家中高齡者的照顧需求、客觀行走狀況、跌倒經驗、對於中高齡者跌倒的擔憂、以及後續設置防跌的措施。使用主題分析法進行資料分析,最後統整兩者結果之間的異同。
    研究共招募29位有跌倒風險中高齡者及29位照顧者,年齡範圍52-88歲,17名男性,生理疾病以缺血性中風、帕金森氏症為主。照顧者與中高齡者關係16位為配偶、12位為子女,其中26位共同居住。中高齡者訪談結果發現四個主題:第一、多重因素引起跌倒,包括行走習慣、疾病、生活環境或是藥物的交互作用造成跌倒,而不是只有單一因素。第二、跌倒當下的因應與需求。中高齡者在跌倒當下會感到驚慌,生理不適導致他們暫時無法起身求救,因此需要照顧者迅速提供協助。第三、跌倒造成之擔憂。中高齡者跌倒後會有多種擔憂,包含擔心生理傷害、害怕再次跌倒、社交活動減少、與不敢在高跌倒風險環境活動。第四、跌倒因應。針對跌倒因應透過調整個人的生活習慣、住家中的環境安全或是使用輔具避免再次跌倒。照顧者結果有四個主題:第一、中高齡者特性影響照顧者的防跌照護,例如自主的中高齡者抗拒被照顧、失能嚴重的中高齡者依賴照顧者,對於防跌設備的接受度也影響照顧者提供照護的方式。第二、照顧者因應中高齡者跌倒的方式。跌倒後,照顧者會嘗試減少環境中跌倒危險因子、提供輔助設備,並調整中高齡者生活習慣,避免跌倒再發生。第三、跌倒事件照顧者當下及後續之期望。中高齡者跌倒當下,照顧者希望能夠馬上得知跌倒的發生以便即時前往協助,並要求中高齡者後續遵從防跌指示行動。第四、跌倒對照顧者的影響與負擔。提供照護會影響照顧者的生活作息,而擔憂再度跌倒亦會增加照顧者的負擔。
    統整中高齡者與照顧者的結果,中高齡者認為可能是多種因素造成跌倒,而照顧者雖有提到中高齡者因生理疾病或環境因素導致跌倒,但聚焦於中高齡者特性,像是高估活動能力或是不願麻煩他人的心態,更增加跌倒發生的可能性。因此建構居家與社區預防跌倒之計畫有其必要性,例如提供中高齡者平衡與肌力訓練、協助 選擇合適的鞋子、建構防跌的生活環境,並給予適切的照顧與社會資源,以降低高齡者跌倒發生與後續傷害。

    Falls are a major issue in older care, and it increases risks of injuries and decreases mobility and social activities for older adults. This study explored the experiences and coping strategies of adults aged 55 and above at risk of falling and their caregivers. Participants included middle-aged and older adults with risks of falls and their caregivers. Data was gathered through semi-structured interviews and thematic analysis.
    There were four main themes emerged for middle-aged and older adults. First, multiple factors contributed to falls, such as walking habits, diseases, environments, and medications. Second, immediate response and assistance were crucial after a fall. Third, fear of falling affected their willingness to engage in activities. Forth, strategies to prevent falls included modifying habits, improving home safety, and using assistive devices.
    For caregivers, there were also four themes be identified. First, fall prevention is influenced by the personality and acceptance of fall prevention equipment by middled-aged and older adults. Second, coping strategies after a fall include reducing environmental risks and adjusting living habits. Third, caregivers expected immediate notification of falls and adherence to prevention instructions. Forth, caregiving impacted their daily routines and increases stress.
    The study highlights that middle-aged and older adults and their caregivers share similar thoughts on the need for fall notifications, concerns about falling, and coping strategies. While middle-aged and older adults consider falls caused by diseases or environments, caregivers focus more on characteristics of older adults.

    中文摘要i 英文摘要iii 目錄vii 表目錄ix 圖目錄x 第一章 前言1 第一節 研究動機1 第二節 研究問題1 第二章 文獻回顧3 第一節 高齡者跌倒之流行病學3 第二節 導致跌倒之因素4 第三節 跌倒造成之身體傷害、心理影響、社會問題4 第四節 高齡者對於跌倒之主觀經驗7 第五節 照顧有跌倒經驗高齡者對於照顧者之影響8 第六節 研究缺口10 第三章 研究方法12 第一節 研究設計12 第二節 研究參與對象12 第三節 資料收集13 第四節 資料分析方法14 第五節 資料分析的品質18 第六節 研究倫理19 第四章 結果20 第一節 受訪者基本特性20 第二節 中高齡者主觀跌倒經驗與因應28 第三節 照顧者主觀照顧經驗與因應36 第四節 中高齡者與照顧者之主觀跌倒經驗與因應的比對44 第五章 討論46 第一節 中高齡者主觀跌倒經驗與因應47 第二節 照顧者主觀跌倒經驗與因應49 第三節 統整中高齡者與照顧者的結果52 第四節 臨床應用55 第五節 研究限制與未來研究方向56 參考文獻57 附錄一 同意人體研究證明書71 附錄二 台灣版高齡住院病人跌倒風險因子評估表(TW-FRHOP)研究工具使用 同意書72 附錄三 台灣版高齡住院病人跌倒風險因子評估表(TW-FRHOP)73

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