【Purpose】This study evaluated the safety and efficacy of standing-up methods for older adults with Alzheimer’s dementia in nursing care facilities who require supervision. We focused on assessing various approaches for standing up from the end of the bed and selected the safest option based on our findings.

【Methods】We conducted a validated single-case involving two older adults diagnosed with Alzheimer’s dementia who had recently entered a nursing care facility and required assistance to stand up. We employed a motor function analysis device to measure five standing-up motions and analyzed the results.

【Results】In both cases, the two individuals failed to perform the standing-up motion involving placing their hands on their knees. However, when they utilized a handrail for support while standing up, both participants responded positively with comments such as “this is good.” The researchers observed that the standing-up motion was notably smoother when utilizing the handrail for support. Specifically, regarding the power aspect, Ms. A exhibited significantly greater strength in the “standing-up motion with the front handrail” compared to the “standing-up motion involving opening fingers and getting on the bed”（p=0.034）. Ms. B showed significant differences in comparison to the “usual standing-up motion” regarding time（p=0.022） and power（p=0.047）when using the “standing-up motion with the front handrail.” Specifically, the “standing-up motion with the front handrail” demonstrated significantly greater power than both the “usual standing-up motion”（p=0.047） and the “standing-up motion involving opening fingers and getting on the bed”（p=0.035）. Moreover, regarding speed, the “standing-up motion with the front handrail” significantly surpassed both the “usual standing up motion”（p< 0.01）and the “standing-up motion involving opening fingers and getting on the bed”（p=0.026）.

【Conclusions】 The “standing-up motion with the front handrail” was identified as the preferred and stable standing movement for the two older adults with Alzheimer’s dementia in this study.

【Purpose】The Standing test for Imbalance and Disequilibrium（SIDE）has shown validity as a balance scale and has been reported to be associated with falls. However, we did not find any report that examined SIDE as an associated factor for falls in a multivariate analysis as far as we could negotiate. The purpose of this study was to identify factors associated with falls during hospitalization in patients admitted to a convalescent rehabilitation ward.

【Methods】Of 961 patients who entered and were discharged from the convalescent rehabilitation ward of National Center for Geriatrics and Gerontology between January 1, 2016, and December 31, 2020, we examined the medical information of 495 patients, excluding those who had difficulty with the 10-meter walk test or with understanding assessment instructions at the time of admission and those with missing survey items. The subjects were classified as non-fallers or fallers, and the association with SIDE（2a or less/2b or more）, at admission, was determined using Fisherʼs exact probability test. Other items were compared between groups using Mann Whitneyʼs U test and Fisherʼs exact probability test. Logistic regression analysis was performed using the items that showed significant group differences and SIDE as independent variables and the presence or absence of falls as the dependent variable to determine the factors and odds ratios associated with the occurrence of falls. The significance level for each test was p < 0.05.

【Results】There were 422 subjects who did not fall and 73 subjects who fell, and SIDE showed significant group differences. The fallers were significantly older and had significantly lower comfortable walking speed, grip strength to body weight ratio, Functional Independence Measure（FIM）motor items, and FIM cognitive items. Logistic regression analysis revealed that SIDE and FIM cognitive items were significantly related factors.

【Conclusions】 SIDE was determined to be an associated factor for the occurrence of falls and may be a tool to help identify those at high risk for falls.

【Objective】Among patients with proximal femoral fractures, those with lower pre-injury walking ability may be more prone to falling in a certain direction because of asymmetries such as dominant hand and foot, compared with those with a higher walking ability. However, no report exists on whether pre-injury walking ability affects the injured side, namely the direction of the fall（rightward or leftward）. We investigated the association between pre-injury walking ability and the injured side in patients with proximal femoral fractures.

【Methods】The study included patients aged ≥60 years with a proximal femoral fracture who were admitted to the National Hospital Organization Kofu National Hospital between January 1997 and December 2022. Those with difficulty walking before injury were excluded. This case-control study examined age, sex, mechanism of injury, injured side, pre-injury walking ability, and underlying diseases. Pre-injury walking ability was determined according to the use or non-use of walking aids such as canes, and patients were classified into the unaided walking or aided walking groups. The chi-square test was used to compare the injured side between the two groups. Logistic regression analysis was performed with pre-injury walking ability, age, and sex as independent variables and the injured side as the dependent variable.

【Results】This study included 1190 patients, of whom 685 were analyzed. In the analyzed population, the right side was injured in 328 patients（47.9 %） and the left in 357 patients（52.1 %）. Among unaided walkers（473 patients；98 men, 375 women；mean age 82.5 ± 8.4 years）, the right side was injured in 221 patients（46.7 %）and the left in 252 patients（53.3 %）. For aided walkers（212 patients；26 men, 186 women；mean age 88.6 ± 5.9 years）, the right side was injured in 107 patients（50.5 %）and the left in 105 patients （49.5 %）. No significant difference was observed in the injured side between unaided and aided walkers（p = 0.36）. Logistic regression analysis showed no significant differences in pre-injury walking ability（p = 0.54）, age（p = 0.46）, or sex（p = 0.78）.

【Conclusions】 This study showed that pre-injury walking ability might not be associated with the injured side. Further investigation is necessary to explore the association of the injured side with various parameters, including the mechanism of injury and pre-injury walking ability, to elucidate the factors affecting the injured side ─namely, the direction of the fall ─in patients with proximal femoral fractures.

【Objective】This study aimed to investigate whether the severity of cognitive impairment, as determined from the total score of Cognitive-related Behavioral Assessment（CBA）, which is based on behavioral observations, is associated with falls in patients admitted to rehabilitation wards.

【Methods】This retrospective cohort study included patients admitted to the recovery unit between April 2019 and March 2021. CBA was used to assess cognitive impairment, and falls were investigated using the records of the Falls and Falls Incident Report Form in the electronic medical record. To test the association between CBA on admission and falls early in hospitalization, falls within one month of admission were included in the tally, and those with falls within one month of admission were included in the fall group, while those without falls were included in the non-fall group. From the cross-tabulation of the two groups of falls and non-falls and CBA severity, a residual analysis was performed to identify the combination that deviated significantly from the expected values, and the adjusted residuals were calculated. Logistic regression analysis was performed with the presence of falls within one month of admission as the dependent variable and CBA severity as the independent variable.

【Results】This study included 879 patients, with a median age of 76 years（interquartile range：65-83）years. The fall group（68 patients）had a higher proportion of patients with the most severe to moderate CBA severity than the non-fall group（811 patients）. CBA severity in the fall group was as follows：most severe, 4（5.9 ％）；severe, 24（35.3 ％）；moderate, 24（35.3 ％）；mild, 11（16.2 ％）；and normal, 5（7.4 ％）. Residual analysis showed that significantly more patients in the fall group had severe CBA（p ＜0.01）and significantly more patients in the non-fall group had mild CBA（p ＜0.01）. Logistic regression analysis using the presence or absence of falls within one month of admission as the dependent variable showed that the association between falls and CBA severity was significant（odds ratio 1.92；95 ％ CI, 1.00-3.68；p ＜0.05）, even after adjustment for factors related to falls, such as age 70 years or older, as covariates.

【Conclusions】 Severe CBA severity was significantly associated with the risk of early falls in hospitalized patients in recovery units.

【Objective】This study aimed to identify the innovations undertaken and challenges faced by managers of geriatric healthcare facilities in promoting fall prevention in an effort to understand the current measures that contribute to improving staff education and organizational structure.

【Methods】Participants comprised nine safety and floor managers working in four geriatric healthcare facilities in the Kanto and Chubu regions. Semi-structured interviews were conducted, followed by a qualitative descriptive analysis. The interviews focused on strategies and challenges in promoting fall prevention.

【Results】Two measures were identified as strategies for promoting fall prevention care:creating an environment where users can remain calm and supporting staff development. Three challenges were identified in promoting fall prevention:ensuring consistent fall prevention across the organization, maintaining and improving the quality of fall prevention care, and improving the environment.

【Conclusions】Managers did not prioritize fall prevention but rather focused on staff education to enhance the overall quality of care for older adults. The findings indicate that establishing a methodology for educational interventions for staff members focused on fall prevention is a pressing necessity. This realization will also necessitate developing organizational management skills of managers.