정돈해 주고 걸어서 이동할 경우 경사지나 공사지 등은 피하고, 보행시 손은 주 머니를 넣지 않고 이동하도록 한다. 낙상사고 후 통증과 외상이 없더라도 검사를 해야한다. 검사를 하지않고 방치할 경우 사망의 위험성이 있다.
그리고 골절 후에는 입원이 지연되지 않도록 하고 빠른시간 내에 병원에 이송 될수 있도록 하는 체계적인 시스템이 필요하다. 의료기관 내원시 신속한 대응과 전문적 치료가 요구되며 재활치료와 같은 지속적 관리가 필요하다. 골절 후의 빠 른 호전을 위해 그리고 골절 재발 및 2차 피해를 막기 위한 내원환자와 환자를 돌보는 가족 및 의료진 등의 통합적 주의가 필요하다.
본 연구의 제한점 및 추후 연구를 위한 제언은 다음과 같다. 퇴원손상심층자료 는 특성상 행정자료로 낙상으로 인한 고령의 고관절 골절 환자만을 대상으로 한 자료로서 표본과 변수가 다소 한정되어 있어 추가적인 자료를 보완하여 살펴볼 필요가 있다. 다양한 사회활동 참여로 인해 낙상의 위험이 높을 수 있으나 연령 이 증가하면서 신체 기능의 저하로 인한 낙상의 위험도 높아질 수 있어 연령대 별 낙상의 위험요인에 대한 추후 연구가 필요할 것으로 생각된다.
본 연구를 통하여 노인의 낙상으로 인한 고관절 환자의 사망요인을 분석하여 환자의 생존율과 삶의 질을 높이고 증가하는 의료비용을 감소시킬 수 있는 효율 적인 정책을 수립 하는데 필요한 기초 정보를 제공하는 근거자료로 활용될 수 있는 계기가 되었으면 한다.
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김병철 오산시, 폐지수거 어르신 혹한기·낙상 예방교육 실시. 서울일보 기사입 력 2018.10.30.
Figure 2. Kaplan-Meier survival estimates byOsteoporosis, Parkinson, CCI , bed number,Surgery status,fracture type
〔부록〕
〔ABSTRACT〕
Factors associatel with mortality due to fall-related hip fracture in older adults
The population structure is changing due to the entry into an aging society and the frequency of hip fractures is increasing due to various accidents.
Among them, hip fractures due to falls have a high risk of death. To reduce the mortality rate from these hip fractures and to come up with countermeasures, an understanding of the factors affecting the death is needed.
This study established a database for 3,892 hip fracture patients aged 65 or older from the Korea Disease Control and Prevention (KCD-10) through the data inquiry of discharge damage in the Centers for Disease Control and Prevention (2010-2014). Factors affecting death of hip fracture due to falling were identified according to demographic, pathological, and fall-related characteristics.
Computational statistics were processed using the difference between death and non-occurrence variables due to hip fractures and the demographic characteristics, disease characteristics, fall-related characteristics of those aged 65 and older, and factors affecting mortality. The difference between the parameters of the mortality and non-occurrence due to hip fractures was analyzed by x2-test and was analyzed by Cox-hazard proportional risk to measure the effect on death after hip fracture.
According to the statistical analysis, men were statistically more at risk than women in the case of gender, given the sociological characteristics of the factors affecting the death of hip fracture patients due to falls (p<).001 ). In age, 75 to 84 years of age were more dangerous than 65 to 74 years of age,
but were not statistically significant (p = .254), and those over 85 years of age were significantly more dangerous than 65 to 74 years of age ( p<).001 ). In the pathological nature, groups of patients without osteoporosis were statistically significantly more dangerous (p<.001). The military with Parkinson was statistically more dangerous than without Parkinson (p=.028). Deaths in counties with relatively high CCI were significantly more dangerous than those with relatively low CCI (p<.001). In the form of fractures, femur tibial fractures were statistically more dangerous than electronic fractures (p=.036). A group of patients who did not operate in the presence of surgery was statistically significantly more dangerous (p<.). Compared to 100~299 units in the medical institution disease constants and 300~499, 500~999 and over 1000 groups with larger lesions, the larger the medical institution disease constants were statistically more dangerous (p=.032). Factors affecting the death of a site in case of damage were residential areas, collective facilities (care centers, hospice facilities, shelter, etc), roads, transportation areas, medical facilities, schools, sports facilities, and outdoor areas, which were statistically more dangerous than the military where the damaged market place was located (p=039). Factors that contribute to death from damage were statistically more dangerous during treatment and during other accidents during daily life (found lying down on the road, unclear transportation accidents), exercise, leisure, education, etc., during treatment, and in the absence of income from work, and during treatment and other accidents during the day of damage (p=.015).
In this study, the risk of death in hip joint patients due to falls was shown to be high depending on gender, age, co-morbidities, fracture type, surgical condition, damaged site and damage activity.
As the number of elderly people increases, the importance of fall and policies to prevent hip fractures are needed more. In order to reduce hip fractures caused by falls, not only preventive policies but also environmental cleanup and
rapid response by medical institutions should prevent death.
Based on these findings, it is hoped to be used as a basis for establishing policies that can increase the survival rate of hip patients and actively manage the fall of senior citizens aged 65 or older in Korea.
Key words: fall, old man, hip fracture, death.