한국 농촌지역 노인에서 낙상 경험과 낙상 두려움이 일상활동 제한에 미치는 영향

이주현,안은미,김계은,정유경,김정현,김지혜,이건아,임세진,정소원 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.2

Background: The purpose of this study is to assess the prevalence of falls and to correlate if the fear of falling results in avoidance of activities in a rural community elderly population. Methods: A cross-sectional study was done in 299 rural residents in Korea aged >60 years, between June 19, 2007 and June 21, 2007. Questionnaires about basic demographics, falling events, fear of falling (K-ABC), and limitations of daily activities (K-IADL) were completed. Results: Among the 299 participants, 26.1% had experienced a fall. 197 participants confirmed that they experienced fear of falling (66.9%). This was further broken down to participants who were 'a little concerned’ (31.4%), ‘much concerned’ (20.7%), and ‘very much concerned’ (13.7%). 183 people (61.2%) had limited daily activities caused by a fear of falling. Fallers experienced higher levels of anxiety and fear of falling than non-fallers (p<0.001). Comparing fear of falling with limited daily activities shows that the greater the fear of falling, the larger the limitation in daily activities and the lower the K-IADL score. After adjusting for falling, multiple linear regression showed that fear of falling and limited daily activities were positively correlated (p<0.001). Among groups with fear of falling, non-fallers, exercise group (p=0.024), and good perceived health group (p=0.022) had no limitations in activities compared with the control groups. Conclusion: Modifying drinking habits, diet habits, and social activities associated with perceived health states may improve daily activity levels in the elderly residing in rural communities, even though they have the fear of falling. 연구배경: 최근 노령화가 진행됨에 따라 노인 질환의 증가와 의료비 상승이 중요한 사회문제로 등장하고 있다. 이 연구는 농촌지역 노인의 낙상 경험 유무에 따른 낙상 두려움 정도를 조사하고, 낙상 두려움이 일상활동 제한 여부와 연관성이 있는가를 조사한 연구이다. 방법: 연구 대상자는 2007년 6월 19일에서 2007년 6월 21일까지 춘천시 사북면 5개 리에 거주하는 60세 이상 노인 299명이며, 가정 방문을 통하여 설문조사를 실시하였다. 결과: 연구 대상자 299명 중 지난 1년간 낙상을 경험한 노인은 78명(26.1%)이었고, 낙상 경험 노인과 비경험 노인의 일반적 특성을 비교한 결과, 성별, 배우자 유무, 교육수준, 고혈압, 골절에서 유의한 차이가 있는 것으로 나타났다(p<0.05). 연구 대상자의 낙상에 대한 두려움은 197명(66.9%)에서 있었고, 대상자의 183명(61.2%)에서 낙상에 대한 두려움으로 일상활동을 제한하고 있는 것으로 나타났다. 낙상 경험 유무에 따른 낙상 두려움의 차이를 분석한 결과, 낙상 경험 집단이 주관적 염려도 높고, 균형 자신감이 낮아 낙상에 대한 두려움이 낙상 비경험 집단보다 크게 나타났다(p<0.001). 낙상에 대한 두려움 유무에 따른 노인의 일상활동 제한 정도를 비교한 결과 두려움이 커질수록 주관적 일상활동 제한이 크게 나타나고, K-IADL(도구적 일상활동 수행능력) 점수도 낮아졌다. 낙상 경험을 보정하더라도 낙상에 대한 두려움이 커질수록 일상활동 제한이 높은 것으로 나타났고(p<0.001), 낙상에 대한 두려움이 있더라도 일상활동 제한이 있는 경우와 없는 경우를 비 교 분석하여 관련 요인을 알아본 결과 낙상 비경험집단, 운동을 하는 집단(p=0.024), 주관적 건강수준이 좋은 집단 (p=0.022)에서 낙상 두려움이 있더라도 일상활동 제한이 없는 것으로 나타났다. 결론: 낙상에 대한 두려움은 자신감의 결여이며, 낙상경험과 무관하게 낙상에 대한 두려움 자체로도 일상활동에 부정적 영향을 미쳐서 활동을 억제하게 되는 것을 본 연구를 통해 알 수 있다. 또한 낙상의 두려움이 있더라도 운동을 하고 주관적 건강수준이 좋은 집단에서는 일상활동 제한이 없다는 본 연구 결과에 따라 농촌 노인의 주관적 건강수준에 영향을 미치는 인자들에 대한 교정을 통해 주관적 건강수준을 높인다면 낙상 두려움이 있는 노인일지라도 일상활동을 영위하는 수준을 높일 수 있을 것이다.

Fear of Falling in Older Adults: Comprehensive Review

정덕유 한국간호과학회 2008 Asian Nursing Research Vol.2 No.4

Fear of falling has been reported in a high percentage of community-dwelling elderly who both do and don’t have a history of falling. The aims of this review are to: (a) elucidate the definition of fear of falling; (b) clarify measurements of fear of falling based on its definition; and (c) describe the risk factors for fear of falling. Despite the importance of the percentage and the consequences of fear of falling, its definition is still vague and warrants clarification. Based on a literature review, major fear of falling measurements involve the evaluation of fear of falling and use of a fall efficacy scale. Using a correct definition of fear of falling, nurses working close with older adults need to identify the different definitions of fear of falling and fall efficacy scale. In addition, nurses who work closely with older adults should encourage them to increase or maintain modifiable factors by maximizing their basic health status and enhancing their physical activity to decrease fear of falling. [Asian Nursing Research 2008;2(4):214–222] Fear of falling has been reported in a high percentage of community-dwelling elderly who both do and don’t have a history of falling. The aims of this review are to: (a) elucidate the definition of fear of falling; (b) clarify measurements of fear of falling based on its definition; and (c) describe the risk factors for fear of falling. Despite the importance of the percentage and the consequences of fear of falling, its definition is still vague and warrants clarification. Based on a literature review, major fear of falling measurements involve the evaluation of fear of falling and use of a fall efficacy scale. Using a correct definition of fear of falling, nurses working close with older adults need to identify the different definitions of fear of falling and fall efficacy scale. In addition, nurses who work closely with older adults should encourage them to increase or maintain modifiable factors by maximizing their basic health status and enhancing their physical activity to decrease fear of falling. [Asian Nursing Research 2008;2(4):214–222]

낙상 두려움 정도와 주택 내부 공간 계획 요소 분석 - 고령자 및 고령자 진입 층을 중심으로

박성준 한국문화공간건축학회 2016 한국문화공간건축학회논문집 Vol.- No.54

This research aims to suggest the housing design directions for the elderly and the pre-elderly, responding to prevent the falling accidents and to decrease the fear of falling. The fear of falling reduces the possibility of ‘Active Aging’ and impedes the quality of life for the elderly and the pre-elderly. Therefore, the purpose of this study is for the elderly and the pre-elderly to suggest the housing design directions for ‘Active Aging’ through analyzing main factors related to the fear of falls both inside and outside, the scale in the fear of falls, and the housing design elements according to their priority. The methods of this study are literature review and questionnaire survey. By analyzing literatures and previous studies, we deduced the items for investigating the fear of falling and the preference and the importance in housing design elements based on the universal design and barrier-free design. According to the study, firstly, the elderly and the pre-elderly had the fear of fall regarding the outside activities in poor weather condition and the movement of bending over, going up and down the stairs. Secondly, the group experienced in falling had low satisfaction for the housing planning elements. Thirdly, the importance and the satisfaction of the housing planning elements were high overall regardless of their experience of falling. Lastly, the housing planning elements such as non-slip flooring, the accessibility of bedroom and kitchen, and the flexibility of storage space were considered by priority. In this research, the direction of the housing design elements for the elderly and the pre-elderly are proposed, correlating with the scale in the fear of falling, This research can be used as a basis of house remodeling principles in preparation of the population aging.

Risk Factors Associated with the Fear of Falling in Community-Living Elderly People in Korea: Role of Psychological Factors

JongIl Park,JongChul Yang,Sangkeun Chung 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.6

Little is known about the risk factors for the fear of falling in elderly Korean individuals. Thus, the present study aimed to investigate the risk factors for fear of falling in a representative elderly population of over 10,000 individuals aged 65 years and older. A multivariate multinomial analysis revealed that the risk factors associated with a severe fear of falling were being female [odds ratio (OR)=4.396], older age (OR=5.550 for those aged ≥85 years), lower level of education (OR=0.719 for those with ≥13 years of schooling), chronic illness (OR=2.788 for those with more than three chronic illnesses), poor subjective health (OR=6.268), functional impairments (OR=2.340), a history of falling (OR=7.062), and depression (OR=1.774). The ORs for each of these risk factors were particularly high in participants with a severe fear of falling. Particularly, a history of falling and/or poor subjective health status had strong independent associations with the fear of falling. The present findings may help health care professionals identify individuals that would benefit from interventions aimed at reducing the fear of falling.

지역 거주 노인의 균형 능력과 낙상 공포감의 관계

정미숙,박지원,Jung, Mi-Suk,Park, Ji-Won 대한물리치료학회 2012 대한물리치료학회지 Vol.24 No.1

Purpose: The purpose of this study was to examine the difference between the faller and the non-faller in the test for balance and fear of falling. This was also done to determine whether the balance and the fear of falling are correlated in the elderly. Method: Forty eight subjects participated in this study, who attended the senior center in Daegu. Prior to the test, demographic data was collected. As for the balance test, Berg Balance Scale (BBS), Timed Up & Go (TUG), Short Physical Performance Battery (SPPB), Functional Reach Test (FRT), and One Leg Stance (OLS) were used. For measuring the fear of falling, Falls Efficacy Scale (FES) and Activities-specific Balance Confidence Scale (ABC) were used. Independent t-test and Pearson's correlation was performed using PASW 18.0 for windows. Result: All balance tests, except OLS, and fear of falling could discriminate between the faller and the non-faller. There existed a significant correlation between some balance test and fear of falling (r=0.64~0.86). Conclusion: The findings indicate that assessing the falling in the elderly, there needs to be a consideration of multiple aspects including the fear of falling and not only the balance test.

여성 고령자의 낙상경험 및 낙상공포 수준에 따른 체력의 차이

김선연(Sun Yeon Kim),윤완영(Wan Young Yoon),이중철(Joong Chul Lee),임승길(Seung Kil Lim) 한국사회체육학회 2010 한국사회체육학회지 Vol.0 No.41

The purpose of this study was to verify the difference in physical fitness according to the experience of falling and intensity of fear of falling in elderly females. The subjects were comprised of 164 elderly women (aged 65-88). Subjects were divided into four groups: 1) have fallen-high K-SAFE group, 2) have fallen -low K-SAFE group, 3) have not fallen-high K-SAFE, 4) have not fallen-low K-SAFE group. Fear of falling was measured with Korean survey of activities and fear of falling (K-SAFE) questionnaire. Physical fitness was assessed by measuring upper and lower extremity strength, aerobic endurance, upper and lower extremity flexibility, agility, and dynamic and static balance. In order to analyze collected data, 2×2 ANCOVA was utilized. The statistical significance was accepted at .05 levels. The results were as follows: Age affect upper and lower extremity strength, aerobic endurance, upper extremity flexibility, agility, and dynamic and static balance(p<.05). Upper and lower extremity strength, aerobic endurance, lower extremity flexibility, agility, and dynamic and the static balance of the low K-SAFE groups were significantly higher than the high K-SAFE groups(p<.05). Upper extremity strength and upper extremity flexibility of the have not fallen groups were significantly higher than the have fallen groups(p<.05). In conclusion, high intensity of fear of falling was associated with a reduction in Upper and lower extremity strength, aerobic endurance, lower extremity flexibility, agility, and dynamic and the static balance. Therefore, if elderly women have an intense fear of falling, even though they did not actually fall, they need countermeasures, education in fall prevention and specific exercises to help strength a balance, which will help ease fears and prevent falls.

A Prediction Model of Fear of Falling in Older Adults Living in a Continuing-Care Retirement Community(CCRC) in United States

정덕유(Jung, Dukyoo) 한국노년학회 2009 한국노년학 Vol.29 No.1

배경: 낙상은 노인의 가장 일반적이고 심각한 건강문제로 대두되고 있다. 낙상은 중요한 신체적 심리적 영향을 주며 결과적으로 신체적 행동약화나 기능의 위축, 사회적 기능 약화 등을 야기시킨다. 하지만, 상대적으로 낙상 후의 심리적, 정신적 부분은 간과되어져왔다. 낙상 후 노인들이 심리적 또는 정신적으로 보고하는 대표적인 증상으로는 다시 낙상을 할 것이라는 두려움으로 나타났다. 목표: 이 논문은 노인의 낙상에 대한 두려움에 영향을 주는 요인에 대한 모델을 테스트하는데 있다. 또한, 낙상에 대한 두려움에 영향을 주는 중요한 요인 중 하나인 노인의 운동과 운동에 대한 신념, 운동에 대한 기대감의 관계를 연구함에 있다. 방법: 미국 메릴랜드 주 볼티모어시 지역에 거주하는 노인149명을 대상으로 2004 11월부터 2005년 3월까지 수집된 2차 자료를 이용해서 결과가 분석되었다. 참가 가능 노인으로는 본 연구에 참여하기로 동의한 노인을 대상으로, 노인요양시설에 거주하며, 인지적으로 이상이 없고 (MMSE>20), 65세 이상의 나이를 가진 노인을 대상으로 한다. 자료 수집은 구조화된 설문지를 통해서 이루어졌다. 자료 분석을 위해, SPSS 12.0을 통해 빈도분석과 상관분석 등이 사용되었고, 모델 평가를 하기 위해서 AMOS프로그램을 통해 path analysis를 시행하였다. 결과: 모델 내 49개의 path중에 13개의 path가 유의하게 나타났고 모델의 22%가 설명되어졌다. 모델의 확실성은 chi-square를 통해서 조사되었고 결과 모델의 확실성이 입증되었다. 또한, CFI 는 0.99 RMSEA는 0.00으로 모델을 지지하는 결과가 나타났다. 특히, 성별, 과거 낙상경험, 운동은 노인의 낙상에 대한 두려움을 설명하는 중요한 변수로 나타났다. 논의: 본 연구는 노인의 낙상에 대한 두려움을 총체적으로 설명하기 위한 모델을 제시한다. 또한, 운동에 대한 신념과 결과에 대한 기대치가 노인의 운동을 설명하는 직접적 변수로, 낙상에 대한 두려움을 설명하는 간접적인 변수로 나타났다. 이 연구는 노인들이 낙상의 두려움을 줄이기 위해 적극적으로 운동에 참여하도록 하는데 중요한 이론적 근거를 제공한다. Background: Falls are among the most common and serious health problems of older people. The psychological symptoms of falling have received relatively little attention compared to physical problems. Objective: The purpose of this study is to test a model to explain the factors that influence fear of falling among older adults living in a continuing care retirement community (CCRC) in Baltimore city, United States. Methods: A secondary analysis was conducted using data obtained from a Health Promotion Survey done on 149 older adults living in a CCRC. Data was originally obtained during face to face interviews with each participant. Descriptive statistics and bivariate correlations were used to describe the sample and evaluate simple correlations. A path analysis was done using the AMOS 4.0 statistical program. Results: Of the 49 hypothesized paths, 13 were statistically significant, and the model accounted for 22% of the variance in fear of falling among the elderly. There was support for the fit of the model to the data with a nonsignificant chi square at 0.478 (df=2, p=0.79), and the ratio of chi-square to degrees of freedom was 0.24, a CFI of 0.99 and RMSEA of 0.00. In particular, gender, a history of falling, and exercise were significant predictors of fear of falling. Conclusions/Implications: As anticipated, exercise is an important factor to prevent fear of falling. As a modifiable variable, self-efficacy and outcome expectation indirectly influence fear of falling through exercise.

낙상 경험, 낙상 두려움, 낙상 두려움으로 인한 활동제약이 노쇠에 미치는 영향

지윤정(Yoonjung Ji),백원희(Wonhee Baek) 한국자료분석학회 2023 Journal of the Korean Data Analysis Society Vol.25 No.5

본 연구는 낙상 경험, 낙상 두려움, 낙상 두려움으로 인한 활동제약이 65세 이상 노인의 노쇠에 미치는 영향을 확인하기 위한 서술적 조사연구이다. 본 연구는 제8차 고령화연구패널조사 자료를 이용하였으며, 노쇠는 자가 건강 평가, 신체 상태, 정신 상태, 인지능력, 일상생활 활동, 도구적 일상생활 활동, 만성질환의 7개 요인과 41개의 항목으로 구성된 노쇠지수를 이용하여 도출하였다. 대상자의 노쇠에 미치는 영향요인을 파악하기 위해서 단계적 회귀분석을 사용하여 분석하였다. 본 연구의 대상자의 연령은 평균 76.0±7.4세였다. 최종모델에서 다른 요인을 조정하였을 때, 나이(β= 0.52, p<.001), 교육 수준(β= -2.29, p<.001), 배우자 유무(β= -0.75, p<.001), 사회적 만남 횟수(β= -1.04, p<.001)가 노쇠의 영향요인이었다. 낙상관련 요인에 있어서는 다른 요인을 조정하였을 때, 낙상 무경험자에 비하여 유경험자일수록(β= 1.47, p<.001), 낙상에 대한 두려움이 없는 대상자에 비하여 두려움이 약간 있거나(β= 2.87, p<.001), 두려움이 많을수록(β= 8.85, p<.001), 낙상 두려움으로 인한 활동제약이 없는 대상자에 비하여 활동 제약이 있는 대상자일수록(β= 5.14, p<.001) 노쇠지수가 증가하였다. 본 연구 결과를 바탕으로 낙상 사고를 예방하고, 낙상에 대한 두려움을 감소시키며, 낙상 두려움으로 인한 활동 제약을 극복할 수 있는 중재를 제공하면 노쇠를 예방하고 개선하여 노인이 보다 건강한 노화를 이룰 수 있을 것으로 기대된다. The purpose of this study was to determine the effects of fall experience, fear of fall, and activity limitations due to fear of fall on frailty in older people. This study used national data from the 8th Korean Longitudinal Study of Aging, and frailty index was assessed by 7 divisions and 41 items: self-health assessment, physical condition, mental condition, cognitive ability, activities of daily living, instrumental activities of daily living, and chronic diseases. Stepwise regression analysis was used to identify factors influencing the participants' frailty. The average age of the participants was 76.0 ± 7.4 years. When other factors were adjusted in the final model, age(β= 0.52, p<.001), education level(β= -2.29, p<.001), presence of spouse(β= -0.75, p<.001), social network(β= -1.04, p<.001) was an influential factor in frailty. Compared to individuals without a history of falls, those with a history of falls had a higher frailty(β= 1.47, p< .001). Additionally, individuals with a little fear of fall(β= 2.87, p< .001) or a high level of fear of fall(β= 8.85, p< .001) had higher frailty compared to those with no fear of fall. Furthermore, older people with activity limitation due to fear of fall had higher frailty index scores compared to those without activity limitation(β= 5.14, p< .001). Based on the results of this study, it will be possible to prevent and improve frailty through interventions to prevent falling accidents, reduce fear of fall, and relieve activity limitation due to fear of fall.

노인의 신체적 건강과 낙상두려움의 관계: 고령친화주거환경의 조절효과를 중심으로

한지나(Jina Han) 한국보건교육건강증진학회 2020 보건교육건강증진학회지 Vol.37 No.5

Objectives: This study aimed to investigate the association between age-friendly home environments and fear of falling among older Korean people and the moderation of age-friendly home environments in the relationship between physical health and fear of falling. Methods: A total of 10,450 community-dwelling older individuals who were 65 years old and over from the Survey of Living Conditions of Korean Older Persons were included. Logistic regression models were tested. Results: Older individuals living in age-friendly home environments were less likely to have a fear of falling. Although worse health conditions were positively related to the fear of falling, age-friendly home environments reduced the impact of self-rated health and vision impairment on the fear of falling. Conclusion: These results suggest that home modification in an age-friendly manner might be necessary to prevent fear of falling among older people with physical health difficulties. Proving the information that age-friendly home environments are related to fear of falling is also essential when health education is conducted for older people.

지역사회 재가 허약노인의 낙상두려움 관련요인 성별 비교

최경원(Choi, Kyungwon),박언아(Park, Un-A),이인숙(Lee, In-Sook) 한국노년학회 2011 한국노년학 Vol.31 No.3

본 연구는 허약노인의 성별에 따른 낙상두려움, 건강상태, 규칙적 운동 횟수 등을 비교하고 낙상두려움에 영향 미치는 요인을 규명하고자 하였다. 본 연구는 253개 보건소의 2009년 맞춤형 방문건강관리사업 중에서 허약노인 사례관리를 위해 수집된 65세 이상 노인들의 기초자료를 이용하였다. 연구대상자는 총 3903명(남 259명, 여 3644명)으로, 평균 연령은 남성이 75.17세, 여성이 평균 77.54세였으며, 남성의 75.3%, 여성의 85.4%가 낙상 두려움이 있다고 응답하였다. 저소득층 허약노인의 낙상두려움에 영향을 미치는 요인은 남성의 경우 정적 균형감, 과거 낙상경험이었으며, 여성 노인의 경우 정적 균형감, 복합적 이동능력, 우울과 과거 낙상경험, 교육수준으로 나타났다. 본 연구결과를 토대로 허약노인의 낙상두려움 여부 및 영향요인을 주기적으로 평가하여 고위험군을 발견하고, 낙상 및 낙상두려움 발생을 예방하기 위해 이들을 대상으로 정서적 접근을 포함한 다요인적 통합 프로그램을 성별에 따른 맞춤형으로 개발, 제공할 것을 제안한다. Purpose: This study was to investigate the factors influencing the fear of falling in frail elderly according to gender. Methods: The participants were the elderly over 65 years who were registered for case management for frail elderly of 253 public health centers. For data analysis, descriptive statistics and multiple logistic regression were performed using SPSS version 18.0. Results: Prevalence of fear of falling and the influential factors were different according to gender. 75.3% of the male elderly, 85.4% of the female elderly had the fear of falling. The predictors for men's fear of falling were static balance ability, experiences of previous falls, whereas for women static balance ability, TImed up and go, depression, experiences of previous falls, educational status were significant. Conclusion: Fear of falling and the influential factors of the frail elderly according to gender should be assessed regularly to find the high risk group. On the basis of that, prevention program for fear of falling and fall need to be developed and provided, which should be gender sensitive.