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Phys. Ther. Korea 2023; 30(1): 1-7
Published online February 20, 2023
https://doi.org/10.12674/ptk.2023.30.1.1
© Korean Research Society of Physical Therapy
Falls in Patients of Medical Institutions in South Korea: A Literature Review
Jongwon Choi 
, PT, BPT, Woochol Joseph Choi , PT, PhD
Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea
Correspondence to: Woochol Joseph Choi
E-mail: wcjchoi@yonsei.ac.kr
https://orcid.org/0000-0002-6623-3806
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Like many other countries, falls and related injuries in older adults are great concerns in South Korea. In particular, falls are common in medical institutions, often causing the increase of the length of hospitalization. Objects: The purpose of this review was to help understand and address falls in hospitalized individuals in South Korea.
Methods: The review was conducted on literature published in Korean from 2010 to 2022, searched in the Korea Citation Index and PubMed. Keywords used for the search were as follows: falls, fall risk, fall risk assessment, hospital, inpatient, intervention, Korea, and prevention.
Results: A total of 54 articles were found and reviewed. The most common place of fall accidents was the inpatient room, where there were many cases of falls while walking. Loss of balance was the most common cause of falls, and many falls occurred in patients admitted to the internal medicine. Furthermore, a risk of falling increased with the type of medications taken. In terms of tools to assess patients’ fall risk, the Morse Fall Scale (MFS) was commonly used. Patient-specific fall prevention activities were common to address falls, and they decreased the frequency of falls and the fear of falling. Factors influencing the effectiveness of the fall prevention activities included attitudes toward falls, education, environmental factors, patient safety culture, and self-efficacy in preventing falls.
Conclusion: Our results should help understand and address falls and injuries in medical institutions.
Keywords: Falls, Inpatients, Prevention, Risk assessment
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Review Article
Phys. Ther. Korea 2023; 30(1): 1-7
Published online February 20, 2023 https://doi.org/10.12674/ptk.2023.30.1.1
Copyright © Korean Research Society of Physical Therapy.
Falls in Patients of Medical Institutions in South Korea: A Literature Review
Jongwon Choi , PT, BPT, Woochol Joseph Choi , PT, PhD
Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea
Correspondence to:Woochol Joseph Choi
E-mail: wcjchoi@yonsei.ac.kr
https://orcid.org/0000-0002-6623-3806
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Like many other countries, falls and related injuries in older adults are great concerns in South Korea. In particular, falls are common in medical institutions, often causing the increase of the length of hospitalization. Objects: The purpose of this review was to help understand and address falls in hospitalized individuals in South Korea.
Methods: The review was conducted on literature published in Korean from 2010 to 2022, searched in the Korea Citation Index and PubMed. Keywords used for the search were as follows: falls, fall risk, fall risk assessment, hospital, inpatient, intervention, Korea, and prevention.
Results: A total of 54 articles were found and reviewed. The most common place of fall accidents was the inpatient room, where there were many cases of falls while walking. Loss of balance was the most common cause of falls, and many falls occurred in patients admitted to the internal medicine. Furthermore, a risk of falling increased with the type of medications taken. In terms of tools to assess patients’ fall risk, the Morse Fall Scale (MFS) was commonly used. Patient-specific fall prevention activities were common to address falls, and they decreased the frequency of falls and the fear of falling. Factors influencing the effectiveness of the fall prevention activities included attitudes toward falls, education, environmental factors, patient safety culture, and self-efficacy in preventing falls.
Conclusion: Our results should help understand and address falls and injuries in medical institutions.
Keywords: Falls, Inpatients, Prevention, Risk assessment
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Table 1 . Articles reviewed in this study.
Category Number Article Fall incidence and fall risk factor 20 Ahn and Kim [13]; Cho and Lee [24]; Cho and Lee [11]; Cho et al. [14]; Choi et al. [10]; Hong et al. [25]; Hwang and Jung [26]; Jang and Lee [12]; Jeong et al. [23]; Kang and Song [20]; Kim et al. [21]; Kim and Lee [16]; Kim and Lee [27]; Lee and Yoon [18]; Lee and Kim [28]; Lee [22]; Lee and Gu [15]; Lee et al. [29]; Lim and Gu [19], Kim and Choi-Kwon [17] Fall risk assessment tool 9 Baek et al. [32]; Cho et al. [35]; Choi et al. [36]; Kang and Song [33]; Kim et al. [30]; Kim et al [31]; Kim et al. [38]; Lee et al. [37]; Yoo et al. [34] Fall prevention intervention 7 Chae and Yang [39]; Ju and Jeon [41]; Kim and Jung [40]; Kim et al. [45]; Lee et al. [42]; Lim and Gu [44]; Park et al. [43] Factor influencing the effectiveness of interventions 18 Chang et al. [58]; Cho and Jang [60]; Jang and Kim [49]; Jeong and Park [52]; Jin and Ha [53]; Jung and Jung [50]; Jung et al. [48]; Jung [64]; Jung and Kim [63]; Kim [59]; Kim and Seo [54]; Lee and Choi [47]; Lim and Gu [55]; Park and Son [56]; Park and Han [46]; Park [61]; Park and Yun [62]; Yoo [51] Total 54
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Table 2 . Sensitivity, specificity, PPV, NPV, AUC value and Youden index according to cutoff point of various fall risk assessment tools by each study.
Study Tool Cutoff (score) Sensitivity (%) Specificity (%) PPV (%) NPV (%) AUC Youden index Kim et al. [30] MFS 50 78.9 55.8 30.8 91.4 0.761 JHFRAT 12 69.0 60.0 30.1 88.6 0.708 BMFRA 11 76.1 58.3 31.8 90.9 0.715 Kim et al. [31] MFS 40 78.1 82.2 0.837 HFRM II 3 81.3 61.5 0.745 STRATIFY 2 84.4 73.5 0.828 Baek et al. [32] MFS 51 72.0 91.0 63.0 94.0 0.770 0.630 Kang and Song [33] MFS 45 86.7 60.8 68.9 82.0 0.806 JHFRAT 11 62.5 63.3 63.0 62.8 0.656 BMFRA 10 75.0 58.3 64.3 70.0 0.695 Yoo et al. [34] MFS 40 78.1 82.2 12.4 99.1 0.802 0.603 Fall risk score 6 84.4 86.0 16.4 99.4 0.852 0.704 HFRM II 3 81.3 61.5 6.4 99.0 0.714 0.428 STRATIFY 2 84.4 73.5 9.3 99.3 0.790 0.579 Cho et al. [35] MFS 45 59.3 65.0 36.1 82.7 0.641 0.240 JHFRAT 13 29.1 89.7 48.5 79.2 0.708 0.190 HFRM II 5 57.3 78.0 46.5 84.6 0.742 0.350 Choi et al. [36] MFS 50 61.8 76.8 13.3 97.5 0.728 JHFRAT 9 82.4 55.3 9.2 98.3 0.698 FAS-K 4 85.3 49.4 8.5 98.4 0.757 Lee et al. [37] MFS 32.5 78.8 37.9 0.613 0.167 TUG 18.58 (second) 77.8 54.8 0.687 0.326 Age 55 (years) 67.6 50.0 0.627 0.184 Kim et al. [38] MFS 50 85.7 58.8 3.0 100.0 0.719 JHFRAT 14 67.8 80.2 7.0 99.9 0.728 PPV, positive predictive value; NPV, negative predictive value; AUC, area under receiver operating characteristics curve; MFS, Morse Fall Scale; JHFRAT, Johns Hopkins Hospital Fall Risk Assessment Tool; BMFRA, Bobath Memorial Hospital Fall Risk Assessment Scale; HFRM II, Hendrich II Fall Risk Model; STRATIFY, St. Thomas’s Risk Assessment Tool in Falling Elderly Inpatients; FAS-K, Fall Assessment Scale-Korean version; TUG, Timed Up and Go test..