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To explore the incidence, characteristics, complications and socioeconomic impacts associated with falls in community-dwelling elderly.
From September 1, 2015 to October 12, 2015, a questionnaire-based survey was conducted involving a total of 2,012 elderly who lived in Guro-gu (Seoul), Yeongdeungpo-gu (Seoul), Yangpyeong-gu (Gyeonggi-do), Dalseong-gu (Daegu), and Jung-gu (Daegu). The subjects were interviewed using a structured questionnaire to obtain demographic characteristics and comprehensive falling histories. The socioeconomic cost related to falls was estimated using the statistical data provided by the Health Insurance Review and Assessment Service.
Falls were recorded in 666 out of the 2,012 subjects (33.1%) during the past year. Frequent falls occurred during December, in the afternoons, when the floor was slippery. The most common injuries included the low back and the most common injury type was sprain. The total direct costs related to falls involving the 2,012 subjects were 303,061,019 KRW (Korean won). The average medical cost related to falls in the 2,012 subjects was 150,627 KRW and the average medical cost of 666 subjects who experienced falls was 455,047 KRW. Estimates of the total population over the age of 60 years showed that the annual direct costs associated with falls in Korea over the age of 60 years were about 1.378 trillion KRW.
This study was conducted to explore the incidence, characteristics, complications, and socioeconomic impacts of falls in community-dwelling elderly. This study is expected to be used as a source of basic data for the establishment of medical policy for the elderly and the development of a fall prevention program for the elderly in Korea.
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To evaluate the association between balance function and asymmetry of knee extension strength in an elderly Korean population.
The strength of the knee extensors in each leg was measured in 306 community-dwelling elderly subjects (age, 76.70±4.85 years) and 25 young healthy subjects (age, 34.23±8.93 years). Based on the difference in strength of both legs, the elderly subjects were divided into symmetric (n=128) and asymmetric (n=178) strength groups using an asymmetry cutoff 20%. We determined the postural control ability of the subjects using InBody posturography, Berg Balance Scale (BBS), Timed Up and Go test (TUG) and Short Physical Performance Battery (SPPB). The sway index (SI) of the subjects in four positions was assessed using posturography.
The group with asymmetric strength presented a significantly higher SI than the group with symmetric strength, in the normal position with eyes open and eyes open on pillows. In the normal position with the eyes closed and in postures with the eyes closed on pillows, the statistical analysis revealed no significant differences between the two groups. The three tests for physical performance (BBS, TUG, and SPPB) show no statistically significant difference between the two groups.
The asymmetric strength group showed a significantly lower balance than the group with symmetric strength based on several posturographic parameters. Ambulatory elderly individuals with asymmetry in knee extension strength, showed deficits in balance control even in normal clinical tests.
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To evaluate characteristics of the postural instability in patients with stroke and to present a prediction model of post-stroke falls.
Patients with a first-ever stroke who had been evaluated by the Balance Master (BM) at post-stroke 3 months (±1 month) between August 2011 and December 2015 were enrolled. Parameters for the postural instability, such as the weight bearing asymmetry (WBA) and postural sway velocity (PSV), were obtained. The fall events in daily lives were assessed via structured telephone interview with a fall related questionnaire.
A total of 71 patients (45 men; 45 with ischemic stroke) were enrolled in this study. All subjects underwent BM evaluation at 3.03±0.40 months after stroke. The mean WBA was 17.18%±13.10% and mean PSV (measured as °/s) were noted as 0.66±0.37 (eyes-open on firm surface), 0.89±0.75 (eyes-closed on firm surface), 1.45±1.09 (eyes-open on soft surface), and 3.10±1.76 (eyes-closed on soft surface). A prediction model of post-stroke falls was drawn by multiple logistic regression analysis as follows: Risk of post-stroke falls = -2.848 + 1.878 x (PSVECSS) + 0.154 x (age=1 if age≥65; age=0 if age<65).
The weight bearing asymmetry and postural sway were significantly increased in patients with stroke. Older age and impaired postural control increased the risk of post-stroke falls.
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To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population.
A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests.
SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers.
This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.
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To describe the longitudinal characteristics of unintentional fall accidents using a representative population-based sample of Korean adults.
We examined data from the Korean Community Health Survey from 2008 to 2013. Univariate analysis and multivariable logistic regression were used to identify the characteristics of fall accidents in adults.
Between 2008 and 2013, the incidence rate of fall accidents requiring medical treatment increased from 1,248 to 3,423 per 100,000 people (p<0.001), while the proportion of indoor fall accidents decreased from 38.12% to 23.16% (p<0.001). Females had more annual fall accidents than males (p<0.001). The major reason for fall accidents was slippery floors (33.7% in 2011 and 36.3% in 2013). Between 2008 and 2010, variables associated with higher fall accident risk included specific months (August and September), old age, female gender, current drinker, current smoker, diabetes, osteoarthritis, osteoporosis, and depression. A high level of education and living with a partner were negatively associated with fall accident risk. In 2013, people experiencing more than 1 fall accident felt more fear of falling than those having no fall accidents (odds ratio [OR] for 1 fall, 2.12; 95% confidence interval [CI], 2.04–2.12; OR for more than 2 falls, 2.97; 95% CI, 2.83–3.10).
The occurrence of fall accidents has consistently increased in Korea from 2008 to 2013. Future intervention studies are needed to reduce the increasing incidence rates of fall accidents in community dwelling adults.
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To investigate differences in plantar pressure distribution between a normal gait and unpredictable slip events to predict the initiation of the slipping process.
Eleven male participants were enrolled. Subjects walked onto a wooden tile, and two layers of oily vinyl sheet were placed on the expected spot of the 4th step to induce a slip. An insole pressure-measuring system was used to monitor plantar pressure distribution. This system measured plantar pressure in four regions (the toes, metatarsal head, arch, and heel) for three events: the step during normal gait; the recovered step, when the subject recovered from a slip; and the uncorrected, harmful slipped step. Four variables were analyzed: peak pressure (PP), contact time (CT), the pressure-time integral (PTI), and the instant of peak pressure (IPP).
The plantar pressure pattern in the heel was unique, as compared with other parts of the sole. In the heel, PP, CT, and PTI values were high in slipped and recovered steps compared with normal steps. The IPP differed markedly among the three steps. The IPPs in the heel for the three events were, in descending order (from latest to earliest), slipped, recovered, and normal steps, whereas in the other regions the order was normal, recovered, and slipped steps. Finally, the metatarsal head-to-heel IPP ratios for the normal, recovered, and slipped steps were 6.1±2.9, 3.1±3.0, and 2.2±2.5, respectively.
A distinctive plantar pressure pattern in the heel might be useful for early detection of a slip event to prevent slip-related injuries.
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To ascertain if there is a correlation between low back pain (LBP), fear of falling, and disability so that the patients with LBP are aware of the fact that other problems may occur with LBP. Hence, steps can be taken for decreasing the fear of falling and disability in order to improve the condition of patients.
A sample size of 100 patients with low back pain, with a range of ages from 40 to 73 years, participated in the study. The Falls Efficacy Scale was used to assess the fear of falling and the Oswestry Disability Index was used to assess the disability and pain in LBP individuals.
The Pearson correlation analysis signifies the relationship between pain, fear of falling, and disability in LBP.
First, LBP increases the fear of falling. Second, LBP can result in a person becoming disabled. Third, the fear of falling and disability are correlated with each other.
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To investigate disparities in the fear of falling between urban and rural communities in relation to socio-demographics, health status, and functional level.
A total of 974 subjects aged 40 years or older participated in this study (335 urban residents and 639 rural). They completed a questionnaire about socio-demographics, health-related variables, and experience with falls. We employed both direct questioning and the Korean version of Falls Efficacy Scale-International (KFES-I) to investigate fear of falling in terms of perceptive fear and higher level of concern over falling during daily activities. The Korean version of Instrumental Activities of Daily Living was used to assess functional independency.
Aging, female gender, fall history, and the presence of chronic medical problems were independently associated with higher prevalence for the fear of falling. Both perceptive fear of falling and a higher level of concern over falling were more prevalent in the rural senior population compared with those in the urban population when they had the following characteristics: lower income or educational background, physical laborer or unemployed, no chronic medical morbidity, or functional independency in daily activities.
The disparity in the fear of falling between the two areas is thought to be related to age structure, and it may also exist in healthy or functionally independent senior populations under the influence of socio-environmental factors. A senior population with lower socio-economic status residing in a rural area might be related with a greater vulnerability to the fear of falling. We should consider regional characteristics when we design fall-related studies or develop fall-prevention programs at the community level.
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To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance.
Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire.
Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearson's correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years).
Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.
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To determine the associating factors of fear of falling (FOF) and the correlations between FOF and quality of life (QOL) on subacute stroke patients in Korea.
Fifty hemiplegic subacute stroke patients in our clinic were recruited. We directly asked patients with their fear of falling and interviewed them with the Korean version of falls efficacy scale-international (KFES-I). We divided the participants into two groups; with FOF and without FOF. We compared these groups with the strength of hemiplegic hip abductor, knee extensor, ankle plantar flexor, functional ambulation category (FAC) scale, stroke specific quality of life (SSQOL), and hospital anxiety depression scale (HADS).
Thirty-four participants were enrolled, and more than half of the patients with subacute stroke had FOF. We compared the patients with and without FOF. According to the results, FOF was associated with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.05). FOF was also associated with the anxiety score of HADS (p<0.05). KFES-I had a significant negative correlation with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.01).
The FOF was associated with not only QOL but also with the physical and psychological factors, and in particular, anxiety. Therefore, further concerns about FOF in subacute stroke patients might be required.
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To assess the effect of lower limb strength on falls and balance in community-dwelling elderly persons by a health status questionnaire, evaluation of lower limb strength and balance.
A total of 86 subjects (age 69.8±5.3) were categorized into one of two groups, "Fallers" and "Non-fallers". Thirty one participants who had reported the experience of having fallen unexpectedly at least once in the past year were assigned into the group "Fallers", and the remaining 55 subjects having no fall history in the past year, "Non-fallers". A self-assessment questionnaire was taken. Lower limb strength was measured by a "Chair stand test". Balance was measured by the stability index of the fall risk test protocol of Balance System SD® (Biodex, New York, USA). The differences between the two groups were compared and the correlation between lower limb strength and balance were analyzed.
The questionnaire demonstrated no significant differences between two groups. The "Chair stand test" showed a significantly less for the "Fallers" (p<0.05). The stability index was significantly greater in the "Fallers" group (p<0.05). There was a moderate negative correlation between the "Chair stand test" and the "Stability index" (R=-0.576, p<0.01).
This study suggests that the "Chair stand test" is a useful screening process for lower limb strength which correlates to risk for falls and balance in the elderly.
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Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study
To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax®).
A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax®, which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax®.
Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups.
These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.
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Objective: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a patient with stroke.
Method: One hundred and three stroke patients admitted to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated.
Results: Fifteen (14.6%) have falled at least one time, and most of the falls occurred in their own room while walking. Risks for falls were associated with multiple brain lesion involving both anterior and posterior circulation, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient. Fifteen (78.9%) of total 19 incidents did not cause any problem, but 4 falls (21.1%) caused mild injury - pain, and simple contusion. Severe injury such as fracture or intracerebral hemorrhage were not caused by these falls.
Conclusion: The incidence of fall in a patient with stroke was 14.6%. And risks for falls were associated with multiple brain lesion, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient.
Objective: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a rehabilitation hospital.
Method: Two hundred nine consecutive admissions to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated.
Results: Twenty four (11.5%) experienced at least one fall, and most of the falls occurred in their own room during walking. Risks for falls were associated with the presence of the sensory or cognitive function disturbance, the ability of walking, the use of antihypertensive drug, and presence of caregiver hired by the patient. No injury was observed in 25 (76%) of total 33 incidents, and 8 falls (24%) caused mild injury - pain, and simple contusion. There was no fracture or intracerebral hemorrhage.
Conclusion: These data suggest that high risk groups of patients who are prone to the falls within the rehabilitation setting can be identified for the prevention, and afterward for preventive measures.
Fall is a major threat to the stroke patients. The purpose of this study is to find out the potential risk factors for recurrent falls in the stroke patients.
The subjects were sampled 20 hemiplegic fallers who experienced at least one fall at the stroke center of Hangkang Sacred Heart hospital. Balance subscale and gait scale of Tinetti was used as a screening test for referral to mobility fuction. The potential contributing factors for fall were social activity, impulsivity, congnition, motivation. These factors were correlated with falls. The authors also surveyed the places, postures of activities, and injurires from falls.
The falls occurred 2.5 times average in studied subjects and is most of subjects the first fall occurred in their first month of standing and gait training. 58.3% of falls occurred indoor(33.3% in room), 29.2% at hospital, 12.5% outdoor. The activities related to fall were walking 36.8%, rising from a chair 36.8%, sitting 10.5%. Although, most(75%) of injuries were soft tissue contusions or strains, the other 25.1% of falls accompanied fractures. The femur fracture was 18.8%, and compressed spine fracture was 6.3%. The social activity was most strongly correlated with falls with high correlation coefficent of 0.72. The other factors were not significant with lower coefficient values, balance scale of 0.35, gait scale of 0.24, motivation of 0.40, congnition of 0.26, impulsivity of 0.19. It was suggested that activity plays an important mediating risk factor for falls in the stroke patients.
These data support the concept of preventive strategy for falls in the stroke patients who are at risk.
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