Circumstances Related to Falls in the Dementia Special Care Unit of Geriatric Care Facility in Japan

Abstract

Background: Elderly people with dementia are liable to fall. Herein we report the circumstances of falls in the dementia special care unit of the geriatric care facility “Assist Sakuradai” of Maki psychiatric hospital during the eight months from August 1, 1999 to March 31, 2000. Methods: The participants were 61 patients admitted to our dementia special care unit. The diagnosis of dementia was based on DSM‐IV criteria. Cognitive impairment was assessed with Folstein's Mini‐Mental State Examination (MMSE) and the revised version of Hasegawa's dementia scale (HDS‐R). The evaluation of activity of daily living was assessed with Nishimura's activity of daily living scale (N‐ADL). Information related to falls was obtained from incident reports. Results: Forty‐one percent (n=25) of patients (n=61) suffered falls and a total of 69 falls were recorded at the dementia special care unit during the period. Mean scores ± SD (P value using the Mann‐Whitney test) of N‐ADL, HDS‐R, and MMSE for fallers vs. nonfallers were 25.1 ± 8.09 vs. 31.0 ± 9.33 (P=0.013), 8.72 ± 6.88 vs. 8.92 ± 6.67 (P=0.90) and 11.8 ± 7.28 vs. 11.4 ± 5.95 (P=0.747), respectively. Falling accidents occurred most often in the hall (n=34, 49%, P<0.01) and most in association with walking or transferring (n=29, 42%, P<0.01) at our dementia special care unit. The falling accident rate was defined as falls/time/number of staff and was ranked in the order of the greatest number of falls in specific time frames, as follows; 19:30–20:15 (1.8), 20:15–8:00 (1.02), 16:50–19:00 (0.81), 12:30–16:30 (0.50), 9:00–12:30 (0.41), and 8:15–9:00 (0.11). Conclusion: Our data suggest that the patients with low N‐ADL, patients who use the hall, or patients who were walking or transferring are the most liable to fall and that we should pay intense attention to the working hours between 19:30 and 8:00.