Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls

강병희,정경원,허요 대한응급의학회 2021 Clinical and Experimental Emergency Medicine Vol.8 No.1

Objective Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. Methods From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. Results Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality. Conclusion Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

간호·간병통합서비스 이용환자의 낙상발생률과 낙상의 특성

손재이,박병규,이찬희,안금희,김정남,박민현,최은영,부은희,강민진,홍정화 한국보건행정학회 2019 보건행정학회지 Vol.29 No.2

Background: Falls are the most frequent adverse events reported in hospitals. The aim of this study was to investigate the incidence rate and characteristics of falls in patients who used comprehensive nursing care service in National Health Insurance Service Ilsan Hospital. Methods: Incidence rate of falls was investigated in patients using comprehensive nursing care service, from July 2013 to Jun 2017 and compared with those not using this service. The characteristics and risk factors for falls, and fall-related injuries were obtained. Results: Among the 62,445 patients who used the comprehensive nursing care service for 4 years, total of 672 falls were reported. The incidence rate of falls per 1,000 patients-day was 1.15. The percentage of fall-related injuries was 26.9% and that of major injury was 2.2%. Although the incidence rate of all falls was slightly higher in patients using comprehensive nursing care service than those not using this service, falls-related injuries were not correlated with the implementation of this service. Conclusion: The falls could be more frequently detected and reported in comprehensive nursing care service, but there was no difference in fall-related injuries.

The effects of mental health on recurrent falls among elderly adults, based on Korean Community Health Survey data

Kyung Hee Jo,Jong Park,So Yeon Ryu 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: This study aimed to identify the effect of mental health on frequency of falls (single and recurrent falls) among elderly adults. METHODS: Data were drawn from the 2015 Korean Community Health Survey. A chi-square test was conducted to compare differences in fall frequency according to health-related behaviors, chronic diseases, and mental health. Subsequently, multinomial logistic regression analysis was used to identify the effects of mental health on single and recurrent falls based on variables found to be significant in the chi-square test. RESULTS: Recurrent falls were found to be more risky than single falls. Depression was significantly related to single falls (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.12 to 1.44). Depression (OR, 1.56; 95% CI, 1.38 to 1.76), sleep disorder (5 hours or less: OR, 1.12; 95% CI, 1.02 to 1.23; more than 9 hours: OR, 1.24; 95% CI, 1.07 to 1.44, respectively), and subjective stress (OR, 2.30; 95% CI, 1.90 to 2.78) were significantly related to recurrent falls. CONCLUSIONS: The study’s findings suggest that specialized fall prevention programs are needed to address different types of falls in elderly adults. To prevent recurrent falls, systematic treatment strategies and rehabilitation training must improve physical function and mental health.

어지럼 낙상 사고의 발생 유형 및 분석: 한국 3차 의료기관에서의 5개년간 분석

김성균,이성호,이선희,송재준,곽미정,이희선,임기정 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.6

Background and Objectives A fall refers to a sudden fall accident resulting in injury and hurt of the human body. In the hospital, fall accidents occur mainly in dizzy patients or elderly people, but can also occur even in young people who fail to adapt to the unfamiliar hospital environment. This study analyzed the incidence of fall accidents and its pattern in dizzy patients in a tertiary hospital in South Korea. Subjects and Method This study was conducted using 477 fall accidents that occurred in a tertiary hospital in Korea from 2011 to 2015. Extensively investigated were related fall risk factors such as patient’s sex, age, medical department, diagnosis, first witness, mental status, physical activity, patient risk factors, walking aids, medication use and treatment. Results Dizziness induced falls consisted of 20.5% of the total fall accidents. Sedative medications were frequently used in patients of dizziness induced falls (42.9%). Fall acidents were mainly detected by nurses 33%. The frequente sites of fall were the bed rooms (55%), the corridor (15%) or the bath rooms (8%). Types of physical damage were no damage (47%), abrasion or bruising (20%), laceration (10%), bath rooms (8%), fracture (3%), and head trauma (1%). In 532 treatments, observation was recommended for 68%, sterilization 15.2%, suture 4.7%, cast 1%, and surgery 1%. Conclusion The study finds that the fall risk screening test and Multifactorial Fall Prevention Program should be performed for all high-risk patients of fall. About 20% of falls were associated with otologic dizziness, and otolaryngology doctors should pay attention to the fall problem and the medication related to dizziness, which may potentially increase the risk of falls. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(6):271-8

Predictive validity of the gait scale in the Performance Oriented Mobility Assessment for stroke survivors: a retrospective cohort study

안승헌,지영주,이동건,송선해,이규창 물리치료재활과학회 2016 Physical therapy rehabilitation science Vol.5 No.1

Objective: The present study was to investigate the discrimination capacity of the Performance Oriented MobilityAssessment-Gait Scale (POMA-GS), for predicting falls in stroke survivors. Design: Retrospective cohort study. Methods: Data including the characteristics and number of falls of 52 chronic stroke patients from a rehabilitation center werecollected. The number of falls each subject had experienced in the previous year were investigated through interviews. The subjectswere divided into two groups depending on the number of falls: if falls occurred twice or more on the basis of the time ofstudy after stroke, they were defined as the falls group and if there was no fall experience or one fall, they were defined as thenon-falls group. The subjects were examined with the POMA-GS, and physical functions were examined using by the One LegStand Test (OLST), Sit to Stand Test (SST), 10-m Walk Test, Lower Extremity in Fugl-Meyer assessment (FM-LE), and TrunkImpairment Scale (TIS). The validity of POMA-GS for falls prediction was analyzed. Results: In the POMA-GS, which predicts falls in stroke survivors, the cut-off value was 8.5 (sensitivity 72%; specificity 65%)and the area under the curve was 0.75 (95% confidence interval: 0.60-0.90, p<0.007). There was a significant difference in theOLST, SST, FM-LE, and TIS between the subjects with POMA-GS >8.5 and the subjects with POMA-GS ≤8.5. Conclusions: The POMA-GS could be a useful tool in predicting falls in stroke survivors, as its discrimination capacity and predictivevalidity is proven satisfactory.

Association of Falls and Fear of Falling with Mortality in Korean Adults: The Dong-gu Study

오진규,최창균,김선아,권순석,이영훈,남해성,박경수,류소연,최성우,신민호 전남대학교 의과학연구소 2019 전남의대학술지 Vol.55 No.2

This study evaluated the association between falls and the fear of falling (FOF) with the risk of all-cause mortality in Korean adults. The study enrolled 4,386 subjects aged 50 years and over who participated in the Dong-gu Study. Falls in the past year were categorized as yes or no. Injurious falls were defined as falls that resulted in fractures, head injuries, sprains or strains, bruising or bleeding, or other unspecified injuries. FOF was classified as low or high. The associations of falls and fall-related characteristics with mortality were assessed using Cox proportional hazards models. The average follow-up was 7.8 years. During this period, 255 men and 146 women died. In a fully adjusted model, falls in the past year were not associated with an increased risk of all-cause mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.85-1.58), but a history of injurious falls was associated with an increased risk of mortality (HR 1.36, 95% CI 1.04-1.79). Compared with subjects without a FOF, subjects who were moderately or very afraid of falling had a higher mortality rate (HR 1.26, 95% CI 0.97-1.63). In conclusion, injurious falls and a high FOF increased the risk of all-cause mortality in Koreans. This study suggests that injurious falls and FOF can predict mortality in the general population.

Incidence of falls and fall-related characteristics in hospitalized children in South Korea: a descriptive study

Hyeyeong Park,Hyunju Kang Korean Academy of Child Health Nursing 2024 Child Health Nursing Research Vol.30 No.3

Purpose: With the recent increase in interest in patient safety, prevention of falls in hospitalized children has become important. This study aimed to identify the incidence rate of falls among hospitalized children and explore fall-related characteristics. Methods: This retrospective descriptive study analyzed the medical information of 18,119 patients aged <18 years admitted to a general hospital in South Korea from electronic medical records and fall event reports between January 1, 2018, and September 30, 2023. The study variables included the general and clinical characteristics of the fall group and fall-related characteristics of the fall events. This study employed descriptive statistics and a chi-square test using IBM SPSS version 26.0. Results: Among the patients, 82 fall events were identified. Therefore, the fall incidence rate was 4.5 falls per 1,000 patients. Furthermore, a statistically significant difference was found concerning the type of injury sustained between children >1 year old and those <1 year old, and most cases had no damage or bruises. More cases were found in which falls occurred two days after hospitalization in winter and summer than on the day or the day after hospitalization, which was a statistically significant difference. In addition, fall prevalence was higher between 8 am and 4 pm, and when no caregiver was present. Conclusion: Based on the results of this study, education and interventions to prevent fall events in infants and toddlers should persist throughout hospitalization, and it is necessary to guide continuous management and observation of the caregivers.

Changes in Fall Patterns and Influencing Factors in Korean Older adults: The Korean Frailty and Aging Cohort Study (KFACS)

Mi-So Shim,Gwang Suk Kim,Minkyung Park,Namhee Kim 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study was conducted to derive the fall patterns and to investigate the influencing factors using data from the baseline (2016-2017) and follow-up (2018-2019) of the Korean Frailty and Aging Cohort Study (KFACS). Method(s): Participants were 566 community-dwelling older adults aged ≥70 years old who had fall experience. Falls (fall experience, fall-related injuries, and fracture site), frailty, and health-related characteristics were assessed. Latent class analysis and latent transition analysis were performed to derive fall latent classes (patterns) and to identify transition probability of the fall patterns from the baseline to follow-up. After that, multinomial logistic regression was performed to identify influencing factors of fall patterns. Result(s): Three fall patterns were derived for each of baseline and follow-up. The fall patterns of follow-up were as follows: the group that did not experience falls (Class 1), the group with bruises and lacerations due to falls (Class 2), the group with fractures due to falls (Class 3). In follow-up, when using Class 1 as a reference, the influencing factors to be included in Class 2 were lower education level (RRR 0.546, p=.011), low alcohol consumption (RRR 0.503, p=.039), and poor balance (RRR 2.743, p<.001). In Class 3, men (RRR 0.223, p=.041), high frailty score (RRR 0.586, p=.045), and when classified as Class 2 (the group with sprains due to falls) in the baseline (RRR 0.243, p=.023) compared to classified as Class 3 (the group with fractures due to falls) were significant factors. Conclusion(s): This study provides a workable profile of the older adults’ fall patterns and related factors. Findings indicate that previous fall experience, alcohol drinking, frailty, and level of balance were associated with the fall patterns. Therefore, the fall patterns should be considered when evaluating history of falls, and fall prevention interventions targeting influencing factors should be developed for older adults.

노인에서 만성 어지럼의 분류 및 낙상과의 관계

양동석,이다영,오선영,박지윤 대한평형의학회 2018 Research in Vestibular Science Vol.17 No.1

Objectives: Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness.Methods: We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months. Results: Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group. Conclusions: The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.

The Impact of Physical Performance and Fear of Falling on Fall Risk in Hemodialysis Patients: A Cross-Sectional Study

Choi, Jiwon,Hwang, Sun-Kyung 한국성인간호학회 2024 성인간호학회지 Vol.36 No.1

Purpose: This study aimed to investigate the impact of physical performance and fear of falling on fall risk in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis. Methods: This study included 132 patients who regularly received hemodialysis treatment at outpatient clinics in B City from January to April 2022. Data were collected on demographic and clinical characteristics, physical performance (the Short Physical Performance Battery [SPPB]), fear of falling (the Korean Falls Efficacy Scale-International [KFES-I]), and fall risk (the Morse Fall Scale [MFS]). The collected data were analyzed using hierarchical multiple regression in the SPSS/WIN 25.0 program. Results: Thirty-eight patients (28.8%) had experienced accidental falls in the past year, with an average of 1.68 falls per patient. The average SPPB score was 7.89±3.55 (range, 0 to 12), the KFES-I score was 23.18±9.36 (range, 16 to 64), and the MFS score was 45.68±19.52 (range, 0 to 125). Fall risk showed a significant negative correlation with physical function (r=-.72, p<.001) and a significant positive correlation with fear of falling (r=.65, p<.001). Factors affecting the patients fall risk included the level of serum intact parathyroid hormone (β=.15, p=.004), fear of falling (β=.24, p=.010), number of falls (β=.34, p<.001), and physical performance (β=-.41, p<.001). The regression model was statistically significant (F=22.71, p<.001), with an explanatory power of 64.9%. Conclusion: To prevent accidental falls in ESRD patients undergoing hemodialysis treatment, it is necessary to develop and apply interventions that can enhance physical performance and reduce the fear of falling.