[in Japanese]

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　The purpose of this study was to evaluate the compliance rate of nurses with the Nursing Quality Indicator that is aimed at preventing falls among the elderly. A self-evaluation was completed by nurses working in longterm care health facilities through the director of nurses in October 2013. We also assessed the nurses’age, nursing experience, and their responses to the Approaches to Dementia Questionnaire.　The study participants were 1,985 nurses (98.9 % effective response rate) with an average age of 47.6 (±9.6) years. The nurses answered that they practiced the items almost over 70 %. But the item “it is important to consider the perspectives of the elderly with dementia when taking care of them.”：“devising nursing care for the prevention of falls caused by feeling lonely and confusion” had the lowest practice rate among all the items of the index (n＝1,047, 52.9%). We found that all items of the index were significantly correlated with the Personhood of ADQ-J.　All items were practiced by a large proportion of nurses. Therefore It was suggest that this indicator has a high usability when be conducted training and education of the elderly with dementia in long-term care health facilities.

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【Objective】To determine the incidence and characteristics of serious fall-related injuries, such as fractures, in elderly patients under home nursing care.【Methods】A prospective cohort study with a one-year follow-up was conducted. A total of 1,415 outpatients under long-term care insurance were recruited from 43 hospitals in Japan. The annual incidence of fractures, injuries leading to hospitalization, and deaths due to falling using a fall diary, as well as the details of falls leading to injuries, were investigated. The condition of patients 6 months after the onset of serious injuries was also analyzed.【Results】Incidence of serious injuries (patients with serious injuries/ total patients × 100 %) was 6.6 % (n=94), 8.93/100 person-years. Incidence of fractures was 6.0 % (n=85), 8.08/100 person-years; injuries leading to hospitalization was 3.3 % (n=47), 4.47/100 person-years; and death was 0 %. Number of fracture regions was 21 in the upper extremities (annual incidence 1.5%), 19 in the vertebra (1.3 %), 16 in the ribs (1.1 %), and 14 in the hips (1.0%). Of all falls leading to serious injuries, 63 occurred indoors (67.0%), including 19 in the living room (20.2 %). Falls occurred most frequently during walking (39.4 %), followed by starting to walk (13.8 %) and standing up (13.8%). Falling mostly occurred due to loss of balance (66 %). Most frequent behavior leading to falling was excretion (14.9%), followed by picking up things (12.8%). Falls occurred mostly on wooden floors (27.7%), followed by concrete (18.1%). At 6 months after the onset of serious injuries, patients under home care accounted for 81.6 %, those hospitalized 13.8 %, and those under nursing home 4.6 %. Mobility and level of care required significantly worsened after onset of serious injuries (p ＜ 0.001).【Conclusions】Japanese patients under home nursing care had about a three-fold higher incidence of fall-related serious injuries than those of community-dwelling people. Mobility significantly worsened after the onset of serious injuries and 81.6 % of the injured were under home care.

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【Purpose】This study aimed to examine the effect of foot baths on falls, physical function and autonomic function in frail elderly people.【Subjects】The subjects were 38 older adults (mean age 78.0 ± 6.7 years)　who could walk independently and received rehabilitation services in our day-care center.【Methods】Subjects were divided into intervention and control groups. Those in the intervention group received a foot bath before rehabilitation treatment twice a week for 3 months. Physical function was measured using the grip strength, 10-meter walking speed, Timed Up and Go test, one-leg standing time test, functional reach test, ankle dorsiflexion angle, and two-point discrimination of plantar test. Autonomic function was measured by using “kiritsu meijin (provided by CROSSWELL)”．【Result】All subjects completed the study, 19 in the intervention group and 16 in the control group. There were no differences in baseline characteristics between the groups. After the intervention, a significant improvement in ankle dorsiflexion angle and two-point discrimination of plantar (p ＜ 0.01) was found only in the intervention group. There was no significant difference in autonomic function or falls experience between the groups.【Conclusion】We found that foot baths led to partially improved lower limb function. However, further verification will be necessary about the effect on fall prevention.

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【Objective】The purpose of this study was to investigate the department-specific characteristics of falls in an acute care hospital through a retrospective review of incidents reports.【Methods】The survey studied the assessment sheets of fall incidents among 4,123 patient admissions during the term of investigation from April 2012 through March 2013.【Results】There were 83 incidents involving 78 patients (42 male and 36 female) for a 1.7 ‰ rate of falls among 4,123 patient admissions. Many of the falls involved patients over 70, and occurred within 5 days of admission while going to and from toilets. Patients evaluated as risk grade Ⅱ and Ⅲ on the assessment sheets accounted for the majority of fall incidents. As the risk grade rises, the rate of falls rises significantly. The percentage of total fall incidents was greatest in internal medicine, followed by gastrointestinal surgery, brain surgery, and orthopedic surgery departments in decreasing order. Risk grade Ⅱ comprised a high percentage of fall incidents in brain surgery, whereas risk grade Ⅲ comprised a majority of incidents in internal medicine.　The total rate of falls for the entire inpatient population was highest in gastrointestinal surgery, followed by brain surgery, internal medicine, and orthopedic surgery in decreasing order. For gastrointestinal surgery the incidence of fails is high at risk grade Ⅱ but at risk grade Ⅲ it is extremely high.【Conclusions】Precautions need to be taken in internal medicine at risk grade Ⅲ , in brain surgery at risk grade Ⅱ, and in gastrointestinal surgery at risk grades Ⅱ and Ⅲ．

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