• 대한간호학회지
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• 제34권8호
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• pp.1483-1490
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• 2004

Community-based centres were surveyed to determine the frequency of and risk factors for falls among elderly Koreans. We examined fall-related risk factors, including physiological and physical health, psychosocial functions, self-reported physical capacity and activity, vision, and the use of medication, among 351 elderly people aged 65 years or older, with ambulatory. Forty-two per cent of elderly Korean subjects reported at least one episode of falling in the previous 12 months, $38\%$ of whom had consequences that required either the attention of a physician or hospitalization. Factors significantly associated with an increased risk of falling were a restricted activity during the previous five years (adjusted OR 1.3), use of alternative therapy (adjusted OR 2.7), low knee flexor and extensor-muscle strength (adjusted OR 1.21 and 1.20), and poor balance with closed eyes (adjusted OR 8.32). We conclude that falls among older persons living in the community are common in Korea and that indicator of bad health and frailty or variables directly related to neuromuscular impairment are significant predictors of the risk of falling.

• 가정∙방문간호학회지
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• 제17권2호
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• pp.95-103
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• 2010

Purpose: To examine the effects of a fall prevention exercise program on the community-dwelling elderly. Methods: The nonequivalent control group pretest-posttest design involved 16. subjects in the experimental group and 17 in the control group. The experimental group received the fall prevention exercise program for 50 minutes, three times each week for 12 weeks. Results: After program participation, the experimental group of subjects showed significantly higher lower limb strength higher endurance, and higher balance than the control group of subjects. The danger of being injured in a fall was also significantly lower in the experimental group. However, there were no significant differences in body constituent factors, agility, and flexibility between the two groups after the intervention. Conclusion: The 12 week fall prevention exercise program was effective in increasing lower limb muscular strength, endurance, balance, and body strength, and in decreasing the danger status of fall injuries. These results suggest that this fall prevention exercise program could be utilized as an effective nursing intervention modality in elderly persons.

• 한국간호교육학회지
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• 제27권1호
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• pp.68-79
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• 2021

Purpose: This study aimed to identify the educational needs of nurses and nursing students for the development of a simulation module of home visiting care for frail, elderly people. Methods: Focus group interviews were conducted with 15 home visiting nurses working in public health centers and 14 nursing students who experienced home visiting from September 10 to October 10, 2018. Results: Bloom's taxonomy of learning objectives, namely, cognitive, affective, and psychomotor domains was used as a framework for data analysis. The defined educational needs for each domain were as follows: "understanding frail, elderly people" for the cognitive domain; "intervention for mental health" and "building a therapeutic relationship" for the affective domain; and "nursing skills", "health education for healthy lifestyles", "referral to the community resource connection", "protection for visiting nurses" for the psychomotor domain. Conclusion: Based on the findings of this study, a simulation module of home visiting care for frail, elderly people can be developed and used for nursing students and nurses to strengthen the capacity for home visiting care.

• Hip & pelvis
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• 제35권1호
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• pp.54-61
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• 2023

Purpose: The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods: A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results: Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion: Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.

• The Korean Journal of Medicine
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• 제99권4호
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• pp.165-168
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• 2024

Initiating dialysis at an advanced age is both a clinical challenge and an ethical dilemma, because the benefits in older adults with advanced chronic kidney disease may be offset by high rates of dialysis-related morbidity. Geriatric conditions, such as aging, frailty, functional impairment, and cognitive impairment, significantly influence the prognosis of elderly patients. Therefore, it becomes important to provide patients and families with prognostic information regarding timing of initiation, which is further complicated by the competing mortality risk. Shared decision-making by clinicians and patients can yield better clinical outcomes and quality of life. Through this approach, patients can opt for the most appropriate treatment based on their personal values, which often entails conservative management.

• 한국노년학
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• 제31권3호
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• pp.539-551
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• 2011

본 연구는 허약노인의 성별에 따른 낙상두려움, 건강상태, 규칙적 운동 횟수 등을 비교하고 낙상두려움에 영향 미치는 요인을 규명하고자 하였다. 본 연구는 253개 보건소의 2009년 맞춤형 방문건강관리사업 중에서 허약 노인 사례관리를 위해 수집된 65세 이상 노인들의 기초자료를 이용하였다. 연구대상자는 총 3903명(남 259명, 여 3644명)으로, 평균 연령은 남성이 75.17세, 여성이 평균 77.54세였으며, 남성의 75.3%, 여성의 85.4%가 낙상 두려움이 있다고 응답하였다. 저소득층 허약노인의 낙상두려움에 영향을 미치는 요인은 남성의 경우 정적 균형감, 과거 낙상경험이었으며, 여성 노인의 경우 정적 균형감, 복합적 이동능력, 우울과 과거 낙상경험, 교육 수준으로 나타났다. 본 연구결과를 토대로 허약노인의 낙상두려움 여부 및 영향요인을 주기적으로 평가하여 고위험군을 발견하고, 낙상 및 낙상두려움 발생을 예방하기 위해 이들을 대상으로 정서적 접근을 포함한 다요인적 통합 프로그램을 성별에 따른 맞춤형으로 개발, 제공할 것을 제안한다.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.827-833
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• 2020

Objective : Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation. Methods : We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/㎠), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment. Results : Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score. Conclusion : The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.

• Journal of Korean Neurosurgical Society
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• 제64권3호
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• pp.460-468
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• 2021

Objective : Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. Methods : A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. Results : Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with all-cause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. Conclusion : Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.

• PNF and Movement
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• 제20권1호
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• pp.125-134
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• 2022

Purpose: The aim of this study was to establish an association between grip strength and gait variability in the elderly. Methods: The participants in this experiment (n = 20) were aged 65 or older. Power grip and lateral pinch forces were obtained in grip strength tests, and spatiotemporal gait parameters were collected from IMU sensors during 6 min actual walking to test the gait of participants. The collected gait parameters were converted to coefficient of variation (CV) values. To confirm the association between grip strength and gait variability, a partial correlation analysis was conducted in which height, weight, and gait speed were input as controlling variables. Results: Grip power showed a significant negative correlation with the stride length CV (r = -0.52), and the lateral pinch force showed a significant negative correlation with the stance CV (r = -0.65) and swing CV (r = -0.63). Conclusion: This study reveals that gait variability decreases as grip strength increases, although height, weight, and gait speed were controlled. Thus, grip strength testing, a simple aging evaluation method, can help identify unstable gait in older adults at risk of falling, and grip strength can be utilized as a non-invasive measurement method for frailty management and prevention.

• 농촌의학ㆍ지역보건
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• 제35권1호
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• pp.1-12
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• 2010

본 연구는 재가노인과 시설거주노인의 허약노인 비율, 허약정도, 건강증진행위 및 주관적 건강상태를 비교하여, 거주유형에 따른 허약노인의 특성을 고려한 건강관리전략을 수립하는데 기여 하고자 실시한 서술적 조사연구이다. 연구대상자는 65세 이상의 D광역시에 소재한 7개 노인정을 이용하는 재가노인 120명과 5개 무료 및 실비 요양 시설에 거주하고 있는 시설거주노인 122명 총 242명을 대상으로 2009년 6월 15일부터 8월 2일까지 자료를 수집하였다. 연구도구로는 허약노인선정도구로서 장기요양보험제도에서 사용하는 기초측정표 설문지, Walker 등[18]이 개발한 건강증진생활양식 측정도구를 기반으로 한 건강증진 행위 측정도구, Lawston 등[19]이 개발한 주관적 건강상태 측정도구를 사용하여 측정하였다. 수집 된 자료는 SPSS Win 15.0을 이용하여 빈도와 백분율, $x^2$-test, ANCOVA, Scheffe 사후검증으로 분석하였다. 본 연구의 결과는 다음과 같다. 첫째, 재가노인 중 허약노인은 20.8%, 시설거주노인 중 허약노인은 49.2%로 나타났다. 둘째, 시설거주노인의 허약정도는 9.41점으로 재가노인은 6.46점보다 더 심한 것으로 나타났다(p<.05). 재가노인의 건강증진행위점수는 2.12점으로 시설거주노인의 1.99점보다 높았으며(p=0.046), 건강증진행위 하위항목별로 보면 재가노인의 영적성장(p=.008)과 대인관계(p=.043)점수가 시설거주노인보다 높았다. 주관적 건강상태는 재가노인과 시설거주노인 간에 차이가 없었다. 셋째, 허약노인과 비허약노인의 거주유형별 허약정도를 보면, 재가 허약노인과 시설거주 허약노인이 비허약노인보다 허약정도가 심하고, 비허약노인 중에서는 시설거주 비허약노인이 재가 비허약노인보다 허약정도가 심한 것으로 나타났다(p<.05). 건강증진행위점수는 재가 비허약노인과 시설거주 비허약노인이 허약노인보다 높았고, 허약노인 중에서는 재가 허약노인은 시설거주 허약노인보다 높은 것으로 나타났다(p<.05). 주관적 건강상태점수는 시설거주 비허약노인과 재가 비허약노인이 허약노인보다 높았고, 허약노인 중에서는 시설거주 허약노인이 재가 허약노인보다 높았다(p<.05). 결론적으로 재가노인과 시설거주노인을 비교해 보았을 때, 시설거주노인 중에서 허약노인의 비율이 높고 시설거주노인의 건강증진행위 수행이 부족하므로 이런 특성을 반영하여 거주유형에 따른 노인 허약예방프로그램의 개발과 적용이 필요하다.