[in Japanese]

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【Objective】This study described (1) empirical care interventions for fall prevention of the elderly with dementia without physical restraints by health-care and care staff members in nursing homes and (2) the factors of the nursing homes and the staff members that enabled those care interventions. We suggested fall prevention strategies for the elderly with dementia in hospital wards.【Methods】Participants were 29 healthcare and care staff members working in four nursing homes in A prefecture. This was a qualitative study using focus group interviews and analysis.【Results】Four domains emerged following category refinement. Those domains were [basis of care interventions for fall prevention without physical restraints], [ability required to collect global information of the elderly], [global information and observation of the elderly], and [care balancing activity and security]. The healthcare and care staff members cultivated [ability required to collect global information of the elderly] supported by [basis of care interventions for fall prevention without physical restraints]. They deepened [global information and observation of the elderly] and provided [care balancing activity and security] for the elderly with dementia.【Discussions】For improved fall prevention in nursing homes for the elderly with dementia without physical restraints, healthcare and care staff members must collect and share information with their colleagues. Further, managers should review the hospital and ward structure, and the nurses should cultivate the ability required to collect global information.

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【Objective】To analyze the conditions of the falls according to the movement status of residents in long-term care facilities.【Methods】Incident reports from April 2013 to March 2014 in three long-term care facilities in Ibaraki Prefecture, Japan, were analyzed. Facility residents were classified into three groups according to movement status; totally cared wheelchair users, partially cared wheelchair users, or walkers. The location, time, and manner of the falls according to movement status were analyzed.【Results】Out of the 341 residents, 154 residents experienced falls during the one-year period. The total fall rate was 45%, 1.6/1,000 person-days; however, fall occurrences were different for each movement status; the totally cared wheelchair users was 19%, 0.1/1,000person-years; the partially cared wheelchair users was 57%, 1.2/1,000 person-years, and the walkers was 43%, 0.3/1,000 person-days. Regarding the location of the falls, the totally cared wheelchair users were most likely to fall in their bedrooms, dining room, and public spaces, and the partially cared wheelchair users and walkers were most likely to fall in their bedrooms. Both groups of wheelchair users were most likely to fall between 2:00 p.m. and 4:00 p.m., while most walkers experienced falls between 6:00 a.m. and 8:00 a.m. Regarding the manner of the falls, the totally cared wheelchair users were most likely to fall during care from caregivers, the partially cared wheelchair users were most likely to fall during transfer by themselves, and the walkers were most likely to fall during walking.【Conclusion】The occurrence rate and conditions of the falls differed according to the movement status of the residents. Taking movement status into account when designing fall prevention plans may help reduce the number of falls.

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【Objective】We investigated the age, total number of falls, number of falls according to types of disorders, location of falls, time between ward admission and falling, Functional Independence Measure score at the time of falling, and fall risk assessment score of patients in a convalescent rehabilitation ward.【Methods and Results】Participants were 383 hospitalized patients in the convalescent rehabilitation ward of Hospital A. Their mean age was 73.6 ± 14.3 years, 246 with cerebrovascular disease, 117 with a musculoskeletal disorder, and 20 with disuse syndrome. On the basis of fall report forms, we carried out a cross-sectional investigation of age, total number of falls, number of falls according to types of disorders, location of falls, time between ward admission and falling, FIM scores at the time of falling, and fall assessment score. During the study period, 91 falls were recorded for 63 patients in the convalescent rehabilitation ward, accounting for 16.4% of the patients hospitalized in that ward. They comprised 33 men and 30 women, with a mean age of 75.5 ± 13.4 years, compared with a mean age of 73.2 ± 14.5 years for patients who did not fall. 44 patients who were suffering from cerebrovascular disease recorded falls, as did 14 patients with a musculoskeletal disorder, and 5 with disuse syndrome. Most falls occurred in the patient’s rooms, followed by the ward lavatories. The fall occurred within one week in 30.8% of cases, and 85.7% of falls occurred within two months since admission. Fall group was lower in the FIM together M-FIM, C-FIM, T-FIM.With the fall assessment score, the fall occurred in 72 of 291 people (24.7%) in risk level II and occurred in 19 of 78 people (24.4%) in risk level III.【Conclusions】Patients were more prone to falling on the ward and in the lavatories, and had spent a comparatively short time in the convalescent rehabilitation ward. Their FIM scores were moderate, while our results suggested that more patients who fell tended to have been assessed as Risk Level III or higher.

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【Purpose】The purpose of this study was to clarify the association of falls and pain with each of the following factors, among community-based elderly individuals: health-related quality of life (QOL), fear of falling, and a wellfunctioning life.【Method】The subjects were high-risk individuals, who participated in a secondary-prevention in a care project; from among the 727 people who participated in the project, which was carried out from October to December 2012, consent was obtained from 495 people (males: 32; females: 463). The response rate was 68.1%. The research items were the falls, the fear of falling, pain, obstacles to walking, and life ability, a health-related QOL.【Results】The participants were divided into four groups based on whether they had experienced a fall (i.e., fall and non-fall group) and pain (pain and non-pain group). The non-fall and non-pain group comprised 15.4% of the participants, the fall and non-pain group 11.5% of the participants, the non-fall and pain group comprised 31.9% of the participants, and the fall and pain group comprised 41.2% of the participants. The proportion with a fear of falling feeling, the non-fall and non-pain group is small compared with the other groups in 82.9%, and the difference between the groups was observed. The results of the Tokyo Metropolitan Institute of Gerontology Index of Competence revealed that compared to the other groups, the fall and pain group obtained significantly higher overall scores on the scale and on the Instrumental Activities of Daily Living Scale. However, the non-fall and pain group and the fall and pain group obtained significantly lower physical summary scores on health-related QOL.【Conclusions】This study involved studying high-risk care individuals, who participated in a secondaryprevention in a care project. Life ability was well maintained even in the case of individuals who had experienced a fall and pain as well as in the case of those who had a fear of falling on account of having experienced a fall or pain, and these individuals also showed a reduction in health-related QOL related to bodily functions. Therefore, it is necessary to implement care prevention measures for the elderly, in the case of certain circumstances and situations.

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