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May 12, 1993

Cross-national Comparisons of Long-term Care Become a Gold Mine for Rigorous Investigators

JAMA. 1993;269(18):2340. doi:10.1001/jama.1993.03500180024011

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A FEW YEARS ago, investigators from the United States and Japan teamed up to ask why nursing home residents in the United States had more hip fractures than their counterparts in Japan, despite their higher bone density. They hypothesized that elderly Japanese people fall less frequently because they have stronger quadriceps muscles owing to their custom of squatting to sleep on tatami mats or to use Japanese-style toilets.

The researchers soon learned that quadriceps strength and gait characteristics were nearly identical in the two study groups. Yet during the 4-month study, only 10% of the Japanese nursing home residents had falls, compared with 37% of their American counterparts (J Am Geriatr Soc. 1991;39:A10).

The researchers examined many other variables, including how much the residents are assisted with walking and dressing and the use of assisting devices. They were all essentially the same except for one: falls in the US cohort