낙상 경험이 있는 지역사회 거주 노인의 반복 낙상 위험 요인

심미소(Mi-So Shim),우정희(Chung Hee Woo) 학습자중심교과교육학회 2024 학습자중심교과교육연구 Vol.24 No.8

목적 본 연구에서는 지난 1년 동안 낙상을 경험한 노인을 대상으로 반복 낙상의 위험요인을 분석하였다. 연구를 통해 지역사회 거주 노인의 반복 낙상 위험 요인 예방을 위한 중재 개발의 기초자료를 제시하고자 하였다. 방법 본 연구에서는 2020년 노인실태조사 자료를 이용하여 이차자료분석을 시행하였다. 지난 1년 동안 낙상 경험이 있는 지역사회 거주 노인 650명을 분석에 포함하였다. 반복 낙상의 위험요인을 파악하기 위해 일반적 특성, 건강관련 특성, 낙상의 원인을 포함하여 다항 로지스틱 회귀분석을 실시하였다. 결과 지난 1년간 대상자의 낙상 경험 횟수는 1회가 435명(66.9%), 2회가 156명(24.0%), 3회 이상이 59명(9.1%)이었다. 다항 로지스틱 회귀분석을 위해 지난 1년간 낙상을 경험한 횟수가 1회인 군을 참조군으로 선정하였으며, 분석 결과 우울이 있는 경우, 5회 sit-to-stand 검사를 수행하지 못하는 경우, 낙상의 원인이 신체적 문제인 경우가 반복 낙상의 위험요인으로 나타났다. 결론 지역사회 거주 노인의 반복 낙상의 예방을 위해 보건의료인은 참가자의 균형 장애, 신체적 문제와 함께 우울과 같은 정신적 문제를 고려할 필요가 있다. Objectives This study aimed to identify risk factors for recurrent falls among community-dwelling older adults who had experienced a fall in the past year. Methods This study performed secondary analysis using data from the 2020 National Survey of Older Koreans. Data from 650 community-dwelling older adults with one or more fall experiences in the past year were utilized. To identify risk factors for recurrent falls, a multinomial logistic regression analysis was conducted including general characteristics, health-related characteristics, and reasons for falls. Results The distribution of participants according to the number of falls in the past year was 435 (66.9%) people who had fallen once, 156 (24.0%) people who had fallen twice, and 59 (9.1%) people who had fallen three or more times. In the multinomial logistic regression analysis, the categorical number of falls (1, 2, and 3 or more) were considered as dependent variables, and the category of “1” was determined as the reference group. The findings of the analysis revealed that failure to perform a five-time-sit-to-stand test and depression were risk factors for the group that experienced falls twice. In addition, depression and physical reasons for falling were found to be risk factors in the group that experienced falls three or more times. Conclusions This study suggested that risk factors for recurrent falls among community-dwelling older adults comprehensively. Health care providers who provide screening and intervention to prevent recurrent falls need to consider mental problems such as depression along with the participants' balance disorder and physical problems.

Sex Differences in Factors Associated with Falls in Community-Dwelling Older Adults: Using the 2017 National Survey of Older Koreans

Minyoung Lee,Jeongok Park,Sue Kim,Kyung Hee Lee,Gi Wook Ryu 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aims: Falls in older adults are a major public health issue, and it results in hospital admission, frailty, disability, burden of treatment, depression, and death. Previous studies have identified falls-related risk factors such as sensory limitations, cognitive impairment, frailty, comorbidities, and physical function. Although these risk factors vary between men and women, especially in older adults, only a few studies have been conducted to investigate the association between sex difference and falls. This study aimed to identify sex differences in the factors associated with falls in community-dwelling older adults in South Korea. Methods: This study was a secondary data analysis using the dataset from the 2017 National Survey of Older Koreans. A total of 10,236 elderly adults aged 65 years and above were enrolled. We excluded 63 who were “unmatched” for falls. Data on frailty, instrumental activities of daily living (IADL); activities of daily living (ADL); depressive symptoms; cognitive functions; chronic health problems; and socio-demographic characteristics were collected. The data were analyzed with descriptive statistics, t-test, Chi-square test, and logistic regressions. Results: This study comprised 4,109 (40.1%) men and 6,127 (59.9%) women, with the majority aged 65 to 74 years (52.1%). In total, 1,619 (15.8%) participants experienced at least one fall in the past year. In men, the factors significantly associated with falls were middle school education (OR=1.471; CI=95% 1.096~1.972), frailty (OR=1.546; CI=95% 1.076~2.220), mild depression (OR=2.205; CI=95% 1.611~3.017), and osteoporosis (OR=3.326; CI=95% 1.958~5.652). In women, the factors significantly associated with falls were living alone (OR=1.331; CI=95% 1.116~1.589), IADL (OR=1.081; CI=95% 1.039~1.126), mild depression (OR=1.944; CI=95% 1.612~2.344), severe depression (OR=1.346; CI=95% 1.113~1.627), osteoporosis (OR=1.303; CI=95% 1.118~1.591), and arthritis (OR=1.158; CI=95% 1.008~1.331). Conclusions: Developing fall prevention programs should consider sex-related differences especially among community-dwelling elderly individuals.

한국 노인의 넘어짐과 연계된 인체손상에 대한 이해와 예방: 체계적 문헌 고찰

임기택,이지은,박하은,박수영,최우철 한국전문물리치료학회 2019 한국전문물리치료학회지 Vol.26 No.2

Background: Fall-related injuries in older adults are a major health problem, and the risks and mechanisms of these injuries should be affected by race, culture, living environment, and/or economic status. Objects: Research articles have been systematically reviewed to understand fall-related injuries in older adults in South Korea. Methods: 128 published research papers have been found through the Korea Citation Index and the Korean Studies Information Service System, and reviewed in various perspectives, including incidents, fall death rates, medical costs, causes, injury sites and types, locations where falls occurred, prevention strategies, scholarly fields interested in fall injuries, and the role of physical therapy. Results: Fall-related injuries were found to be more common in women than in men, and the number of incidents increased with age, with the highest rate found in individuals over 85 years old. Risk of fall injury was associated with education level, comorbidities, and fear of falling. Common places where falls occurred included the bathroom, living room, stairs, and hallway. Common types of injury included bruises, fractures, and sprains in the lower extremities. Intervention strategies included exercise programs, education, and protective clothing. Scholarly fields interested in fall-related injuries in older adults included medicine, nursing, physical therapy, occupational therapy, physical education, pharmacology, oriental medicine, biomedical engineering, design, clothing, and textiles. Physical therapy intervention using proprioceptive neuromuscular facilitation has been used to improve one’s balance. Conclusion: Any movement during the activities of daily living can lead to a fall. Physical therapists are highly educated to analyze human movements and should be involved in more research and practices to solve fall-related injuries in older adults.

Environmental Factors Influencing the Prevalence of Falls in South Korea

Beom-Ryong Kim,도광선,임종은 물리치료재활과학회 2022 Physical therapy rehabilitation science Vol.11 No.1

Objective: This study is a systematic review conducted to analyze the environmental factors that cause falls in the older adult. Design: Systematic reviewMethods: The study was conducted by searching the Research Information Sharing Service (RISS), Korean studies Information Service System (KISS), and Data Base Periodical Information Academic (DBpia) databases for literature published in South Korea up to July 2020. A total of 12 studies were selected for analysis based on the inclusion and exclusion criteria. Results: The results of the analysis revealed that all the selected literature were surveys and the study subjects were 65 years of age and above. The sample size ranged from a minimum of 95 subjects to a maximum of 3,278. A total of eight tools were used to measure the environmental factors associated with falls. The prevalence and recurrence of falls increase with age and deterioration of health. Older adult individuals who experience falls encounter difficulties in recovering from impaired physical function and disability; moreover, in severe cases, falls may lead to death. Falls are largely associated with a combination of intrinsic and extrinsic (i.e., environmental) factors. The purpose of this study was to assess potential extrinsic risk factors for falls. Falls occur in indoor environments, such as washrooms, bathrooms and living rooms, and outdoor environments, including roads and stairways, depending on the season, time of day, and use of ambulatory aids. In such environments, falls are mainly caused by slipping and stuttering. Conclusions: Therefore, as the rate of fall is influenced by several factors, extrinsic factors should be improved by developing comprehensive accident prevention programs that address the improvement of environmental risk factors around places of residence to reduce risk factors among the older adult, who, especially, are at a high risk for falls.

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.

Different Effects of Single-leg Stance Exercise and Bridging Exercise with Core Stability Exercise on Older Adults Balance

Brissa Isabel Salsabila,Farid Rahman,Yenny Lindoyo 한국운동생리학회 2023 운동과학 Vol.32 No.3

PURPOSE: Older adults experience a degenerative process that causes several health problems such as an increased risk of falling due to poor balance. However, to reduce the risk of falling exercise is used as an early intervention. The study aimed to understand the differences in the effect of single-leg stance exercises and bridging exercises with core stability exercises on increasing balance in older adults. METHODS: A quasi-experimental study was conducted at the Salus Medica Physical Medicine and Rehabilitation Clinic using a sample of 30 individuals divided into two groups. The interventions were conducted twice weekly for one month. The evaluation included first, middle, and final evaluations using the Berg Balance Scale. Moreover, the statistical test was used to determine the effect of intergroup administration on increasing the balance of older adults, whereas the independent t-test was used to determine the effects of intergroup administration on increasing balance among older adults. RESULTS: The results of the repeated-measures analysis of variance revealed that the p-value assumed sphericity in both groups (p=.000), which implies that the two groups improved the balance of the older adults. The independent t-test identified that the p-value equal variances were assumed (p=.572), which indicated no difference in the effect between the two groups in increasing the balance of older adults. CONCLUSIONS: No significant difference between single-leg stance exercises with core stability exercises and bridging exercises with core stability exercises in improving balance among older adults was observed.

지역사회 거주 노인의 특성 및 주거환경과 낙상 간 관련성 연구

진연주,홍익표 대한작업치료학회 2022 대한작업치료학회지 Vol.30 No.2

Objective: The purpose of this study was to examine the association between falls and thedemographic and health-related characteristics of older adults as well as their homeenvironments. Methods: A total of 9,411 community-dwelling older adults were retrieved from the 2020National Survey of Older Koreans. The relationships among falls, demographic andhealth-related characteristics, and home environment were analyzed using step-wisehierarchical logistic regression models. The dependent variable was fall events during thepast 12 months, and the independent variables were demographics, health-relatedcharacteristics, and home environments. Results: The majority of the sample individuals were 65-74 years in age (n = 6,069, 64.49%)and female (n = 5,626, 59.78%). A total of 585 (6.2%) older adults experienced a fallduring the past year. Among the older adults, those living in another house type (odds ratio[OR] = 3.91, 95% confidence interval [CI] 1.85-8.27), having no spouse ([OR] = 2.30,95% [CI] 1.37-3.85), and having no jobs ([OR] = 2.13, 95% [CI] 1.49-3.04) were likelyto have a fall during the past 12 months. Conclusion: The findings of this study can inform clinicians regarding the fall-relatedcharacteristics in community-dwelling older adults and help practitioners prioritize treatmentplans for home modifications. 목적 : 본 연구는 낙상과 관련된 노인의 일반적 특성 및 건강 관련 특성과 주거환경 사이의 관련성을 확인하고자 하였다. 연구방법 : 2020년 노인실태조사 자료를 활용하여 지역사회에 거주하는 만 65세 노인을 대상으로 낙상과일반적 및 건강 관련 특성, 주거환경 간의 관계를 분석하였다. 변수의 결측치를 제외한 9,411명의 자료를 활용하였다. 노인의 낙상 여부에 따른 일반적 및 주거환경, 건강 관련 변수들의 관련성을 파악하기위해 다중 로지스틱 회귀분석을 실시하였다. 결과 : 지난 1년간 낙상을 경험한 노인은 585명(6.2%), 낙상을 경험하지 않은 노인 8,826명(93.8%)으로나타났다. 전체 대상자의 연령은 65~74세가 6,069명(64.49%)으로 여성이 59.78%에 해당하였다. 낙상과 가장 큰 관련이 있는 요인으로 주택 종류 중 기타 3.91배(95% CI: 1.85, 8.27)로 나타났으며 배우자가 없을 때 2.30배(95% CI: 1.37, 3.85), 일한 경험은 있으나 현재 일을 하지 않는 노인의 경우2.13배(95% CI: 1.49, 3.04) 등의 순서로 나타났다. 결론 : 본 연구를 통해 노인의 낙상 위험과 관련된 요인을 확인하고 주거환경 개선을 위한 대상자 분류 및선정을 위한 자료로 사용될 수 있기를 기대한다.

Femoral Intertrochanteric Fractures of the Patients in the Emergency Department due to Minor Falls: Special Consideration in the Middle-old to Oldest-old Patients

Jung Min Jang,최한성,이종석,정기영,Hoon Pyo Hong,고석훈 대한노인병학회 2019 Annals of geriatric medicine and research Vol.23 No.3

Background: The older population (≥65 years) has rapidly increased in size in recent years. Among them, the middle-to-oldest-old (≥75 years) tend to have a poor health status. Therefore, subdivision and evaluation of older patients with traumatic injury are required. We focused on the risk of femoral intertrochanteric fractures occurring in older adults due to minor falls and compared young-old and middle-to-oldest-old populations. Methods: The medical records of patients who visited the emergency center due to hip injuries between March 2017 and March 2019 were retrospectively analyzed. Patients were divided into older adult (≥65 years) and non-older (age 18–64 years) groups; the older adult group was subdivided into young-old (65–74 years), middle-old (75–84 years), and oldest-old (≥85 years) groups. This study investigated the occurrence rate of femoral intertrochanteric fractures and related factors. Results: The older adult group had a higher incidence of femoral intertrochanteric fractures than that in the non-older adult group (95.3% vs. 4.7%, p

노인의 낙상 경험

신경림(Shin Kyung Rim),강윤희(Kang Younhee),정덕유(Jung Dukyoo),박효정(Park Hyo Jung),엄지연(Eom Ji Yon),윤은숙(Yun Eun Suk),김미정(Kim Mi Jung) 질적연구학회 2010 질적연구 Vol.11 No.1

Purpose: The purpose of this study was to explore experiences among older adults who has fallen within one year. Methods: The participants in this study were 14 old adults who has fallen within one year. Among them, 3 resided in nursing home and the others were dwelled in community. Data collection was conducted using a face to face interview in nursing home and focus group interview in community center, which were recorded on audio tape. Transcribed data was analyzed through thematic analysis method. Results: The results of this study were deduced as 2 main themes and 6 other themes. Study participants reported pros and cons after they had fall experiences. They indicated pros such as vigilance, affirmative coping for preventing repeated falling, and reconfirmation toward meaning of life. Additionally, physical withdrawn, psychological withdrawn, and passive handling with regard to repeated falling. Conclusion: The results of this study supported the older adults who had an experience of falling may have both positive and negative reflects. Based on the results, effective fall intervention program should be developed.

Test-retest Reliability and Sensitivity to Change of a New Fall Risk Assessment System: A Pilot Study

Miji Kim,김선영,Chang Won Won 대한노인병학회 2018 Annals of geriatric medicine and research Vol.22 No.2

Background: The new fall risk assessment (FRA) system is a composite and comprehen-sive assessment tool developed to predict the risk of falls. The aim of this pilot study was to examine the new FRA system’s test-retest reliability and sensitivity to change in commu-nity-dwelling older adults. Methods: This was an observational study with a test-retest de-sign and an 8-week fall prevention exercise program. A sample of 28 community-dwelling older adults with a mean age of 73.0 years (range, 65–80 years) participated in the study. The new FRA system was administered twice within a 7-day period for test-retest reliability expressed as intraclass correlation coefficient (ICC) and standard error of measurement (SEM) assessment. Eighteen subjects of them completed the 8-week fall prevention exer-cise intervention to evaluate the new FRA system’s sensitivity to change. Results: In the evaluation of interrater reliability for the new FRA system, the ICC (95% confidence inter-val) of the total score was 0.77 (0.47–0.98), with good reliability. The SEM was 11.61 for the total FRA score. A good to excellent reliability was observed, with ICC levels of 0.73 to 0.91 for the 4 composite scores of the new FRA system. Following the 8-week exercise intervention, the mean total FRA score (effect size, 0.58) significantly increased (p=0.028). Conclusion: The new FRA system has generally moderate to excellent interrater reliability and reliable sensitivity to change in community-dwelling older adults. Our findings provide support for the reliability of the new FRA system in healthy older adults without a fall his-tory. (Ann Geriatr Med Res 2018;22:80-87)