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It could be said that falls may be a common health problem among Vietnamese elderly, but data about this type of health issue is incomprehensive explored. Several studies showed that the elderly have highest injury incidence ratecompared with other agegroup and falls, which took place in the home, represented a major proportion of injuries among the elderly(Chuan et al., 2001; Hanh, 1999; Hoang, 2004). A recent study found that falls are common injuries among older adults and accountfor the highest proportion of economic costs for their family (Nguyen et al., 2013). However, no study on associated factors for falls within older population has been conducted recently (To et al., 2014).
1 3.1 ………………………………………………………… 3.1.1 …………………………………………………………… 3.1.2 Definition Terms………………………………………………………… 3.2 of Research Hypotheses……………………………………………………………… Chapter 4: Material and Methods 4.1 Study Design…………………………………………………………………… 4.2 Sampling and Setting……………………………………………………………… 4.3 Research Instruments……………………………………………………………… 4.4 Research Progress………………………………………………………………… 4.4.1 Training the Observers………………………………………………… 4.4.2 Pilot study…………………………………………………………… 4.4.3 Validity and Reliability………………………………………………… 4.4.4 Data Collection ………………………………………………………… 4.5 Data Analysis……………………………………………………………………… 4.5.1 Data Screening and Recoding ………………………………………… 4.5.2 StatisticAnalyses………………………………………………………………… 4.6 Ethical Consideration……………………………………………………………… PREVALENCE OF FALLS AND ASSOCIATED FACTORS IN VIETNAMESE ELDERLY Chapter 1: Introduction 1.1 Statement of the Problem With the rapid ageing of the world’s populations, falls in older adults are a significant public health issue More than one third of persons 65 years of age or older fall each year, and in half ofsuch cases the falls are recurrent(Nevitt, Cummings, Kidd, & Black, 1989; Tinetti, Speechley, & Ginter, 1988).The risk of falling and fall-related injury proportionately increases as older adults age Indeed, it is estimated that about 28-35% of people aged of 65 and over fall each year (Blake & et al, 1988), whereas 32-42% of older over 70 years of age experience falling in their life (Downton & Andrews, 1991; Stalenhoef & et al, 2002) The rate of falling is vary from 20% in Japanese older (Yoshida & Kim, 2006) to 21.6% in Barbados and 34% in Chile (Reyes-Ortiz, Al-Snih, & Markides, 2005) Falls among older adults cause serious consequences to their health and quality of life and shoulder heavier costs of health care onto their family as well Approximately in 10 falls results in a seriousinjury, such as hip fracture, other fracture, subdural hematoma, other serious softtissue injury, or head injury(Nevitt, Cummings, & Hudes, 1991; Sattin, 1992; Tinetti, Doucette, Claus, & Marottoli, 1995).Falls account for approximately 10 percent of visits tothe emergency department and percent of urgent hospitalizations among elderly persons(Runge, 1993; Sattin, 1992) Many longitudinal studies indicated that elderly with fallrelate hospitalization have to pay higher health care cost than nonfallers(Bohl et al., 2010 ; Craig et al., 2013 ; Dubey, Koval, & Zuckerman, 1998; Finkelstein & Miller, 2006; Hartholt et al., 2011 ) 1.2 Problem: Background and Significance Although recognized as a young population, Vietnam is now enter the “aging phase” in its population growth Historically, only 3.71 million older adults over 60 years was reported in 1979, but the number increased by the time from 4.64 million in 1989 to 7.8 million in 2006 (General Statistics Office, 2007) The projected number of elderly in 2020 will be more than 12 million and the proportion of older population is estimated to be 26.1% by 2050 (United Nations, 2007b) Like any older individual in other countries, Vietnamese elderly have to suffer not only physical impairment due to their old age but also illnesses, especially non-communicable diseases Most of the elderly have to cope with noncontagious and chronic diseases such as joint degradation, cardiac problems and blood pressure, prostate, and urination disorders (United Nations, 2007a) In addition, risks of disability are also high for the Vietnamese elderly, particularly in terms of vision and hearing It could be said that falls may be a common health problem among Vietnamese elderly, but data about this type of health issue is incomprehensive explored Several studies showed that the elderly have highest injury incidence ratecompared with other age-group and falls, which took place in the home, represented a major proportion of injuries among the elderly(Chuan et al., 2001; Hanh, 1999; Hoang, 2004) A recent study found that falls are common injuries among older adults and accountfor the highest proportion of economic costs for their family (Nguyen, Ivers, Jan, Martiniuk, & Pham, 2013) However, no study on associated factors for falls within older population has been conducted recently (To et al., 2014) 1.3 Statement of Purpose To provide more data on fall prevalence and associated factors for falls among older adults, I conduct this study There are two objectives must be achieved in this study: Evaluating the fall prevalence among institutionalized older adults Identifying associated factors involving to falls among institutionalized older adults Chapter 2: Literature Review 2.1 Definition of fall Falls are commonly defined as inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position to rest in furniture, wall or other objects.The adoption of a definition is an important requirement when studying falls as many studies fail to specify an operational definition, leaving room for interpretation to study participants This results in many different interpretations of falls(Zecevic & et al, 2006) For example, older people tend to describe a fall as a loss of balance, whereas health care professionals generally refer to events leading to injuries and ill health Therefore, the operational definition of a fall with explicit inclusion and exclusioncriteria is highly important 2.2 Epidemiology of falls among elderly 2.2.1 The prevalence and mortality offall among older age Among older adults, the risk of falling and fall-related injury is known to increase withincreasing age Approximately 28-35% of people aged of 65 and over fall each year (Blake & et al, 1988)increasing to 32-42% for those over 70 years of age(Downton & Andrews, 1991; Stalenhoef & et al, 2002) Approximately 30-50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls (Tinetti, 1987) Given incidence of falls it varies among countries The annual incidence of falls in China was estimated to 6-31% (Gang & Sufang, 2006; Liang, Y., & X., 2004)while in Japan was 20%(Yoshida & Kim, 2006) Some countries in region of the Americas reported the proportion of elderly feltannually ranging from 21.6% in Barbados to 34% in Chile (Reyes-Ortiz et al., 2005) 2.2.2 The consequences of falls among elderly Falls among older adults represent a major public healthproblem associated with increased morbidity, mortality, and health care costs Approximately 10%15% of falls resultin a major injury such as a fracture, serious soft tissueinjury, or traumatic brain injury (Orces, 2014; Tinetti & Williams, 1997) Previous studies havedemonstrated that fall-related fractures treated in hospitalemergency departments and hospitalizations for fall-relatedinjuries are increasing among older adults in developedcountries (Hartholt, Stevens, Polinder, van Der Cammen, & Patka, 2011; Hartholt, van der Velde, Looman, & et al, 2010; Orces, 2013) Overall, 44.2% of adults aged 65 years orolder with fall-related fractures require hospitalization andhip fractures account for 48% of the hospitalizations for fallrelated injuries among women (Hartholt et al., 2010; Orces, 2013).Falls are also associated with restricted mobility; a decline in the ability to carry out activities such as dressing, bathing, shopping, or housekeeping; and an increased risk of placement in a nursing home(Kosorok, Omenn, Diehr, & et al, 1992; Tinetti & Williams, 1998) The mortality of falls varies widely among countries Fall fatality rate for people aged 65 and older in United States is 36.8 per 100,000 population(Stevens & et al, 2007)whereas in Canada mortality rate for the same age group is 9.4 per 10,000 population (Division of Aging and Seniors & PHAC Canada, 2005).Rates of fatal falls among men exceed that of women for all age groups and this is attributed to the fact that men suffer from more co-morbid conditions than women of the same age (Stevens & et al, 2007) One study found that men reported poorer health and a greater number of underlying conditions than women, which substantially increased the impact of hip fracture and consequently increased the risk ofmortality (Fransen & al, 2002) Not only causing injuries and mortality in elderly, falls also cause high healthcare cost to older patients A longitudinal analysis of total 3-year healthcare costs for older adults who experience a fall requiring medical care showed that fallers are sought resulted in higher costs than for nonfallers for up to 12 months after a fall, particularly for falls requiring hospitalization(Bohl et al., 2010 ) A study conducted in Scotland found that the health care cost for falling elderly were over £470 million, with 60% incurred by social services, mainly providing longterm care Cost per person falling was over £1720, rising to over £8600 for those seeking medical assistance A hip fracture admission cost £39,490, compared with £21,960 for other falls-related admissions(Craig et al., 2013 ) In Dutch, falls among older adults led to a total healthcare cost of €474.4 million, which represents 21% of total healthcare expenses due to injuries(Hartholt et al., 2011 ).In American, the direct medical costs associated with fall-relatedinjuries were approximately $19 billion (Finkelstein & Miller, 2006) and are projected torise as the population ages (Dubey et al., 1998) 2.2.3 Main risk factors for falls Although a few falls have a single cause, the majority occur as a result of a complex interaction of risk factors.The risk of falling consistently increases as the number of these risk factors increases(Nevitt et al., 1989; Tinetti et al., 1988).The risk of falling increased in a cohort of elderly persons living in the community, forexample, from percent among those with no risk factors to 78 percent among thosewith four or more risk factors(Tinetti et al., 1988) Those are categorized into fivedimensions: biological, behavioural, environmental, socioeconomic factors(World Health Organization, 2007) personal and Biological risk factors Biological factors embrace characteristics of individuals that are pertaining to the human body For instance, age, gender and race are non-modifiable biological factors These are also associated with changes due to ageing such as the decline of physical, cognitive and affective capacities, and the co-morbidity associated with chronic illnesses Women are more likely than men to fall and sustain fracture (Stevens & et al, 2006), resulting in twice more hospitalizations and emergency department visits than men (Hendrie & et al, 2003) The reasons for these differences may come from gender-related factors such as women being inclined to make greater use of multiple medications and living alone (Ebrahim & Kalache, 1996), women's muscle mass declines faster than that of men, especially in the immediate few years after menopause, and to some extent women are less likely to engage into the practice of muscular building physical activities (e.g sports, exercises) though the life course On the other hand, fall-related mortality disproportionately affects men more than women That is attributed from health seeking behavior differs according to gender Generally, men are not try to seek medical care until a condition becomes severe, resulting in substantial delay to the access to prevention and management of diseases In addition, men are more likely to be engaged in intense and dangerous physical activity and risky behaviors – such as climbing high ladders, cleaning roofs or ignoring the limits of their physical capacity Although the relationship between falls and ethnicity and race remains widely open for research, Caucasians living in the USA have higher risk of falling In addition, the rate of hospitalization for fall-related injuries is two to four times higher among the Whites than Hispanics and Asians/Pacific Islanders, and about 20% higher than African-Americans (Ellis & Trent, 2001) It is also clear 10 differences observed between Singaporeans of Chinese, Malay and Indian ethnic origins, and between native Japanese older community dwellers and JapaneseAmericans and Caucasians Native Japanese people have much lower rates of falls than Japanese-Americans and Caucasians Cognitive impairment has been identified as a fall riskfactor in clinical practice guidelines Behavioral risk factors Behavioral risk factors include those concerning human actions, emotions or daily choices They are potentially modifiable For example, risky behavior such as the intake of multiple medications, excess alcohol use, and sedentary behavior can be modified through strategic interventions for behavioral change Medications may be appropriately recommended for the treatment of a disease,but they also have adverse effects; falling is oneof themostcommonadverse eventsrelatedto drugs(Field, Gurwitz, Avorn, & et al, 2001; Gray, Mahoney, & Blough, 1999; Hanlon, K.E., Koronkowski, & et al, 1997) Manyelderlypatientshaveseveralchronic conditions for which multiple medications are prescribed,furtherincreasingtheassociatedrisks, including falling Although there is a clear relation between falling and the use of a higher number ofmedications, the risks associated with individual classes of drugs have been more variable(Leipzig, Cumming, & Tinetti, 1999).To date, serotonin-reuptake inhibitors, tricyclicantidepressants, neurolepticagents, benzodiazapines, anticonvulsants, and class IA antiarrhythmic medicationshave been shown to have the strongest link to an increased risk of falling(Leipzig et al., 1999; Thapa, Gideon, Cost, Milam, & Ray, 1998) It is believed that moderate physical activities and exercises lowers risk of falls and fall-related injuries in older age based on the evidence that these activities could control weight and contribute to healthy bones, muscles, and joints (Gardner,