| Summary: | 博士 === 國立臺灣師範大學 === 衛生教育學系 === 99 === With the advent of an aging society, falls are the most common and serious public health issue for older adults. Along with significant health and disability impacts, Moreover, falls are leading cause of injury-related death among the elderly. The aims of this study were to investigate the incidences of falling and test a model that explains the relationships between the correlates of falling among the community-dwelling elderly within the framework of the PRECEDE model, through a community- base and by using a cross-sectional survey.
Method: Purposive samples of older adults were living in 42 communities in Taiwan were selected to participate in the fall prevention program, A total of 904 subjects aged 65 years and above. Based upon PRECEDE model and used structured questionnaires, including personal profiles and scales to obtain data on the knowledge, health beliefs, self-efficacy of fall prevention, environmental support, and physical function. Meta-analysis, logistic regression, and structural equation modeling analysis were performed as the main statistical methods.
Results: The main findings were divided into four sections: First, 16.92% of the subjects had suffered from falls in the past year. Second, the meta-analysis (Community sources) showed that “chronic disease” and “use of assistive devices” were the major relevant factors among the reinforcing factors are significantly related to incidences of falls in the preceding year; the effect sizes r value was between small and medium. Third, logistic regression identified the following significant predictors of falls were: “knowledge of fall prevention” among the predisposing factor; “self-efficacy of fall prevention,” “supportive environment,” “reaction time,” “20-meters walking test, ” among the enabling factors; and “living alone,” “use of assistive devices, ” and “chronic disease” among the reinforcing factors. Discriminant analysis showed that classified the percentage of the overall prediction was 82.9%. Fourth, after model modefication, the results indicated a good model fit, and parameter estimates and the direction of the relationship were consistent with the theory. The significant path coefficients with “reinforcing factor,” followed by “prediposing factor,” and finally “enabling factor.”
Conclusion: The above model had a multifactor structure. This study is base upon PRECEDE model framework and uses structural equation modeling to explain the fall model. The results indicated a good model fit . Thus, future programs and policies can apply this model to prevent falls.
Keywords: community-dwelling older adult, PRECEDE model, fall model, environmental support, self-efficacy of fall prevention
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