Witnessed and unwitnessed falls among the elderly with dementia in Japanese nursing homes^†

Abstract

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.

Severity of dementia as a risk factor for repeat falls among the institutionalized elderly in Japan

“…However, when the participants continued to have a normal gait and sustained no injuries after falling, it was not possible for anyone to know about their falls. This is evident from the fact that, in our previous study, 80% of the falls in nursing homes were unwitnessed by the care staff (Kobayashi & Sugai, 2006). Although further investigation will be needed concerning this point, the specialized support programs for caregiving staff, which are managed by nurse specialists in elderly/dementia care to raise their motivation and recognition of fall prevention, might decrease the number of repeat fallers among this specific population (Kato et al.…”

“…It provides a clear map of the factors and causes of falls that already have been covered in preceding studies. The current conceptual framework was a modification of two models: (i) the model of Kobayashi and Sugai (2006), which explained falls in the whole risk management system, including the risk assessment of falls by nurses and care staff; and (ii) the model developed by Rubenstein and Josephson (2006), which identified a fall as an interaction between predisposing factors and precipitating causes.…”

“…Their results may suggest that the type of care facility influences the risk of becoming a faller or non‐faller; moreover, gait balance is not the only risk factor for being a repeat faller. The authors' previous study suggested that not only dementia itself might be associated with fall numbers, but the severity of the dementia also could be associated with the manner of falling (Kobayashi & Sugai, 2006). As we focused on the number of falls in that study, we could not identify the risk factors for repeat fallers.…”

“…The causes of accidental falls are various and recent studies indicate that there is no one perfect way to prevent accidental falls (Rubenstein, 2006). Moreover, studies conducted in different countries have reported that there is a specific population that falls repeatedly in a short period of time (Kron et al, 2003;Lord et al, 2003;Chen et al, 2005;Sugai et al, 2006). The identification of potential repeat fallers in daily care and the prevention of second or third falls among this specific population will decrease the cost of medical care for injuries (Sorensen et al, 2006;Stevens et al, 2006).…”

Falls are unintentional: Studying simulations is a waste of faking time

“…Falls when standing or walking (46%) and from the bed or chair (42%) were common but people had fallen sitting down, toileting, in conflict with others and climbing over bed rails. Of 276 falls by Japanese nursing homes residents with dementia, 24 most occurred in people’s bedrooms: one-third (32%) caused minor injuries (frequently to the head) and nine (3%) caused fractures.…”