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Factors Related to Falls among Home-Based Long-term Care Recipients
노인 장기요양 재가수급자의 낙상 발생 관련 요인

DC Field Value Language
dc.contributor.advisor김홍수-
dc.contributor.author유지선-
dc.date.accessioned2017-10-31T08:00:00Z-
dc.date.available2017-10-31T08:00:00Z-
dc.date.issued2017-08-
dc.identifier.other000000145620-
dc.identifier.urihttps://hdl.handle.net/10371/137682-
dc.description학위논문 (석사)-- 서울대학교 보건대학원 보건학과, 2017. 8. 김홍수.-
dc.description.abstractPreventing falls in home care is essential for aging in place without harm. A quality indicator for home-based long-term care, the occurrence of falls is a widespread safety problem that often leads to limitation in physical activity and acts as a disabling factor to older adults ability to maintain independence. In particular, recipients of long-term care in the home are vulnerable to the occurrence and sequelae of falls in the community due to their elevated level of dependency, comorbidity and the nature of home care. The occurrence of falls in this setting often results in nursing home admission and hospitalization, which imposes a substantial burden at both the individual and system level. Targeting an intervention to fortify weaknesses in factors related to the occurrence of falls may prevent them from aligning themselves in a way that hazards result in harm. Yet in Korea, few empirical studies have examined the effect of such factors on the risk of falls in the home-based long-term care setting. Therefore, the purpose of the study is to determine sociodemographic, health, and environmental factors related to the occurrence of falls among Koreas home-based long-term care recipients at baseline, and at 6-month follow-up.

This study is a secondary analysis of data collected from 357 home-based long-term care recipients randomly selected from 19 home care service agencies serving Seoul and Gyeonggi province, of which 184 participants were reassessed at 6-month follow-up. Data was collected through home visits using the Korean translation of interRAI Home Care Assessment System. interRAI-HC assessments provide a comprehensive profile of home care clients including their function, health, social support, environment and services. Falls were defined as the unintentional change in position coming to rest on the ground, floor or onto the next lower surface during the past 90 days. As for analyses, the distribution of fall status and related characteristics were analyzed using descriptive statistics, bivariate, and multivariate regressions. Logistic regression was carried out to examine factors associated with the risk of falling at baseline assessment in model one, and sought to determine predictive factors of the occurrence of falls at 6-month follow-up in model two.

Of the 357 participants at baseline, nearly 14% fell one or more times. Social and health characteristics such as the experience of decline in social activities, conflict with family or friends, unsteady gait, cognitive impairment and pain were significantly associated with falling. In model 1, not living with an informal caregiver, decline in social activities with distress, conflict with family or friends, unsteady gait, less cognitive impairment, and low depression were identified as falls risk factors. Overall, results of the first model showed a heavy influence of social support and isolation on the risk of falling.

Among 154 participants reassessed at six months, thirty individuals(16.3%) had experienced at least one fall, of which 20 were recurrent fallers. Model 2 prospectively examined factors predictive of falls occurrence at 6-month follow-up, and demonstrated the presence of significant relationships of both social and health-related factors with the occurrence of falls at 6-month follow-up. Decline in social activities with distress(OR=6.7) and unsteady gait(OR=5.7) remained significant in model 2. Results confirm the multi-faceted nature of contributing factors of falls occurrence.

Home care agencies should make routine assessments of the social and health conditions of older adults receiving home-based long-term care, especially for those who live without an informal caregiver. Social factors such as reduced social participation and relational conflict could be accompanied by social isolation that could signal neglect, and when accompanied by gait problems, could point to a increase in the risk of falls. These signs should be formally tracked by a comprehensive assessment of care recipients with follow-up, as changes in social and health conditions that are systematically captured may be utilized to identify at-risk older adults for preventive interventions to reduce the occurrence of falls in the home-based long-term care setting.
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dc.description.tableofcontents1. Introduction 1
1.1. Background 1
1.2. Objective 6
2. Literature Review 7
2.1. Definition of home-based long-term care recipients and falls 7
2.2. Issues related to the occurrence of falls in the home-based long-term care setting 9
2.3. Falls prevalence and prevention efforts in the home-based long-term care setting 11
2.4. Factors related to falls among home-based long-term care recipients 14
2.4.1. Studies abroad 14
2.4.2. Studies in Korea 17
2.4.3. Studies on community-dwelling older adults 18
3. Method 22
3.1. Conceptual Framework 22
3.2. Study Data 24
3.3. Assessment Tool 25
3.4. Measures 27
3.4.1. Falls Status 27
3.4.2. Sociodemographic Variables 27
3.4.3. Social Variables 27
3.4.4. Health Variables 28
3.4.5. Environmental Variable 30
3.5. Statistical Analysis 33
4. Result 34
4.1. Characteristics of the sample at baseline 34
4.2. Distribution of fall status at baseline 37
4.3. Factors associated with falls status at baseline 38
4.3.1. Bivariate analysis: falls-related factors and fall status at baseline 38
4.3.2. Multivariate logistic regression analysis: factors related to fall status at baseline 41
4.4. Characteristics of the sample at 6-month follow-up 43
4.5. Distribution of fall status at 6-month follow-up 46
4.6. Factors associated with fall status at 6-month follow-up 47
4.6.1. Bivariate analysis: falls-related factors and fall status at 6- month follow-up 47
4.6.2. Multivariate logistic regression analysis: factors related to fall status at 6-month follow-up 50
5. Discussion 52
5.1. Fall status among home-based long-term care recipients 52
5.2. Sociodemographic factors related to falls among home-based long-term care receipients 54
5.3. Social factors related to falls among home-based long-term recipients 57
5.4. Health factors related to falls among home-based long-term care recipients 60
5.5. Environmental factors related to falls among home-based long-term care recipients 65
5.6. Public health policy implications 66
5.7. Significance and limitations of the study 72
References 74
Abstract in Korean 86
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dc.formatapplication/pdf-
dc.format.extent4068661 bytes-
dc.format.mediumapplication/pdf-
dc.language.isoen-
dc.publisher서울대학교 보건대학원-
dc.subjectOlder Adults-
dc.subjectFalls-
dc.subjectFalls Risk-
dc.subjectCommunity-
dc.subjectLong-term Care-
dc.subjectHome Care-
dc.subject.ddc614-
dc.titleFactors Related to Falls among Home-Based Long-term Care Recipients-
dc.title.alternative노인 장기요양 재가수급자의 낙상 발생 관련 요인-
dc.typeThesis-
dc.description.degreeMaster-
dc.contributor.affiliation보건대학원 보건학과-
dc.date.awarded2017-08-
Appears in Collections:
Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Theses (Master's Degree_보건학과)
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