Geriatric Health Services Facilities Research Articles

〝Nutrition Congress〟like NST in the Geriatric health services facility for the eldely

〝Nutrition Congress〟like NST in the Geriatric health services facility for the eldely

Predicting falls from behavioral and psychological symptoms of dementia in older people residing in facilities.

The aim of the present study was to examine whether behavioral and psychological symptoms of dementia at the time of admission could be a predictor of falls in older people with dementia residing in geriatric health service facilities. Three geriatric health services facilities located in Fukushima Prefecture, Japan, were the targeted facilities. Of the 305 people admitted between May 2013 and November 2014, 242 (74 men, 168 women) who scored ≤20 points on the Hasegawa Dementia Scale-Revised were targeted for analysis. A total of 15 items from the Long-term Care Certification Questionnaire Group 4 were used to assess behavioral and psychological symptoms of dementia, and were compared by the presence or absence of falls. Of the 242 participants, 153 were non-fallers and 89 were fallers. After adjusting for sex, age, Revised Hasegawa Dementia Scale-Revised, degree of care (which showed a significant relationship with falls in univariate analysis), activities of daily living and history of falls, the influence of behavioral and psychological symptoms of dementia on falls was examined, and showed a significant association with falls and a significant increase of hazard ratio for the behavioral symptoms "wandering" 2.23 (95% confidence interval 1.35-3.68) and "agitation" 1.94 (95% confidence interval 1.24-3.04). Because the risk of falling is high for residents who at the time of admission have the behavioral and psychological symptoms of dementia of "wandering" and "agitation," it is necessary to predict the possibility of falling at an early stage, monitor the residents and adjust the environment. Geriatr Gerontol Int 2018; 18: 1573-1577.

An analysis of the reliability and validity of the Life-trouble Scale for elderly patients living in geriatric facilities

The purpose of this study was to develop the Life-trouble Scale for elderly people with dementia to concretely determine their life troubles in geriatric facilities. The subjects of this study were elderly people living in geriatric health services facilities whose degree of life independence was evaluated as ≥II, who had a diagnosis of dementia, and who agreed to participate in this study.The study population included 191 subjects (male, n=144, 75.4%; female, n=47, 24.6%). The average age was 85.72 (±6.96) years, the mean degree of need for nursing care was 3.73 (±1.22), and the mean MMSE score was 9.11 (±8.80).Based on the factor analysis of the Life-trouble Scale, the first factor was named, "Basic Life Behavior and Life Trouble with Communication." The second factor was named, "Life Trouble Associated with Irritation and Confusion". The third factor was named, "Trouble with Human Relations Associated with Feelings and Changes in Consciousness". The fourth factor was named, "Life Trouble Associated with Changes in Consciousness and Repeated Behavior". The Cronbach's α of the 4 factors was 0.884, and the NPI and Crichton rating scales were significantly correlated with the 4 factors. The results showed that the Life-trouble Scale had reliability and validity, and that it was useful for solving problems in geriatric health services facilities.

Hyponatremia and mortality among very elderly residents in a geriatric health service facility.

Hyponatremia is common among elderly patients. This study aimed to examine the prognostic value of hyponatremia among elderly residents in a geriatric facility. We retrospectively examined the association between serum sodium levels and mortality among 118 residents (82% female, mean age 85.5years) in a single geriatric health service facility. We defined hyponatremia as Na < 135mEq/L. On the basis of single measurements of serum sodium at periodic examinations, the patients were divided into hyponatremia and non-hyponatremia groups. Multivariable Cox proportional hazards models were used to evaluate the effect of hyponatremia on mortality from May 2005 to April 2007. Thirty-three patients (28%) had hyponatremia. Over a 1-year follow-up period, the cumulative survival rate was significantly lower in patients with hyponatremia than in those without hyponatremia. In a multivariate analysis, including traditional risk factors for death, hyponatremia was associated with an increased mortality risk (adjusted hazard ratio 2.73; 95% confidence interval 1.01-5.16; p = 0.047). Hyponatremia is common and is a predictor of mortality in the near future among very elderly residents of a geriatric facility.

The analysis of the current condition of convalescent rehabilitation for stroke patients - A study in one facility, including a sub-analysis of the elderly

To investigate the clinical conditions of convalescent rehabilitation for stroke patients. We classified 147 stroke patients into 4 groups according to their discharge destination as follows: A, home; B, institution; C, geriatric health services facility; D, nursing home-type unit. A comparative examination was carried out for the following items: age, period from the onset to hospitalization (POH), NIHSS scores (NS), length of stay (LS), quantity of rehabilitation (QR), stroke types, FIM scores at admission and discharge (FS), and motor FIM gains (MFG) and efficiency scores (MFE). In addition, we performed a sub-analysis of 107 elderly patients (≥65) among the 147 total subjects. Group A was the youngest on average. The mean values of POH, NS, and LS increased in order from group A to group D. The average QR was the smallest in group A and the largest in group C. There was no marked difference in stroke types among the four groups. The FS revealed a gradual decline from group A to group D. The MFG in groups B and C was higher than in groups A and D. In the elderly patients, the MFG decreased in groups B and C, and a reduction of the MFE was demonstrated in group C. A relationship was noted between the ADL levels at admission and discharge. It was suggested that MFG and MFE were not predictive factors for the outcome and that elderly patients with a low ADL level tended to have a reduced effect of rehabilitation.

Adherence to blood pressure measurement guidelines in long-term care facilities: A cross sectional study.

ObjectiveTo assess the extent to which long‐term care facilities in Japan adhere to blood pressure (BP) measurement guidelines.DesignCross‐sectional, observational survey.SettingJapan (nationwide).ParticipantsGeriatric health service facilities that responded to a questionnaire among 701 facilities that provide short‐time daycare rehabilitation services in Japan.MethodsA written questionnaire that asked about types of measurement devices, number of measurements used to obtain an average BP, resting time prior to measurement, and measurement methods when patients’ arms were covered with thin (eg, a light shirt) or thick sleeves (eg, a sweater) was administered.Main outcome measureProportion of geriatric health service facilities adherent to BP measurement guidelines.ResultsThe response rate was 63.2% (443/701). Appropriate upper‐arm BP measurement devices were used at 302 facilities (68.2%). The number of measurements was appropriate at 7 facilities (1.6%). Pre‐measurement resting time was appropriate (≥5 minutes) at 205 facilities (46.3%). Of the 302 facilities that used appropriate BP measurement devices, 4 (1.3%) measured BP on a bare arm if it was covered with a thin sleeve, while 266 (88.1%) measured BP over a thin sleeve. When arms were covered with thick sleeves, BP was measured on a bare arm at 127 facilities (42.1%) and over a sleeve at 78 facilities (25.8%).Conclusions BP measurement guidelines were not necessarily followed by long‐term care service facilities in Japan. Modification of guidelines regarding removing thick sweaters and assessing BP on a visit‐to‐visit basis might be needed.

Life-space and Related Factors for the Elderly in a Geriatric Health Service Facility.

To investigate (1) the concurrent validity of the Nursing Home Life-Space Diameter (NHLSD) and the Home-based Life-Space Assessment (Hb-LSA), (2) the correlated factors of life-space, and (3) the factors that affected the NHLSD score for the elderly in a geriatric health service facility, or Roken. This cross-sectional study included 32 participants in a Roken. Staff members, who had received essential guidance for assessment, examined the cognitive function, physical function, mood, communication ability, objective quality of life, vitality, and daily behavior of the participants. Correlation analysis between NHLSD and other measurements and multiple regression analysis with NHLSD as a dependent variable were conducted. NHLSD and Hb-LSA were significantly correlated (r=0.710, P<0.01). NHLSD was significantly correlated with more measurements than Hb-LSA was; i.e., NHLSD was significantly correlated with communication ability, independence of daily living (Barthel Index; BI), maximum knee extension strength, grip strength, function in daily living, and three QOL measurements: positive affects, ability to communicate, and spontaneity and activity. A stepwise multiple regression analysis indicated that the BI total score, the maximum knee extension strength, and spontaneity and activity (one of the QOL items) were significantly correlated with the NHLSD score. NHLSD can measure the mobility levels of elderly persons in Roken. In addition to physical conditions and dependence of ADLs, spontaneity (or low levels of apathy) may be an important factor for promoting physical activity in Roken.

Perceived Difficulties and Challenges of Nurses Providing Terminal Care at Geriatric Health Service Facilities

Perceived Difficulties and Challenges of Nurses Providing Terminal Care at Geriatric Health Service Facilities

The relationship between functions provided by geriatric health services facilities in a community and the development status of senior housing

The relationship between functions provided by geriatric health services facilities in a community and the development status of senior housing

Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

Association of physical activity with a systolic blood pressure difference between arms in older people.

A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2018; 18: 95-100.

ケア実践者が認識する介護老人保健施設における認知症高齢者の「拒薬・拒食・拒絶」の現状

ケア実践者が認識する介護老人保健施設における認知症高齢者の「拒薬・拒食・拒絶」の現状

介護老人保健施設における看護職,介護職,リハビリテーション職,および支援相談員の在宅支援行動

介護老人保健施設における看護職,介護職,リハビリテーション職,および支援相談員の在宅支援行動

CHANGE OF FUNCTION AND PARTICIPATION DURING AND AFTER THE STAY IN THE NURSING HOME USING THE ICF

ICF staging is a set of simple scales using ICF codes hierarchically arranged to a Guttman-type scale. The high validity of the scales with its high sensitivity and specificity to change enables us to measure the functional change of the elderly person over time; This study shows the change of function and participation for senior persons during their stay in the geriatric health services facilities in Japan (Roken facilities) after their return to home. The participants were elderly persons newly admitted to the 177 Roken facilities that provides geriatric rehabilitation. The measurement included physical functions, activity and participation, behavior. This study measures continuously six times per person: on admission, just after returning home from the facility, after one week, one, three and nine months after returning home. Related items are summed to obtain reference scores which were tested using the generalized linear model. Of 504 elderly person volunteered in the initial survey, 474 persons completed the one-month follow-up and 195 persons completed all five follow-ups. Although elder persons’ functions and participations improved during their stay at Roken facilities, most of the functions began to deteriorate after discharge. In contrast, their social participation was maintained throughout the period after they returned home. Therefore, this study suggested the benefit and limitation of the geriatric rehabilitation. This result affirmed the sensitivity of the ICF scales to capture changes in various functional domains.

Variations in status of preparation of personal protective equipment for preventing norovirus gastroenteritis in long-term care facilities for the elderly.

Residents of long-term care facilities are highly susceptible to norovirus gastroenteritis, and each facility is concerned about the need to implement norovirus infection control. Among control measures, personal protective equipment (PPE), such as disposable gloves and masks, plays a major role in reducing infectious spread. However, the preparation status of PPE in facilities before infection outbreaks has not been reported. The aim was to clarify the implementation status of preventive measures for norovirus gastroenteritis and the cost of preparing the necessary PPE in long-term care facilities. A questionnaire survey of facilities affiliated with the Kyoto Prefecture and Osaka Prefecture branches of the Japan Association of Geriatric Health Services Facilities was conducted. The survey items were the characteristics of the facility, whether preventive measures had been implemented for norovirus gastroenteritis from October through the following March in both 2009 and 2010, and the quantities and unit prices of PPE prepared for preventive measures. Twenty-six (11.2%) of 232 surveyed facilities (as of August 2011) answered the survey. Among them, 24 (92.3%) in 2009 and 25 (96.2%) in 2010 reported having implemented preventive measures for norovirus gastroenteritis, while 21 facilities (80.8%) in 2009 and 22 facilities (84.6%) in 2010 had prepared PPE. The median total cost for preparing the PPE needed for the preventive measures was US $2601 (range US $221-9192) in 2009 and US $3904 (range US $305-6427) in 2010. Although the results need careful interpretation because of the low response rate, most of the surveyed long-term care facilities had implemented preventive measures for norovirus gastroenteritis. However, the cost of preparing the PPE needed for the preventive measures varied among the facilities.

End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

Effect of waxy barley, Kirarimochi, consumption on bowel movements of late-stage elderly residents at Roken nursing home

BackgroundIt is very important for the late-stage elderly to have the least stressful bowel movements for maintaining a good quality of life. It is generally accepted that consuming adequate dietary fiber is a promising method for the prevention and management of stressful bowel movements such as those during constipation. Therefore, we examined the effect of long-term consumption of waxy barley, which is high in dietary fiber, on the bowel movements of the late-stage elderly living at Roken nursing home (a geriatric health services facility), Japan.MethodsWe compared the defecation and laxative administration frequencies of the subjects before and after waxy barley consumption, for which we served 28 residents a boiled mixture of rice and waxy barley (variety name, Kirarimochi) as the main meals for 5 months, from November to March. In October, all residents were served boiled rice as the main meals.ResultsThe residents were categorized into “constipated” subjects and “non-constipated” subjects according to their weekly defecation frequency during October. Among the 14 residents categorized as constipated subjects, monthly number of days with defecation in November, January, and March significantly increased in comparison to monthly number of days with defecation in October. In addition, monthly number of days with laxative administration significantly decreased in December and February in comparison to monthly number of days with laxative administration in October. In contrast, the defecation and laxative administration frequencies did not change after waxy barley consumption among the 14 residents categorized as non-constipated subjects.ConclusionsConsumption of waxy barley, Kirarimochi, for 5 months improved the bowel movements of the constipated subjects; however, the consumption had no effect on the bowel movements of the non-constipated subjects at Roken nursing home. These results indicate that consuming waxy barley, Kirarimochi, is beneficial for the management of constipation in the late-stage elderly residents at Roken nursing home.

The Influence of Behavioral and Psychological Symptoms of Dementia on the Autonomic Nervous System

Stress is one of the most potent of many factors that can cause expression of behavioral and psychological symptoms of dementia (BPSD). Stress can also increase autonomic nervous activity. This study aimed to examine the relationships between BPSD and autonomic function in the elderly with dementia. We recruited 35 participants diagnosed with dementia from nearby geriatric health service facilities. The Neuropsychiatric Inventory was used for the evaluation of BPSD, and a TAS 9 VIEW (manufactured by YKC) was used for the heart rate variability analysis to measure autonomic nervous system activity. We constructed a model in which the autonomic nervous system comprised a category and performed a structural equation modeling analysis to calculate the standardization coefficient and correlation coefficient for each factor. The results showed that the influence of BPSD resulted in suppression of sympathetic and enhancement of parasympathetic nervous system activity.

Effects of a Cooking Program Based on Brain-activating Rehabilitation for Elderly Residents with Dementia in a Roken Facility: A Randomized Controlled Trial.

Rehabilitation for dementia is important in Roken Geriatric Health Service Facilities in Japan. This study evaluated the effects of a cooking program as rehabilitation for elderly residents with dementia. We carried out a 12-week cooking program based on the five principles of brain-activating rehabilitation (BAR): fostering a pleasant atmosphere, interactive communication, establishing social roles, giving and receiving praise, and errorless learning. The program was carried out in small groups and consisted of 90-min classes once a week. Participants were 36 elderly residents with dementia (mean 85.4 ± 6.5 years) who were randomly divided into intervention (n = 18) and control (n = 18) groups. The control group participated in recreation and both groups received individual conventional rehabilitation twice a week for 30 min. The effects of intervention were evaluated using nine outcome measures. A total of 29 participants were included in the analysis (two-way analysis of variance). The attendance rate was 86.6% in the intervention group (n = 13). The Yamaguchi Kanji Symbol Substitution Test (executive function) showed significant interaction (F(1, 27) = 4.305, P = 0.048) between the two groups: the control group (n = 16) showed significant deterioration (pre 4.9 ± 5.6 to post 3.0 ± 4.9; P = 0.032). The dementia behavior disturbance scale also showed significant interaction (F(1, 29) = 13.298, P = 0.001): the intervention group (n = 16) showed significant improvement (pre 21.6 ± 12.2 to post 11.4 ± 11.5; P < 0.001). No significant differences were observed in the other outcome measures. Our findings suggest that a cooking program based on BAR can reduce the behavioral and psychological symptoms of dementia and maintain executive function.

The association of change in medication regimen and use of inappropriate medication based on beers criteria with adverse outcomes in Japanese long‐term care facilities

To describe medication use including potentially inappropriate medication (PIM) and examine the association between adverse outcomes and patient factors including PIM use in Japanese elderly patients in long-term care facilities. This was a retrospective cohort study of 470 patients in 53 Geriatric Health Service Facilities and 44 Sanatorium Type Medical Care Facilities for the Elderly Requiring Long Term Care. Standardized forms were used to collect information including oral and parenteral medication use on admission, and 1 month and 3 months after admission. PIMs were determined by the 2003 or 2012 Beers criteria. Adverse outcomes were any medical events leading to emergency department transfer, hospitalization to acute care hospitals or death. A total of 2,227 oral medications and 197 parenteral medications were prescribed for 470 patients on admission. PIM exposure based on the 2003 and 2012 Beers criteria was observed in 11.9% and 37.5%, respectively. Adverse outcomes within 3 months after admission were observed in 8.9% of the entire cohort, and were associated with age, sex, facility type and number of parenteral medications on admission. Adverse outcomes between one and three months after admission were associated with age, sex, number of parenteral medications at one month, and a change in the number of oral and parenteral medications within one month after admission. PIM exposure was not associated with adverse outcomes in any models. Use of PIM was prevalent in long-term care facilities. Our findings support the importance of comprehensive assessment of medication regimens including parenteral medication. Geriatr Gerontol Int 2017; 17: 591-597.