요양병원 치매 환자의 낙상실태와 낙상위험요인 분석

임정옥,구미옥 한국노인간호학회 2016 노인간호학회지 Vol.18 No.2

Purpose: This study was conducted to examine circumstances related to falls in patients who had a fall, and identify fall risk factors among inpatients with dementia in long-term care hospitals. Methods: Eighty-four patients who experienced a fall were matched with 168 control patients by gender, age, and length of hospital stay. Data were collected from patients' medical records and fall reports, and analyzed using descriptive statistics, x2 test, Fisher's exact test, and logistic regression analysis with the SPSS/WIN 21.0 program. Results: Incidence of falls was 12.6/100 persons/year. Of the 84 patients who experienced a fall, 42.9% fell once, 16.7% fell twice, and 40.5% fell three or more. In the fall group, falls commonly occurred during nurses' day duty (42.3%). The most common causes of falls were walking (54.9%), and loss of balance (56.7%). The fall risk factors which predicted fall occurrence were arrhythmia, urinary problems, unstable gait, behavioral and psychological symptoms of dementia, the use of diuretics and antidepressant drugs, dependence on a caregiver, use of a hospital bed and patients at high-risk for a fall. Conclusion: These findings can be used to develop fall risk assessment tools and fall prevention programs for inpatients with dementia in long-term care hospitals.

Falls and Their Associated Risks in Parkinson’s Disease Patients in Nigeria

Temitope Hannah Farombi,Mayowa O Owolabi,Adesola Ogunniyi 대한파킨슨병및이상운동질환학회 2016 Journal Of Movement Disorders Vol.9 No.3

Objective Falls are a devastating consequence of Parkinson’s disease (PD) and are due to motor imbalance. However, the frequency of falls and their risk factors among Nigerians with PD is not known despite the significant increase in PD cases in the country. To assess fall risk factors and frequency in Nigerian PD patients. Methods Using an analytical design to compare falling versus non-falling patients, 81 PD patients were assessed for clinical factors, frequency of falls, and candidate risk factors for falls according to the Tinetti Balance and Gait, Unified Parkinson’s Disease Rating Scale subsection 1, and Timed Up and Go Tests. Descriptive, bivariate, and multivariate analyses were performed at the 95% confidence level. Results The mean age of participants was 65.6 ± 9.7 years. Falls were about three times (p < 0.001) more common in PD patients. Of the falling patients, 67.7% sustained injuries, 67.7% had recurrent falls and 44.9% admitted to having a fear of falling. The independent statistical predictors of fall were fear of falling [odds ratio (OR): 3.86], disease severity (OR: 1.09) and disease duration (OR: 1.01). Conclusion The frequency of falls in PD patients was significantly higher when compared with the healthy adult population, and the modifiable predictor was fear of falling with a potential to significantly reduce falls when strategically addressed

노인전문병원 간호사의 낙상에 관한 지식 및 태도, 낙상 예방활동에 관한 연구

유광수 한국보건간호학회 2017 韓國保健看護學會誌 Vol.31 No.3

Purpose: The purpose of this study is designed to identity the extent of geriatric hospital nurse’s knowledge attitude and fall prevention activities toward falls, thereby identifying the relationship between them. Methods: Knowledge of the falls targeting 350 people who work in the nurse elderly hospital, located at J city, attitudes about fall prevention activity data were collected for nurses working in the geriatric hospital. The collected data were analyzed with descriptive statistics, t-test, one-way ANOVA, Scheff’s test, correlation coefficients. Results: Attitude and prevention activities of fall showed that there is a correlation. Showed that age was a significant effect on falls prevention activities age 45 years and olde and attitude. The higher the fall prevention activities were found to be low. Conclusion: In relationship between knowledge, attitudes and prevention activities regarding falls, knowledge about falls had no correlation with attitude and prevention activities and a correlation was found between attitudes and prevention activity regarding falls. Accordingly, it is required to implement training program to improve nurse’s attitude to falls, and repetitive fall prevention training and education is expected to contribute to increasing the practice of fall prevention activity.

노인들의 낙상 예방 활동에 관한 고찰

이재갑,김명준,김성은,김진 한국지역사회건강관리협회 대한건강과학학회 2014 대한건강과학학회지 Vol.11 No.2

Purpose : A Study on the falls and prevent falls through the study of literature from the necessity and the prevention of procedure is designed to find a way. Method : Analyze the related papers. Result : (1)Percentage falls is ① Somewhere in 30 to 50 % of older adults, experienced the falls. ② Community appeared higher than in the fall rate is 40 to 80 percent of hospitals or nursing agencies. ③ Women there is a high occurrence of falls than men. ④ The occurrence of the more difficult economic situation, fall is high. ⑤ There is a higher occurrence of cases that have experienced in falls. ⑥ If there is a disease, have a higher occurrence of falls. ⑦ The environmental problem is happening to increase the occurrence (2)Fall cause classification ; Should be categorized into groups to control of the causes of falls. Therefore, physical, psychological, environmental, classified by environmental factors. (3)The problems caused by falls : 65 percent of the fall an old man's suffered a cerebral hemorrhage, fractures, sprains, contusions, lacerations, abrasions, damaged. (5)Prevention methods : It was exercise and music, rhythm, education programs, a combination of effective. Conclusion : Evaluation of the possible fall on a regular basis. And the development of any program that combines rhythmic movements and interesting education enhances its effectiveness.

한국 노인의 낙상 실태와 위험요인: 일부 지역의 인구비례 할당 표본 조사

임재영,박원범,오민균,강은경,백남종 대한노인병학회 2010 Annals of geriatric medicine and research Vol.14 No.1

Background: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. Methods: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arran- gement(with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. Results: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. Conclusion: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female partici- pants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls. 연구배경: 일부 지역의 인구 비례할당 표본 조사를 통하여노인의 낙상의 발생과 그 결과를 조사하고 낙상 위험 인자를확인하고자 하였다. 방법: 한 지역의 65세 이상 인구의 비례할당 표본을 대상으로 숙련된 조사요원에 의한 전화조사를 통해 낙상발생 날짜,시간, 장소, 상황 등에 대하여 조사하였다. 그리고 관련된부상 등 낙상 결과에 관한 조사와 낙상에 대한 위험인자,즉 독거 유무, 알코올섭취량, 운동량, 청각과 시각장애, 기억력, 감각 문제, 하지 위약 및 관절염 증상 등을 물어보았다. 또한 낙상의 두려움과 두려움 관련 활동제한도 평가하였다. 결과: 지난1년 동안 낙상의 발생률이 13%였고, 여성의발생률이 더 높았다. 낙상은 주로 봄이나 여름 10시~3시사이에 주로 나타났다. 낙상의 일반적인 이유는 미끄러짐과걸려 넘어짐이었다. 14.9%의 사람이 골절상을 입었다. 여성이 낙상의 중요한 위험요소였는데, 여성의 경우 더 심각하게부상을 나타내는 경향이 있었다. 최근 1년 동안 낙상의 주된위험요소로는 하지의 고유수용체감각의 감소였다. 특히 여성에서 낙상에 대한 두려움 때문에 활동을 제한하는 경향을보였다. 결론: 노인에서 여성 자체가 낙상의 위험인자이다. 여성노인이 더 자주 넘어지고 낙상 후에 더 나쁜 낙상 결과를갖게 되며, 낙상 관련 두려움과 이로 인한 활동제한도 더많았다.

노인환자의 낙상 위험 약물 사용 현황과 낙상 발생 위험도 분석

최서윤,박윤희,김재연,곽혜선,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.2

Central nervous system drugs, antihypertensives can cause drowsiness, confusion resulting in a fall. Taking these medicines further increases the risk of falls in elderly patients who have high risk of falls and take many kinds of drugs. A lot of researches on risk factors about a fall have been performed, but disturbance variables are often distorted the results. In this study, using case-crossover design to control other factors, we investigated the impact of drugs causing a fall to hospitalized elderly patients. We selected patients over 65 years of age who were reported about fall accidents between January 2009 and September 2011. Age, sex, fall risk assessment score, and underlying diseases were investigated. To analyze the risk of drug inducing fall, we researched the inpatients’exposure of medication within 7 days before having fall (risk period) and 1 month before the fall (period in contrast). Selected drugs inducing fall have already been noted as risk factors for a fall in literatures; Antihypertensive drugs, anticonvulsants,alzheimer's disease therapeutics, antiparkinsonian agents, antidepressants, antipsychotics, anxiolytics, sedatives, hypnotics and opioid analgesics, antihistamines, skeletal muscle relaxants and others such as metoclopramide. We found the elderly patients who have experience taking the medicine inducing a fall are 162 (96.4%), accounted for the majority. Patients taken four or more fall risk drugs in risk period were 71 cases (42.3%), compared to 26 cases (15.5%) in the contrasting period, which means the more fall risk drugs were taken during 7 days before having fall(p<0.001). Exposure medications such as diuretics (OR=2.3, 95% CI=1.3-4.2), antipsychotics (OR=2.8, 95% CI=1.2-6.4), zolpidem (OR=3.5, 95% CI=1.4-8.9), opioid analgesics (OR=3.5,95% CI=2.1-5.6) were significantly more likely to have falls during hospitalization. As mentioned above, the majority of elderly patients experienced a fall were exposed to fall risk drugs and took multi-drugs of them more than four. Therefore, it is needed to prepare the role of mediator as a pharmacist for preventing falls in elderly patients.

일개 종합병원 입원환자의 낙상 실태 및 관련요인

양화미,천병철 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

Background: Toestimate fall incidence rate and associated factorsin inpatients from a generalhospital. Method: The data werecollected from 104 fall incident reportsdeveloped by the patient safety committee in a general hospital in Seoul from 01 January 2007 to 31 December 2008. Information included general characteristicsof patients, factors related to fall, types, places,circumstances and outcomes of fall. Result: The incidence rate of fall, which was 4.4 per 1,000 total dischargedpatientsand 0.5 per 1,000 patientdays, was much lower than that of several hospitals in the United States. The difference may reflect the different incidence reporting systemof each hospital. Fall-pronepatients were, in general, ~65 years of age, had an alert mental status, were ambulatory with some a ssistance, and were dependenton and ambulatory device. High incidence of falls was associated with patients with circulatory disease. The majority of fall event susually occurredin bed orat the bedsidein thepatient's room, and occurred more of tenduring the night than during the day or evening. Risk factors of fall wereuse of drugs (antihypertensive or neuropsychiatric drugs) and environmental factors (e.g., overly highbed height, surrounding objects, inadequate fitnessshoes and slippery floor). Physical injury occurred in 43.3% of fall events, which typically required diagnosis of injuryand treatmentsuchas suturing. Riskfactorsforrepeatedfallswereuseofa neuropsychiatric drug (oddsratio=13.9) and gait disturbance (oddsratio=91.2). Risk factors for fall-related injurywerealert mental status(oddsratio=3.3 timesmore likelyto fall than thosewhoweredrowsyor ina stupor) and general weakness(odds ratio=3.3 times more likelyto fall than thosewhowerenot generally weak). Conclusion : Medicaland nursing staff shouldbe awareof the fall risk factorsof hospitalized patientsand should intensively pursue preventative strategies. Development of fall prevention education based on these resultsis recommended.

노인요양원 요양보호사의 낙상관련지식과 낙상예방돌봄행위

김미선(Kim, Mee Sun),은영(Eun, Young) 대한근관절건강학회 2014 근관절건강학회지 Vol.21 No.1

Purpose: The purpose of this study was to understand care workers’ fall-related knowledge and caring behaviors for fall prevention in nursing home. Methods: This study was a descriptive survey study. Data have been collected from 125 care workers in 5 nursing homes. Data were analyzed using frequency, t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficients. Results: 1) The average percentage of correct answers for care workers’ fall-related knowledge was 72.2%. There were significant differences in fall-related knowledge by age, experiences of re-education about care for fall injuries, and experiences to transfer fall patients to another hospital. 2) The average level of care workers caring behaviors for fall prevention was 3.81 points out of 4. There were significant differences by experiences of education about care for fall injuries in nursing home and concern of fall injury prevention. 3) There was a significant correlation between fall-related knowledge and caring behaviors for fall prevention (r=.320, p<.001). Conclusion: The level of fall-related knowledge is positively correlated to the level of caring behaviors for fall prevention. Therefore, nurses should prepare education programs to increase care workers’ fall-related knowledge and caring behaviors for fall prevention.

뇌졸중 환자의 낙상 형태와 낙상 관련요인

권미지,Kwon, Mi-Ji 대한물리치료학회 2008 대한물리치료학회지 Vol.20 No.3

Purpose: We analyzed the incidence of falls and the related factors, circumstances, and consequences associated with falls in stroke patients. Methods: We recruited 127 stroke patients and used a self-reported questionnaire to measure fall prevalence rates and the related factors, circumstances, and consequences of falls. The chi-square test was used to establish associations between related factors. Results: The prevalence of falls in stroke patients was 69.3%, and was associated with gender and time since the stroke. Falls occurred 2-5 times (55.4%) poststroke and most subjects first fall in the 2$\sim$6 month (46.5%) after the stroke. Most (55%) falls occurred at the hospital. Walking was the most frequent circumstance for falls (38.5%). Most (54.4%) falls led to consequences such as fractures, ligament strains, bruises, or abrasions. Conclusion: Fall-prevention strategies decrease the number of falls and the severity of fall-related injuries. These data support the concept of preventive strategies for falls in stroke patients who are at risk.

Effective Detection Method For Falls According to the Distance Between Two Tri-axial Accelerometers

Jae-Hyung Kim,Geun-Chul Park,Soo-Hong Kim,Soo-Sung Kim,Hae-Rim Lee,Gye-Rok Jeon 한국물리학회 2016 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.68 No.7

Falls and fall-related injuries are a significant problem in the elderly population. A number of different approaches for detecting falls and activities of daily living (ADLs) have been conducted in recent years. However, distinguishing between real falls and certain fall-like ADL is often difficult. The aim of this study is to discriminate falls from fall-like ADLs such as jogging, jumping, and jumping down. The distance between two tri-axial accelerometers attached to the abdomen and the sternum was increased from 10 to 30 cm in 10-cm intervals. Experiments for falls and ADLs were performed to investigate the feasibility of the detection system for falls developed in this study. When the distances between the two tri-axial electrometers were 20 and 30 cm, fall-like ADLs were effectively distinguished from falls. The thresholds for three parameters - SVM, Diff Z, and Sum diff Z - were set; falls could be distinguished from ADL action sequences when the SVM value was larger than 4 g (TH1), the Diff Z parameter was larger than 1.25 g (TH2), and the Sum diff Z parameter was larger than 15 m/s (TH3). In particular, when the SVM, Diff Z, and Sum diff Z parameter were sequentially applied to thresholds (TH1, TH2, and TH3), fall-like ADL action sequences were accurately discriminated from falls.