• Physical Therapy Rehabilitation Science
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• v.11 no.1
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• pp.66-77
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• 2022

Objective: This study is a systematic review conducted to analyze the environmental factors that cause falls in the older adult. Design: Systematic review Methods: The study was conducted by searching the Research Information Sharing Service (RISS), Korean studies Information Service System (KISS), and Data Base Periodical Information Academic (DBpia) databases for literature published in South Korea up to July 2020. A total of 12 studies were selected for analysis based on the inclusion and exclusion criteria. Results: The results of the analysis revealed that all the selected literature were surveys and the study subjects were 65 years of age and above. The sample size ranged from a minimum of 95 subjects to a maximum of 3,278. A total of eight tools were used to measure the environmental factors associated with falls. The prevalence and recurrence of falls increase with age and deterioration of health. Older adult individuals who experience falls encounter difficulties in recovering from impaired physical function and disability; moreover, in severe cases, falls may lead to death. Falls are largely associated with a combination of intrinsic and extrinsic (i.e., environmental) factors. The purpose of this study was to assess potential extrinsic risk factors for falls. Falls occur in indoor environments, such as washrooms, bathrooms and living rooms, and outdoor environments, including roads and stairways, depending on the season, time of day, and use of ambulatory aids. In such environments, falls are mainly caused by slipping and stuttering. Conclusions: Therefore, as the rate of fall is influenced by several factors, extrinsic factors should be improved by developing comprehensive accident prevention programs that address the improvement of environmental risk factors around places of residence to reduce risk factors among the older adult, who, especially, are at a high risk for falls.

• The Journal of Korean Physical Therapy
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• v.20 no.3
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• pp.19-28
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• 2008

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.

• Physical Therapy Korea
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• v.30 no.1
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• pp.1-7
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• 2023

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.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.65-73
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• 2020

PURPOSE: This study examined the effects of coordinative locomotor training on the physical factors for falls in the elderly with mild cognitive impairment. METHODS: This study examined thirty subjects diagnosed with mild cognitive impairment by the radiologic findings, history, and physical examination. The subjects were assigned to a control group (n = 15) or experimental group (n = 15, coordinative locomotor training). The experimental group underwent coordinative locomotor training for four weeks, with training sessions two times per week. The control group was given a fall-prevention education for 60 minutes without coordinative locomotor training. To evaluate the physical factors for falls, the lower extremity strength and the Korean version of the Fullerton advanced balance scale and biorescue were measured for balance. These tests were conducted before and after training. RESULTS: Significant differences were observed between the two groups after the four weeks of coordinative locomotor training for the elderly with mild cognitive impairment the experimental group had a greater degree of improvement in the physical factors for falls. CONCLUSION: These findings suggest that coordinative locomotor training may have a functional effect on fall-prevention and the mobility of the elderly with mild cognitive impairment. In addition, it is expected to provide systematic and effective data that can be used as a fall prevention program for the elderly with mild cognitive impairment in each institution.

• Physical Therapy Korea
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• v.30 no.1
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• pp.78-85
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• 2023

Background: Despite fall prevention strategies suggested by researchers, falls are still a major health concern in older adults. Understanding factors that differentiate successful versus unsuccessful balance recovery may help improve the prevention strategies. Objects: The purpose of this review was to identify biomechanical factors that differentiate successful versus unsuccessful balance recovery in the event of a fall. Methods: The literature was searched through Google Scholar and PubMed. The following keywords were used: 'falls,' 'protective response,' 'protective strategy,' 'automated postural response,' 'slips,' 'trips,' 'stepping strategy,' 'muscle activity,' 'balance recovery,' 'successful balance recovery,' and 'failed balance recovery.' Results: A total of 64 articles were found and reviewed. Most of studies included in this review suggested that kinematics during a fall was important to recover balance successfully. To be successful, appropriate movements were required, which governed by several things depending on the direction and characteristics of the fall. Studies also suggested that lower limb muscle activity and joint moments were important for successful balance recovery. Other factors associated with successful balance recovery included fall direction, age, appropriate protective strategy, overall health, comorbidity, gait speed, sex and anticipation of the fall. Conclusion: This review discusses biomechanical factors related to successful versus unsuccessful balance recovery to help understand falls. Our review should help guide future research, or improve prevention strategies in the area of fall and injuries in older adults.

• Physical Therapy Korea
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• v.28 no.3
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• pp.161-167
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• 2021

Understanding sciences behind fall-related hip fractures in older adults is important to develop effective interventions for prevention. The aim of this review is to provide biomechanical understanding and prevention strategies of falls and related hip fractures in older adults, in order to guide future research directions from biomechanical perspectives. While most hip fractures are due to a fall, a few of falls are injurious causing hip fractures, and most falls are non-injurious. Fall mechanics are important in determining injurious versus non-injurious falls. Many different biomechanical factors contribute to the risk of hip fracture, and effects of each individual factors are known well. However, combining effects, and correlation and causation among the factors are poorly understood. While fall prevention interventions include exercise, vision correction, vitamin D intake and environment modification, injury prevention strategies include use of hip protectors, compliant flooring and safe landing strategies, vitamin D intake and exercise. While fall risk assessments have well been established, limited efforts have been made for injury risk assessments. Better understanding is necessary on the correlation and causation among factors affecting the risk of falls and related hip fractures in older adults. Development of the hip fracture risk assessment technique is required to establish more efficient intervention models for fall-related hip fractures in older adults.

• Physical Therapy Korea
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• v.11 no.4
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• pp.51-60
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• 2004

Falls are common, costly, and a leading cause of death among older adults. The major predisposing factors of a fall may include age-related deterioration in the dynamic system composed of auditory, somatosensory, vestibular, visual, musculoskeletal, and neuromuscular subsystems. Older adults with a history of frequent falls demonstrated significant reductions in gait velocity, muscle force production, and balance performance. These altered neuromechanical characteristics may be further exaggerated when faced with conflicting multisensory conditions. Despite the important contribution of multisensory function on the sensorimotor system during postural and locomotor tasks, it remains unclear whether multisensory intervention will produce dynamic balance improvement during locomotion in older adults with a history of frequent falls. Therefore, the purpose of this paper is to address important factors associated with falls in elderly adults and provide theoretical rationale for a multisensory intervention program model.

• Physical Therapy Rehabilitation Science
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• v.7 no.3
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• pp.139-145
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• 2018

Objective: Older persons with diabetes mellitus (DM) are particularly more likely to have fallen in the previous year than those without DM. The purpose of this study was to investigate the relationship between the risk of falls and type 2 DM in older adults who are 65 years of age or above. Design: A systematic review. Methods: PubMed and other two databases were searched up to August 2, 2018. Observational and cohort studies evaluating fall risk in people who are 65 years of age or above with DM were included. This review extracted the following information from each study selected: first author's surname, year of publication, country, average follow-up period, sex, age at enrollment, study population, measurement variables, relative risk, 95% confidence intervals and controlled variables. Results: This review involved nine cohort studies with 3,765 older adults with DM and 12,989 older adults without DM. Six studies compared with or without DM and two studies compared fallers with non-fallers with DM. Risk factors for falls included impaired cognitive function, diabetes-related complications (peripheral nerve dysfunction, visual impairment), and physical function (balance, gait velocity, muscle strength, and severity of physical activities). Conclusions: People who are 65 years of age or above with DM have increased risk of falling caused by impaired cognitive function, peripheral nerve dysfunction, visual impairment, and physical function in community-dwellers. For adults who are 65 years of age or older with DM, research fields and clinical settings should consider therapeutic approaches to improve these risk factors for falls.

• The Journal of Korean Physical Therapy
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• v.22 no.4
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• pp.1-6
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• 2010

Purpose: This study was designed to evaluate the clinical utility of the Four square step test (FSST) for predicting falls in stroke patients, to compare the ability of the FSST test to discriminate between subgroups of fallers, and to determine if the test has any predictive value in identifying stroke patients who will fall. Methods: Stroke patients (N=37) who could walk at least 50 m with minimal assistance were recruited consecutively when attending a physical therapy session during their rehabilitation. Dynamic standing balance was measured using the FSST. The main outcome measures were FSST time and fall number. Numbers of falls were compared with FSST scores. Differences between the groups in FSST scores were examined using a t-test and 1-way analysis of variance. Post hoc analysis using the Tukey B procedure was used to identify specific group differences. Alpha was set at 0.05. Results: A total of 15 participants (40.5%) reported falls 6 had recurrent falls (2 falls) and 9 fell once. The mean FSST time differed significantly between groups with zero and multiple falls. A cutoff score of greater than 17 seconds on the FSST was associated with a sensitivity of 83% and a specificity of 84% for the identification of subjects with multiple risk factors for falls. Conclusion: The FSST is a feasible and valid clinical test of dynamic standing balance and can predict falls in post-stroke patients.

• Physical Therapy Korea
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• v.21 no.2
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• pp.37-47
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• 2014

Falls are common after stroke and most frequently related to loss of balance while walking. Consequently, preventing falls is one of the goals of acute, rehabilitative, and chronic stroke care. The purpose of this study was to investigate the incidence and risk factors of falls and to determine how well the Falls Efficacy Scale (FES), Timed Up and Go test (TUG), and Berg Balance Scale (BBS) could distinguish between fallers and non-fallers among stroke patients during inpatient rehabilitation. One hundred and fifteen participants with at least 3 months post-stroke and able to walk at least 3 m with or without a mono cane participated in this study. Fifty-four (47%) participants reported falling, and 15 (27.8%) had a recurrent fall. Logistic regression analysis for predicting falls showed that left hemiplegia [odds ratio (OR)=4.68] and fear of falling (OR=5.99) were strong risk factors for falls. Fallers performed worse than non-fallers on the FES, TUG, and BBS (p<.05, p<.01, respectively). In the receiver operator characteristic curve analysis, the TUG demonstrated the best discriminating ability among the three assessment tools. The cut-off score was 22 seconds on the TUG for discriminating fallers from non-fallers (sensitivity=88.9%, specificity=45.9%) and 27 seconds for discriminating recurrent fallers from single fallers and non-fallers (sensitivity=71.4%, specificity=40.2%). Results suggest that there is a need for providing fall prevention and injury minimization programs for stroke patients who record over 22 seconds on the TUG.