No abstract

The study examined the impact of dementia severity on repeat fallers among the institutionalized elderly. A secondary analysis of a dataset containing information on 466 residents (86 of whom were fallers) of nine care facilities around Tokyo was carried out. Descriptive statistics were used to determine the baseline characteristics. Then, logistic regression analysis was carried out to identify the risk factors between the non-fallers and fallers and between the single and repeat fallers. Finally, the relative risks that had an impact on the repeat fallers were calculated. Sixty-one persons (13.1%) were identified as single fallers and 25 (5.4%) were identified as repeat fallers. An unstable gait was a dominant risk factor. In addition, the person's sex and the facility type were identified as risk factors for the fallers, while severe dementia was identified as a risk factor for the repeat fallers. Nurses should recognize the combination of severe dementia and unstable gait as a warning sign for potential repeat fallers.

Aim:  The purpose of this research was to describe the incidence of witnessed and unwitnessed falls among the elderly with dementia and to examine the differences between them. Methods:  We analyzed 276 reports from nine nursing homes in Japan. Descriptive statistics were used to investigate the situations when a fall occurred or when an incident was found. Fisher’s exact test was used to calculate the P‐value to examine the association between witnessed or unwitnessed falls and the variables set in each component of our model. After identifying the variables possibly associated with witnessed and unwitnessed falls, we examined the compounded effects among these variables and classified them into two groups: witnessed and unwitnessed falls. Then, we scrutinized the distribution of the observational data among the variables. Results:  Fourteen percent of the falls were witnessed. Four variables, the careworker/nurse as the reporter, Clinical Dementia Rating, depression in the elderly, and the time of the fall/discovery of the fall, were identified as variables that were different between the witnessed and unwitnessed falls. When compared to nurses, careworkers witnessed more falls specifically during the day. Falls were rarely witnessed among the subjects with mild dementia, although they were found after the incident throughout the day. The number of severely impaired fallers that were either witnessed or found were equal during every hour of the day. Conclusion:  The cognitive level of the elderly and the work shift of the care professionals potentially influenced the large number of unwitnessed falls. Nursing home administrators should consider these elements in fall prevention, especially for the elderly with dementia.

No abstract

The purpose of this study was to examine how the use of medical/social services by elderly persons changes over time as they approach death. This research was conducted at a public visiting nursing office in Tokyo. Nursing records of all elderly persons, those who died at home or died within 1 week of hospital admission between April 1993 and June 1997 were reviewed. The percent of patients using each type of medical or social service was calculated for three time periods before death: more than 6 months, 1–6 months and within 1 month. This retrospective examination clearly demonstrates a shift in specific service usage by elderly persons during the months prior to death. As terminal illness becomes more advanced, the use of medical services increases more remarkably than the use of social services. The increase in nurse visits is far greater than that of home aid visits. Visiting nurses should demonstrate their skills of care appropriate to the changeable conditions of the elderly and their families in the terminal stage.