黃璉華臺灣大學：護理學研究所陳怡如Chen, I-JuI-JuChen2007-11-272018-07-072007-11-272018-07-072006http://ntur.lib.ntu.edu.tw//handle/246246/55789促進老年人身體活動、維持功能性體適能與預防跌倒,是增進公共健康與生活品的重要議題。本研究的目的是要瞭解台北市老人的身體活動、功能性體適能與跌倒的狀況及其相關關係;瞭解身體活動與功能性體適能對跌倒的解釋能力與模式。 經過分層兩階段集體抽樣後，有332位65歲以上老人願意參與，其中312位是本研究分析的主要對象，本研究之參與率為20.41%。本研究確認了個案的身體活動(身體活動量、家事活動量與休閒活動量)、功能性體適能(身體組成、上身肌力、下身肌力、心肺耐力、下肢柔軟度、上肢柔軟度與敏捷度/動態平衡)和跌倒(次數與跌倒效能)等狀況。 年齡、性別、自覺健康狀況、疾病數目和關節炎是身體活動的影響因素。和美國女性老人相比，本研究女性個案的下肢肌力較好，但是敏捷度較差。本研究個案的跌倒效能普遍比西方老人要來的高。年紀越大、罹患越多疾病、服用越多種藥物、沒有配偶、獨居、柔軟度與心肺耐力較差的個案，跌倒次數比較多。研究發現跌倒次數與心肺耐力、柔軟度呈負相關;而身體活動量、肌力、心肺耐力、柔軟度則和跌倒效能呈現正相關。 本研究發現人口學變項(年齡、性別、獨居)、自覺健康、跌倒資訊的有無等變項和身體活動、體適能的交互作用，可以解釋20.3%跌倒次數與28.6%跌倒效能的變異量。本研究發現跌倒複雜且非單一變項可以解釋的本質，研究結果強調變項間的交互作用對跌倒次數的解釋力。 未來相關的研究應該探討不同文化與性別老人族群的體適能與身體活動對跌倒影響。健康專業人員應該鼓勵女性老人多參與休閒活動，並應該提供促進敏捷度活動的資訊與機會;也應該鼓勵男性老人多做家事，並應提供促進柔軟度的活動資訊與機會。社區衛生工作者可以運用本研究提出的模式，配合老人體能檢測，來篩檢社區中跌倒的高危險群，也可以作為分配社區健康醫療資源的參考。Promoting physical activity, maintaining functional fitness and preventing fall among older population have emerged as important issues to improve public health and quality of living. The main purpose of this study is to examine the physical activity, functional fitness and fall conditions, to investigate the predict power of physical activity and functional fitness on fall, and to establish the relationships and model among physical activity, functional fitness, and fall in the older adults in Taipei. 332 subjects over the age of 65 or over and living in Taipei City, were participated in this study after probability proportional to size sampling. The response rate was 20.41%. The information of 312 cases was used to analyze. The status of physical activity (physical activity score, household score, and leisure time activity score), functional fitness (body composition, upper and lower body strength, aerobic endurance, upper and lower body flexibility, and agility/dynamic balance), and fall (number of fall and fall efficacy scale) were identified. Age, gender, perceived health status, number of disease, and arthritis were identified as the influencing factors of physical activities. That female had better lower body strength and poor agility/dynamic balance than older American female was noticed. The scores of fall efficacy were higher in older Taiwanese than western older adults. Older age, more number of disease and medication category, no spouse, living alone, poor flexibility and aerobic endurance were identified as determinants of number of fall. The relationships between physical activity and strength, aerobic endurance, flexibility, fall efficacy; and between the number of fall, aerobic endurance and flexibility were also found. Models of physical activity, functional fitness, and the number of fall, and the fall efficacy among elderly according to different living arrangement and health status perceptions were identified. Interactive effects of demographic characteristic, physical activity, fitness, and information about fall prevention could explain 20.3% and 28.6% variance of number of fall and fall efficacy, respectively. This study highlights the importance of examining the interactive effects of demographic characteristics, physical activity, and functional fitness on fall Cross-cultural and gender studies are recommended to examine the influencing mechanisms of fitness and the amount of physical activity on fall in older population. Health professional can encourage older females to participate more leisure time activity and improve their agility/dynamic balance; and can offer older males to perform more household work and to improve their flexibility. Community health workers can apply the proposed models and senior fitness tests to screen the high risk group of fall and allocate health resources.Tables of Contents List of Tables………………………………………………………VII List of Figures…………………………….……………………..XII List of Abbreviations…………………..………..........XIII Chapter I: Introduction..................................1 Chapter II: Literature Review………………………........4 Fall…………………………………………………………........4 Definition………………………………………………….4 Epidemiology of fall……………………………….5 The influences of fall…………………………….5 Overview of fall prevention programs………………8 Exercise training in fall prevention………………10 Physical activity …………………………………....12 Definition……………………………………………….12 Importance of physical activity………………………14 Physical activity epidemiology………………………16 Measurements…………………………………………….17 Functional fitness………………...........………………….18 The components of functional fitness.…………………... 21 Body mass Index……………………………….……...21 Muscular strength…………………………………...22 Aerobic endurance………………………………………24 Flexibility……………………………………………….25 Agility/dynamic balance………………...........26 Tests of functional fitness……………………………………27 American Alliance for Health, Physical Education Recreation and Dance.……...........................28 Established Population for Epidemiologic Studies of the Elderly……….....28 Physical fitness study in older Taiwanese…………..29 Senior Fitness Test……………………………………………30 Conclusions………………………………………………………..32 Purpose….……………………………...34 Research objectives………………………………..35 Conceptual framework………………………………36 Operational definition of terms……………………36 Research questions……………….……….…………37 Chapter III: Methodology……………………………………….38 Research design…………………………………………38 Population & Sampling…………………………………38 Procedures………………………………………………41 Research assistant training………………41 Human subjects………………………………42 Pilot study.……………………………….42 Promoting…………………………………..44 Instrumentation………………………………………….44 Modified Baecke Questionnaire (MBQ)……44 Fall Assessment Survey (FAS)…………..45 Senior Fitness Tests (SFT)……………47 Body mass index……………49 Chair stand test…………………49 Arm curl test……………………50 2 minutes step test…………51 Chair sit and reach test………52 Back scratch test……………54 8 Feet up and go test……...55 Data analysis……………………………………….56 Chapter IV: Results……………………………………………….57 Participants………………………………………....57 Answer to research questions…….……………….60 Research question one…………………..60 Physical activity……………60 Functional fitness………….65 Fall……………………………..77 Research question two………………….88 Research question three………………....90 Research question four……………………91 Research question five.……………….92 Model of physical activity, functional fitness and number of fall..........93 Model of physical activity, functional fitness and fall efficacy ..……102 Chapter V: Discussions…………………………………………..109 Physical activity and influencing factors…….109 Age and physical activity………109 Gender and physical activity….109 Perceived health status and physical activity……………………………….111 Disease and physical activity…………112 Function fitness and influence factors…………113 Compare with Americans………………....113 Age, gender, marital status and function fitness…..…………………………117 Disease and functional fitness……….117 Fall.……………………………………………....118 Compare fall conditions with other studies ……………………………….118 Compare fall efficacy with other studies….………………………………..120 Physical activity correlated with functional fitness……………………………..121 Physical activity and functional fitness correlated with number of fall…….……123 Physical activity and functional fitness correlated with fall efficacy………...........125 Proposed model to explain the number of fall..126 Proposed model to explain fall efficacy…………128 Chapter VI Conclu……………………………………………….…131 Limitations…………………………………………….131 Implications & Suggestions…………………………132 Appendices………………………………………………………..135 Appendix 1 PPS Sampling plan…………………………135 Appendix 2 MMSE……………………………………….137 Appendix 3 Agreement of author of MBQ Chinese Version…138 Appendix 4 Agreement of FAS……………………………………139 Appendix 5 Permission of IRB …………………………………140 Appendix 6 Permission of Government of Taipei City………141 Appendix 7 Consent form ………………………………142 Appendix 8 Questionnaire of MBQ ………………………………144 Appendix 9 Questionnaire of MBQ Chinese Version…….147 Appendix 10 Questionnaire of FAS…………………………..150 Appendix 11 Scorecard of SFT…………………………………..154 References………………………………………………………...155 List of Tables 1. Results of home visiting………………………………………………………….....40 2. Training plan of research assistant…………………………………………………..42 3. Demographic characteristics of the subjects in pilot study…………………...........43 4. Demographic characteristics of the subjects in test retest…………………………44 5. Criterion validity of senior fitness test items (SFT)……………………………….48 6. Test retest reliability and 95% confidence intervals (CI) for SFT items………......49 7. Demographic characteristics of subjects in Taipei City……………………….......59 8. Physical activity of subjects in Taipei City………………………………………....61 9. Correlations among physical activity and age, number of disease and medication category……………………………………………………………………………..62 10. Differences of physical activity with different demographic characteristics…….63 11. Covariate analysis of household score with different age groups………………..63 12. Covariate analysis of PA score with different perceived health status groups.......64 13. Differences of physical activity in different gender, marital status, living arrangement, fall in past 6 months, and specific diseases…………………………..65 14. Function fitness among subjects in Taipei City………………………………......66 15. Correlations among functional fitness, age, number of disease and medication category……………………………………………………………………………...67 16. Differences of functional fitness with different demographic characteristics……68 17. Covariate analysis of BMI with different age groups………………………….....69 18. Covariate analysis of chair stand test with different age, education and perceived health status groups……………………………………………………………….....70 19. Covariate analysis of arm curl test with different age and perceived health status groups……………………………………………………………………………......71 20. Covariate analysis of 2 minutes set test with different age, education, perceived health status groups…………………………………………………………………...71 21. Covariate analysis of chair sit and reach test with different age groups……………………………………………………………………………........72 22. Covariate analysis of back scratch test with different age and education groups......72 23. Covariate analysis of 8 feet up.& go test with different age and education groups……………………………………………………………………….…........73 24. Differences of functional fitness with different gender, marital status, living arrangement, and specific diseases ………………………………………………...75 25. Fall conditions among the subjects in Taipei City…………………………..……78 26. Correlations among the number of fall, age, number of diseases and medication category…………………………………………………………………………......80 27. Differences of the number of fall with different demographic characteristics.…...81 28. Covariate analysis of the number of fall with different age groups…………..........81 29. Differences of the number of in different gender, marital status, living arrangement, information of fall, specific diseases and medications..............................................................82 30. Correlations between FES and age, number of disease and medication category……………………..……………………………………………….………84 31. Differences of FES with different demographic characteristics………….……….85 32. Covariate analysis of FES with different age and perceived health status groups…..………………………………………………………………….……………86 33. Differences of FES with different gender, marital status, living arrangement, information of fall, specific diseases and medications groups ………………………...87 34. Correlations among physical activity and functional fitness………………………89 35-1. Correlations between physical activity and the number of fall……………........90 35-2. Correlations between physical activity and FES……………………….……..…90 36-1. Correlations between function fitness and the number of fall………………........92 36-2. Correlations between functional fitness and FES………………………….…….92 37. Results of simple regression of the number of fall……………………….….............94 38. Results of multiple regression of the number of fall…………………….…….......95 39. R2 of specific independent variables in regression model of the number of fall.......97 40. Regression models of the number of fall after considering the interaction among variables……………………………………………………………………………….98 41. Selected regression model of the number of fall.……………………………...........99 42. Discriminant analysis of selected personal variables, physical activity and functional fitness on the number of fall…………………………………………….101 43. Discriminant function classification result of the number of fall…………….........101 44. Results of simple regression of FES…….………………………………………...102 45. Results of multiple regression of FES ………….…………………………………103 46. R2 of specific independent variables in regression model of FES…………...........106 47. Regression models of FES after considering the interaction among variables……107 48. Selected regression model of FES…………………..………………………………..108 49. Data of SFT in different age group among male participants………………...........115 50. Data of SFT in different age group among female participants……………............116 List of Figures 1. Conceptual framework: Model of physical activity, functional fitness, and fall…361002450 bytesapplication/pdfen-US老人體能活動功能性體適能跌倒older adultphysical activityfunctional fitnessfall[SDGs]SDG3otherhttp://ntur.lib.ntu.edu.tw/bitstream/246246/55789/1/ntu-95-D89426001-1.pdf