Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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Falls in Patients of Medical Institutions in South Korea: A Literature Review

  • Jongwon Choi (Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University) ;
  • Woochol Joseph Choi (Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University)
  • Received : 2023.01.30
  • Accepted : 2023.02.10
  • Published : 2023.02.20
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Abstract

Background: Like many other countries, falls and related injuries in older adults are great concerns in South Korea. In particular, falls are common in medical institutions, often causing the increase of the length of hospitalization. Objects: The purpose of this review was to help understand and address falls in hospitalized individuals in South Korea. Methods: The review was conducted on literature published in Korean from 2010 to 2022, searched in the Korea Citation Index and PubMed. Keywords used for the search were as follows: falls, fall risk, fall risk assessment, hospital, inpatient, intervention, Korea, and prevention. Results: A total of 54 articles were found and reviewed. The most common place of fall accidents was the inpatient room, where there were many cases of falls while walking. Loss of balance was the most common cause of falls, and many falls occurred in patients admitted to the internal medicine. Furthermore, a risk of falling increased with the type of medications taken. In terms of tools to assess patients' fall risk, the Morse Fall Scale (MFS) was commonly used. Patient-specific fall prevention activities were common to address falls, and they decreased the frequency of falls and the fear of falling. Factors influencing the effectiveness of the fall prevention activities included attitudes toward falls, education, environmental factors, patient safety culture, and self-efficacy in preventing falls. Conclusion: Our results should help understand and address falls and injuries in medical institutions.

Keywords

Acknowledgement

This work was supported, in part, by the "Brain Korea 21 FOUR Project", the National Research Foundation of Korea (Award number: F21SH8303039) for Department of Physical Therapy in the Graduate School of Yonsei University, and by the "Regional Innovation Strategy (RIS)" through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (MOE) (2022RIS-005).

References

  1. Kim YE, Park H, Jo MW, Oh IH, Go DS, Jung J, et al. Trends and patterns of burden of disease and injuries in Korea using disability-adjusted life years. J Korean Med Sci 2019;34(Suppl 1):e75.
  2. Korea Institute for Healthcare Accreditation. Korean patient safety incident report 2021. Korea Institute for Healthcare Accreditation [Internet]. Seoul: 2023 Jun 28 [cited 2023 Jan 21]. Available from: https://www.kops.or.kr/portal/board/statAnlrpt/boardDetail.do?ctgryId=&bbsId=statAnlrpt&tmplatTyCode=J&nttNo=20000000003222
  3. Hou WH, Kang CM, Ho MH, Kuo JM, Chen HL, Chang WY. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. J Clin Nurs 2017;26(5-6):698-706. https://doi.org/10.1111/jocn.13510
  4. Schwendimann R, Buhler H, De Geest S, Milisen K. Characteristics of hospital inpatient falls across clinical departments. Gerontology 2008;54(6):342-8. https://doi.org/10.1159/000129954
  5. Yang Y, Komisar V, Shishov N, Lo B, Korall AM, Feldman F, et al. The effect of fall biomechanics on risk for hip fracture in older adults: a cohort study of video-captured falls in longterm care. J Bone Miner Res 2020;35(10):1914-22. https://doi.org/10.1002/jbmr.4048
  6. DeGoede KM, Ashton-Miller JA, Schultz AB. Fall-related upper body injuries in the older adult: a review of the biomechanical issues. J Biomech 2003;36(7):1043-53. https://doi.org/10.1016/S0021-9290(03)00034-4
  7. Currie LM, Mellino LV, Cimino JJ, Bakken S. Development and representation of a fall-injury risk assessment instrument in a clinical information system. Stud Health Technol Inform 2004;107(Pt 1):721-5.
  8. Bergland A, Wyller TB. Risk factors for serious fall related injury in elderly women living at home. Inj Prev 2004;10(5):308-13. https://doi.org/10.1136/ip.2003.004721
  9. Oliver D, Killick S, Even T, Willmott M. Do falls and falls-injuries in hospital indicate negligent care -- and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006. Qual Saf Health Care 2008;17(6):431-6. https://doi.org/10.1136/qshc.2007.024703
  10. Choi EH, Ko MS, Yoo CS, Kim MK. Characteristics of fall events and fall risk factors among inpatients in general hospitals in Korea. J Korean Clin Nurs Res 2017;23(3):350-60.
  11. Cho MS, Lee HY. Factors associated with injuries after inpatient falls in a tertiary hospital. J Korean Clin Nurs Res 2017;23(2):202-10.
  12. Jang IS, Lee SG. Fall risk factors and characteristics of an acute hospital setting across clinical departments. J Korean Acad Fundam Nurs 2014;21(3):264-74. https://doi.org/10.7739/jkafn.2014.21.3.264
  13. Ahn S, Kim DE. Factors affecting the degree of harm from fall incidents in hospitals. J Korean Acad Nurs Adm 2021;27(5):334-43. https://doi.org/10.11111/jkana.2021.27.5.334
  14. Cho YS, Lee YO, Youn YS. Risk factors for falls in tertiary hospital inpatients: a survival analysis. J Korean Crit Care Nurs 2019;12(1):57-70. https://doi.org/10.34250/jkccn.2019.12.1.57
  15. Lee YJ, Gu MO. Circumstances, risk factors, and the predictors of falls among patients in the small and medium-sized hospitals. J Korean Clin Nurs Res 2015;21(2):252-65.
  16. Kim SJ, Lee YM. Falls risk factors of elderly inpatients. JKDAS 2014;16(4):2191-203.
  17. Kim YS, Choi-Kwon S. Fall risk factors and fall risk assessment of inpatients. Korean J Adult Nurs 2013;25(1):74-82. https://doi.org/10.7475/kjan.2013.25.1.74
  18. Lee AS, Yoon CK. Risk factors of falls in hospital for the elderly. JKDAS 2010;12(5):2511-23.
  19. Lim JO, Gu MO. Fall-related circumstances and fall risk factors among inpatients with dementia in long-term care hospital. J Korean Gerontol Nurs 2016;18(2):72-83. https://doi.org/10.17079/jkgn.2016.18.2.72
  20. Kang YO, Song R. Identifying characteristics of fall episodes and fall-related risks of hospitalized patients. J Muscle Joint Health 2015;22(3):149-59. https://doi.org/10.5953/JMJH.2015.22.3.149
  21. Kim MS, Jung HM, Lee HY, Kim J. Risk factors for fall-related serious injury among Korean adults: a cross-sectional retrospective analysis. Int J Environ Res Public Health 2021;18(3):1239.
  22. Lee YJ. Medication use as a risk factor for falls in hospitalized elderly patients in Korea. Korean J Clin Pharm 2011;21(3):243-8.
  23. Jeong HS, Lee EN, Kim SS. Factors affecting fear of falling in stroke patients. J Muscle Jt Health 2011;18(2):215-26. https://doi.org/10.5953/JMJH.2011.18.2.215
  24. Cho KH, Lee WH. Changes to balance and trunk repositioning sense according to frequency of falls in stroke patients. Korean J Health Promot 2011;11(1):48-55.
  25. Hong HJ, Kim NC, Jin Y, Piao J, Lee SM. Trigger factors and outcomes of falls among Korean hospitalized patients: analysis of electronic medical records. Clin Nurs Res 2015;24(1):51-72. https://doi.org/10.1177/1054773814524225
  26. Hwang DH, Jung D. The effects of symptom experiences and depression on falls efficacy in elderly patients undergoing chemotherapy. J Korean Clin Nurs Res 2019;25(2):189-97.
  27. Kim SM, Lee SA. Factors affecting falls of demented inpatients. J Korean Gerontol Soc 2019;39(2):231-40. https://doi.org/10.31888/JKGS.2019.39.2.231
  28. Lee YH, Kim MS. Risk factors according to fall risk level in general hospital inpatients. J Korean Acad Fundam Nurs 2022;29(1):35-44. https://doi.org/10.7739/jkafn.2022.29.1.35
  29. Lee YS, Choi EJ, Kim YH, Park HA. Factors influencing falls in high- and low-risk patients in a tertiary hospital in Korea. J Patient Saf 2020;16(4):e376-82. https://doi.org/10.1097/PTS.0000000000000593
  30. Kim KS, Kim JA, Choi YK, Kim YJ, Park MH, Kim HY, et al. A comparative study on the validity of fall risk assessment scales in Korean hospitals. Asian Nurs Res (Korean Soc Nurs Sci) 2011;5(1):28-37. https://doi.org/10.1016/S1976-1317(11)60011-X
  31. Kim SR, Yoo SH, Shin YS, Jeon JY, Kim JY, Kang SJ, et al. Comparison of the reliability and validity of fall risk assessment tools in patients with acute neurological disorders. Korean J Adult Nurs 2013;25(1):24-32. https://doi.org/10.7475/kjan.2013.25.1.24
  32. Baek S, Piao J, Jin Y, Lee SM. Validity of the Morse Fall Scale implemented in an electronic medical record system. J Clin Nurs 2014;23(17-18):2434-40. https://doi.org/10.1111/jocn.12359
  33. Kang YO, Song R. Validation of fall risk assessment scales among hospitalized patients in South Korea using retrospective data analysis. Korean J Adult Nurs 2015;27(1):29-38. https://doi.org/10.7475/kjan.2015.27.1.29
  34. Yoo SH, Kim SR, Shin YS. A prediction model of falls for patients with neurological disorder in acute care hospital. J Neurol Sci 2015;356(1-2):113-7. https://doi.org/10.1016/j.jns.2015.06.027
  35. Cho EH, Woo YJ, Han A, Chung YC, Kim YH, Park HA. Comparison of the predictive validity of three fall risk assessment tools and analysis of fall-risk factors at a tertiary teaching hospital. J Clin Nurs 2020;29(17-18):3482-93. https://doi.org/10.1111/jocn.15387
  36. Choi EH, Ko MS, Lee SA, Park JH. Validation of adult fall assessment scale Korean version for adult patients in general hospitals in Korea. J Korean Clin Nurs Res 2020;26(2):265-73.
  37. Lee KB, Lee JS, Jeon IP, Choo DY, Baik MJ, Kim EH, et al. An analysis of fall incidence rate and risk factors in an inpatient rehabilitation unit: a retrospective study. Top Stroke Rehabil 2021;28(2):81-7. https://doi.org/10.1080/10749357.2020.1774723
  38. Kim YJ, Choi KO, Cho SH, Kim SJ. Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting. J Clin Nurs 2022;31(23-24):3584-94. https://doi.org/10.1111/jocn.16185
  39. Chae BK, Yang JH. Effects of exercise type on functional fitness and fall in women patients with Parkinson's disease. Korean J Phys Educ 2011;50(6):487-99.
  40. Kim H, Jung MY. Effects of one-to-one fall prevention education on decrease in falls of adults with stroke. J Korea Contents Assoc 2015;15(5):426-35. https://doi.org/10.5392/JKCA.2015.15.05.426
  41. Ju HJ, Jeon MY. Effects of walking program with dance on gait, cognition, and risk of falls of elderly with dementia in a long-term care hospital. J Korean Biol Nurs Sci 2018;20(3):141-9. https://doi.org/10.7586/jkbns.2018.20.3.141
  42. Lee HO, Lee BH, Lee CH. Effect of strength exercise on patient fall prevention program: focusing on the fall high risk group elderly patients. J Health Info Stat 2017;42(4):338-45. https://doi.org/10.21032/jhis.2017.42.4.338
  43. Park BM, Ryu HS, Kwon KE, Lee CY. Development and effect of a fall prevention program based on the king's goal attainment theory for fall high-risk elderly patients in long-term care hospital. J Korean Acad Nurs 2019;49(2):203-14. https://doi.org/10.4040/jkan.2019.49.2.203
  44. Lim JO, Gu MO. Development and effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals: for older adults with dementia and caregivers in long-term care hospitals. J Korean Acad Nurs 2022;52(3):341-58. https://doi.org/10.4040/jkan.21230
  45. Kim SY, Kim JA, Kim GW, Lee AR, Lee H, Choi YS, et al. Effects of fall education program using tablet PCs: hospitalized patients. AJMAHS 2016;6(3):323-31. https://doi.org/10.14257/AJMAHS.2016.03.36
  46. Park KY, Han D. Physical therapists' attitudes to the falls and predictors of implementing falls prevention. J Korean Data Anal Soc 2012;14(5):2585-94.
  47. Lee IK, Choi JY. Factors associated with nurses' activities for hospital fall prevention. Korean J Rehabil Nurs 2013;16(1):55-62. https://doi.org/10.7587/kjrehn.2013.55
  48. Jung JY, Park YJ, Jung GH. Effects of long term care hospital care-givers' fall prevention self efficacy and fall prevention health belief on fall prevention awareness. J Korea Contents Assoc 2015;15(2):333-43. https://doi.org/10.5392/JKCA.2015.15.02.333
  49. Jang KS, Kim HS. Factors influencing fall prevention nursing performance of hospital nurses. Korean J Emerg Med Serv 2016;20(3):69-83. https://doi.org/10.14408/KJEMS.2016.20.3.069
  50. Jung JY, Jung GH. The affect factors of geriatric hospital nurse's falls prevention activities. J Health Info Stat 2016;41(2):203-11. https://doi.org/10.21032/jhis.2016.41.2.203
  51. Yoo KS. Knowledge, attitude and prevention activities related to fall among of geriatric hospital nurse. J Korean Public Health Nurs 2017;31(3):436-50.
  52. Jeong H, Park M. Factors influencing nurses' implementation of evidence-based fall management in geriatric hospitals. J Korean Acad Nurs Adm 2017;23(3):270-9. https://doi.org/10.11111/jkana.2017.23.3.270
  53. Jin M, Ha Y. Influencing factors on hospital fall prevention activities of tertiary hospital nurses and general hospital nurses. J Health Info Stat 2017;42(4):361-70. https://doi.org/10.21032/jhis.2017.42.4.361
  54. Kim SH, Seo JM. Geriatric hospital nurses' knowledge, attitude toward falls, and fall prevention activities. J Korean Gerontol Nurs 2017;19(2): 81-91.
  55. Lim JO, Gu MO. The influence of fall-related knowledge and fall prevention self-efficacy of care-givers working in longterm care hospitals with older adults with dementia on fall prevention behaviors and fall management behaviors. Korean J Health Serv Manag 2018;12(4):155-72. https://doi.org/10.12811/kshsm.2018.12.4.155
  56. Park JH, Son JT. Structural analysis of variables related to fall prevention behavior of registered nurses in small-to-medium sized hospitals. J Korean Acad Fundam Nurs 2018;25(4):269-81. https://doi.org/10.7739/jkafn.2018.25.4.269
  57. Lee YB, Park JH. Attitude toward falls, caring behaviors for fall prevention, and risk perception on caregivers who care for patients with dementia. AJMAHS 2019;9(12):717-25. https://doi.org/10.35873/ajmahs.2019.9.12.064
  58. Chang KO, Lee TJ, Jung MY. The effect of knowledge, attitude and perceptions of patient safety culture on fall prevention activities in mental hospital nurses. JKAIS 2019;20(5):372-83.
  59. Kim HS. Attitudes toward nurses' fall related factors and prevention activities. KALCI 2019;19(11):1065-82. https://doi.org/10.22251/jlcci.2019.19.11.1065
  60. Cho MY, Jang SJ. Nurses' knowledge, attitude, and fall prevention practices at South Korean hospitals: a cross-sectional survey. BMC Nurs 2020;19(1):108.
  61. Park Y. Barriers to the practice of fall prevention by nurses and nurse assistants at geriatric hospitals. J Korean Gerontol Soc 2020;40(2):311-23. https://doi.org/10.31888/JKGS.2020.40.2.311
  62. Park Y, Yun HJ. A multilevel investigation of fall prevention behavior among nursing staff of South Korean geriatric hospitals. Glob J Health Sci 2020;12(10):97-106. https://doi.org/10.5539/gjhs.v12n10p97
  63. Jung SY, Kim EY. Influence of the patient safety culture and nursing work environment on fall prevention activities of hospital nurses. J Korean Acad Nurs Adm 2022;28(2):78-87. https://doi.org/10.11111/jkana.2022.28.2.78
  64. Jung KI. Factors influencing of prevention behavior for hospital fall in nursing students. JKDAS 2015;17(2):1115-28.