The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
권호 표지
DOI QR코드

DOI QR Code

Factors Influencing Fear of Falling in Patients with Parkinson's Disease in the Community

지역사회에 거주하는 파킨슨병환자의 낙상공포 영향 요인

  • Received : 2015.10.27
  • Accepted : 2015.12.01
  • Published : 2016.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to examine the relation of motor function, depression, and fear of falling, and to identify factors influencing fear of falling in patients with Parkinson's disease in the community. The participants were 180 patients with Parkinson's disease who were selected by convenience sampling. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. There was a significant difference in fear of falling according to gender, occupation, walking assistance device, number of falls, Parkinson's disease stage, duration of illness, antihypertensive drug, motor function, and depression. Fear of falling showed significant positive correlations with motor function, and depression. Depression, number of falls, Parkinson's disease stage, gender, antihypertensive drug, and motor function were significant predictors influencing fear of falling in patients with Parkinson's disease, and these variables accounted for 36.0% of the variance. Depression of the influencing factors was the strongest factor. The results of this study suggest that a variety of intervention strategies for preventing or mitigating depression with systematic nursing assessment of the influencing factors on fear of falling are needed to prevent fear of falling in patients with Parkinson's disease.

본 연구는 지역사회에 거주하는 파킨슨병환자의 운동기능, 우울, 낙상공포의 관계를 파악하고 낙상공포에 미치는 영향요인을 규명하기 위한 것이다. 대상자는 편의표집에 의해 선정된 파킨슨병환자 180명이다. 수집된 자료는 IBM SPSS Statistics 20.0을 이용하여 기술통계, t-test, ANOVA, Pearson correlation coefficient와 multiple linear regression으로 분석하였다. 그 결과, 파킨슨병환자는 여성, 직업이 없는 경우. 보행보조기구 사용자, 2회 이상 낙상 경험자, 파킨슨병 4단계 환자, 유병기간이 9년을 초과한 경우, 항고혈압제 복용 환자, 독립적 운동수행력 하위군, 우울이 있는 경우 낙상공포가 더 높게 나타났다. 낙상공포는 운동기능 및 우울과 유의한 순상관관계를 나타냈다. 파킨슨병환자의 낙상공포의 영향요인은 우울, 낙상횟수, 파킨슨병 단계, 성별, 항고혈압제, 운동기능으로 변량의 36.0%의 설명력을 나타냈으며 영향요인 중 우울이 가장 강력한 요인으로 나타났다. 따라서 지역사회 거주하는 파킨슨병환자의 낙상공포를 예방하기 위해서는 영향요인에 대한 체계적 간호사정과 함께 우울을 완화할 수 있는 중재전략이 필요함을 제시해 주었다.

Keywords

References

  1. Y. A. Grimbergen, A. Schrag, G. Mazibrada, G. F. Borm, and B. R. Bloem. "Impact of falls and fear of falling on health-related quality of life in patients with Parkinson's disease," J. of Parkinson's Disease, Vol.3, No.3, pp.409-413, 2013. https://doi.org/10.3233/JPD-120113
  2. H. Stolze, S. Klebe, C. Zechlin, C. Baecker, L. Friege, and G. Deuschl, "Falls in frequent neurological diseases: Prevalence, risk factors and aetiology," J. of Neurology, Vol.251, No.1, pp.79-84, 2004. https://doi.org/10.1007/s00415-004-0276-8
  3. M. K. Mak and M. Y. Pang, "Fear of falling is independently associated with recurrent falls in patients with parkinson's disease: a 1-year prospective study," J. of neurology, Vol.256, No.10, pp.1689-1695, 2009. https://doi.org/10.1007/s00415-009-5184-5
  4. J. A. Idjadi, G. B. Aharonoff, H. Su, J. Richmond, K. A. Egol, and J. D. Zuckerman, et al, "Hip fracture outcomes in patients with Parkinson's disease," American J. of Orthopedics, Vol.34, No.7, pp.341-346, 2005.
  5. K. Robinson, A. Dennison, D. Roalf, J. Noorigian, H. Cianci, and L. Bunting-Perry, et al, "Falling risk factors in parkinson's disease," NeuroRehabilitation, Vol.20, No.3, pp.169-182, 2005.
  6. A. C. Dennison, J. Y. Noorigian, K. M. Robinson, D. N. Fisman, H. J. Cianci, and P. Moberg, et al, "Falling in parkinson disease: Identifying and prioritizing risk factors in recurrent fallers," American J. of Physical Medicine & Rehabilitation, Vol.86, No.8, pp.621-632, 2007. https://doi.org/10.1097/PHM.0b013e311611583
  7. Y. A. Grimbergen, M. Munneke, and B. R. Bloem, "Falls in Parkinson's disease," Current Opinion in Neurology, Vol.17, No.4, pp.405-415, 2004. https://doi.org/10.1097/01.wco.0000137530.68867.93
  8. N. E. Allen, A. K. Schwarzel, and C. G. Canning, "Recurrent falls in Parkinson's disease: a systematic review," Parkinson's Disease, Vol.2013, No.2013, pp.1-16, 2013.
  9. G. A. R. Zijlstra, J. C. M. van Haastregt, J. T. M. van Eijk, E. van Rossum, P. A. Stalenhoef, and G. I. Kempen, "Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people," Age and Ageing, Vol.36, No.3, pp.304-309, 2007. https://doi.org/10.1093/ageing/afm021
  10. S. Rahman, H. J. Griffin, N. P. Quinn, and M. Jahanshahi, "On the nature of fear of falling in Parkinson's disease," Behavioural Neurology, Vol.24, No.3, pp.219-228, 2011. https://doi.org/10.1155/2011/274539
  11. M. H. Nilsson, G. M. Hariz, S. Iwarsson, and P. Hagell, "Walking ability is a major contributor to fear of falling in people with Parkinson's disease: implications for rehabilitation," Parkinson's Disease. Vol.2012, No.2012, pp.1-7, 2012.
  12. R. Biemiller, and I. H. Richard, "Managing depression in Parkinson's patients: risk factors and clinical pearls," Neurodegenerative Disease Management, Vol.4, No.4, pp.329-336, 2014. https://doi.org/10.2217/nmt.14.31
  13. 김용균, 가상현실 운동프로그램이 파킨슨병 환자의 균형, 보행 및 낙상 효능감에 미치는 영향, 한국교통대학교 일반대학원, 석사학위논문, 2015.
  14. M. S. Bryant, D. H. Rintala, J. G. Hou, and E. J. Protas, "Relationship of Falls and Fear of Falling to Activity Limitations and Physical Inactivity in Parkinson's Disease," J. of Aging and Physical Activity, Vol.23, No.2, pp.187-193, 2015. https://doi.org/10.1123/japa.2013-0244
  15. M. S. Bryant, D. H. Rintala, J. G. Hou, and E. J. Protas, "Influence of fear of falling on gait and balance in Parkinson's disease," Disability and Rehabilitation, Vol.36, No.9, pp.744-748, 2014. https://doi.org/10.3109/09638288.2013.814722
  16. B. Lindholm, P. Hagell, O. Hansson, and M. H. Nilsson, "Factors associated with fear of falling in people with Parkinson's disease," BMC Neurology, Vol.14, No.19, pp.1-7, 2014. https://doi.org/10.1186/1471-2377-14-1
  17. S. Fahn and R. L. Elton, Members of the UPDRS Development Committee. The Unified Parkinson's Disease Rating Scale. In S. Fahn, C. D. Marsden, D. B. Calne, and M, Goldstein, eds, Recent Developments in Parkinson's Disease, Vol.2, Florham Park, NJ: Macmillan Healthcare Information, 1987.
  18. 이수영, 황수진, "파킨슨병 환자의 낙상과 비-낙상에 대한 통합형파킨슨병 평가척도(Unified Parkinson's Disease Rating Scale)의 비교" 특수 교육재활과학연구, 제50권, 제4호, pp.171-182, 2011.
  19. H. M. Wichowicz, J. Stawek, M. Derejko, and W. J. Cubata, "Factors associated with depression in Parkinson' disease: A cross-sectional in a polish population," European Psychiatry, Vol.21, No.8, pp.516-520, 2006. https://doi.org/10.1016/j.eurpsy.2006.01.012
  20. 배은숙, 천상명, 김재우, 강창완, "파킨슨병 환자의 우울 예측 모형," 보건교육.건강증진학회지, 제30권, 제5호, pp.139-151, 2013.
  21. F. Faul, E. Erdfelder, A. G. Lang, and A. Buchner, "G*Power 3: a flexible statistical power analysis program of the social, behavioral, and biomedical sciences. Behavior Research Methods," Vol.39, No.2, pp.175-191, 2007. https://doi.org/10.3758/BF03193146
  22. 대한노인정신의학회, 한국형 치매평가검사, 학지사, 2003
  23. M. M. Hoehn and M. D. Yahr, "Parkinsonism: onset, progression, and mortality," Neurology, Vol.17, No.5, pp.427-442, 1967. https://doi.org/10.1212/WNL.17.5.427
  24. A. T. Beck, Depression: clinical, experimental and theoretical aspects, Harper & low, 1967.
  25. 이민규, 이영호, 박세현, 손창호, 정영조, 홍성국 외, "한국판 Beck 우울척도의 표준화 연구 I : 신뢰도 및 요인분석," 정신병리학, 제4권, 제1호, pp.77-95, 1995.
  26. R. Tideiksaar, Falls in older people:prevention & management(4th edition), Health Professional Press, 2010.
  27. 최정현, 태극운동이 낙상 위험 노인의 신체적,심리적 기능 및 낙상에 미치는 효과, 가톨릭대학교대학원, 박사학위논문, 2002.
  28. 이은옥, 임난영, 박현애, 이인숙, 김종임, 배정이외, 간호연구와 통계분석, 수문사, 2010.
  29. B. Menon, R. Nayar, S. Kumar, S. Cherkil, A. Venkatachalam, and K. Surendran, et al, "Parkinson's Disease, Depression, and Quality-of-Life," Indian J. of Psychological Medicine, Vol.37, No.2, pp.144-148, 2015. https://doi.org/10.4103/0253-7176.155611
  30. S. B. Jonasson, S. Ullen, S. Iwarsson, J. Lexell, and M. H. Nilsson, "Concerns About Falling in Parkinson's Disease: Associations with Disabilities and Personal and Environmental Factors," J. of Parkinson's Disease. Vol.5, No.2, pp.341-349, 2015. https://doi.org/10.3233/JPD-140524
  31. M. Martin, M. Shinberg, M. Kuchibhatla, L. Ray, J. J. Carollo, and M. L. Schenkman, "Gait initiation in community dwelling adults with parkinson disease: comparison with older and younger adults without the disease," Physical Therapy, Vol.82, pp.566-577, 2002.
  32. Y. H. Hiorth, K. Lode, and J. P. Larsen, "Frequencies of falls and associated features at different stages of Parkinson's disease," European J. of Neurology, Vol.20, No.1, pp.160-166, 2013. https://doi.org/10.1111/j.1468-1331.2012.03821.x
  33. 김미영, 김창환, 임비오, "파킨슨 환자들의 질병등급척도가 보행에 미치는 영향," 한국체육학회지-자연과학, 제52권, 제4호, pp.545-552, 2013.
  34. 김정선, "퇴행성관절염 환자의 낙상공포에 영향을 미치는 요인," 대한간호학회지, 제37권, 제7호, pp.1184-1192, 2007.
  35. 박형숙, 박경연, "지역사회 재가노인의 사지근력과 낙상의 관계에서 우울의 매개작용," 대한간호학회지, 제38권, 제5호, pp.730-738, 2008.
  36. E. M. Andersen, F. D. Wolinsky, J. P. Miller, M. M. Wilson, T. K. Malmstrom, and D. K. Miller, "Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans," The Gerontologist, Vol.46, No.2, pp.249-257, 2006. https://doi.org/10.1093/geront/46.2.249