Impact of Falls and Fall-Related Hospitalization on Subsequent Vitality Decline Among Japanese Nursing Home Residents: A Longitudinal Fixed-Effects Analysis.

OBJECTIVES: Falls in older adults are associated with injuries, functional decline, and psychological consequences, including fear of falling. The vitality index (VI) assesses behavioral motivation by observing engagement in activities, communication, and self-care. Little is known about how falls affect behavioral vitality, particularly among nursing home residents. The objective of this study was to examine the association between falls and subsequent VI changes among long-term care facility residents using longitudinal data. DESIGN: This was a retrospective cohort study. SETTING AND PARTICIPANTS: Participants included 338 residents with mobility in 5 Japanese nursing homes, using monthly data from August 2022 to June 2024. Residents with severe care needs or a Barthel Index score of 0 were excluded. METHODS: Falls were documented from care charts, excluding bed-related falls. Fixed-effects linear probability models examined VI decline at 1-, 2-, and 3-month intervals after falls, with stratified analyses by dementia status. RESULTS: Among the 338 residents, 182 (53.8%) experienced falls. Overall, falls were not significantly associated with VI decline. Nonetheless, among residents without dementia, fall-related hospitalizations were associated with increased VI decline at 2 and 3 months (β = 0.070, P = .024; β = 0.082, P = .019, respectively). Exploratory analyses suggested that fall-related hospitalizations primarily affected on and off toilet at 3 months, whereas non-fall-related hospitalizations selectively reduced willingness to get out of bed at 2 months or rehabilitation/activity at 3 months. No significant associations were observed among the residents with dementia. CONCLUSIONS AND IMPLICATIONS: Fall-related hospitalization, rather than falls alone, may lead to a medium-term vitality decline among nursing home residents without dementia. Postdischarge monitoring and tailored interventions may be critical for maintaining daily functioning.