【Purpose】The purpose of this study was to determine the relationship between the need for oral care assistance and falls during hospitalization in patients who admitted to an acute general ward.

【Methods】 A single-center retrospective cohort study. Between April and September in 2018, 6,009 patients who were admitted to our hospital (acute general ward), excluding inpatients with completely bedridden patients were included. The data were from Form 1 and H files, which are part of the DPC (Diagnosis Procedure Combination). Fall assessment data were used to assess the risk of falling. Albumin and hemoglobin levels at admission were used to assess nutritional status and anemia. Logistic regression analysis was used for statistical analysis. The necessity of oral care was used as an exposure factor, and age, gender, nutritional status, anemia, ADL on admission, and clinical severity were successively entered as covariates for explanatory variables.

【Results】139 patients (2.3%) had a falls. The odds ratio of the need for oral care assistance for falls in univariate analysis was 3.84 (95%CI: 2.73-5.39, p<0.001). When adjusted for age, gender, nutritional status, and presence of anemia, the odds ratio was 2.59 (95%CI: 1.62-4.14, p<0.001). The odds ratio was 2.31 (95%CI: 1.20-4.44, p=0.012) when adjusted for falls assessment, ADL on admission, and clinical severity, and the same was true for validation using the Bootstrap method. Sensitivity analysis also confirmed that the odds ratio for necessity of oral care for falls was also high.

【Conclusions】 The need for oral care assistance on admission was associated with falls during hospitalization even after adjusting for age, gender, nutritional status, presence of anemia, falls assessment, and ADL and clinical severity on admission. Among patients admitted to an acute general hospital ward, those who required oral care assistance on admission were at higher risk of falling.

【Objective】We aimed to clarify the ethical influence of fall prevention sensors on older adults, their families, nurses and care workers, and drew comparisons between the type of sensors or experience of healthcare staff.

【Methods】This cross-sectional study used anonymous self-administered questionnaires completed by nurses and care workers in selected long-term care facilities between April and May 2014. We collected demographic data and information on experience of encountering falls and the use of fall prevention sensors. The ethical influence of the sensors on older adults, their families, nurses and care workers were evaluated using a Likert evaluation scale ranging from 1 (“I agree very much”) to 6 (“I do not agree at all”).

【Results】A total of 672 nurses and 382 care workers participated. The experience of using fall prevention sensors was significantly higher among the nurses than care workers (92.3 %vs. 84.3 %, p < 0.001). Connected sensors caused a sense of restraint and restriction on the behaviors of older adults, distress to older adults and their families, and feelings of guilt and perception of causing physical restraint for nurses and care workers. On the other hand, non-connected sensors were considered supportive in the maintenance and expansion of older adults’ activities of daily living (ADL) and in allowing “want to” requests and contributed to assurance of older adults and their families. Compared to care workers, the nurses felt that the sensors could lead to restraint and behavioral restriction in older adults and cause distress in older adults and their families.

【Conclusions】Based on the ethical influence of fall prevention sensors, nurses and care workers need to collaborate and, with organizational support, make comprehensive clinical judgments on sensor type selection, installation methods, and sensor adaptation.

【Objective】This study assessed the state of awareness of the need for physical restraint (hereafter, “restraint”) and restraint-free fall prevention practices among nurses carrying out fall prevention for older adults with cognitive impairment, as well as influencing factors.

【Methods】Participants were 304 general hospital ward nurses in Toyama prefecture experienced in caring for older adults with cognitive impairment (hereafter, “older adults”). A questionnaire survey was conducted between January-March 2019 to evaluate the awareness of the need for restraint of older adults using the Japanese version of the Physical Restraint Use Questionnaire (J-PRUQ), whether restraint-free fall prevention was being practiced, basic attributes of nurses, ward environment and culture, amount of interest toward older adults, and nurses’ awareness of restraint use and fall prevention.

【Results】Responses from 238 nurses (valid responses：78.3 %) were analyzed. In descending order, the mean and standard deviation of the J-PRUQ scores were 3.95 ± 0.76 for allowing medical treatment to proceed without interruption, 3.45 ± 0.81 for fall prevention, and 2.69 ± 0.71 for providing a safe environment. Factors related to decreased J-PRUQ scores by multiple regression analysis included:「do not think that not using restraint would cause trouble for the nurse handling the next shift」and「in the ward, fall prevention is performed without restraint based on nurse’s discretion」forward culture, and「can prevent falls without restraint」,「do not feel the need for restraint for fall prevention」, and「female」for nurses’ awareness. Logistic regression analysis revealed「can practice fall prevention considered necessary without restraint based on the ward team’s discretion」for nurses’ awareness to be an influencing factor for restraint-free fall prevention practices (odds ratio of 17-fold).

【Conclusions】 The items with the highest recognition of the need for physical restraint by general hospital nurses in elderly patients with cognitive impairment were catheter removal, suture removal, feeding tube removal, and falling out of bed. A culture of performing fall prevention and awareness that falls are preventable without restraint contributed to a reduced recognition of the need for restraint. The importance of organizational support to promote behavior aimed at reducing restraint use was suggested.

【Objective】Bone fracture caused by colliding with the floor from falls is a serious injury that the quality of life in elderly people depends on. Although the mechanical response on the joint after colliding with the floor from falls using a three-dimensional human body model has been studied to clarify the bone fracture mechanism, this may be influenced by the difference in individual body movement during falls. This study focused on the hip joint during backward falls and aimed to analyze the effect of various body movements during backward falls on the mechanical response of the hip joint.

【Methods】A three-dimensional human body model was constructed, with an elastic element attached to the hip joint. The material for the floor was concrete. The force acting on the elastic element during falls simulated by the model was defined as the mechanical response of the hip joint. Participants of this study were 10 healthy adult males aged 22.1 ± 1.0 years. Participants fell backwards onto a safe mat used for gymnastics, and the fall motion was measured three-dimensionally using a motion capture system. Movement of the entire body during backward fall was simulated using the three-dimensional human body model, and the mechanical response of the hip joint upon collision with the floor was estimated.

【Results】Peaks of anterior and posterior components of the mechanical response of the hip joint were 1.05 ± 0.48 kN and 0.88 ± 0.41 kN, respectively. Peaks of proximal and distal components of the mechanical response of the hip joint were 1.49 ± 0.87 kN and 2.15 ± 1.23 kN, respectively. The largest value of the proximal component among all participants reached the fracture load of the femoral neck, and that participant hit a different body segment on the floor first than other participants. The participant with the smallest mechanical response of the hip joint did not bounce the entire body after colliding with the floor.

【Conclusions】The mechanical response of the hip joint during backward falls depended on the body segment that hit the floor first and the movement of the hip and thigh after colliding with the floor.