ArticleAge and ageing2025
Day and night nurse staffing levels and hospital-associated disability in older adults in Japan: a retrospective cohort study.
Article in Age and ageing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Non-pharmacological therapies for sleep and occupational stress regulation among nightshift nurses: a systematic review and Bayesian network meta-analysis based on randomized controlled trials.Frontiers in public health · 2026Pooled it
- Hospital Nurse Understaffing and Patient Mortality, Readmission, and Length of Stay.JAMA network open · 2026Article
- Inverting the 'dementia triangle' as a salutogenic approach to avoiding the "treadmill of disasters" in changed behaviors: a qualitative study.Frontiers in dementia · 2026Article
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6 authors.
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Abstract
backgroundHospital-associated disability (HAD) in older adults often results from preventable factors. Nurse staffing at the ward level is a key modifiable factor in mitigating HAD.
objectiveTo investigate the relationship between nurse staffing shortfalls during typical day and night shifts and the risk of HAD in older adults in acute care hospitals.
designRetrospective cohort study.
settingGeneral medical or surgical wards in nine acute care hospitals in Japan. SUBJECTS: Hospital admissions of patients aged ≥65 years.
methodsElectronic claims data and daily ward-level nursing rosters were used to measure nurse staffing shortfalls based on the patient-to-nurse ratio relative to the annual mean.
resultsAmong 57 498 hospital admissions [23 981 (41.7%) female, median age 76 (interquartile range [IQR] 71-76) years], 30 507 (70%) were functionally independent at admission. Functional deterioration occurred in 15 458 (26.9%) admissions. The median (IQR) patient-to-nurse ratio across the whole day was 6.11 (5.54-6.59), 3.70 (3.34-3.90) for the day shift, and 9.38 (8.57-10.37) for the night shift. The median (IQR) deviation from typical ward-level staffing was -0.21 (-0.64 to 0.20) for the whole day, -0.23 (-0.56 to 0.09) for the day shift, and 0.01 (-0.51 to 0.49) for the night shift. For each patient above the mean patient-to-nurse ratio, the risk of HAD increased by 7%.
conclusionAttention to the deviations from the usual staffing levels for both day and night shifts may be important in efforts to reduce the risk of HAD in older adults.
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