Abstract
Objectives
Comparing the incidence rate of in-hospital falls between patients hospitalized in
window beds and nonwindow beds.
Design
Retrospective cohort study.
Setting
A general hospital in Mie, Japan.
Participants
A total of 2767 patients (mean age, 68.4 years) hospitalized in four-bedded rooms
between January 2014 and December 2016.
Measures
We identified patients' bed status (window/nonwindow) and the incidence of in-hospital
falls using data on medical records and incidence reports, respectively.
Results
During an observation period of 25,450 person-days, 57 patients had in-hospital falls
(incidence rate, 2.24/1000 person-days). Incidence rate for in-hospital falls was
significantly lower in the window-bed group (n = 1273) than in the nonwindow-bed group
(n = 1494) [incidence rate ratio (IRR) 0.49, 95% confidence interval (CI), 0.29, 0.84].
In the multivariable analysis adjusted for age, gender, BMI, smoking and drinking
habit, surgical operation during hospitalization, and independence in daily living,
the window-bed group exhibited significantly lower incidence rate for in-hospital
falls than the nonwindow-bed group (IRR 0.54, 95% CI 0.32, 0.93). Sensitivity analysis
excluding patients aged <60 years suggested a consistent result: incidence rate for
in-hospital falls was significantly lower in the window-bed group (n = 1123) than
in the nonwindow-bed group (n = 925) (IRR 0.55, 95% CI 0.31, 0.95).
Conclusions and implications
The incidence rate of in-hospital falls was significantly lower among patients hospitalized
in window beds than nonwindow beds. Hospitalization in window beds might be a novel,
simple preventive option for in-hospital falls. Further large-scale, prospective,
multicenter research is required.
Keywords
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References
- The incidence and costs of inpatient falls in hospitals.(Available at:)https://improvement.nhs.uk/documents/1471/Falls_report_July2017.v2.pdfDate: 2017Date accessed: January 11, 2019
- Falls in English and Welsh hospitals: A national observational study based on retrospective analysis of 12 months of patient safety incident reports.Qual Saf Health Care. 2008; 17: 424-430
- Falls and consequent injuries in hospitalized patients: Effects of an interdisciplinary falls prevention program.BMC Health Serv Res. 2006; 6: 69
- Circumstances and consequences of falls in community-dwelling older women.J Womens Health (Larchmt). 2007; 16: 1437-1446
- Preventing falls and fall-related injuries in hospitals.Clin Geriatr Med. 2010; 26: 645-692
- Inpatient fall prevention programs as a patient safety strategy: A systematic review.Ann Intern Med. 2013; 158: 390-396
- Seasonal ambient changes influence inpatient falls.Age Ageing. 2017; 46: 513-517
- Falls risk factors in the hospital setting: A systematic review.Int J Nurs Pract. 2001; 7: 38-45
- Circadian and wakefulness-sleep modulation of cognition in humans.Front Mol Neurosci. 2012; 5: 50
- Mechanisms linking circadian clocks, sleep, and neurodegeneration.Science. 2016; 354: 1004-1008
- Management of insomnia in hospitalized patients.Ann Intern Med. 1984; 100: 398-404
- Delirium in elderly people.Lancet. 2014; 383: 911-922
- Melatonin in humans.N Engl J Med. 1997; 336: 186-195
- Diminished melatonin secretion in the elderly caused by insufficient environmental illumination.J Clin Endocrinol Metab. 2001; 86: 129-134
- Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial.JAMA. 2008; 299: 2642-2655
- Bright light treatment in elderly patients with nonseasonal major depressive disorder: A randomized placebo-controlled trial.Arch Gen Psychiatry. 2011; 68: 61-70
- Decreased daytime light intensity at nonwindow hospital beds: Comparisons with light intensity at window hospital beds and light exposure in nonhospitalized elderly individuals.Chronobiol Int. 2018; 35: 719-723
- Criteria for evaluating the degree of independence of disabled elderly persons in performing activities of daily living, Tokyo, Japan, Ministry Secretariat of Health and Welfare for the Elderly Bureau.1991 ([in Japanese])
- Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis.JAMA. 2017; 318: 1687-1699
- Risk of fractures following cataract surgery in Medicare beneficiaries.JAMA. 2012; 308: 493-501
- The role of environmental light in sleep and health: Effects of ocular aging and cataract surgery.Sleep Med Rev. 2010; 14: 269-280
- Bright light induction of strong (type 0) resetting of the human circadian pacemaker.Science. 1989; 244: 1328-1333
- Impact of windows and daylight exposure on overall health and sleep quality of office workers: A case-control pilot study.J Clin Sleep Med. 2014; 10: 603-611
- Preventive effects of ramelteon on delirium: A randomized placebo-controlled trial.JAMA Psychiatry. 2014; 71: 397-403
- Bright light exposure during the daytime affects circadian rhythms of urinary melatonin and salivary immunoglobulin A.Chronobiol Int. 1999; 16: 359-371
- Repeated exposures to daytime bright light increase nocturnal melatonin rise and maintain circadian phase in young subjects under fixed sleep schedule.Am J Physiol Regul Integr Comp Physiol. 2006; 291: 1799-1807
- Positive effect of daylight exposure on nocturnal urinary melatonin excretion in the elderly: A cross-sectional analysis of the HEIJO-KYO study.J Clin Endocrinol Metab. 2012; 97: 4166-4173
- Association between melatonin secretion and nocturia in elderly individuals: A cross-sectional study of the HEIJO-KYO cohort.J Urol. 2014; 191: 1816-1821
- Physiological levels of melatonin relate to cognitive function and depressive symptoms: The HEIJO-KYO cohort.J Clin Endocrinol Metab. 2015; 100: 3090-3096
Article info
Publication history
Published online: August 22, 2019
Footnotes
J.I. and K.O. contributed equally to this work.
This work was supported by research funding from JSPS KAKENHI (grant no.: 15K08827).
K.O. and K.S. received research grants from YKK AP Inc; Ushio Inc; Tokyo Electric Power Company; EnviroLife Research Institute Co, Ltd; Sekisui Chemical Co, Ltd; LIXIL Corp; and Kyocera Corp. The other authors declare no conflicts of interest.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
