The Comparison of Falling Risk Between Elderly Living at Home and

Elderly Living at Nursing Home in Makassar City

Dies Izah Qonita*1, Yudi Hardianto2, Irianto3

1
Undergraduate Student, Program Study of Physical Therapy, Faculty of Nursing,
Hasanuddin University-Indonesia

2
Lecturer, Undergraduate Program Study of Physical Therapy, Faculty of Nursing,
Hasanuddin University-Indonesia
3
Lecturer, Undergraduate Program Study of Physical Therapy, Faculty of Nursing,
Hasanuddin University-Indonesia

*corresponding author.*email adress: dies.izzah@gmail.com

Abstract
Objective : The purpose of this study was to look at the differences in the risk of falling
between the elderly who living at home and the elderly who living in nursing homes in
Makassar city.
Method : The method in this study was cross-sectional and interviews with 40
respondents, 20 people living at home and 20 living in nursing homes. Measurement of
the risk of falling using the TUG test. Data were analyzed by Independent T Test.
Result : TUG test results in the elderly who live at home 12.8605 seconds and the
elderly who live in nursing homes 21.4890 seconds. The biggest contributing factor is
due to not exercising, visual impairment and a history of illness.
Conclusion: There is a difference in the risk of falling in the elderly living at home and
elderly living in nursing homes.

KEYWORDS : risk of fall, elderly, home, nursing home

Introduction
The elderly population in the city of Makassar which is classified as displaced and
almost displaced based on local government data is currently increasing. This requires
serious attention and treatment from many parties 1. The attention and handling of the
elderly that need to be considered one of them is the risk of falling which increases with
increasing age2. One of the main needs of the elderly and one of the risk factors for falls
is a place to live, for older people who still have a family usually still live in a family
home, but the elderly and do not have families that can care for, can live in nursing
homes.
Elderly identical with age that will affect the physical, mental, and bodily functions
that are affected by several risk factors for falling elderly, namely intrinsic (biological)
and extrinsic (environmental) factors3. Risk of falling is also influenced by differences in
residence. This can be seen from the results of Kartika's research in the city of
Yogyakarta (2017) which states that the elderly who live in nursing homes, have a higher
risk of falling than those who live in the home or community 4. The results of another
study stated that the elderly who live in Tresna Werda Social Service Center (PSTW) tend
to have 4.7 times increased risk of falls compared to the elderly who live in the
community, this is influenced by several factors, especially intrinsic, extrinsic, and
situational factors.
Based on these data needed data to see the difference in the risk of falling elderly
who live at home and elderly who reside in homes in Makassar so that prevention and
treatment of falls on the elderly can be better because there is no data related to the
elderly with the risk of falling in Makassar.

Method
Study Setting, Study Design, Variable of Study
The research was carried out at the Pangamaseang Nursing Home, Theerdora
Nursing Home and Pancasila Muslim LKSLU. This research is a quantitative and
descriptive qualitative study for the explanation. In this study, the methods used were
cross-sectional and interview.
Measurements/ Equipment
To find out the risk of falling, the measurement uses the TUG test, the
administration of this test is to ask the respondent to use commonly worn footwear. the
respondent sits in a reclining chair then gets up and walks three meters long then turns
and sits to his original position. When the patient begins to stand until returning to a
sitting position, the time is recorded. Timed Up and Go Tests with results> 13.5 seconds
have a high risk of falling5. To see the risk factors for falls in the elderly use the interview
method.
The sample was chosen by using purposive sampling, the sample has inclusion and
exclusion criteria. In this study, total sample is 40 people. Inclusion Criteria; Elderly
women aged 60-91 years and approve informed consent. Exclusion Criteria; Have
diseases of the central and peripheral nervous system, musculoskeletal system,
cardiovascular disorders, communication disability, and use a wheelchair.

Result
The general characteristics of respondents in this study were 60-91 years old and
all were female. Respondents were divided into two groups: the elderly who lived in
nursing homes and the elderly who lived at home. The average age of elderly living in
nursing homes is 73.7 years Elderly aged 60-75 years as many as 16 people, aged 70-89
years as many as 4 people, and> 90 there are 1 person. The daily activities of the elderly
at the nursing home tend to be monotonous, the elderly end up feeling bored and
prefer to be lazy which causes them to be less physically active actively in the elderly.
Some respondents in the elderly who live at home are those who live with their
families, some live alone. The elderly who became the sample of this study had an
average age of 66.1 years. Elderly aged 60-75 years there are 18 people and those aged
76-89 years there are 2 people. The daily activities of the elderly who live at home are
generally those who clean the house, take care of grandchildren and chat with
neighbors, this activity makes the elderly actively moving throughout the day.
Risk of Fall
Based on the TUG test the value of falling in the elderly who reside in nursing
homes is 21,139 seconds, while the elderly live in homes is 12,8606. The difference
between the two groups is 8.2785 seconds. In this study for the elderly who live in
nursing homes of 20 people, the elderly who have a high risk of falling as many as 19
people (95%) and the risk of falling as low as 1 person (5%). Percentage risk of falling
elderly based on residence can be seen in the table below:
 Table 1. Table Percentage risk of falling elderly based on residence
Residence High Risk of Falling Low Risk of Falling Total
Nursing home
19 (95%) 1 (5%) 20 (100%)
Home 11 (55%) 9 (45%) 20 (100%)

Risk Factors of Fall

Fall risk factors found in this study based on interviews with respondents. Fall risk
factors consist of intrinsic factors, extrinsic factors and situational factors.. The results of
the interview are as follows:
Table 2. Percentage of Risk Factors of Fall in the Elderly Based on Residence
Percentage Percentage
No. Risk Factors of Fall Nursing home Home
(%) (%)
Motion disorder in the
1. 8 45% 6 30%
lower extremities
2. Nerve disorders - -
3. Vision Impairment 11 55% 11 55%
4. Use walking aids 3 15% 1 5%
Slippery house / nursing
5. 6 30% 3 15%
floor
There are uneven
6. 5 25% 4 20%
stairs / floors
7. Slippery toilet 7 35% 7 35%
8. History has fallen 7 35% 6 30%
9. Do not exercise 8 60% 12 40%
10 Disease history 10 55% 9 45%

Discussion
In the results of this study, the average results of the Timed Up and Go (TUG) test
for elderly living at home were 12.86 seconds while in the nursing home were 21.139
seconds. T test results also indicate a difference in the value of the risk of falling in the
elderly who live in homes and at home. The difference between the two is 8.62785
seconds (Table 1). The low risk of falling in the elderly who live at home is thought to be
due to family support. This is consistent with the results of research Hastari & Ariani
(2018) which states that the risk of falling in the elderly who live at home most have a
low risk of falling. This is because the elderly who live in nursing homes tend to have
higher levels of depression and the higher the level of depression the risk of falling is
also high7. Family support is indeed very important to the development and change of
the elderly. It can also be seen from the results of this study that the elderly who live in
nursing home have more elderly people who are at high risk of falling than the elderly
who live at home.
The average age of the elderly who live at home has a lower age. For the elderly,
age clearly has an important influence on the TUG test, balance and fall incidence. The
aging process causes changes in postural control. Changes in the scope of motion and
joints, body posture, gait, and sensory system will affect balance. As age increases,
reflexes slow down and muscle strength weakens. The increased risk of falling is related
to the weakness of the lower extremity muscle strength 8.
Elderly who live in homes that have a high risk of falling are 11 people (55%) have
vision problems and 6 people (30%) of them have cataracts. Elderly who live in nursing
homes with visual impairment also as many as 11 people (55%) and 1 person (5%) of
whom have cataracts. The results found a significant relationship between visual
impairment and the risk of falls in the elderly 9. According to research by Sudiartawan et
al (2017) elderly who have visual impairment have a 7.231 times bigger chance of
experiencing falls.
Extrinsic factors that cause a risk of falling are: the use of walkers, slippery floors,
slippery bathrooms, and uneven floors. The walker aids found in the results of the
interview are crutches and walkers and all the elderly who use a walker have a high risk
of falling. At the nursing home there are 3 (15%) elderly people who use walking aids,
and 1 (5%) of the elderly who live at home. The use of walking aids due to impaired
limbs or difficulty in walking so we need tools to help with daily activities and to support
the body's burden because the legs are not strong enough to support them. The use of
walking aids helps improve balance, but on the other hand causes the body's tendency
to bend11.
Another extrinsic factor that can cause a high risk of falling is a slippery floor. As
many as 4 (20%) elderly people living at home said the floor of their house was slippery
and 6 (30%) elderly who lived in pati werdha said the floor in the orphanage was
slippery. Residence is one of the places where accidents often occur in the elderly which
can be fatal. In a case study in Yogyakarta, it was found that the dominant
environmental factor causing falls in elderly homes was related to slipping and then
followed by tripping12. In the same case, the main cause of slipping is a wet floor 13.
A slippery bathroom can also cause falls on the elderly. There are 7 people (35%)
elderly who live at home saying the bathroom in his house is slippery and 7 people (35%)
elderly who live in nursing homes also say the same thing. According to the research
results slippery, bumpy floor conditions and the number of objects that are easily shifted
and scattered can cause a risk of falling 14.
Corrugated floors also cause falls in the elderly. In fact 5 people (25%) elderly who
live in nursing homes say there is an uneven floor in the institution where they live and 4
people (20%) elderly who live at home say the same thing. Corrugated floors can cause
foot tripping which can cause falls14. Although the accident falls on the elderly is
motivated by intrinsic factors or disease factors experienced, but extrinsic or
environmental factors also have a major contribution in accidents in the elderly. The
elderly environment condition like this makes the place a "mine field" for the elderly 4.
From the interviews also found situational factors such as a history of falls, a
history of illness, and sports activities. Fall history is more owned by the elderly who live
in nursing homes. A total of 13 people (65%) of dairy elderly experienced falls while the
elderly who lived at home were 6 people (30%) elderly. Elderly who have a history of
falls have a lower functional balance than those who do not have a history of falling this
is because the risk of falling tends to increase in subjects who have a history of falls.
Balance control during walking is a problem for the majority of the elderly group where
vulnerability to imbalance and injury from falls can be increased 15.
 The reduced ability to maintain balance results in an increased risk of falling.
Balance can be trained with regular exercise. There were 12 people (60%) of elderly
people living in nursing homes who did not exercise and who who live at home there are
8 people (40%). The elderly who exercise regularly do not experience muscle and bone
mass loss as much as the elderly who are inactive 16. Exercise can improve body
composition, such as fat, bone health, muscle mass, increase endurance, muscle mass
and muscle strength, and flexibility so that the elderly are healthier , fit, and the risk of
falling is reduced17.
Elderly people living at home have a history of 9 people (45%) and 10 people living
in nursing homes (50%). History of the disease in question is heart disease,
hypertension, gout, cholesterol and diabetes. Handling disease in these respondents on
average by taking medication prescribed by a doctor. According to research the
prevalence of falls due to medical factors (health problems and drug use) is 18% 18. Drugs
that are known to cause falls (falls risk medicines / FRM) include analgesics including
opioids, antipsychotics, anticonvulsants, benzodiazepines, antihypertensives, heart
drugs, antiarrhythmias, antiparkinsins, and diuretics. This class of drugs can cause a
higher potential for falls because the mechanism effects are postural hypotension,
sedation, dizziness, weakness, decreased alertness, drowsiness, muscle weakness, and
other side effects19.

Conclusion
Based on research that has been done, it can be concluded that there is a
difference in the risk of falling in the elderly who live at home is lower than the elderly
who live in nursing homes. The highest percentage of risk factors in nursing home is lack
of exercise (60%) and elderly at home due to visual impairment (55%).

Acknowledgment
Unlimited thanks for the assistance of the leader of the Panti Werdha
Pangamaseang, Panti Werdha Theodora and the head of the Pancasila Muslim LKSLU.

References
1. Burhanuddin B., Said R., Wahdaniar W. Desain Panti Sosial Tresna Werdha Di
Makassar. Nat Natl Acad J Archit. 2018;5(2):115, doi: 10.24252/nature.v5i2a4.
2. Susilo W., Limyati Y., Gunawan D. The Risk of Falling in Elderly Increased with Age
Growth and Unaffected by Gender. J Med Heal. 2017;1(6):568-74, doi:
10.28932/jmh.v1i6.554.
3. CDC. Preventing falls: A Guide to Implementing Effective Community-Based Fall
Prevention Programs. Natl Cent Inj Prev Control. 2015:64.
4. Kartika AD. Perbedaan Hasil Tes Timed Up And Go Lansia Yang The Different Of
Timed Up And Go Test In Elderly : Geriactric Nursing Home Vs . Community. Dsp
UII. 2017.
5. Barry E., Galvin R., Keogh C., Horgan F., Fahey T. Is the Timed Up and Go test a
useful predictor of risk of falls in community dwelling older adults: A systematic
review and meta- analysis. BMC Geriatr. 2014;14(1), doi: 10.1186/1471-2318-14-
14.
6. Hastari G., Ariani NP. Gambaran Resiko Jatuh dan Dukungan Keluarga Pada Lansia
di RW 08 Kelurahan Pasir Jaya Kecamatan Bogor Barat. Politeknik Kesehatan
Kementrian Kesehatan Bandung, 2018.
7. Avionita N., Sudyasih T. Hubungan Tingkat Depresi Dengan Resiko Jatuh pada
Lanjut Usia di Rumah Pelayanan Lanjut Usia Budi Dharma, Yogyakarta.
Universitas ’Aisyiyah Yogyakarta, 2017.
8. Wulan DS., Hisyam B., Taufiqurrahman A. Hubungan Antara Hasil Pemeriksaan
Tes Timed Up And Go Dengan Kejadian Jatuh Pada Lansia Didesa Turgorejo
Harjobinangun Pakem Yogyakarta. J Kedokt Dan Kesehat Indones. 2013;5(1):108.
9. Anggraini. Faktor-faktor yang berhubungan dengan kejadian jatuh pada lansia di
wilayah kerja Puskesmas Andalas 2017. Sch Unand. 2016.
10. Sudiartawan IW., Yanti NLPE., Wijaya AANT. Analisis faktor risiko penyebab jatuh
pada lanjut usia. Ners Widya Husada. 2017;4(3):95-102.
11. Ashar PH. Gambaran Persepsi Faktor Risiko Jatuh Pada Lansia di Panti Werdha
Budi Mulia 4 Margaguna Jakarta Selatan. UIN Syarif Hidayatullah, 2016.
12. Sabatini SN. Risiko Jatuh di Teras dan Kamar Mandi Rumah Lansia , Studi Kasus :
Yogyakarta. Temu Ilm IPLBI. 2016:141-6.
13. Sabatini SN., Kusuma HE., Tambunan L. Faktor eksternal risiko jatuh lansia: studi
empiris. Pros Temu Ilm IPLBI. 2015;(1):30-1, doi: 10.1007/s00424-013-1432-8.
14. Agustina L. Deskriptif Tentang Karakteristik Lingkungan yang Berisiko Terjadinya
Jatuh Pada Lansia di Desa Susukan Kecamatan Susukan Kabupaten Semarang. J
Keperawatan. 2014;7(2):100-6.
15. Nurmalasari M., Widajanti N., Dharmanta RS. Hubungan Riwayat Jatuh dan Timed
Up and Go Test pada Pasien Geriatri. J Penyakit Dalam Indones. 2019;5(4):164-8,
doi: 10.7454/jpdi.v5i4.241.
16. Supriyono E. Aktivitas Fisik Keseimbangan Guna Mengurangi Resiko Jatuh Pada
Lansia. PPS UNY. 2015;11(2):91-101.
17. Ambardini RL. Aktivitas Fisik Pada Lanjut Usia. Staff UNY. 2009:1-10.
18. Paolo C., Loredana G., Gianfranco S., et al. Unexplained Falls Are Frequent in
Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study
(Unexplained Falls in Older Patients). Curr Gerontol Geriatr Res. 2013;1(6).
19. Rahmawati F., Mustafidah N., Annisa L. Prevalensi Penggunaan Fall Risk Medicine
pada Pasien Lanjut Usia di Instalasi Rawat Jalan Rumah Sakit Madiun. J Manaj dan
Pelayanan Farm. 2019;9(2):135-42, doi: 10.22146/jmpf.45206.