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지역사회 노인의 약물사용과 주거환경이 낙상경험에 미치는 영향

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Alternative Title
The Effects of Drug Use and Residential Environment on Fall Experience of the Elderly in the Community
Abstract
The purpose of this study was to provide a basis for the intervention to fall prevention while considering drug management and residential environment of elderly at home, by analyzing the effect of community-dwelling elderly's drug use status and residential environment on history of falls. This is a descriptive study, composed of 285 community-dwelling elderly people over 65 years of age. The data was collected from April 23 to May 20, 2019. Comparison of history of falls according to subject's characteristics, drug use status, and housing environment was analyzed using Chi-square test whereas risk factors for history of falls was analyzed through multiple logical regression analysis. The results of the study are as follows: 1. 51.2% of the subjects experienced average of 2.62 falls (±2.25) in the pst year 2. As a result of univariate analysis for the characteristics of subjects, it was shown that falls is highly relevant with increased age (age: 65-69 OR 1.0 / 70-75 OR 2.57, p=.004 / 75-80 OR 2.53, p=.011 / 80 or older OR 2.70, p=.002), living alone (OR 3.25, p<.001), less than one-million won (=1,000 $) of monthly income (income: half million-one million won OR 5.27, p<.001 / less than half million won OR 4.25, p<.001), and medicaid beneficiary (OR 4.27, p<.001). The risk of falls was significantly increased in elderly with chronic disease (OR 5.52, p<.001), especially elderly with hyperlipidemia (OR 1.98, p=.024), diabetes mellitus (OR 2.16, p=.021), arthritis (OR 3.74, p<.001), osteoporosis (OR 2.20, p=.013), and depression (OR 15.80, p=.008). As the number of chronic diseases increased, in addition, the likelihood of falls was higher than in those without chronic disease (number of chronic disease: 1 class OR 2.88, p=.018, 2-3 class OR 6.34, p<.001, 4 class or more OR 10.28, p<.001). 3. As a result of univariate analysis for drugs affecting history of falls, the risk of falls was increased with the use of following types of drugs : antihypertensive drugs (OR 2.25, p=.001), antihyperlipidemic drugs (OR 2.47, p=.001), antiulcer drugs (OR 2.19, p=.004), anticoagulants (OR 2.30, p=.003), nonsteroidal antiinflammatory drugs (OR 3.40, p=.001), brain function agents (OR 3.30, p=.024), antianxiety agents (OR 4.43, p=.022), antidepressants (OR 6.13, p=.019), sedative-hypnotic drugs (OR 10.15, p=.028), non-narcotic analgesics (OR 2.41, p=.027), narcotic analgesics (OR 10.15, p=.028), and antihistamine (OR 9.07, p=.038). 4. As a result of univariate analysis for residential environment affecting history of falls, the risk of falls increased when the score of environment risk factor assessment tool showed 4 or higher points in stairs nearby the house (OR 2.91, p=.005), inside of the house (OR 6.86, p<.001), and bathroom (OR 4.12, p=.001) while 2 or higher points in Streets nearby the house (OR 5.28, p<.001), entrance (OR 5.07, p<.001), and kitchen surroundings (OR 3.58, p<.001). 5. Multiple logistic regression analysis was performed with adjusted age and gender to identify the most important risk factors affecting incidence of falls in community-dwelling elderly. As a result, the risk of falls was significantly correlated with the use of drugs including antihistamines (OR 9.49, p=.048), antihyperlipidemic drugs (OR 2.25, p=.009), and sedative-hypnotic drugs (OR 17.73, p=.011), anticoagulants (OR 1.93, p=.048), and with the environmental risk factors assessment score 2 or higher points in streets nearby the house (OR 2.57, p=.012), entrance (OR 2.39, p=.030), and kitchen surroundings (OR 2.69, p=.012). Based on the above results, the following suggestions are made: 1. It is suggested to establish multi-dimensional intervention program in which health status, drug use status, and housing environment are considered, and a study to review the effect of intervention program in community-dwelling elderly at home. 2. During the preventive education for falls, a need to keep prescription must be emphasized while monitoring the presence of multi-drug therapy using drug check-list. In addition, an active health education is necessary to recognize the residential environment risk factors by residential environment risk check-list and to provide manuals regarding safety rules at home for betterment of lifestyle behavior and the improvement of environment. 3. Local government need to apply cut-off score in this study, which used residential environment risk factor assessment tool, to draw statistically significant result to select the elderly with high risk of falls and to seek ways to support improvement of the residential environment. 4. Visiting nurses need careful inspection and intervention plan for vulnerable group of community-dwelling elderly by recognizing the effect of drug use and residential environment on falls. 5. Based on the master plan of Community integrated health services 2018, we propose a paradigm shift in the elderly health care plan by providing integrated package programs that include guideline, intervention, and overall assessment tools for risk of falls within the national health care system.
Author(s)
韓知潤
Issued Date
2019
Awarded Date
2019. 8
Type
Dissertation
URI
http://dcoll.jejunu.ac.kr/common/orgView/000000009073
Alternative Author(s)
Han, Ji Yoon
Affiliation
제주대학교 대학원
Department
대학원 간호학과
Advisor
박은옥
Table Of Contents
Ⅰ. 서론
1. 연구의 필요성 1
2. 연구의 목적 5
3. 용어의 정의 5

Ⅱ. 연구 방법
1. 연구 설계 6
2. 연구 대상 6
3. 연구 도구 7
4. 자료수집 및 분석방법 9
5. 연구의 윤리적 고려 11

Ⅲ. 연구 결과
1. 대상자의 일반적 특성 12
2. 대상자의 약물사용 16
3. 대상자의 주거환경 19
4. 대상자의 낙상경험 실태 23
5. 대상자 특성과 낙상경험률 비교 24
6. 약물사용과 주거환경에 따른 낙상경험률 비교 28
7. 낙상경험에 영향을 미치는 요인 34

Ⅳ. 논의 46
Ⅴ. 결론 및 제언 65

참고문헌 70

Abstract 78

Appendix 81
Degree
Master
Publisher
제주대학교 대학원
Citation
韓知潤. (2019). 지역사회 노인의 약물사용과 주거환경이 낙상경험에 미치는 영향
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