Factors associated with proximal femoral fractures in older adults during hospital stay: a cross-sectional study.

BACKGROUND: Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial. OBJECTIVE: This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays. DESIGN: A retrospective observational study. SETTINGS: Acute care hospitals in Japan. PARTICIPANTS: Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures. METHODS: Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays. RESULTS: Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'. CONCLUSIONS: Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.

Relationship Between Unit Characteristics and Fall Incidence: A Cross-Sectional Survey Using Administrative Data in Japan.

BACKGROUND: Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. PURPOSE: This study was designed to identify the unit characteristics significantly related to fall risk. METHODS: A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. RESULTS: Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). CONCLUSIONS: The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.

Influence of nurse work environment and psychological distress on resignation from hospitals: a prospective study.

With the global nurse shortage, identifying nurse work environments that allow nurses to continue working is a common concern worldwide. This study examined whether a better nurse work environment (1) is associated with reducing nurses' psychological distress; (2) reduces nurse resignations; (3) weakens the influence of psychological distress on their resignation through interaction effect; and (4) whether psychological distress increases nurse turnover. Multilevel logistic regression analyses were performed using data obtained in 2014 from 2,123 staff nurses from a prospective longitudinal survey project of Japanese hospitals. The nurse work environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) consisting of five subscales and a composite, and psychological distress by K6. All the PES-NWI subscales and composite (ORs 0.679-0.834) were related to K6, significantly. Regarding nurse turnover, K6 had a consistent effect (ORs 1.834-1.937), and only subscale 2 of the PES-NWI had a direct effect (OR 0.754), but there was no effect due to the interaction term. That is, (1) and (4) were validated, (2) was partly validated, but (3) was not. As better work environment reduces K6 and a lower K6 decreases nurses' resignation, high-level hospital managers need to continue improving the nurse work environment.

Uneven distribution of stressful working conditions among Japanese nurses: a secondary analysis of nurses with and without children.

Supportive measures for employees raising children may have increased workloads on other nurses, causing psychological stress. This study aimed to clarify the differences in working conditions and psychological status among female Japanese nurses based on child-rearing attributes. We used data from 1,600 female nurses at 10 Japanese hospitals collected by the study of the Work Environment for Hospital Nurses in Japan conducted in 2016. The variables included work conditions (number of night shifts per month, daily overtime, number of paid holidays per year, and social support received), psychological status (sense of coherence, emotional exhaustion, and work engagement), and sociodemographic characteristics. An analysis of covariance was performed on the differences between the three groups (without children, with preschool-age children, and with children of other ages groups). The group without children had a relatively higher workload (p<0.01) and lower social support (p<0.01 and p<0.05). Additionally, they had higher emotional exhaustion and lower work engagement (p<0.01). This study confirmed the uneven distribution of work environment by work-life balance measures.

Development and psychometric validation of an educational support assessment scale for novice home healthcare nurses.

BACKGROUND: Educational support quality is an essential factor in determining the education of novice home healthcare nurses. This study developed a scale to assess the educational support provided by home healthcare agencies among novice home healthcare nurses. METHODS: Hypothetical components were derived from a literature review, including experiential learning theory. Expert panels evaluated the initial scale items, and the scale was tested with 3000 agencies from April to June 2022. A total of 627 valid responses were analyzed. RESULTS: Exploratory factor analysis produced a four-subscale structure consisting of 34 items that supported the hypothesized components. Cronbach's alphas ranged 0.889 to 0.961, and the intraclass correlation coefficients ranged 0.703 to 0.905 in the test-retest survey. CONCLUSIONS: The educational support assessment scale developed for novice home healthcare nurses is valid and reliable. Managers in home healthcare agencies should apply the results of assessments using the scale to improve their human resource development.

Factors associated with non-home discharge of patients hospitalized for hip fracture: A nationwide retrospective study using the Japanese diagnostic procedure combination database.

In Japan, the length of stay in acute care hospitals has been shortened, home medical care has been promoted following national policy. However, many issues remain in promoting home medical care. The aim of this study was to clarify the profiles of patients with hip fractures, aged ≥ 65 years, who were hospitalized in acute care institutions at the time of discharge and the influence on nonhome discharge. This study used data from patients who satisfied all the following conditions: Patients aged ≥ 65 years who were hospitalized and discharged between April 2018 and March 2019; Patients with hip fractures, and; Patients who were admitted from home. The patients were classified into the home discharge and nonhome discharge groups. Multivariate analysis was conducted by comparing socio-demographic status, patient background factors, patient status at discharge, and hospital function. This study included 31,752 patients (73.7%) and 11,312 patients (26.3%) in the nonhome discharge group and home discharge group, respectively. Overall, the proportions of males and females were 22.2% and 77.8%, respectively. The average (standard deviation) age of the patients was 84.1 years (7.4) and 81.3 years (8.5) in the nonhome discharge and home discharge groups, respectively (P < .01). The following factors affected nonhome discharge: 75 to 84 years (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.68-1.96), ≥85 years (OR = 2.17, 95% CI = 2.01-2.36), electrocardiography or respiratory treatment "(Factor A3) (OR = 1.44, 95% CI = 1.23-1.68), level of assistance with activities of daily living "(Factor B1)" (OR = 4.56, 95% CI = 4.22-4.92), and hospital where the patient-to-nurse ratio is 7:1 (OR = 2.12, 95% CI = 1.91-2.35). The results suggested that support from activities of daily living caregivers and implementing medical treatments such as respiratory care are required to advance home medical care. This study's method enables analysis focusing on aspiration pneumonia and cerebral infarction, which are common among older adults. Furthermore, specific measures for promoting home medical care for patients who are highly dependent on medical and long-term care may be developed.

Workplace social capital mediates the relationship between authentic leadership and three dimensions of organizational commitment of hospital nurses: A cross-sectional study.

AIM: This study aimed to examine the mediating effect of workplace social capital on the relationship between authentic leadership and the three dimensions of organizational commitment: affective, normative, and continuance. METHODS: In January 2019, anonymous self-reported questionnaires were distributed to 1220 nurses working in the general wards of two university hospitals in Japan. Structural equation modeling was used to examine the mediating effects of workplace social capital on the relationship between nurse managers' authentic leadership and the three dimensions of organizational commitment. RESULTS: Six hundred and fifty-nine data points were analyzed (valid response rate = 54.0%). Participants' average age was 28.6 years (standard deviation: 6.6), and 93.3% were female. The mediation indirect effect of workplace social capital between authentic leadership and organizational commitment was statistically significant in the models of affective organizational commitment and normative organizational commitment, but not in the model of continuance organizational commitment. CONCLUSIONS: The effects of authentic leadership and workplace social capital had different impacts on each of the three dimensions of organizational commitment. Nurse managers' authentic leadership and workplace social capital can enhance nurses' positive commitment to the organization.

The association between burnout and multiple roles at work and in the family among female Japanese nurses: a cross-sectional study.

Female nurses experience work-family conflict due to performing multiple roles, leading to burnout. Thus, this study aimed to verify the association between burnout and the multiple work and family roles performed among Japanese female nurses. The data for 2,255 nurses at 23 Japanese hospitals obtained from the Work Environment for Nurses Study in Japan were used. The variables included burnout, demographic information, additional work roles, and child-rearing or caregiving. Half of the nurses were categorized under the "no-role" group (NRG), approximately a quarter under the "work-role" group (WRG), 16% under the "family-role" group (FRG), and 7.3% under the "multiple-role" group (MRG). Compared to the NRG, the FRG and MRG showed statistically lower emotional exhaustion (B=-0.79, p<0.05; B=-0.94, p<0.05, respectively) and depersonalization (B=-0.80, p<0.05; B=-1.09, p<0.05, respectively). Personal accomplishment was not statistically different among the four groups. Burnout was relatively low among nurses with family roles, suggesting that family roles may have a positive spillover effect on work-related emotions.

Impact of organizational justice and manager's mental health on staff nurses' affective commitment: A multilevel analysis of the work environment of hospital nurses in Japan-Part II (WENS-J-II).

Background: Nursing shortage is a global and priority issue. Affective commitment has been identified as a key to retention in the workplace. Exploring the way to promote the nurse's affective commitment is necessary to maintain the nursing workforce and care quality. The staff nurse's organizational justice (procedural and interactional justice) and the manager's condition of mental health have the potential to be related to the staff nurse's affective commitment. Objective: To explore the impact on the nurse's affective commitment from procedural and interactional justices at individual and unit levels and the manager's mental health. Design: A multi-site longitudinal design. Settings: Nine Japanese hospitals with more than 200 beds and located in an area with more than 150,000 people. Participants: 385 staff nurses and their 42 nurse managers who completed both surveys in 2016 and 2017. Methods: We analyzed the data from a two-year national survey of the Work Environment for hospital Nurses in Japan part II. Nurse staff and their managers completed the surveys. This multilevel analysis performed four random intercept models on affective commitment and entered the variables of procedural and interactional justices and manager mental health into the models. Results: The staff nurse's affective commitment was positively associated with procedural justice climate (unit level), interactional justice climate (unit-level), and the perception of interactional justice (individual justice). The manager's mental health (psychological distress) had a negative relationship with affective commitment. Conclusions: The climates of procedural and interactional justice, the individual perception of interactional justice, and the manager's mental health impacted the nurses' affective commitment as a predictor of retention. Moreover, the perception of interactional justice and the organizational contexts (organizational justice climates and managers' psychological distress) were mediated by affective commitment. Thus, support to maintain the manager's mental health is required to promote staff's affective commitment related to retention. Registration: None. Tweetable abstract: Nurse staff's affective commitment was stimulated by interactional justice, two types of organizational justice climate, and the manager's mental health.

Development of a Shortened Version of the Nurse Managers' Empowering Behavioral Scale for Staff Nurses.

The original version of the Nurse Managers' Empowering Behavioral Scale for Staff Nurses (NMEB-SN) was both unique and comprehensive. However, it was considered lengthy. Hence, the intention of this particular study was to develop a shortened version of the NMEB-SN comprising 15 items across five subscales. Responses from 1268 staff nurses working at 10 Japanese hospitals were included in the analysis to confirm the validity and reliability of the scale. The results ensured internal consistency, construct and criterion-related validity, and test-retest reliability. The NMEB-SN short version is applicable in the context of practical and efficient nursing management to attract more nurses to the workplace.

Association between nursing practice environment and sense of coherence among staff nurses: A cross-sectional study in Japan.

AIM: This study aimed to investigate the association between work environment and sense of coherence among staff nurses. BACKGROUND: In Antonovsky's salutogenetic theory, factors that causes stress are not always harmful when people's sense of coherence is high. Although the effects of sense of coherence have repeatedly been confirmed, few studies have examined factors that increase sense of coherence. METHODS: We used cross-sectional data (N = 6172) surveyed in 2017 from a 2-year longitudinal study in 2016 and 2017. Multiple group structural equation modelling was conducted for years of nurse experience of different groups. RESULTS: Work environment subscale scores for nurses with less than 5 years of experience ranged from 2.3 to 2.9 and for those with more than 5 years, from 2.1 to 2.7. The averages of sense of coherence for the groups were 36.9 and 39.7, respectively. For both groups, there was a statistically significant association between work environment and sense of coherence. CONCLUSIONS: Improvement of nurses' work environment may increase sense of coherence, leading to improvements in health. IMPLICATIONS FOR NURSING MANAGEMENT: The study suggests that nurse managers should improve the work environment to increase sense of coherence of staff nurses, leading to improved health for any length of a nurse's experience.

The development and validation of the Japanese version of job satisfaction scale: a cross-sectional study on home healthcare nurses.

OBJECTIVE: A reliable and valid tool is required to assess home healthcare nurses' job satisfaction for evaluating and improving the work environment and clinical practice of home healthcare. This study aimed to develop and examine the Japanese version of the Home Healthcare Nurses' Job Satisfaction Scale (HHNJS-J). The Home Healthcare Nurses' Job Satisfaction Scale (HHNJS) was translated into Japanese; a backward translation was performed until equivalence between the original and the backward-translated HHNJS was confirmed. Subsequently, a mail survey was conducted among 409 home healthcare nurses from 154 home healthcare agencies in Japan. We evaluated construct validity through Confirmatory Factor Analysis (CFA), and criterion-related validity and internal consistency were also tested. RESULTS: The CFA revealed a second-order seven-factor structure and adequate internal consistency, although, the fit of the data to the factor structure was moderate. As per the goodness-of-fit indices of the final model of the CFA, the comparative fit index was 0.89 and root mean square error of approximation was 0.06. This newly translated scale can be used to assess the job satisfaction of home healthcare nurses within Japan. The HHNJS-J evaluated acceptable reliability and validity among Japanese home healthcare nurses and had application in clinical practice in Japan.

Comparison of the Mental Burden on Nursing Care Providers With and Without Mat-Type Sleep State Sensors at a Nursing Home in Tokyo, Japan: Quasi-Experimental Study.

BACKGROUND: Increasing need for nursing care has led to the increased burden on formal caregivers, with those in nursing homes having to deal with exhausting labor. Although research activities on the use of internet of things devices to support nursing care for older adults exist, there is limited evidence on the effectiveness of these interventions among formal caregivers in nursing homes. OBJECTIVE: This study aims to investigate whether mat-type sleep state sensors for supporting nursing care can reduce the mental burden of formal caregivers in a nursing home. METHODS: This was a quasi-experimental study at a nursing home in Tokyo, Japan. The study participants were formal caregivers who cared for residents in private rooms on the fourth and fifth floors of the nursing home. In the intervention group, formal caregivers took care of residents who used sleep state sensors on the fourth floor of the nursing home. The sleep state sensors were mat types and designed to detect body motion such as the frequency of toss and turning and to measure heartbeat and respiration. One sensor was placed on a bed in a private room. When body motion is detected, the information is instantly displayed on a monitor at a staff station. In addition, the mental condition of the formal caregivers was measured using a validated self-reported outcome measure-the Profile of Mood States (POMS), Short-Form, 2nd edition. Formal caregivers in both groups received the POMS at baseline, midpoint (week 4), and endpoint (week 8) to identify changes in these domains. The primary outcome was the difference in total mood disturbance (TMD) of the POMS at baseline and week 8. RESULTS: Of the 22 eligible formal caregivers, 12 (intervention group) utilized sleep state sensors for 8 weeks. The remaining 10 formal caregivers (control group) provided nursing care as usual. As for the primary outcome of the difference between TMD at baseline and week 8, TMD in the intervention group improved by -3.67 versus 4.70 in the control group, resulting in a mean difference of -8.37 (95% CI -32.02 to 15.29; P=.48) in favor of the intervention. CONCLUSIONS: The present 8-week study showed that sleep state sensing for elderly residents might not be associated with reduced mental burdens on formal caregivers in nursing homes.

Reliability and validity of the Japanese version of the Person-Centered Care Assessment Tool.

AIM: To evaluate the reliability and validity of the Japanese version of the Person-Centered Care Assessment Tool (P-CAT-J) in a Japanese long-term care setting. METHODS: This was a cross-sectional survey using self-administered questionnaires distributed among the nurses or care staff of 2000 special nursing homes randomly selected nationwide using stratified random sampling according to each prefecture's ratio of numbers of facilities. The internal consistency of the tool was calculated using Cronbach's α and construct validity was assessed using confirmatory factor analysis. The criterion-related validity of the scale was based on the partial correlation between the possible outcomes of person-centered care (PCC). RESULTS: In total, 324 samples were analyzed after excluding samples with incomplete P-CAT-J. Cronbach's α value for the entire P-CAT-J was adequate, although internal consistency values for each factor were not strong. Confirmatory factor analysis revealed an acceptable value after adjusting for error variables. The partial correlation coefficients among workplace satisfaction, quality of care, PCC implementation and total P-CAT-J score were significantly correlated. CONCLUSIONS: The overall P-CAT-J was developed with good reliability and acceptable criteria based on the responses of long-term care staff in Japan. The P-CAT-J has the potential for international comparison and can provide long-term care staff with PCC examples to learn relevant actions and concepts. Geriatr Gerontol Int 2022; 22: 344-349.

A concept analysis of psychological safety: Further understanding for application to health care.

AIM: To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care. DESIGN: A Rodgers' concept analysis. METHODS: The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web. RESULTS: An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.

A Longitudinal Study of the Impact of Personal and Professional Resources on Nurses' Work Engagement: A Comparison of Early-Career and Mid-Later-Career Nurses.

To predict and ensure a healthy and high-performing nursing workforce, it is necessary to identify the antecedents that promote work engagement, especially among early-career nurses. To date no study has focused on this. This longitudinal survey, administered to 1204 nurses working in seven general hospitals with 200 or more beds in four prefectures in Japan at two different times in 2019, aims to examine the causal relationship between the personal and professional resources for nurses to work vigorously (PPR-N) and work engagement among nurses in the early stages of their careers, considering time as a key mediating factor. The analysis of structural equation modeling using the cross-lagged effect model supported that PPR-N had significant and positive effects on work engagement after 3 months among early-career nurses with less than 10 years of nursing experience. The PPR-N is a reliable antecedent of work engagement, which is typical of early-career nurses. These results may be provided guidance for managers in overseeing the work environment to ensure a thriving sustainable nursing workforce.

Validity and reliability of Japanese version of the pressure ulcer knowledge assessment tool.

AIM: To develop Japanese version of the pressure ulcer knowledge assessment tool, a tool for measuring nurses' pressure ulcer knowledge to effectively evaluate the efficacy of current educational programs, resulting in prevention and early treatment, and to verify its validity and reliability among Japanese nurses. MATERIALS AND METHODS: A total of 1716 nurses across three university hospitals participated in this study. All had been employed for at least one year. Managers, part-timers, and those in the operating room and the outpatient ward were excluded from the study as it is limited to bedside preventive care. The original tool was translated into Japanese using the Brislin's translation model. A cross-sectional study was used to examine the reliability and validity of the measure within a Japanese sample. Assessment of the multiple-choice test items included analysis of the validity (item difficulty and discriminating index), construct validity, internal consistency, and stability (test-retest reliability). RESULTS: The item difficulty indices ranged from 0.17 to 0.95, whereas values for item discrimination ranged from 0.15 to 0.45. Known group validity of the scale was confirmed; therefore, the higher-expertize group consisting of wound, ostomy, and continence nurses significantly outperformed nurses certified in other fields. The overall internal consistency reliability was 0.86 with a two-week test-retest intraclass correlation of 0.60. CONCLUSIONS: The instrument may be applied as a reliable and valid measure to assess nurses' pressure ulcer knowledge in the fields of nursing education, research, and practice in Japan.

Developing the nursing practice environment scale for home health care: A trial study in Japan.

AIM: To develop the nursing practice environment scale in home health care (NPES-HHC), which measures the attractiveness of nursing practice environments in Japan. DESIGN: Cross-sectional study. METHODS: The answers of 1,050 mail surveys conducted for nurses at 421 home-visit nursing agencies in Japan were analysed. Exploratory and confirmatory factor analyses of the NPES-HHC's candidate items were performed. Relationships between the newly developed NPES-HHC and participants' intention to remain at the workplace, job satisfaction and quality of care were also tested. RESULTS: A seven-dimensional model with 37 items was obtained by exploratory factor analysis (Cronbach's alpha: 0.77-0.92). Confirmatory factor analysis supported this model. NPES-HHC scores had significant positive relations with participants' intention to remain at the workplace, job satisfaction and quality of care (p < .01). The NPES-HHC is a reliable and valid instrument to assess the attractiveness of the practice environment for home-visit nursing agencies.

Work environment for hospital nurses in Japan: The relationships between nurses' perceptions of their work environment and nursing outcomes.

AIM: To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NOs ). DESIGN: A 2-year prospective longitudinal survey (2013-2015). METHOD(S): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit. RESULTS: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan.

OBJECTIVE: To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. DESIGN AND SETTING: Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). PARTICIPANTS: A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. METHODS: Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. RESULTS: Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. CONCLUSIONS: Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.