The Impact of the Interior Environment on Resident Falls in Japanese Skilled Nursing Facilities

Presented by: Akemi Kotaki, Mitzi Perritt, Ray Darville, Sally Ann Swearingen, Leisha Bridwell

Japan has the oldest population in the world; 23.3% of citizens are 65 years or older. Japanese life expectancy is 83.1 years increasing to 86.6 by 2060 (Ministry of Internal Affairs/Communications, 2010). Older adults in the US comprise 13% of the population (U.S. Census Bureau, 2012). Falls are common among nursing home residents and pose a significant problem in many countries. Falls result from environmental hazards, medications, vision problems, and impairments in strength, gait, or balance (Bradley, 2011). Shobha (2005) identified environmental hazards as a leading cause of falls. This study investigated the interior environmental risk factors for falls within 13 Japanese nursing homes, using documented fall incident report data of 1,228 falls, to determine which locations and interior environmental features (flooring, furniture, assistive devices, and lighting) were associated with higher risk of falls. Fall rate served as the single dependent variable. Independent variables involved four categories of interior environmental factors (flooring, furniture, assistive devices, and lighting) and seven areas (resident rooms and bathrooms, public toilet rooms, public shower/tub rooms, lobbies/entrances, lounge/social/dining areas, corridors, and elevator interiors/elevator lobbies). The environmental variables analyzed include the following. • Flooring o Floor materials o Pattern contrast o Floor reflectance o Threshold height o Flooring transitions o Hard-surface flooring texture o Carpet height o Carpet texture o Value contrast between floors and walls • Furniture o Bed height (floor to top of mattress) o Bed location o Bed clearance (on either side of bed) o Chair style o Arm height o Chair seat height o Chair kickspace o Value contrast between chairs and the floor o Chair type o Chair stability o Resident corridor seating o Reception desk at entrance • Assistive Devices o Bedrails o Handrails o Handrail placement o Toilet room grab bars placement o Toilet seat height o Shower grab bars placement o Shower seat: not provided o Tub height • Lighting o Permanent wall-mounted night lights en route to bathrooms o Permanent wall-mounted night lights near resident beds o Permanent wall-mounted night lights in bathrooms o Light switch location (near bed) o Light switch location (latch side of door) o Lighting levels o Lighting levels o Lighting levels o Natural lighting (skylights) o Natural lighting (windows in room) Analysis targeted the number of resident falls during 2012. Facilities 10 years old or older (n = 7) had a 1.5 times higher fall rate compared to newer facilities (n = 6). Newer facilities featured private resident rooms compared to older facilities that had shared rooms. Analysis of the data may suggest that private rooms are associated with fewer falls than shared rooms. Fall data also suggested that falls were significantly more likely to occur in certain areas. Of the 1,228 falls, 52% occurred in resident rooms, and 25% of falls happened in the lounge/social/dining areas. A high incidence of falls in resident rooms could be due to nighttime urinary incontinence as residents rush to use the toilet without the help of staff (Chiarelli, Mackenzie, & Osmotherly, 2009). Other substantive data patterns also were observed.


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  • Chiarelli, P. E., Mackenzie, L. A., & Osmotherly, P. G. (2009). Urinary incontinence is associated with an increase in a systematic review. Australian Journal of Physiotherapy, 55, 89-95. Retrieved October 24, 2012, from
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  • U.S. Census Bureau (2012). Statistical abstract of the United States. Retrieved from
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