# 一名76歲病人至基層醫療診所做年度健康檢查。病人主訴過去6個月跌倒1次,站立時感覺不穩。依據CDC STEADI計畫,護理師應優先施行的介入為?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363451&lang=zh-tw  
> language: zh-TW  
> subject: Health Screening  
> category: HPM

## 題目

一名76歲病人至基層醫療診所做年度健康檢查。病人主訴過去6個月跌倒1次,站立時感覺不穩。依據CDC STEADI計畫,護理師應優先施行的介入為?

## 選項

1. 安排髖部X光檢查，以排除個案六個月前報告的跌倒造成的骨折
2. 將個案轉介給聽力學家進行聽力評估，作為預防跌倒的一部分
3. 執行Timed Up and Go(TUG)測試,完成跌倒風險完整評估 **✔ 正確答案**
4. 建議個案開始每天30分鐘的步行計劃，以降低跌倒風險

**正確答案: 3**

## 解析

CDC STEADI(Stopping Elderly Accidents, Deaths, and Injuries)為篩檢-評估-介入流程。本案12個月內1次跌倒+不穩,屬篩檢陽性。下一步為結構化評估: TUG、30秒椅子站立、4階段平衡。TUG ≥12秒代表跌倒風險升高,啟動多要素介入(藥物審視、維生素D、平衡與肌力運動、居家安全、視力與鞋子)。髖部X光屬事後影像;有氧運動忽略平衡訓練;聽力評估屬評估後下游介入。

## 深入解析

臨床判斷
STEADI流程: 篩→評→介。本案1次跌倒+不穩=陽性。下一步: TUG、30秒椅子站立、4階段平衡。TUG ≥12秒=高風險。

記憶口訣
STEADI: 篩→評(TUG≥12秒)→介(藥、維D、運動、居家)

韓 vs 美
STEADI為CDC框架但TUG與椅子站立等工具國際通用。臺灣老年醫學會跌倒指引採同樣測試;社區及老年醫療機構已採多因素跌倒評估。

## 臨床情境

臨床指引
CDC STEADI多因素評估(篩檢陽性):
- TUG: 起立、走3 m、回程、坐下。≥12秒=高風險。
- 30秒椅子站立: 不用手撐起立次數;依性別年齡常模。
- 4階段平衡: 漸進姿勢;Tandem或單腳失敗=高風險。
- 姿勢性血壓、視力、鞋子、居家風險、藥物審視(benzodiazepine、opioid、抗膽鹼藥為重點)。
- 維生素D 800-1000 IU/日,有監督運動(太極、Otago)。

注意
12個月內2次以上跌倒或傷害性跌倒需立即轉介醫師 — 老年綜合評估。

## 重要概念

- **STEADI** — CDC計畫Stopping Elderly Accidents, Deaths, and Injuries。三步: 3個關鍵問題篩檢、以效度工具評估高風險者、實證多因素介入。免費工具見cdc.gov/steadi。
- **TUG(Timed Up and Go)** — 標準化行動能力測試: 病人由椅子起立、行3公尺、回轉、坐下。≥12秒=跌倒風險升高。為社區長者敏感篩檢工具。
- **多因素介入** — 實證跌倒預防組合: 藥物審視(減用鎮靜、抗膽鹼、多重用藥)、維生素D、平衡與肌力訓練、居家風險減少、視力與鞋子矯正、姿勢性血壓管理。

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