The effect of support surface on the prevention of pressure injury in acute care settings: A multi-center prospective observational study.

PURPOSE: This study aimed to analyze if a multi-foam core mattress with a laminated cover can reduce the incidence of pressure injuries, compared to an alternating air mattress overlay among critically ill patients in acute settings. DESIGN: Prospective observational study. PARTICIPANTS: and setting: Patients with a Braden scale score ≤16 on intensive care unit admission at five general hospitals in Korea were included in this study between February 2022 and March 2022. METHODS: One hundred and twenty patients in acute settings were enrolled and categorized into two groups: a multi-form core mattress with a laminated cover group (n = 60) and an alternating air mattress overlay group (n = 60). Data were collected for 7 days by wound care nurses. RESULTS: Pressure injury developed at a significantly lower rate in the multi-form core mattress with a laminated cover group (n = 4/60, 6.7 %) than in the alternating air mattress overlay group (n = 25/60, 25.0 %) (P = 0.011). Using a multi-foam core mattress with a laminated cover demonstrated a protective effect against pressure injuries (odds ratio 0.123, 95 % confidence interval 0.024-0.620, P = 0.011). CONCLUSIONS: A multi-foam core mattress with a laminated cover was significantly more effective than an alternating air mattress overlay in preventing pressure injury in critically ill patients.

[Development and Evaluation of Evidence-Based Nursing Protocol for Extracorporeal Membrane Oxygenation to Critically Ill Patients].

PURPOSE: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. METHODS: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. RESULTS: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). CONCLUSION: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

A Comparison of the Charlson and Elixhauser Methods for Predicting Nursing Indicators in Gastrectomy with Gastric Cancer Patients.

Background: Comorbidity indices such as Charlson's (CCI) and Elixhauser's (ECI) are used to adjust the patient's care, depending on the severity of their condition. However, no study has compared these indices' ability to predict nursing-sensitive outcomes (NSOs). We compared the performance of CCI and ECI in predicting NSOs in gastric cancer patients' gastrectomy. Methods: Gastric cancer patients with gastrectomy, aged 19 years or older and admitted between 2015 and 2016, were selected from the Korea Insurance Review and Assessment Service database. We examined the relationships between NSOs and CCI or ECI while adjusting patient and hospital characteristics with logistic regression. Results: The ECI item model was the best in view of the C-statistic and Akaike Information Criterion for total NSO, physiologic/metabolic derangement, and deep vein thrombosis, while the Charlson item model was the best for upper gastrointestinal tract bleeding. For the C-statistic, the ECI item model was the best for in-hospital mortality, CNS complications, shock/cardiac arrest, urinary tract infection, pulmonary failure, and wound infection, while the CCI item model was the best for hospital-acquired pneumonia and pressure ulcers. Conclusions: In predicting 8 of 11 NSOs, the ECI item model outperformed the others. For other NSOs, the best model varies between the ECI item and CCI item model.

Association between nurse staffing levels and rotavirus infection in neonatal intensive care units: A retrospective observational study.

OBJECTIVES: To explore the relationship between nurse staffing levels and rotavirus infection in neonatal intensive care units. RESEARCH METHODOLOGY: This study adopted a retrospective observational design with data from the Health Insurance Review and Assessment Service (2018) database in South Korea. Participants were 35,308 infants in neonatal intensive care units. Multiple logistic regression analyses were employed to examine the association between nurse staffing levels and rotavirus infection in neonatal intensive care units after adjusting for confounding variables such as patient and hospital-related characteristics. RESULTS: A total of 1,514 (4.3%) infants developed rotavirus infection. Among the confounding variables, infectious disease, and being admitted from January to March and in December significantly increased the risk of rotavirus infection, whereas low birth weight, cardiovascular disorders, neonatal jaundice, receiving breastmilk, central line insertion, and ventilator usage significantly decreased the risk. Neonatal intensive care units with a grade 5 nurse staffing level (compared with grades 1-4) had a higher risk of rotavirus infection. CONCLUSIONS: The results suggest that neonatal intensive care units with higher (vs lower) nurse staffing levels are associated with lower rotavirus infection rates among infants. High-risk infants are extremely susceptible to hospital-acquired infections, and more intensive nursing care that differs from that provided to adult or paediatric patients is required. Therefore, nurse staffing levels with less than a 2:1 patient-to-nurse ratio are needed to control and prevent rotavirus infection in neonatal intensive care units.

Effects of aerobic exercise on waist circumference, VO2 max, blood glucose, insulin, and lipid index in middle-aged women: A meta-analysis of randomized controlled trials.

This study confirms the effectiveness of aerobic exercise on waist circumference, Vo2 max, blood glucose, insulin, serum lipid in middle-aged women. The Ovid-Medline, Embase, the Cochrane Library, and CINAHL were searched. The risk of bias 2 revised in 2019 was used to assess the risk of bias in randomized controlled trials (RCTs). Selected studies were meta-analyzed with Review Manager 5.3. Data were compiled from 15 RCTs comprising 1,110 participants. Overall, aerobic exercise reduced waist circumference and blood glucose, and increased VO2 max significantly. We recommend the application of aerobic exercise to prevent metabolic disease in middle-aged women.

Comparison of metabolic syndrome and related factors in married pre-menopausal white- and blue-collar woman.

This study aimed to identify the prevalence and associated factors of metabolic syndrome in pre-menopausal married women with white-collar and blue-collar jobs. This study analyzed 4,447 women with jobs in the Korean National Health and Nutrition Examination Survey (2010-2018). The prevalence of metabolic syndrome was higher among blue-collar women (15.3%) than among white-collar women (10.5%). Age, family type, alcohol consumption, frequency of high-risk drinking, perceived health status, and body mass index (BMI) were significantly associated with metabolic syndrome in the white-collar (p < .05). Age, family type, frequency of eating out, and BMI were associated in the blue-collar (p < .05). Blue-collar women were more vulnerable to metabolic syndrome than white-collar ones. To prevent metabolic syndrome in pre-menopausal married women with jobs, lifestyle modifications such as mitigating obesity and reducing alcohol consumption with aging are necessary.

What Types of Exercise Are More Effective in Reducing Obesity and Blood Pressure for Middle-Aged Women? A Systematic Review With Meta-Analysis.

BACKGROUND: A systematic review was performed to identify the types of physical activities effective as interventions in preventing metabolic syndrome in middle-aged women. METHODS: Electronic databases (MEDLINE, EMBASE, the Cochrane Library, and CINAHL) served as the data sources. Cochrane's Risk of Bias 2 was applied to assess the risk of bias of the randomized controlled trials. Meta-analyses were performed on selected studies using Review Manager 5.3. Thirty-one trials enrolling 2,202 participants were included. RESULTS: Compared to controls, the effects of physical activity were indicated by pooled mean differences, which were -0.57 kg for body weight, -0.43 kg/m2 for body mass index, -1.63 cm for waist circumference, -4.89 mmHg for systolic blood pressure (BP), and -2.71 mmHg for diastolic BP. The effects were greater on the measurements of waist circumference and BP than on body weight and BMI. The types of physical activities were further analyzed according to sub-groups. Only aerobic exercise did not affect body weight and resistance exercise did not significantly change any results. Contrarily, combined exercises significantly reduced measurements of waist circumference and BP. CONCLUSION: This review can provide valuable information for research and implementation of measures to prevent metabolic syndrome in middle-aged women.

Comparison of Bleeding, Hematoma, Pain, and Discomfort After Bone Marrow Examination With or Without Sandbag Compression.

PURPOSE: A safe and effective hemostatic care is necessary after bone marrow examination to minimize bleeding, pain, and discomfort. However, a standardized hemostatic care protocol following bone marrow examination has not been established. The purpose of this study was to investigate the differences in bleeding, hematoma, pain, and discomfort by the hemostatic method used following bone marrow examination. METHODS: This study was carried out with a pre-test/post-test nonequivalent control group design. Sixty-four patients undergoing bone marrow examination at the hemato-oncology ward in a tertiary hospital in South Korea were assigned to an intervention (n = 30) and comparison group (n = 34). The intervention group was treated using a compression dressing alone, while the comparison group received a compression dressing followed by sandbag compression. Both groups received two hours of bedrest. Bleeding, hematoma, pain, and discomfort were measured at one and two hours after the biopsy. RESULTS: No significant differences in the occurrence of bleeding between the groups at one and two hours after bone marrow examination were observed, and no participant developed hematoma. The intervention group had significantly lower pain than the comparison group two hours after the bone marrow examination as well as lower discomfort one hour and two hours after the bone marrow examination (p < .05). CONCLUSION: Applying only compression dressing after a bone marrow examination is effective in reducing pain and discomfort without measurable differences in bleeding and hematoma, suggesting that compression dressings alone could be effective in lowering pain and discomfort following bone marrow examination.

Effects of Video-Based Information Provision Using a Smart Pad on Patients Undergoing Bone Marrow Biopsy.

The purpose is to determine the effect of video-based information provision using a smart pad on uncertainty, anxiety, physiological parameters, pain, and educational satisfaction among patients hospitalized for a bone marrow biopsy. This study was done with a pre-/posttest nonequivalent control group design. The subjects were 65 patients in the hematology-oncology ward of a university hospital in Cheongju, South Korea, who underwent a bone marrow biopsy between August 2017 and May 2018. Thirty volunteers were allocated to the control group and 35 volunteers to the intervention group. The experimental group showed significantly lower uncertainty and significantly greater satisfaction with education than did the control group. No significant difference was observed in anxiety, systolic and diastolic blood pressure, pulse, and pain. Video-based information provision using a smart pad was effective for lowering uncertainty among patients receiving a bone marrow biopsy, as well as for boosting their sense of educational satisfaction.

The mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure.

AIM: There have been few studies done looking at the relationship between resilience, Type D personality, and self-care behavior in patients with heart failure. The purpose of this study was to identify the mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure. METHODS: The subjects consisted of a sample of 90 heart failure patients aged ≥20 years who visited the cardiology outpatient clinic in the Chungbuk area of South Korea. RESULTS: Among 90 patients, 49 subjects (54.0%) were classified as Type D personality, who exhibited statistically significant differences in resilience and self-care behavior (p < .001). A statistically significant correlation was also observed between self-care behavior score and resilience score (p < .01). The resilience had full mediation effects on the relationship between Type D personality and self-care behavior. In other words, the higher their resilience, the better their self-care behavior. CONCLUSIONS: The study showed that resilience and Type D personality have important effects on self-care behavior.

Effects of an Electrocardiography Training Program: Team-Based Learning for Early-Stage Intensive Care Unit Nurses.

BACKGROUND: Team-based learning (TBL) can be one way of improving professional and practical skills for nurses. This study explored the effectiveness of an electrocardiography training program using TBL for early-stage nurses in intensive care units. METHOD: This study used a pretest-posttest nonequivalent control group. A total of 65 participants were enrolled in the study (36 in the experimental group and 29 in the control group). Participants in the experimental group were trained with TBL, and participants in the control group had lecture-based learning on electrocardiography education. RESULTS: There was no statistically significant difference between the team-based and lecture-based learning groups after the training in participants' knowledge of electrocardiography and reading ability of bedside (lead II rhythm) electrocardiography monitoring (p > .05). However, there was a statistically significant difference between the two groups in the reading ability of the 12-lead electrocardiography (p < .001). CONCLUSION: TBL was more effective in improving nurses' reading ability of the 12-lead electrocardiography. [J Contin Educ Nurs. 2020;51(4):174-180.].

Gender Differences in Hypertension Treatment and Control in Young Adults.

BACKGROUND: Compared with older adults, young adults exhibit poor treatment and control of hypertension. However, little is known about the factors affecting the treatment and control of hypertension in young adults. PURPOSE: This study was aimed to identify the factors affecting the treatment and control of hypertension in early adulthood by gender in South Korea. METHODS: This secondary data analysis study used a data set from the Korean National Health and Nutrition Examination Survey. The inclusion criteria were as follows: (a) 19-44 years old and (b) having an indicator of hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive drugs). Seven hundred eighty participants were included in this study. The odds ratios and 95% confidence intervals were derived using composite-sample multiple logistic regression. RESULTS: In men, age, marital status, family history of hypertension, treatment of hyperlipidemia, abdominal obesity, high-sodium diet, cholesterol, and aerobic exercise were found to be associated with hypertension treatment and control. In women, age, employment status, cardiovascular risk factors, body mass index, high-sodium diet, and drinking were found to be associated with hypertension treatment and control. CONCLUSIONS: The factors affecting the treatment and control of hypertension differed between the two genders. Therefore, healthcare providers should consider the differences in the factors between the two genders in early adulthood. To improve the treatment and control of hypertension, the guidelines for treatment interventions and management should be gender-specific from early adulthood. Nurses should actively suggest health-related behavioral modifications such as performing aerobic exercise for young adult men and reducing alcohol consumption for women.

Age-related macular degeneration among the elderly: The 5th National Health and Nutrition Examination Survey, 2010 through 2012.

AIM: This study was conducted to identify the prevalence and factors associated with age-related macular degeneration (AMD) in Korean elderly. METHODS: The study population of this cross-sectional survey was the Korean Health and Nutrition Examination Survey (KHANES) 2010 through 2012, the fifth population-based study. RESULTS: Analysis of 2,767 elderly (above age 65) from 23,376 participants showed the prevalence of any AMD to be 17.6% in the Korean elderly. Factors that were significantly positively associated with AMD included age, sex, occupation, low socioeconomic status, liver cirrhosis and physical activity (p < .01). Significantly negatively associated with AMD were cardiovascular disease, obesity, and beta-carotene intake (p < .05). CONCLUSIONS: This study estimated the prevalence rate and assessed factors associated with AMD in the elderly. This can be used to build a strategy for elderly eye health, and provides valuable information for screening for putative risks in the elderly.

Risk factors of repeated falls in the community dwelling old people.

This study aimed to provide evidence for the development of an algorithm to identify older adults with a high risk for repeated falls, along with strategies to prevent repeated falls, by analyzing the known physical, psychological, and environmental factors related to falls in older adults. One hundred fifty-seven community-dwelling older adults aged 65 years or older who experienced a fall within the past year were enrolled in this study. Participants' physical, psychological, environmental, and fall prevention-related characteristics were surveyed using structured questionnaires to identify the risk factors for repeated falls. The use of antidepressants, depression score, and compliance with fall prevention behaviors were found to differ significantly between the two groups, and the use of antidepressants and depression were found to be significant predictors of repeated falls. Depression should be considered as a major variable when developing an algorithm to identify the risk of repeated falls among older adults living at home. Also, the practice of fall prevention behaviors was higher in the repeated-falls group, likely due to that group's efforts to prevent additional falls.

The association between nurse staffing levels and paediatric nursing-sensitive outcomes in tertiary hospitals.

AIM: This study aimed to explore the association between paediatric nursing-sensitive outcomes and nurse staffing levels. BACKGROUND: Although previous studies have reported an association between low nursing-sensitive outcomes and high nurse staffing levels in adult populations, there are few studies on paediatric nursing-sensitive outcomes. METHODS: This study used electronic Health insurance review and assessment data for all children under 18 years old admitted at 46 tertiary hospitals in Korea between 2013 and 2014. Multiple logistic regression was used to examine relationships among nurse staffing levels and 11 paediatric nursing-sensitive outcomes. RESULTS: Nurse staffing levels had a clear relationship with the occurrence of lower respiratory tract infection and gastrointestinal infection. Five paediatric nursing-sensitive outcomes (pneumonia, sepsis, arrest / shock / respiratory failure, wound infection and postoperative cardiopulmonary complication) showed weak relationships with nurse staffing levels. Pressure ulcers and failure to rescue had the lowest incidences in hospitals with the lowest nurse staffing levels. CONCLUSIONS: We demonstrated evidence for the relationships of nurse staffing levels with seven paediatric nursing-sensitive outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: For quality paediatric nursing care, nurse staffing improvement is required. The study results could be useful evidence for appropriateness of nursing staffing in paediatric facilities.

The relationship of subepidermal moisture and early stage pressure injury by visual skin assessment.

AIM: The purpose of this study was to examine the relationship of subepidermal moisture and early stage pressure injury by visual skin assessment in elderly Korean. METHODS: Twenty-nine elderly participated at a particular nursing home. Data were collected for 12 weeks by one wound care nurse. Visual skin assessment and subepidermal moisture value were measured at both buttocks, both ischia, both trochanters, sacrum, and coccyx of each subject once a week. RESULTS: Subepidermal moisture value of stage 1 pressure injury was significantly higher than that of no injury and blanching erythema. After adjustment with covariates, odds ratios of blanching erythema to normal skin and stage 1 pressure injury to blanching erythema/normal skin were statistically significant (p < 0.05). Odds ratio of blanching erythema to normal skin was 1.003 (p = .047) by 1-week prior subepidermal moisture value, and that of concurrent subepidermal moisture value was 1.004 (p = .011). Odds ratio of stage 1 pressure injury to normal skin/blanching erythema was 1.003 (p = .005) by 1-week prior subepidermal moisture value, and that for concurrent subepidermal moisture value was 1.007 (p = .030). Subepidermal moisture was associated with concurrent and future (1 week later) skin damage at both trochanters. CONCLUSION: Subepidermal moisture would be used to predict early skin damage in clinical nursing field for the effective pressure injury prevention.

The use of sub-epidermal moisture measurement in predicting blanching erythema in jaundice patients.

OBJECTIVE: To investigate the relationship between sub-epidermal moisture (SEM) and visual skin assessment (VSA) in pressure ulcers (PU) patients with jaundice in Korea. METHOD: This is a longitudinal observational study. Data was collected by a wound care nurse, at a tertiary hospital, for six weeks beginning in June 2013. Once a week for the six weeks, the nurse assessed VSA and measured SEM, for each subject, on seven anatomical sites (both buttocks, both ischial tuberosities, both trochanters, and the sacral coccyx), using a NOVA Petite dermal phase meter for SEM. The measurements ranged from 0 to 999, and higher SEM indicates higher water content in the tissue. RESULTS: There were 22 adults participated in the study. The SEMs in category I PU were significantly higher than those in patients who had no injury, or blanching erythema. The SEM difference between category I PU and either blanching erythema or no injury was more than 60 points at the sacral coccyx, and the difference between blanching erythema and no PU was more than 100 points at the trochanters. After the covariates were adjusted for, the odds ratios (ORs) for blanching erythema were statistically significant. The ORs for blanching erythema versus normal skin was 1.016 higher than the concurrent SEMs. Also, The ORs of 1-point concurrent SEMs for blanching erythema versus normal skin at Sacral coccyx, right and left ischial tuberosity and left trochanter were 1.015, 1.128, 1.137 and 1.051 respectively (p<0.05). CONCLUSION: SEM was associated with concurrent early skin damage, specifically blanching erythema with jaundice. Therefore, SEM may be used to predict early skin damage in patients with jaundice in clinical nursing for effective PU prevention and management.

Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study.

BACKGROUND: Nurse staffing level is an important factor on nursing sensitive outcome. The relationships of nurse staffing level with nursing sensitive outcomes such as mortality, upper gastrointestinal bleeding and pressure ulcer have been explored in the United States, Canada, Australia, and New Zealand. Lower level of hospital nurse staffing seems associated with more adverse outcomes, especially mortality. However, there is insufficient evidence of the nurse staffing level-outcome relationship in other indicators. OBJECTIVES: This study was conducted to describe the status and prove the relationships of nurse staffing level with nursing sensitive outcome indicators for adult medical and surgical inpatients in Korea. Patient and hospital characteristics as covariates on nurse sensitive outcome were also explored. DESIGN: This was a retrospective observational study. SETTING: The study setting was all 46 tertiary hospitals in Korea. PARTICIPANTS: We selected all anonymized patients aged 19 years or older and admitted at tertiary hospitals for two years (2013-2014) using electronic reimbursement claims data. METHOD: Multiple logistic regression was used to examine relationships of nurse staffing level (accounted for full-time registered nurses in general ward only) with Nursing-sensitive outcomes (NSOs) adjusted for patient and hospital characteristics. NSOs included urinary tract infection, upper gastrointestinal tract bleeding, deep vein thrombosis, hospital-acquired pneumonia, pressure ulcer, sepsis, shock/cardiac arrest, CNS complication, in-hospital death, wound infection, physiologic/metabolic derangement and pulmonary failure. RESULTS: The total number of patients in 46 tertiary hospitals in Korea for two years was 3,665,307. Among these, number of patients who had at least one nursing-sensitive outcome was 338,369 (9.23%). The significant relationships of nurse staffing level with six nursing-sensitive outcome rates (urinary tract infection, upper gastrointestinal tract bleeding, hospital-acquired pneumonia, shock/cardiac arrest, in-hospital death, and wound infection) were shown. These six nursing-sensitive outcomes showed an increasing trend as nurse staffing level degraded even after adjusting for patient and hospital characteristics. When the nursing-sensitive outcomes between those of group 1 (bed-to-nurse ratio < 2:1) and group 3 (between 2.5:1 and 3:1) were compared, the adjusted incidence rate of shock/cardiac arrest showed the highest difference (1.06%). CONCLUSION: We demonstrated strong evidence for the relationships of nurse staffing level with six nursing-sensitive outcomes. We can use this study to improve nursing quality and to inform patients of the nursing quality of hospitals so they can choose hospitals with better nursing quality. The nurse staffing level should be optimized for better outcomes.

Factors influencing falls in the frail elderly individuals in urban and rural areas.

BACKGROUND: Falls in older people commonly cause morbidity and mortality, loss of independence, and poor quality of life. Differences in residential environments might influence falls experienced by elderly people in urban and rural areas. AIM: The purpose of this study was to provide data through the comparative analysis of physical and environmental factors influencing falls in the frail elderly individuals in urban and rural areas, which might be used for developing the fall prevention program. METHODS: A total of 534 frail elderly individuals living in regional communities were assessed over 2 months. Discomfort when walking, avoiding falls, awareness of falls, physical activity, fear of falling, depression, and a safety score for the home environment were measured. RESULTS: Frail elderly individuals in urban and rural areas had significant differences in terms of their prior experience of falls; the number of falls; the intake of hypertension medication, arthritis medication, and painkillers, respectively, discomfort when walking; physical activity; and the safety score of their home environments. There were significant differences between the frail elderly individuals living in urban and rural areas with the highest incidence of falls with regard to their education level, marital status, residential types, the intake of arthritis medication and painkillers, walking discomfort, physical activity, and the safety score of their home environments. In the factors influencing falls of frail elderly individuals in urban areas, stroke, visual impairment, and the fear of falling were significant explanatory variables. In the factors influencing falls of frail elderly individuals in rural areas, dizziness, walking discomfort and the fear of falling were significant explanatory variables. DISCUSSION: These results indicate that different factors influence falls among the elderly living in different residential areas. CONCLUSION: Based on these results, a multidimensional customized fall prevention program should be considered by various factors according to residential environments to effectively prevent falls among elderly adults.

[Effects of a fall prevention program on falls in frail elders living at home in rural communities].

PURPOSE: This study was conducted to determine the effects of a fall prevention program on falls, physical function, psychological function, and home environmental safety in frail elders living at home in rural communities. METHODS: The design of this study was a nonequivalent control group pre posttest design. The study was conducted from July to November, 2012 with 30 participants in the experimental group and 30 in the control group. Participants were registered at the public health center of E County. The prevention program on falls consisted of laughter therapy, exercise, foot care and education. The program was provided once a week for 8 weeks and each session lasted 80 minutes. RESULTS: The risk score for falls and depression in the experimental group decreased significantly compared with scores for the control group. Compliance with prevention behavior related to falls, knowledge score on falls, safety scores of home environment, physical balance, muscle strength of lower extremities, and self-efficacy for fall prevention significantly increased in the experimental group compared with the control group. CONCLUSION: These results suggest that the prevention program on falls is effective for the prevention of falls in frail elders living at home.