A look at the reports of accidents or near accidents in our hospital revealed that the incidence of falls or stumbles in children was at the top of the list in frequency. In the past five years, our pediatric ward has experienced an average of about 10 such cases annually. Regarding the risk of falling, advice is given by nurses to parents during the orientation session when their babies and little children are hospitalized. However,the advice was entirely subjective - not going by any rule or guidelines. Recently, an assessment score sheet for the risk factors for falling and a preventive measure against falls was drafted and trial used, with the result that changes were observed in the way the nurses in their 20s watch and take care of the little patients. Moreover, they became able to look after the infants according to their age, developmental stage and disposition. The use of the common pamphlet helped the young nurses gain selfconfidence even though they are inexperienced in child-rearing and nursing.  From these results, we concluded that the uniform guideline and order of priority led to the improvement of the quality of nursing in the nurses in their 20s.

OBJECTIVESNormal activity monitoring methods are mainly useful for relatively healthy and ablebodied people, but are not necessarily appropriate for elderly persons who may have difficulty in walking, or for the frail who may be bedridden. The purpose of this study was to examine 24-hour heart rate recording for the comparison of activity levels in daily life of elderly persons of different ambulatory abilities.

METHODSForty-two elderly females (mean, 82.1 years old) volunteered to participate in this study. The subjects were divided into four groups on the basis of their ambulatory status, and their 24-hour heart rate recordings were compared with their results of activity assessments.

RESULTSThe results of activity assessments showed a tendency to decrease as the ambulatory ability of the group decreased. The "total heart beats", calculated as the sum of all heart rates over 24 hours, were almost the same among the four groups, and therefore did not show a similar tendency. However, the "total excess-beats product (TEBP)" correlated with the results of activity assessments. TEBP was calculated as the sum of all differences in beats between each heart rate in 24 hours and the mean heart rate during sleeping at night. Therefore, TEBP may reflect a more active state than the bedridden state.

CONCLUSIONSThese results suggest that comparison of activity levels in daily life using 24-hour heart rate recording might be possible by the calculation of TEBP, and that this method might be useful for the comparison of the activity levels of elderly persons of diffent ambulatory abilities.