Bedridden Elderly People Research Articles

Profile of the elderly in a long-term care home in the municipality of Nanuque (MG)

Introduction: Studying the profile of institutionalized elderly people allows us to get to know their peculiarities. This serves to guide the care required. Objective: To analyze the profile of the elderly at Lar São Vicente de Paulo in Nanuque MG - Brazil. Methodology: A cross-sectional, qualitative and descriptive study using data analysis of 38 institutionalized elderly people. The data was collected by adapting a questionnaire from Scherrer et al (2019). The information is on health, epidemiological, demographic and economic profile. The daily routine was observed, such as: physical exercise, bedridden elderly, wheelchair users and elderly people who wander, in addition to pathologies. Results: Occupation of the Home: 100% are retired or pensioners; 55.2% women and 44.8% men. 34.2% were admitted by their family; 31.5% because they lived alone; 13.2% because they lost their spouse; 10.8% because of a safety risk; 5.2% because of illness and 5.2% because of a sick spouse; 63.2% are ambulant; 10.5% use a wheelchair and 26.3% are bedridden. Main illnesses: diabetes in 21% of men and 13.1% of women, hypertension in 31.5% of men and 10.5% of women, Parkinson's disease in 2.6% of men and 5.2% of women and Alzheimer's disease in 8% of men and 8% of women. The elderly do physical activities and 36% of them participate in the motor physiotherapy program. Conclusion: Most of the elderly at the Home are single women with no children and low levels of education, and men with no family ties, low incomes and low levels of education. Many suffer from diabetes, hypertension and depression, and two have degenerative diseases.

Vitamin D deficiency in bedridden elderly people at home

The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Posture Monitoring for Health Care of Bedridden Elderly Patients Using 3D Human Skeleton Analysis via Machine Learning Approach

For bedridden elderly people, pressure ulcer is the most common and serious complication and could be prevented by regular repositioning. However, due to a shortage of long-term care workers, repositioning might not be implemented as often as required. Posture monitoring by using modern health/medical caring technology can potentially solve this problem. We propose a RGB-D camera system to recognize the posture of the bedridden elderly patients based on the analysis of 3D human skeleton which consists of articulated joints. Since practically most bedridden patients were covered with a blanket, only four 3D joints were used in our system. After the recognition of the posture, a warning message will be sent to the caregiver for assistance if the patient stays in the same posture for more than a predetermined period (e.g., two hours). Experimental results indicate that our proposed method is capable of achieving a high accuracy in posture recognition (above 95%). To the best of our knowledge, this application of using human skeleton analysis for patient care is novel. The proposed scheme is promising for clinical applications and will undertake an intensive test in health care facilities in the near future after redesigning a proper RGB-D (Red-Green-Blue-Depth) camera system. In addition, a desktop computer can be used for multi-point monitoring to reduce cost, since real-time processing is not required in this application.

A Flexible Turning and Sensing System for Pressure Ulcers Prevention

Pressure ulcers (PU) are one of the most frequent hazards of long-term bedridden patients. With the continuous increase of aging, the number of long-term bedridden disabled and semi-disabled elderly people is increasing. At the same time, there is a serious shortage of professional pressure ulcer nursing staff. There is also a lack of flexible turning equipment for PU prevention. The research in the field of pressure ulcer prevention at home and abroad is carried out steadily, and the equipment for turning over by pneumatic or mechanical drive is developed. However, these devices often have insurmountable defects, such as complex structure, cost constraints, difficult control, weak body feeling, and so on. Under these circumstances, a set of pneumatic turnover mattresses based on clinical nursing methods have been developed. The mattress is divided into a turnover area and two support areas. The turnover airbag is linked with the support airbag to improve the patient’s comfort when passively turning over. The turnover amplitude and interval can be adjusted to provide a personalized turnover experience for bedridden patients. To improve the safety of the turning mattress during automatic turning, we also add a temperature sensor based on the principle of infrared reflection to monitor the status of bedridden patients, which can realize real-time temperature measurement, monitoring of getting out of bed and monitoring of the turning process.

Association of Skin Microbiome with the Onset and Recurrence of Pressure Injury in Bedridden Elderly People.

Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.

α-Tocopherol promotes HaCaT keratinocyte wound repair through the regulation of polarity proteins leading to the polarized cell migration.

In many developed countries including Japan, how to care the bedridden elderly people with chronic wounds such as decubitus becomes one of the most concerned issues. Although antioxidant micronutrients including vitamin E, especially α-tocopherol (α-Toc), are reported to shorten a period of wound closure, the promoting effect of α-Toc on wound healing independent of its antioxidant activity remains to be fully elucidated. The aim of this study was to examine whether α-Toc affects wound-mediated HaCaT keratinocyte polarization process including the recruitment of polarity regulating proteins, leading to wound repair independently of its antioxidant activity. We investigated the effects of α-Toc and other antioxidants such as Trolox, a cell-permeable α-Toc analog on the migration, proliferation, and cell polarization of HaCaT keratinocytes after wounding. We analyzed the localization and complex formation of polarity proteins, partitioning defective 3 (Par3), and atypical protein kinase C (aPKC), and aPKC activity by immunohistochemistry, immunoprecipitation analyses, and in vitro kinase assays, respectively. α-Toc but not other antioxidants enhanced the wound closure and cell polarization in HaCaT keratinocytes after wounding. α-Toc regulated the localization and complex formation of Par3 and aPKC during wound healing. Knockdown of aPKC or Par3 abrogated α-Toc-mediated promotion of the wound closure and cell polarization in HaCaT keratinocytes. Furthermore, aPKC kinase activity was significantly increased in α-Toc-treated cells through activation of phosphatidylinositol 3-kinase/Akt signaling pathway. These results suggest that α-Toc promotes HaCaT keratinocyte wound repair by regulating the aPKC kinase activity and the formation of aPKC-Par3 complex. © 2017 BioFactors, 44(2):180-191, 2018.

B214 介護用アクティブセンシングマットシステムの開発(OS3 フルードパワーの基礎と応用2)

In recent years, we have two problems for aging society in Japan. One is the problem that the elderly people are sometimes fall out of bed. This is likely to occur by rolling over of the elderly people. So it is reported that the care of constant attendance is required. By the way, the other is the bedsore problem of bedridden patients. The bedridden elderly people have a problem that they cause the congestion or the pressure ulcer. This is because they keep the same posture for a long time and the pressured body has been inhibited. So it is essential to change the postural of the patients. Further, the burden of caretakers is large. Therefore, in this study, we develop an active sensing mat that is effective for prevention of the congestion and the falls from bed. In addition, we reveal the effectiveness of the proposed mat through some experimental results.

Conceptual Design of a Mechatronic System for Supporting Basic Quality of Life of Bedridden Elderly People

Ambient Assisted Living is an important subject to be explored and developed, especially in developed countries, due to the increasing number of aged people. In this context the development of mechatronic support systems for bedridden elderly people (BEP) living in their homes is essential in order to support independence, autonomy and improve their quality of life. Some basic tasks as eating, taking a bath and/or hygiene cares become difficult to execute, regarding that often the main caregiver is the other element of the aged couple (husband or wife). This paper presents the conceptual design of a mechanical system especially devoted to assist the caregiver in the handling and repositioning of the BEP. Issues as reducing the number of caregivers, to only one, and reducing the system's handling complexity (because most of the time it will be used by an aged person) are considered. The expertise obtained from the visits to rehabilitation centers and hospitals, and from working meetings, are considered in the development of the proposed mechatronic system.

1P2-C01 介護補助用アクティブセンシングマットの開発(福祉ロボティクス・メカトロニクス(3))

In recent years, we have two problems for aging society in Japan. One is the problem that the elderly people are fall out of bed. This is likely to occur by rolling over. So it is reported that the care of constant attendance is required. By the way, the other is the bedsore problem of bedridden patients. The bedridden elderly people have a problem that they cause the congestion or the pressure ulcer. This is because they keep the same posture for a long time and the pressured body has been inhibited. So it is essential to change the postural of the patients. Further, the burden of caregivers is large. Therefore, in this study, as care support equipment practical, we develop an active sensing mat that is effective for prevention of the congestion and the falls from bed. In addition, we reveal the effectiveness of the proposed mat.

Location of Patient Laid Down on Gatch Bed in order to Decrease Pressures around Abdominal Regions While Backrest Lifting

The purpose of this study is to propose a lying location on a gatch bed for bedridden elderly people or patients, in order to decrease pressures around the abdominal region during backrest lifting. A proposed lying location is defined as the location where an ischial tuberosity of the patient is positioned right above the rotational axis of the backrest. A patient dummy has been developed to directly measure the abdominal pressures. Experiments were carried out to verify the effects of the proposed lying location during the backrest lifting and lowering. The pressures and slipping displacements were measured using the developed patient dummy in the conventional and proposed lying location. As a result the pressures and slipping displacements were decreased in the proposed lying location.

Development and validity of a new model for assessing pressure redistribution properties of support surfaces

Pressure ulcers are a common problem, especially in older patients. In Japan, most institutionalized older people are malnourished and show extreme bony prominence (EBP). EBP is a significant factor in the development of pressure ulcers due to increased interface pressure concentrated at the skin surface over the EBP. The use of support surfaces is recommended for the prophylaxis of pressure ulcers. However, the present equivocal criteria for evaluating the pressure redistribution of support surfaces are inadequate. Since pressure redistribution is influenced by physique and posture, evaluations using human subjects are limited. For this reason, models that can substitute for humans are necessary. We developed a new EBP model based on the anthropometric measurements, including pelvic inclination, of 100 bedridden elderly people. A comparison between the pressure distribution charts of our model and bedridden elderly subjects demonstrated that maximum contact pressure values, buttock contact pressure values, and bone prominence rates corresponded closely. This indicates that the model provides a good approximation of the features of elderly people with EBP. We subsequently examined the validity of the model through quantitative assessment of pressure redistribution functions consisting of immersion, envelopment, and contact area change. The model was able to detect differences in the hardness of urethane foam, differences in the internal pressure of an air mattress, and sequential changes during the pressure switching mode. These results demonstrate the validity of our new buttock model in evaluating pressure redistribution for a variety of surfaces.

Sympathetic neural influence on bone metabolism in microgravity (Review)

Bone loss is one of the most important complications for astronauts who are exposed to long-term microgravity in space and also for bedridden elderly people. Recent studies have indicated that the sympathetic nervous system plays a role in bone metabolism. This paper reviews findings concerning with sympathetic influences on bone metabolism to hypothesize the mechanism how sympathetic neural functions are related to bone loss in microgravity. Animal studies have suggested that leptin stimulates hypothalamus increasing sympathetic outflow to bone and enhances bone resorption through noradrenaline and β-adrenoreceptors in bone. In humans, even though there have been some controversial findings, use of β-adrenoblockers has been reported to be beneficial for prevention of osteoporosis and bone fracture. On the other hand, microneurographically-recorded sympathetic nerve activity was enhanced by exposure to microgravity in space as well as dry immersion or long-term bed rest to simulate microgravity. The same sympathetic activity became higher in elderly people whose bone mass becomes generally reduced. Our recent findings indicated a significant correlation between muscle sympathetic nerve activity and urinary deoxypyridinoline as a specific marker measuring bone resorption. Based on these findings we would like to propose a following hypothesis concerning the sympathetic involvement in the mechanism of bone loss in microgravity: An exposure to prolonged microgravity may enhance sympathetic neural traffic not only to muscle but also to bone. This sympathetic enhancement increases plasma noradrenaline level and inhibits osteogenesis and facilitates bone resorption through β-adrenoreceptors in bone to facilitate bone resorption to reduce bone mass. The use of β-adrenoblockers to prevent bone loss in microgravity may be reasonable.

A Study on Body Movements of the Bedridden Elderly People in a Special Nursing Home

A Study on Body Movements of the Bedridden Elderly People in a Special Nursing Home

Staging of disuse atrophy of skeletal muscles on immunofluorescence microscopy

The Japanese population is rapidly aging, thereby causing excess demand for facilities for elderly invalids. It is imperative that social measures and scientific studies be carried out to enable better care of bedridden elderly people. The purpose of the present study was to review the histological changes that occur in disuse atrophy of skeletal muscles, the primary pathophysiology of bedridden invalids, with the object of developing a staging standard to be used by researchers and clinicians. Rat hindlimb suspension was used as an experimental model. Atrophy of the soleus muscle was evaluated qualitatively and quantitatively on immunofluorescence microscopy. The myofibrils decreased significantly in the first 2-3 weeks of disuse atrophy. The earliest morphological change was fan-shaped multistep forking of sarcomeres, which appeared by the first week. This type of muscular lesion, designated here as 'sarcomeric disarray', was first described in the present study. Central-core lesions appeared mainly in slow muscle fibers by the second week. These lesions disappeared by the fourth or fifth week. Nerves remained intact and no inflammation or regeneration occurred up to the fifth week. Methods and criteria were compiled for staging of disuse atrophy based on the present results and a diagnosis kit designed for studies on disuse atrophy of skeletal muscles.

Monitoring system of body movements for a bedridden patient

In this article a system to detect the physical behavior of bedridden elderly people is proposed. This system is used to prevent elderly people from falling down and injuring themselves. The basic idea of our approach is to measure the body movements of the person using an acceleration sensor. Based on the data measured, dangerous actions are recorded and warning signals to the care workers are generated via wireless signals. A feature of the system is that the sensor is compactly assembled as a wearable unit. Another feature of the system is that it adopts a simplified wireless network system. Owing to its network capability, the system can monitor the physical movements of many patients. The applicability of the system is now being examined at hospitals.

Autonomic Neural Functions in Space

Autonomic neural functions are important to regulate vital functions in the living body. There are different methods to evaluate indirectly and directly autonomic, sympathetic and parasympathetic, neural functions of human body. Among various methods, microneurography is a technique to evaluate directly sympathetic neural functions in humans. Using this technique sympathetic neural traffic leading to skeletal muscles (muscle sympathetic nerve activity; MSNA) can be recorded from human peripheral nerves in situ. MSNA plays essentially important roles to maintain blood pressure homeostasis against gravity. Orthostatic intolerance is an important problem as an autonomic dysfunction encountered after exposure of human beings to microgravity. There exist at least two different types of sympathetic neural responses, low and high responders to orthostatic stress in orthostatic hypotension seen in neurological disorders. To answer the question if post-spaceflight orthostatic intolerance is induced by low or high MSNA responses to orthostatic stress, MSNA was microneurographically recorded for the first time before, during and after spaceflight in 1998 under Neurolab international research project. The same activity has been recorded during and/or after ground-based short- and long-term simulations of microgravity. MSNA was rather enhanced on the 12(th) and 13(th) day of spaceflight and just after landing day. Postflight MSNA response to head-up tilt was well preserved in astronauts who were orthostatically well tolerant. MSNA was suppressed during short-term simulation of microgravity less than 2 hours but was enhanced after long-term simulation of microgravity more than 3 days. Orthostatic intolerance after exposure to long-term simulation of microgravity was associated with reduced MSNA response to orthostatic stress with impaired baroreflex functions. These findings obtained from MSNA recordings in subjects exposed to space as well as short- and long-term simulations of microgravity indicate that sympathetic neural control is lowered when exposed to short-term microgravity but becomes enhanced after exposure to long-term microgravity. A lack of enhanced sympathetic neural response to orthostatic stress may induce orthostatic intolerance. Based on these findings effective countermeasures should be developed to prevent autonomic dysfunctions induced by exposure to microgravity. These include development of prescription and devices of physical exercise, electrical and magnetic nerve stimulations, body vibration, elastic bandage and stocking, lower body negative pressure, artificial gravity, medical drugs, and combinations of them. These countermeasures will be beneficial to prevent autonomic dysfunctions related to gravitational stress such encountered in bedridden subjects as orthostatic hypotension, atrophy of antigravity muscles and so on. This is particularly important in the present aged-society with many bedridden elderly people. The knowledge accumulated from studies on autonomic neural functions in space should be very useful to establish effective countermeasures and preventive methods for gravity-dependent autonomic dysfunctions.

Effect of Professional Oral Health Care for Bedridden Elderly People

Effect of Professional Oral Health Care for Bedridden Elderly People

The effect of the will of the bedridden elderly to be self-reliant on their life prognoses in Japan

The purpose of this study was to establish the relationship between the will of bedridden elderly people to be self-reliant and their life prognosis, and to clarify the factors related to the will to be self-reliant of such persons.The cohort consisted of 274 bedridden elderly persons aged 65 years and over who lived at home and were observed continually over ten years. Data were obtained from observation records done by four public health nurses who visited the subjects at least once a year and assessed their state of health. The variables studied were demographic variables, activities of daily living, the cause of being bedridden, the strength of the will to be self-reliant and the date of having become bedridden. Cox's proportional hazard model, the Kaplan-Meier method and discriminant analysis were used for statistical analysis.Of the 274 subjects, 107 subjects (39.1%) were male and 167 (60.9%) female, with a mean age of 82 years. The subjects who lived with their families accounted for 96.7%. The mortality hazard ratio for subjects with a weak will to be self-reliant to those with a strong will was 1.64, which was statistically significant. Discriminant analysis demonstrated that the will to be self-reliant showed a significant relationship with age, level of activities of daily living and refraining from expressing one's own feelings in consideration of the family's feelings.Bedridden elderly persons with a strong will to be self-reliant had a significandy better life prognosis than those with a weak one. A strong will to be self-reliant among the elderly is related to age, level of activities of daily living, and refraining from expressing one's own feelings in consideration of the family's feelings.This study clearly points out the need for home care service personnel to work in cooperation with families to emphasize encouragement to build the will to be self-reliant for the elderly in Japan.

在宅寝たきり高齢者の口腔健康状態と治療必要性に関する研究

A survey of the oral health conditions and treatment needs of dental diseases was conducted among 181 bedridden elderly people living at home in Kitakyushu City, Japan. The purpose of this study was to provide baseline data before the planning and implementation of a dental program for bedridden elderly people in Japan. Dentition and periodontal status, wearing of and need for dentures, and the condition of the temporomandibular joint were assessed according to the WHO guidelines (Oral Health Surveys-Basic Method, 3rd Ed., 1987). Interviews were also conducted and data on the general diseases was obtained from the subjects' medical histories. The most frequent causes of being bedridden were cerebrovascular diseases followed by cardiovascular diseases and senility. Mental status was also surveyed. The percentage of the subjects in good, fair and poor mental condition was 29%, 50% and 20%, respectively. Forty-three percent of all persons were edentulous and the mean number of present teeth, DF teeth, D (dacayed) teeth and F (filled) teeth among dentate persons was 9.6, 7.0, 3.9 and 3.1, respectively. The average number of teeth requiring filling, pulp care, crown or bridge abutment and extraction among dentate persons was 1.0, 0.6, 0.1 and 2.4, respectively. The percentage of dentate persons with healthy, bleeding on probing, calculus, shallow pocketing of 4 or 5 mm, and deep pocketing of 6 mm or more was 3%, 4%, 23%, 59% and 11%, respectively. The mean number of sextants with healthy, bleeding, calculus, shallow pockets and deep pockets was 0.1, 0.3, 1.0, 1.3 and 0.1, respectively. Sixty-nine percent of the subjects had dentures and 60% of the denture wearers wore them day and night. Denture treatment was needed by 85% of all persons : new dentures were needed by 40% and denture repairs by 45%. Ninety percent of those interviewed had no unusual symptoms in their temporomandibular joint. Oral and denture hygiene were poor. Only 2% of the subjects were plaque-free and 20% of the denture wearers use their dentures with no visible plaque. Fifty-six percent of those interviewed had some dental complaints ; most frequently reported were difficulties with dentures and chewing. In contrast with this, 46% of the interviewed persons had a subjective need for treatment. Analysis of the results showed poor dental health in this survey group and emphasizes the necessity of improving the dental health service programs for the bedridden elderly people and also the importance of preventive programs for dental diseases in the younger generations.

Disuse atrophy of the left ventricle in chronically bedridden elderly people.

In the elderly cardiac size and function are determined by their level of physical activity. In this study, we assessed by echocardiography, the anatomic and physiologic changes of the heart in 28 elderly patients who had no cardiac disease and who were chronically bedridden. The data obtained were compared to those obtained from a control group of 38 age and sex matched elderly people whose activities had not been restricted. Chronically bedridden patients had markedly smaller left ventricular dimensions in both end-diastole and end-systole and smaller left atrial dimensions than did control subjects (3.7 +/- 0.7 vs 4.7 +/- 0.6 cm, p less than 0.001, 2.4 +/- 0.8 vs 2.9 +/- 0.7 cm, p less than 0.02 and 3.2 +/- 0.5 vs 3.8 +/- 0.9 cm, p less than 0.01, respectively). Though the wall thickness of the interventricular septum did not differ between the study groups, the left ventricular posterior walls of the bedridden group were significantly thinner than in the control group (0.8 +/- 0.2 vs 1.0 +/- 0.2 cm, p less than 0.01). The bedridden group had a significantly lower stroke index (26.9 +/- 6.2 vs 47.0 +/- 11.1 ml/m2, p less than 0.001) and cardiac index (1.84 +/- 0.52 vs 3.15 +/- 0.63 l/min/m2, p less than 0.001) than did the control group. Left ventricular mass index and left ventricular systolic stress were significantly lower in bedridden patients than in control subjects (88.0 +/- 18.1 vs 143.5 +/- 30.9 g/m2, p less than 0.001, and 135.9 +/- 4.9 vs 186.6 +/- 35.7 10(3) dynes/cm2, p less than 0.001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)