BACKGROUND AND PURPOSE: The risks of falls and fractures increase after stroke. Little is known about the prognostic significance of previous falls and fractures after stroke. This study examined whether having a history of either event is associated with poststroke mortality. METHODS: We analyzed stroke register data collected prospectively between 2003 and 2015. Eight sex-specific models were analyzed, to which the following variables were incrementally added to examine their potential confounding effects: age, type of stroke, Oxfordshire Community Stroke Project classification, previous comorbidities, frailty as indicated by the prestroke modified Rankin Scale score, and acute illness parameters. Logistic regression was applied to investigate in-hospital and 30-day mortality, and Cox proportional-hazards models were applied to investigate longer-term outcomes of mortality. RESULTS: In total, 10,477 patients with stroke (86.1% ischemic) were included in the analysis. They were aged 77.7±11.9 years (mean±SD), and 52.2% were women. A history of falls was present in 8.6% of the men (n=430) and 20.2% of the women (n=1,105), while 3.8% (n=189) of the men and 12.9% of the women (n=706) had a history of both falls and fractures. Of the outcomes examined, a history of falls alone was associated with increased in-hospital mortality [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.03–1.71] and 30-day mortality (OR=1.34, 95% CI=1.03–1.73) in women in the fully adjusted models. The Cox proportional-hazards models for longer-term outcomes and the history of falls and fractures combined showed no significant results. CONCLUSIONS: The history of falls is an important factor for acute stroke mortality in women. A previous history of falls may therefore be an important factor to consider in the short-term stroke prognosis, particularly in women.
Accidental Falls* ; Classification ; Comorbidity ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Mortality* ; Prognosis ; Prospective Studies ; Stroke*

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.
Accidental Falls ; Aging ; Developed Countries ; Geriatrics ; Humans ; Internal Medicine ; Korea* ; Methods ; Mortality ; Nursing Homes ; Quality of Life

Falls and fall-related injuries are common in older population and have deleterious effects to the quality of life or independence of daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission and the increase of medical costs. Because Korea has shown extreme demographic shift with its population aging at the fastest pace among developed country, assessment of fall risks and intervention to high risk population are getting more important. The guideline for prevention of falls was developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. This guideline was developed by adaptation process as evidence-based method; four guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation II process, seven statements were made with the grading of evidence and recommendations followed the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls result from various combinations of many factors, the guideline contains multidimensional assessment and multimodal strategy to prevent falls. This guideline was developed for not only primary physician but also patients and general population, therefore it provides detailed recommendations and concrete measures to assess the risk and prevent falls in older people.
Accidental Falls ; Aged ; Aging ; Developed Countries ; Humans ; Internal Medicine ; Korea* ; Mortality ; Nursing Homes ; Quality of Life

Most health promotion and disease prevention programs to reduce mortality and morbidity in adults are effective in the elderly. In elderly people, these programs must also be targeted towards increasing quality of life and decreasing functional disability. Moreover, programs to prevent geriatric syndromes such as frailty, sarcopenia, and falls must be considered. When planning the screening of cancers that are common in the elderly, it must be taken into consideration that the complication rate of screening tests is high in the elderly and that life expectancy is important in deciding when to stop the screening. Life expectancy must be individually evaluated by considering the comorbidity and disability of each individual.
Accidental Falls ; Adult* ; Aged ; Comorbidity ; Health Promotion* ; Humans ; Life Expectancy ; Mass Screening ; Mortality ; Quality of Life ; Sarcopenia

Vitamin D deficiency is common among Koreans and worldwide, leading both physicians and patients to become interested in whether vitamin D supplementation is needed. However, current levels of supplementation with vitamin D are insufficient, especially among aging Koreans. The musculoskeletal effects of vitamin D supplementation have been established, and its extraskeletal effects also have drawn particular interest. Nonetheless, more studies are needed to assess its extraskeletal effects with regard to cardiovascular disease, cancer, and diabetes, as well as its adverse effects. Serum 25-hydroxyvitamin D levels greater than 20 ng/mL are generally appropriate for preventing osteoporosis, while serum 25-hydroxyvitamin D levels greater than 30 ng/mL are probably helpful for the management of osteoporosis and the prevention of fractures and falls. The recommended dietary vitamin D intake is at least 800 IU per day, which appears to reduce the risk of fractures.
Accidental Falls ; Aging ; Cardiovascular Diseases ; Humans ; Mortality ; Osteoporosis ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population.
Accidental Falls ; Aged ; Aging ; Developed Countries ; Humans ; Internal Medicine ; Korea* ; Mortality ; Nursing Homes ; Quality of Life

PURPOSE: This study was conducted to analysis the trends and states of external auses of mortality in Korea from 1985 to 1998. METHODS: This study was based on data published in 1985-1998 from the annual report of cause of death statistics of National Statistical Office. RESULTS: In the proportion of total death cases during 1985-1998, External causes of mortality was ranged from 11 percent to 15 percent. Death rate(per 100,000) of external causes of mortality(ECM) decreased recently from 85.7 in 1991 to 68.9 in 1998. Death rate of ECM in male was 2.6 times higher than that of female. Among total cases of ECM, the first leading cause of death was transport accidents. intentional self-harm was the second leading cause of death(26.8 percent in 1998). In trends of death rate(per 100,000) for ECM during 1885-1998, there were decreased for following causes of death; transport accidents, falls, accidental drowning and submersion, exposure to smoke, fire and flames, accidential poisoning by and exposure to noxious substances, Death rates of ententional self-harm and assault were increased during the periods. The age specific death rate increased with age for all ECM except for assault. The risk of death caused by ECM was higher in aged 65 and over than in ages 0-19 years among all ECM. The risk of death for male aged 65 and over were 6.9 times in transport accidents, 26 times in fall, 37 times in accidential poisoning by and exposure to noxious substances, and 18 times in intentional self-harm compared with 0-19 years. The risk of death for female aged 65 and over were 27 times in fall, 22 times in accidential poisoning by and exposure to noxious substances compared with 0-19 years. In seasonal variation of ECM cases for 1998. There was highest proportion in August(10.4 percent). The highest proportion by death seasion were winter(32.7 percent) in exposure to smoke, fire and flames, summer(27,7 percent) in fall, summer(52.4 percent) in accidental drowning and submersion, summer in 32.0 percent) in accidential poisoning by and exposure to noxious substances, spring(28.2 percent) in intentional self-harm, assault. and autumn(28.2 percent) in transport accidents. CONCLUSION: Above results suggest that a preventive education program for safety accidents should be developed by considering gender and age of the objecties and seasons of the year.
Accidental Falls ; Cause of Death ; Drowning ; Education ; Female ; Fires ; Humans ; Immersion ; Korea* ; Male ; Mortality* ; Poisoning ; Seasons ; Smoke

Physical frailty is a state in which the functional capacity of various organs in the body drops below a certain level, making an individual vulnerable to a variety of stresses; as a result, frail individuals are more likely to experience geriatric diseases, falls, decreased activities of daily living, disability, hospitalization, and mortality. Comprehensive assessments for frail patients are needed, but a simple and rapid screening test such as the FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale can be used in busy outpatient clinics. Physical frailty can be reversible and preventable. Frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reducing polypharmacy.
Accidental Falls ; Activities of Daily Living ; Ambulatory Care Facilities ; Hospitalization ; Humans ; Mass Screening ; Mortality ; Polypharmacy ; Vitamin D ; Walking

OBJECTIVES: Fall is a major cause of morbidity and mortality among older adults. Falls result from many various causes, and dizziness is important risk for falls, especially in the elderly. Research on the relationship between chronic dizziness and falls in elderly people has been rarely performed and these were no studies that analyzed the risk of falls according to subtypes of chronic dizziness. METHODS: We conducted a prospective study of the association between subtypes of chronic dizziness and falls in the elderly between 65 to 75 years. We divided dizzy patients into 5 groups according to the results of symptom, vestibular and autonomic function test. Falls and new events (acute dizziness or other medical conditions) were checked monthly by telephone or out patient department follow-up for 6 months. RESULTS: Thirty-four patients were enrolled and all completed follow-up for 6 months. Nine patients classified as the falling groups and 34 patients as nonfalling group. Whereas the frequencies of orthostatic hypotension (n=6, 67%) and vestibular dysfunction (n=1, 11%) were higher in fall group, psychogenic dizziness (n=12, 35%), and vestibular migraine (n=3, 9%) were more frequent in nonfall group. CONCLUSIONS: The presence of dizziness in the elderly is a strong predictor of fall, especially orthostatic hypotension is an important predictor of fall. In order to lower the risk of falls in the elderly, an approach based on the cause of dizziness is needed.
Accidental Falls ; Adult ; Aged ; Classification ; Dizziness ; Follow-Up Studies ; Humans ; Hypotension, Orthostatic ; Migraine Disorders ; Mortality ; Prospective Studies ; Telephone

Intertrochanteric fractures frequently occur in elderly patients. Early mobilization after rigid internal fixation of unstable intertrochanteric fractures has recently reduced the mortality and morbidity. Between March, 1976 and February, 1980, eighteen patients over 60 years old with unstable intertrochanteric fractures were treated by Jewett nailing after Dimon & Hughstons reduction at the department of Orthopaedic Surgery, Chung Nam University. Among the eighteen patients, twelve patients could be followed, ranging from 6 months to 2.1 years, with an average follow-up of 11 months. The results were obtained as follows: 1. The main causes of fractures were falling down and slip down. 2. In treatment of unstable intertrochanteric fractures by medial displacement and valgus nailing with Jewett nail, early ambulation and early weight bearing were possible with satisfactory results. 3. The average time for fracture union in twelve cases who were followed up were 17.1 weeks, but two cases with severe comminution of posterior and medial fragment of the trochanter revealed delayed union. 4. The medial displacement of distal fragment and valgus nailing in unstable intertrochanteric fracture shortened the operation time and reduced complications by early ambulation, but had disadvantages such as some limitation of motion of affected hip joints, shortening of affected extremities and delayed union.
Accidental Falls ; Aged ; Early Ambulation ; Extremities ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip Joint ; Humans ; Mortality ; Weight-Bearing