노인 낙상 후 손상에 영향을 미치는 요인

Abstract

본 연구는 낙상 노인의 손상 실태를 파악하고 손상 정도에 영향을 미치는 요인을 분석하기 위해 시도되었다. 연구 대상자는 2015년 1월 1일부터 2016년 12월 31일 까지 지역 종합병원의 응급실을 내원한 만 65세 이상 노인 340명이었으며, 연구자가 선행 문헌을 통하여 자료수집 목록을 작성한 후 전자의무기록을 통하여 자료를 수집하였다. 자료수집 목록은 일반적 특성, 손상 실태, 신체 및 질환관련 특성, 낙상관련 환경적 특성을 묻는 문항으로 구성되었으며, IBM SPSS/WIN 20.0 프로그램을 사용하여, 기술 통계량 및 chi-square test, Fisher’s exact test, t-test 와 Logistic regression을 이용하여 자료를 분석하였다.

본 연구 결과는 다음과 같다. 1. 손상 정도는 경증 65명(19.1%), 중등도 이상 275명(80.9)으로 나타났다. 손상 형태와 진단명은 골절이 191명(56.2%)으로 가장 많았고, 손상 부위로 상지가 149명(43.8%)이었다. 응급실 진료 후 122명(35.9%)이 귀가를 했으며, 175명(51.5%)이 입원 치료를 했고, 그 중 111명(32.6%)이 수술적 치료를 받았다. 평균 재원 기간은 19.52±14.90 이며, 퇴원 시 결과 호전 148명(43.5%), 호전 안됨 25명(7.4%), 사망 1명(0.3%) 으로 나타났다.

2. 여성이 219명(64.4%)으로 많았고, 평균 나이는 77.94±7.38세였다. 동거형태는 가족과 거주하는 대상자가 195명(57.4%)이었고, 보험유형으로 의료 보험이 306명(90.0%)었다. 보행장애를 가진 대상자가 42명(12.4%)이었고, 대상자 중 165명(48.5%)이 1~2개의 동반질환이 있었다. 질환은 고혈압이 187명(55.0%)으로 가장 많았고, 1~2개의 약물을 복용 하는 대상자가 177명(52.1%)으로 나타났다. 대상자 중 57명(16.8%)이 재낙상을 했고, 34명(10.0%)이 평소 음주력이 있다고 하였다. 낙상발생 시기는 9시에서 16시가 162명(47.6%)으로, 그리고 낙상발생 계절은 3월에서 5월이 93명(27.4%)으로 가장 빈번하였다. 낙상발생 장소로 실외는 거리가 70명(20.6%), 실내는 방이 71명(30.9%), 기관은 병실 침대, 병원 복도, 병원 화장실이 각각 14명(4.1%)으로 조사되었다. 낙상발생 형태로 미끄러짐이 222명(65.3%)으로 가장 많았다.

3. 일반적 특성에 따른 손상 정도를 분석한 결과 나이가 많을수록 손상 정도가 유의하게 높았다(χ²=8.462, p=.015). 신체 및 질환관련 특성에 따른 손상 정도를 분석한 결과 고혈압과(χ²=4.616, p=.032) 골다공증(χ²=5.302, p=.021)이 있는 경우 손상 정도가 유의하게 높았고, 동반질환이 있거나(χ²=26.130, p<.001), 약물을 복용할 때(χ²=27.448, p<.001), 그리고 평소 음주력을 가지고 있을 때(χ²=4.280, p=.039) 손상 정도가 높은 것으로 나타났다. 낙상관련 환경적 특성에 따른 손상 정도를 분석한 결과 낙상발생 장소에서 유의한 차이를 보였으며, 타 기관의 대상자가 손상 정도가 높은 것으로 나타났다(χ²=11.835, p=.003).

4. 중등도 이상 손상에 영향을 미치는 요인을 분석한 결과 85세 이상 노인이 65세~ 74세 노인에 비해 중등도 이상 손상 위험이 높았으며(OR=2.715, 95% CI=1.037-7.107), 약물을 복용하지 않는 노인보다 1~2개의 약물을 복용하는 노인이 중등도 이상 손상 위험이 높았다(OR=4.209, 95% CI=2.189-8.091).

본 연구에서 고령과 복용약물 개수는 낙상 후 노인의 손상 정도를 높이는 위험요인으로 드러났다. 본 연구 결과를 토대로 80대 이상 노인을 대상으로 복용하고 있는 약물의 부작용과 낙상의 위험성에 대한 맞춤 예방교육을 실시하고, 낙상 발생시 손상을 최소화 할 수 있는 대처법과 연락망을 구축하는 것이 필요하다. 더불어 대상자의 보호자에게도 이와 같은 사항을 함께 교육하여 낙상 예방 및 낙상 시 손상을 최소화하는 노력이 필요하다. |This study was performed to identify the severity of after-fall injuries and the factors affecting injury severity among elderly individuals. This study included 340 geriatric patients aged 65 years and over who, between January 1, 2015 and December 31, 2016, visited the emergency room of a local tertiary hospital after experiencing a fall incident. Based on previous literature, a data collection list was designed. Data was collected through electronic medical records. The data collection list consisted of questions regarding general characteristics, severity of wounds, body- or disease-related characteristics, fall-related environmental characteristics, and progress after the wound. The data was analyzed through descriptive statistics, chi-square tests, Fisher’s exact tests, t-tests, and logistic regression using the IBM SPSS/WIN 20.0 program.

The results of the study are as follows: 1. Severity of injuries was mild in 65 individuals (19.1%) and moderate to severe in 275 individuals (80.9%). The most common injury type and diagnosis in 191 individuals (56.2%) was fracture. In 149 individuals (43.8%), the most commonly injured body part was the upper limb. After treatment at the emergency room, 122 individuals (35.9%) were discharged while 175 individuals (51.5%) were hospitalized. Of those hospitalized, 111 patients (32.6%) had surgery. The mean duration of hospitalization was 19.52±14.90 days. After hospitalization, 148 patients (43.5%) improved, 25 patients (7.4%) not improved, and 1 person (0.3%) died.

2. There were more female patients, 219 (64.4%), than male patients, and the mean age of all patients in this study was 77.94±7.38 years. With respect to patients’ living arrangements, 195 individuals (57.4%) were living with their families. Ninety percent of patients, or 306 individuals, had medical insurance. The number of patients with walking difficulty was 42 (12.4%). Of all patients, 165 (48.5%) had one or two other diseases. Of these additional issues, hypertension was the most common and found in 187 patients (55.0%). The number of patients taking 1-2 medicines was 177 (52.1%). Of all subjects, 57 patients experienced another fall incident after the initial fall (16.8%). Ten percent of subjects, or 34 individuals, reported that they usually drink alcohol. For 162 individuals (47.6%), the most common time frame of fall occurrence was between 9 a.m. and 6 p.m., and the most common season of fall incidence was spring (between March and May) in 93 people (27.4%). The most common locations of fall occurrence were found to be outdoors on the street as reported by 70 people (20.6%), indoors in a room with 71 people (30.9%), or in hospital, falling out of hospital beds, in the hospital corridor and in the hospital rest room, where 14 individuals (4.1%) were affected in each place. The most frequent fall injury was slip found in 222 patients (65.3%).

3. When the severity of fall injuries was analyzed by general characteristics, it was found that the older the patient, the more severe the injury. It was analyzed to be statistically meaningful (χ²=8.462, p=<.015). When wound severity was evaluated by body- or disease-related characteristics, patients with hypertension (χ²=4.616, p=<.032) or osteoporosis (χ²=5.302, p=<.021) sustained more severe injuries. This result was statistically meaningful, and if patients had other diseases (χ²=26.130, p=<.000), were taking medicine (χ²=27.448, p=<.000) or drinking alcohol (χ²=4.280, p=<.039), severity of injuries increased. When the wound severity was assessed by fall-related environmental characteristics, the statistically significant difference was determined by the location of the fall. Patients who suffered a fall in other healthcare facilities had worse injuries (χ²=11.835, p=<.003).

4. When factors affecting the fall injury severity were analyzed, the results revealed that patients aged 85 years or older were 2.715 times more likely than patients aged 65-74 years to have moderate or severe wounds (OR=2.715, 95% CI=1.037-7.107). Older adults taking 1-2 medicines were 4.209 times higher than those not taking medicine to sustain moderate or severe wounds (OR=4.209, 95% CI=2.189-8.091).

In this study, risk factors influencing the severity of after-fall injuries in older adults were found to be age and the number of medicines patients were taking. Based on the results of this study, it is necessary to provide education on the danger and prevention of falls and the adverse effects of medicines, and proper response instructions and emergency contacts to be used in the event of a fall for individuals aged 80 and older in order to minimize injury. Furthermore, efforts also need to be made to educate caregivers of the elderly on these important issues to prevent falls and minimize injury when falls occur.

Keywords: Elderly, Fall, Injury Severity, Risk Factors