介護老人保健施設における車椅子使用者の転倒リスク因子

Risk Factors for Falls among Wheelchair Users in a Long-term Care Health Facility

要旨　目的：本研究の目的は介護老人保健施設における車椅子使用者の転倒リスク因子を明らかにすることである．対象：介護老人保健施設へ新規入所した者のうち，車椅子を日常生活の移動手段とする62名（男性14名，女性48名，平均85.4±7.9歳）であった．方法：入所時評価（ベースライン）は，年齢，過去1年間の転倒歴，身体機能，精神機能，生理機能，医学的処置，経済状況の19項目を評価した．転倒は入所から最長6カ月間を前向きに追跡調査した．統計解析は，単変量解析で転倒と有意に関連した項目を独立変数，転倒発生の有無を従属変数としたロジスティック回帰分析を行った．結果：29名（46.8％）に転倒が発生した．転倒に関連した項目は，「背中が丸くなってきた」「FIM得点高値」「ベンゾジアゼピン系薬の内服」「平均投薬数が多い」であった．ロジスティック回帰分析の結果，入所期間中の転倒発生に対して，「背中が丸くなってきた」が独立関連因子であった（オッズ比4.11）．

Abstract　Purpose : The purpose of this study was to investigate the risk factors for falls among wheelchair users who were institutionalized in a long-term care health facility. Subjects : The participants were 62 new residents (mean age, 85.4±7.9) of a long-term care health facility. Methods : A longitudinal study of 6 months follow-up for falls was carried out. Baseline data were obtained regarding age, history of falls, functional status, psychological variables, physiological function, medical treatments and economic status. Risk factors for falls were analyzed by logistic regression. Results : During the follow-up, falls by 29 patients (46.8％ of participants) were reported. Our analysis showed that four risk factors were significantly associated with falls : the patient had a bent back, a high FIM score, polypharmacy and benzodiazepine use. Logistic regression analysis revealed that a bent back was the best predictor of falls (OR 4.11 ; CI 95％ 1.25.13.5).