Journal of Korean Academy of Nursing

Research Papers

Psychometric Properties of the Fall Risk Perception Questionnaire-Short Version for Inpatients in Acute Care Hospitals: Choi, Jeeeun , Lee, Sujin , Park, Eunjin , Ku, Sangha , Kim, Sunhwa , Yu, Wonhye , Jeong, Eunmi , Park, Sukhee , Park, Yusun , Kim, Hye Young , Kim, Sung Reul; J Korean Acad Nurs 2024;54(2):151-161. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23127

Abstract PDF: Purpose
Patients’ perception of fall risk is a promising new indicator for fall prevention. Therefore, a fall risk perception questionnaire that can be used rapidly and repeatedly in acute care settings is required. This study aimed to develop a short version of the fall risk perception questionnaire (Short-FRPQ) for inpatients.
Methods
For the psychometric measurements, 246 inpatients were recruited from an acute care hospital. The construct (using confirmatory factor analysis and discriminant validity of each item), convergent, and known-group validities were tested to determine the validity of the Short-FRPQ. McDonald’s omega coefficient was used to examine the internal consistency of reliability.
Results
In the confirmatory factor analysis, the fit indices of the Short-FRPQ, comprising 14 items and three factors, appeared to be satisfactory. The Short-FRPQ had a significantly positive correlation with the original scale, the Korean Falls Efficacy Scale-International, and the Morse Fall Scale. The risk of falls group, assessed using the Morse Fall Scale, had a higher score on the Short-FRPQ. McDonald’s omega coefficient was .90.
Conclusion
The Short-FRPQ presents good reliability and validity. As patient participation is essential in fall interventions, evaluating the fall risk perception of inpatients quickly and repeatedly using scales of acceptable validity and reliability is necessary.

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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 LongTerm Care Hospitals: Lim, Jeong Ok , Gu, Mee Ock; J Korean Acad Nurs 2022;52(3):341-358. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21230

Purpose
This study examined the effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals.
Methods
A nonequivalent control group pretest-posttest design was used. The study sample included 42 older adults with dementia (experimental group: 21, control group: 21) and 42 caregivers (experimental group: 21, control group: 21). The program comprised 48 sessions held over 12 weeks and included exercise intervention with resistance and balance, dance walking (45~60 min, three times/week), cognitive and emotional intervention (35~50 min, once per week), and person-centered fall prevention education (10 min, once per week). The program for caregivers consisted of six educational sessions (i.e., fall prevention competency enhancement and person-centered care strategy education, 80 min, once per week) for six weeks. Data were collected before participation and 12 weeks after program completion from February 18 to May 12, 2019. Data analysis was conducted using the chi-square test, t-test, and Mann―Whitney U test with SPSS/WIN 21.0.
Results
The experimental group of older adults with dementia showed significant improvement in physical and cognitive functions, and a decrease in depression, and behavioral and psychological symptoms, when compared with the control group. caregivers in the experimental group exhibited significant improvement in fall-related knowledge and person-centered care of older adults with dementia compared to the control group.
Conclusion
The study findings indicate that this program was effective as a nursing intervention for fall prevention among older adults with dementia in long-term care hospitals.

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Comparison of the Effects of Education Only and Exercise Training Combined with Education on Fall Prevention in Adults Aged 70 Years or Older Residing in Elderly Residential Facilities: Hong, Chahwa , Lee, Haejung , Lee, Misoon; J Korean Acad Nurs 2021;51(2):173-187. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20203

Abstract PDF

Purpose
To compare the effects of education only and exercise training combined with education on fall knowledge, fall efficacy, physical activity, and physical function in adults aged 70 years or older residing in elderly residential facilities.
Method
A three-group pre- and posttest design was utilized: education only (EO; n = 23), education and TheraBand (ET; n = 22), and education and walking (EW; n = 22). Fall education was provided for all three groups. In addition, TheraBand exercise training was provided for the ET and a walking exercise for the EW. Data were collected from November 1st, 2017 to February 15th, 2019 and analyzed with χ² test, paired t-test, and one-way ANOVA using IBM SPSS/WIN ver. 22.0.
Results
Compared with the EO, the ET and the EW were more effective in terms of fall efficacy, physical activity, and lower extremity muscle strength. The EW showed higher improvement in walking abilities than the EO and the ET.
Conclusion
Exercise training combined with education is more effective in preventing falls among community-dwelling adults aged 70 years or older. When considering fall prevention programs for older adults, both TheraBand and walking exercise training combined with education can be chosen based on the participant’s physical status. Aggressive strategies to improve daily walking are required to maintain walking abilities among community-dwelling adults aged 70 years or older.

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Falls caused by balance disorders in the elderly with multiple systems involved: Pathogenic mechanisms and treatment strategies
Liwei Xing, Yi Bao, Binyang Wang, Mingqin Shi, Yuanyuan Wei, Xiaoyi Huang, Youwu Dai, Hongling Shi, Xuesong Gai, Qiu Luo, Yong Yin, Dongdong Qin
Frontiers in Neurology.2023;[Epub] CrossRef

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Original Articles

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: Bom Mi Park, Ho Sihn Ryu, Kyeung Eun Kwon, Chun Young Lee; J Korean Acad Nurs 2019;49(2):203-214. Published online April 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.2.203

Abstract PDF

Purpose

The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects.

Methods

This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an χ²-test, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software.

Results

For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368).

Conclusion

These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.

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Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients: Eun-Ju Choi, Young-Shin Lee, Eun-Jung Yang, Ji-Hui Kim, Yeon-Hee Kim, Hyeoun-Ae Park; J Korean Acad Nurs 2017;47(3):420-430. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.3.420

Abstract PDF

Abstract Purpose

The aim of this study was to explore characteristics of and risk factors for accidental inpatient falls.

Methods

Participants were classified as fallers or non-fallers based on the fall history of inpatients in a tertiary hospital in Seoul between June 2014 and May 2015. Data on falls were obtained from the fall report forms and data on risk factors were obtained from the electronic nursing records. Characteristics of fallers and non-fallers were analyzed using descriptive statistics. Risk factors for falls were identified using univariate analyses and logistic regression analysis.

Results

Average length of stay prior to the fall was 21.52 days and average age of fallers was 61.37 years. Most falls occurred during the night shifts and in the bedroom and were due to sudden leg weakness during ambulation. It was found that gender, BMI, physical problems such elimination, gait, vision and hearing and medications such as sleeping pills, antiarrhythmics, vasodilators, and muscle relaxant were statistically significant factors affecting falls.

Conclusion

The findings show that there are significant risk factors such as BMI and history of surgery which are not part of fall assessment tools. There are also items on fall assessment tools which are not found to be significant such as mental status, emotional unstability, dizziness, and impairment of urination. Therefore, these various risk factors should be examined in the fall risk assessments and these risk factors should be considered in the development of fall assessment tools.

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Psychometric Properties of the Fall Risk Perception Questionnaire-Short Version for Inpatients in Acute Care Hospitals
Jeeeun Choi, Sujin Lee, Eunjin Park, Sangha Ku, Sunhwa Kim, Wonhye Yu, Eunmi Jeong, Sukhee Park, Yusun Park, Hye Young Kim, Sung Reul Kim
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Review Article

Effects of Nursing Interventions for Fall Prevention in Hospitalized Patients: A Meta-analysis: Yoon Lee Kim, Seok Hee Jeong; J Korean Acad Nurs 2015;45(4):469-482. Published online August 31, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.4.469

Abstract PDF

Purpose

The purpose of this study was to identify which nursing interventions are the most effective in fall prevention for hospitalized patients.

Methods

From 3,675 papers searched, 34 were selected for inclusion in the meta-analysis. Number of fallers, falls, falls per 1,000 hospital-days, and injurious falls, fall protection activity, knowledge related to falls, and self-efficacy about falls were evaluated as outcome variables. Data were analyzed using the Comprehensive Meta Analysis (CMA) 2.2 Version program and the effect sizes were shown as the Odd Ratio (OR) and Hedges's g.

Results

Overall effect size of nursing interventions for fall prevention was OR=0.64 (95% CI: 0.57~0.73, p <.05) and Hedges's g= - 0.24. The effect sizes (OR) of each intervention ranged from 0.34 to 0.93, and the most effective nursing intervention was the education & environment intervention (OR=0.34, 95% CI: 0.28~0.42, p <.001), followed by education intervention (OR=0.57, 95% CI: 0.50~0.67, p =.001). Subgroup analyses showed that multifaceted interventions (OR=0.76, 95% CI: 0.73~0.79, p <.001) were more effective than unifactorial interventions, and that activities for prevention of falls (OR=0.08, 95% CI: 0.05~0.15, p <.001) showed the largest effect size among outcome variables.

Conclusion

Falls in hospitalized patients can be effectively prevented using the nursing interventions identified in this study. These findings provide scientific evidence for developing and using effective nursing interventions to improve the safety of hospitalized patients.

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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
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Original Articles

Effects of Community-based Comprehensive Fall Prevention Program on Muscle Strength, Postural Balance and Fall Efficacy in Elderly People: Jeongyee Bae, Seong-il Cho; J Korean Acad Nurs 2014;44(6):697-707. Published online December 31, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.6.697

Abstract PDF

Purpose

The purposes of this study was to develop a comprehensive community-based fall prevention program and to test the effects of the program on the muscle strength, postural balance and fall efficacy for elderly people.

Methods

The design of this study was a nonequivalent control group pretest-posttest design. There were 28 participants in the experimental group and 29 in the control group. The program consisted of balance exercises, elastic resistance exercises and prevention education. The program was provided five times a week for 8 weeks and each session lasted 90 minutes. Data were analyzed using χ²-test, independent t-test and paired t-test using the SPSS program.

Results

Muscle strength of the lower extremities, postural balance and fall efficacy scores significantly improved in the experimental group compared to the control group.

Conclusion

These results suggest that this program can improve lower extremity muscle strength, postural balance and fall efficacy in elders. Therefore, this program is recommended for use in fall prevention programs for elders living in the community.

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Effects of a Fall Prevention Program on Falls in Frail Elders Living at Home in Rural Communities: Jae-Soon Yoo, Mi Yang Jeon, Chul-Gyu Kim; J Korean Acad Nurs 2013;43(5):613-625. Published online October 31, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.5.613

Abstract PDF

Purpose

This study was conducted to determine the effects of a fall prevention program on falls, physical function, psychological function, and home environmental safety in frail elders living at home in rural communities.

Methods

The design of this study was a nonequivalent control group pre posttest design. The study was conducted from July to November, 2012 with 30 participants in the experimental group and 30 in the control group. Participants were registered at the public health center of E County. The prevention program on falls consisted of laughter therapy, exercise, foot care and education. The program was provided once a week for 8 weeks and each session lasted 80 minutes.

Results

The risk score for falls and depression in the experimental group decreased significantly compared with scores for the control group. Compliance with prevention behavior related to falls, knowledge score on falls, safety scores of home environment, physical balance, muscle strength of lower extremities, and self-efficacy for fall prevention significantly increased in the experimental group compared with the control group.

Conclusion

These results suggest that the prevention program on falls is effective for the prevention of falls in frail elders living at home.

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Journal of Health Informatics and Statistics.2017; 42(4): 338. CrossRef
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Risk Factors for Pediatric Inpatient Falls: Myung Sook Cho, Mi Ra Song, Sun Kyung Cha; J Korean Acad Nurs 2013;43(5):595-604. Published online October 15, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.5.595

Abstract PDF

Abstract Purpose

The purpose of this study was to identify risk factors for pediatric inpatients falls.

Methods

The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers.

Results

In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls.

Conclusion

These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.

Citations

Citations to this article as recorded by

Risk factors for falls among children aged 0–18 years: a systematic review
Lan Wang, Mao-Lin Qian, Xiao Shan, Xiao-Qin Liu
World Journal of Pediatrics.2022; 18(10): 647. CrossRef
Analysis of Fall Incident Rate among Hospitalized Korean Children Using Big Data
Eun Joo Kim, Anna Lee
Journal of Pediatric Nursing.2021; 61: 136. CrossRef
A Systematic Review and Meta-Analysis of Fall Prevention Programs for Pediatric Inpatients
Eun-Joo Kim, Geun-Myun Kim, Ji-Young Lim
International Journal of Environmental Research and Public Health.2021; 18(11): 5853. CrossRef
An electronic medical record-based fall risk assessment tool for pediatric inpatients in South Korea: Improved sensitivity and specificity
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Reliability and Validity of a Pediatric Fall Risk Assessment Scale for Hospitalized Patients in Taiwan
Ching-Mei Chang, Cheng-Fan Wen, Hsien-Feng Lin
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Risk factors of falls among inpatients with cancer
M.D. Jun, K.M. Lee, S.A. Park
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Predictive Factors for Inpatient Falls among Children with Cerebral Palsy
Ebru Alemdaroğlu, Sibel Demir Özbudak, Sibel Mandiroğlu, Seda Alakoç Biçer, Neşe Özgirgin, Halil Uçan
Journal of Pediatric Nursing.2017; 32: 25. CrossRef
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Child Health Nursing Research.2014; 20(3): 215. CrossRef

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Effects of a Fall Prevention Program on Physical Fitness and Psychological Functions in Community Dwelling Elders: Myung Soon Kwon; J Korean Acad Nurs 2011;41(2):165-174. Published online April 30, 2011; DOI: https://doi.org/10.4040/jkan.2011.41.2.165

Abstract PDF

Purpose

This study was done to identify effects of a fall prevention program on physical fitness and psychological functions in community dwelling elders.

Methods

A quasi-experimental study was carried out with a nonequivalent control group pre & post-test design. The program, which included exercises and education, consisted of a 12-week group program and an 8-week self-management program using a health calendar. An experimental group (32) and a control group (21) participated.

Results

There were significant differences in SPPB (t=-3.92, p<.001), TUG test (t=4.94, p<.001), standing with right leg (t=-3.60, p=.001), standing with left leg (t=-3.74, p<.001), front and rear maximum step length test (t=-4.34, p<.001), right-left maximum step length test (t=-2.65, p=.011), and fall efficacy (t=-2.42, p=.019). Fall efficacy, fear of falling and depression showed significant differences following the 12-week exercise program and 8-week self-management program in the experimental group.

Conclusion

Study findings indicate that the fall prevention program is an effective nursing intervention to enhance physical fitness and psychological functions for elders. Using a health calendar, the self-management program was more effective for psychological functions compared to only the group program. Therefore, health providers should develop diversified fall prevention programs which include motivation plans to encourage clients in participating.

Citations

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Effects of a fall prevention exercise regimen on physical and psychosocial outcomes in elderly community dwellers: a randomized comparative study
Ji-Yeon Sim, Jung-Wan Koo, Yeon-Gyu Jeong
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Effects of Fall Prevention Elastic Band Exercise on Physical Function Test, Grasp Power, Flexibility, and Muscle Volume in Older Women
Young-Eun Song
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Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community
Eric Lenouvel, Phoebe Ullrich, Waldemar Siemens, Dhayana Dallmeier, Michael Denkinger, Gunver Kienle, G A Rixt Zijlstra, Klaus Hauer, Stefan Klöppel
Cochrane Database of Systematic Reviews.2023;[Epub] CrossRef
Effects of a Stim up Mat Walking Exercise Program on Balance, Gait Function and Joint Motion Range of the Frail Elderly
Gyeong Ran Kim, Mi Sook Song
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Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people
Cheol-Jin Kwak, You Lim Kim, Suk Min Lee
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In Sook Lee, Kwang Ok Lee
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Effect of Tai-Chi on Grip Power, Pain and Fear of Falling in Elderly Person
Chung-uk Oh
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Ji Yeong Yun, Jong Kyung Lee
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Strategies on fall prevention for older people living in the community: A report from a round-table meeting in IAGG 2013
Eun Joo Kim, Hidenori Arai, Piu Chan, Liang-Kung Chen, Keith D. Hill, Bernard Kong, Philip Poi, Maw Pin Tan, Hyung Joon Yoo, Chang Won Won
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Denise Kendrick, Arun Kumar, Hannah Carpenter, G A Rixt Zijlstra, Dawn A Skelton, Juliette R Cook, Zoe Stevens, Carolyn M Belcher, Deborah Haworth, Sheena J Gawler, Heather Gage, Tahir Masud, Ann Bowling, Mirilee Pearl, Richard W Morris, Steve Iliffe, Kim
Cochrane Database of Systematic Reviews.2014;[Epub] CrossRef
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Jeongyee Bae, Seong-il Cho
Journal of Korean Academy of Nursing.2014; 44(6): 697. CrossRef
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JongEun Yim
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Young Hee Kim, Kyung Hee Yang, Kum Sook Park
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Jae-Soon Yoo, Mi Yang Jeon, Chul-Gyu Kim
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Fall Risk in Low-Income Elderly People in One Urban Area: Kyung Won Choi, In-Sook Lee; J Korean Acad Nurs 2010;40(4):589-598. Published online August 31, 2010; DOI: https://doi.org/10.4040/jkan.2010.40.4.589

Abstract PDF

Purpose

The purpose of this study was to investigate the factors that increase of the risk for falls in low-income elders in urban areas.

Methods

The participants were elderly people registered in one of public health centers in one city. Data were collected by interviewing the elders, assessing their environmental risk factors, and surveying relevant secondary data from the public health center records. For data analysis, descriptive statistics and multiple logistic regression were performed using SPSS version 14.

Results

Stroke, diabetes, visual deficits, frequency of dizziness, use of assistive devices and moderate depression were statistically significant risk factors. The comorbidity of chronic diseases with other factors including depression, visual deficit, dizziness, and use of assistive devices significantly increased the risk of falls. From multiple logistic regression analysis, statistically significant predictors of falls were found to be stroke, total environmental risk scores, comorbiditiy of diabetes with visual deficits, and with depression.

Conclusion

Fall prevention interventions should be multifactorial, especially for the elders with stroke or diabetes, who were identified in this study as the high risk group for falls. A fall risk assessment tool for low-income elders should include both the intrinsic factors like depression, dizziness, and use of assistive devices, and the extrinsic factors.

Citations

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21 Crossref

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