| 摘要: | 老人跌倒為公共衛生和臨床醫學的重要議題，約有10%~20%的我國老人曾在一年內跌倒，2-19.7%會造成腦外傷，占台灣老人腦外傷67.3%。老人腦外傷之住院死亡率和併發症是年輕族群的兩倍，消耗較多的醫療成本。存活的老人容易出現嚴重殘障，甚至成為植物人，需要較多的輔具和看護人力。台灣已成為高齡化社會，為降低社會負擔，找出老人跌倒後腦外傷的危險因子是刻不容緩之事。本研究以配對個案對照研究方式從人口學、健康行為、跌倒機轉、環境因子以及慢性疾病種類與用藥等，探討老人跌倒中那些危險因子造成腦外傷。收案時間自民國99年11月至民國101年3月，共收集190位因跌倒至台中市兩家醫院急診就醫且年齡在60歲以上的腦外傷患者，其中男性89位、女性101位。邏輯斯迴歸顯示男性在受傷年齡勝算比為1.05(95%信賴區間1.00～1.09)、心臟病的勝算比為2.01(95%信賴區間1.00～4.07)、向前跌倒勝算比為2.95(95%信賴區間1.13～7.72)、向後倒勝算比為3.86(95%信賴區間1.53～9.75)和抓取物體勝算比為8.26 (95%信賴區間1.75～38.9)。女性在最近一年為輪流居住的勝算比為5.00(95%信賴區間1.56～16.1)、服用心律不整藥物的勝算比為6.88(95%信賴區間1.58～29.9)、向後跌倒的勝算比為3.09(95%信賴區間1.14～8.39)和跌倒時受到撞擊的勝算比為2.40(95%信賴區間1.22～4.71)。男性老人若有心臟病、向後跌倒及無抓物阻止跌倒，容易造成腦外傷。女性老人若有服用心律不整的藥物、輪流住在子女家中、向後跌倒及跌倒過程受到撞擊，容易造成腦外傷。
Falls in older people is an important issue of public health and medicine. About 10~20 % of the Taiwanese elderly suffered from a fall within one year, of which 2-19.7% will result in traumatic brain injuries (TBIs). Older people account for more than 67% of TBIs in Taiwan. In-hospital mortality and complications after TBI in older people are twice compared to younger groups. Older TBI people, who are prone to severe disability and even a vegetative state, need more medical care and nursing manpower. Since Taiwan has become an aging society, it is an urgent matter to identify risk factors for fall-induced traumatic brain injuries in older people for reducing medical and social burden. Therefore, a matched case-control study was conducted to investigate the effects of demographics, health behaviors, fall mechanisms, environmental factors, and chronic diseases and their medications on fall-induced TBIs in older people. During a 17-month period of November 2010 to March 2012, there were 190 patients (aged over 60 years; 53% female) sustained a fall-induced TBI and visited two emergency departments in Taichung City. Two controls for each case, matched on gender and time of falling were recruited. Results of the conditional logistic regression shows that, for men, the odds ratio (OR) of age was 1.05 (95% confidence interval (CI), 1.00 to 1.09), the OR of heart disease was 2.01 (95% CI, 1.00 to 4.07) , the OR of forward falls was 2.95 (95% CI, 1.13 to 7.72 ) , the OR of backward falls was 3.86 (95% CI, 1.53 to 9.75), and the OR of falling without grasping an object was 8.26 (95% CI, 1.75 to 38.9). For women, the OR of residence changes last year was 5.00 (95% CI, 1.56 to 16.1), taking anti-arrhythmic drugs odds ratio was 6.88 (95% CI, 1.58 to 29.9), the OR of fall back was 3.09 (95% CI = 1.14 to 8.39) and the OR of being hit during a fall was 2.40 (95% CI = 1.22 to 4.71). In conclusion, older men who have heart disease, a backward fall, and failure to grasping an object during a fall are prone to have a fall-induced TBI. Older women who take anti-arrhythmic drugs and have changes in residence and a backward fall, and are hit during a fall are prone to have a fall-induced TBI. |
