title: Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients.
abstract: OBJECTIVE
  To explore risk factors for a single fall and multiple falls in the first and second postoperative years among older hip fracture patients.
  
  
  BACKGROUND
  Older hip fracture patients have a high probability of falling again after a fall incident. Risk factors for postoperative falls among older hip fracture patients in Taiwan remain to be confirmed.
  
  
  METHODS
  Secondary analysis.
  
  
  METHODS
  Data collected from control groups of two clinical trials conducted during 2001-2004 and during 2005-2009 were selected. Overall, 181 older adults who underwent hip fracture surgery were assessed at predischarge and postdischarge. Participant data were collected through home visits.
  
  
  RESULTS
  Decline in unaffected limb quadriceps muscle endurance was a crucial predictor of a single fall in the first postoperative year for older hip fracture patients. Advanced age and more severe depressive symptoms were the crucial predictor for multiple falls. Engagement in activities of daily living was the crucial predictor for falls during the first to second postoperative years among older hip fracture patients.
  
  
  CONCLUSIONS
  In Taiwan, postoperative falls that occur within 1-2 years of a hip fracture are associated with a high incidence of single and multiple falls in older people. The crucial predictors of falls in the first and second year after a hip fracture include unaffected limb quadriceps endurance, age, depression status and postdischarge activities of daily livings in older people.
  
  
  CONCLUSIONS
  The identified factors associated with subsequent falls within one and two years of a hip fracture should be incorporated into clinical strategies and taught in nursing courses. Early postoperative lower extremity muscular endurance rehabilitation must be provided. Furthermore, as part of the healthcare plan before hospital discharge, it must be ensured that the community where the older adults live has nutritional education, cognitive screening and psychological support.
authors.affiliation: Tzu Chi University of Science and Technology, Hualien City, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.|School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiang-Fen
authors.initials: HF
authors.lastname: Yeh
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jung-Hua
authors.identifier: http://orcid.org/0000-0001-7104-8413
authors.initials: JH
authors.lastname: Shao
authors.affiliation: Healthy Aging Research Center and Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan.|Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Healthy Aging Research Center and Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan.|Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.|Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yea-Ing L
authors.initials: YL
authors.lastname: Shyu
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D060825:Cognitive Dysfunction / Q000150:complications; D003863:Depression / Q000150:complications; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D019338:Polypharmacy; D011184:Postoperative Period; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors
keywords: clinical nursing; depressive symptoms; hip fracture; multiple falls; older people; predictors; quadriceps muscle endurance; questionnaire; risk factors for falls; single fall