Geriatric Health Services Facilities Research Articles

Role Expectation of Nurse Managers in Geriatric Health Services Facilities

Back ground: The characteristics of geriatric health services facilities (GHSF) in Japan include provision of care focused on the life of the residents, and there is a need for cooperation between care workers and physical therapists responsible for the care. Thus, it is expected that a nurse manager occupies specific roles suited for the above characteristics that are different from those of medical facilities. Thus, we aimed to clarify the role expected of nurse managers via a questionnaire survey administered to nurses and care workers in GHSF. Methods: We used a descriptive, cross-sectional design. The study was conducted in 56 GHSF all over Japan. The instrument used for data collection was a questionnaire. The questionnaires consisted of 35 items for determining role expectation of nurse managers, the background information of respondents. The role of nurse managers was analyzed using principal factor analysis (promax rotation). Findings: A total of 259 nurses and care workers participated in this study. We extracted 34 items by factor analysis, which were classified into three factors (promotion of home nursing, management of medical care, and environment creation for collaboration and education). Among care workers, four factors consisting of 33 items were extracted. Factors one, two, and three were similar to those of nurses; “intervention to ethical problem” was extracted as the additional fourth factor. Conclusion: The roles required for nurse managers in GHSF are the promotion of home nursing, which is the original role of the health services facilities, exhibition of the specialty as a healthcare professional, creation of a work environment that promotes mutual understanding for collaboration with other professionals, and enhancement of the education and training system.

Dysphagia Assessed by the 10-Item Eating Assessment Tool Is Associated with Nutritional Status and Activities of Daily Living in Elderly Individuals Requiring Long-Term Care.

The 10-item Eating Assessment Tool (EAT-10) is a self-administered questionnaire for dysphagia screening, with each item scored from 0 to 4. We assessed the associations among the EAT-10 score, nutritional status and activities of daily living (ADL) in elderly individuals requiring long-term care. Cross-sectional study. Geriatric health services facilities, acute hospitals, and the community. Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=237). The EAT-10, the Mini Nutritional Assessment Short Form (MNA-SF) and the Barthel Index. There were 90 males and 147 females. Mean age was 82 ± 8 years. Eighty-nine were in geriatric health services facilities, 28 were in acute hospitals, and 120 were community-dwelling. The median Barthel Index score was 55 (interquartile range: 25, 80). The median EAT-10 score was 1 (interquartile range: 0, 9), and 101 respondents a score > 3, indicating the presence of dysphagia. The MNA-SF revealed that 81 were malnourished, 117 were at risk of malnutrition, and 39 had a normal nutritional status. The Barthel Index score and MNA-SF score were significantly lower in those with an EAT-10 score between 3 and 40, compared to those with an EAT-10 score between 0 and 2. The EAT-10 has an independent effect on the Barthel Index and the MNA-SF by adjusting for covariates such as age, gender, and setting in multiple regression analysis. Dysphagia assessed by the EAT-10 is associated with nutritional status and ADL in elderly individuals requiring long-term care.

Factors associated with the prognosis of elderly patients with advanced dementia who receive palliative care from geriatric health services facilities.

The aim of the present study is to identify the factors associated with the prognosis of advanced dementia patients who are newly admitted to a geriatric health services facility. This retrospective cohort study used data that were obtained on admission in the care-assessment of long-term care facility patients. The 177 participants with advanced dementia were admitted to our facility between 2006 and 2013. The association between the factors in the care-assessment and the three-month-mortality rates were examined throughout the year. At each of the 3-month time points, the mortarity rates of the patients who had total dependence on oral eating or hypoalbuminemia (<3.5 g/dl by BCG method) were significantly higher in comparison to the patients who had neither of these factors. The mortality rates in the patients with a past history of pneumonia (within 3 months) were significantly associated with both factors. At each time point, the three-month-mortality rates showed a significant decrease in the following patients groups (in order): patients with both total dependence on oral eating and hypoalbuminemia, patients with dependence on oral eating or hypoalbuminemia, patients without these two factors. Our results indicate that the factors in the care-assessment. That were associated with the prognosis of patients with advanced dementia on admission may be total dependence on oral eating and hypoalbuminemia. Evaluating the combination of these two factors can be a simple and useful measure to identify advanced dementia patients with a high risk of death who receive palliative care in a geriatric health services facility.

介護老人保健施設から在宅復帰するための要因

介護老人保健施設から在宅復帰するための要因

Computer Simulation Teaching Materials in the Framework of Behavior Analysis to Teach Care Workers at a Geriatric Health Service Facility Easier Ways to Move Patients

Computer Simulation Teaching Materials in the Framework of Behavior Analysis to Teach Care Workers at a Geriatric Health Service Facility Easier Ways to Move Patients

Characteristic Autonomic Nervous Activity of Institutionalized Elders with Dementia

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = -2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05); however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = -0.55 to -0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= -0.32, p < 0.001) and 1 PD (r = -0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care.

Anma massage (Japanese massage) therapy for patients with Parkinson's disease in geriatric health services facilities: Effectiveness on limited range of motion of the shoulder joint

To determine the efficacy of Anma massage therapy for patients with Parkinson's disease (PD) in geriatric health services facilities. (1) Immediate treatment effects: 10 PD patients, in the intervention period with Hoehn and Yahr (H&Y) scale at stage 5, received 30-40min sessions of Anma massage therapy. In the non-intervention period, six PD patients did not undergo this therapy. The shoulder joint range of motion (ROM) was measured before and after each session. (2) Continuous treatment effects: Six PD patients in the intervention period received the same massage sessions once a week continuously for seven weeks. One week after the completion of the treatment, the ROM of the shoulder joints was measured. (1) Shoulder abduction on the more affected side showed immediate significant improvements. (2) Shoulder abduction on the more affected side and less affected side showed notable effects of continuous treatment procedure leading to significant improvement. The above results suggested the efficacy of successive Anma massage therapy.

The occurrence of visual and cognitive impairment, and eye diseases in the super-elderly in Japan: a cross-sectional single-center study.

Background The current state of eye diseases and treatments in the elderly as well as the relationships between dementia and systemic diseases remain unclear. Therefore, this study evaluated the prevalence of eye diseases, visual impairment, cognitive impairment, and falls (which are an important health issue and are considered one of the Geriatric Giants) in super-elderly people in Japan.Methods The subjects were 31 elderly people (62 eyes; mean age: 84.6 ± 8.8 years; age range 61–98 years) who were admitted to a geriatric health services facility. Eye treatment status, systemic diseases, dementia, and recent falls were investigated. Eye examinations including vision and intraocular pressure measurement, and slit-lamp biomicroscopy were conducted.ResultsMean best corrected visual acuity (logMAR) was 0.51 ± 0.56, and mean intraocular pressure was 13.7 ± 3.5 mmHg. Approximately half of the subjects exhibited excavation of the optic nerve head including cataracts and glaucoma. Ten subjects had visual impairment (i.e., visual acuity of the eye with the better vision <20/40). The mean Hasegawa dementia scale scores between the visually impaired and non-visually impaired groups were 10.2 ± 6 and 16 ± 8 points, respectively (p < 0.05). Furthermore, 70 % of subjects with visual impairment experienced a fall in the past year compared to 48 % of those without visual impairment, although the difference was not significant. Regarding systemic diseases, there were 6, 5, and 15 cases of diabetes, hyperlipidemia, and hypertension, respectively. There was no significant difference between these systemic diseases and visual function after adjusted for age and gender.ConclusionsThe percentages of patients with age-related eye diseases and poor visual acuity in a geriatric health services facility were extremely high. Compared to those without visual impairment, those with visual impairment had lower dementia scores and a higher rate of falls.

Neck Circumference Is Not Associated with Dysphagia but with Undernutrition in Elderly Individuals Requiring Long-term Care.

The purpose was to assess the association between neck circumference, dysphagia, and undernutrition in elderly individuals requiring long-term care. Cross-sectional study. Geriatric health services facilities, acute hospitals, and the community. Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=385). Neck circumference, the Dysphagia Severity Scale (DSS) and the Mini Nutritional Assessment Short Form (MNA-SF). Participants included 130 males and 255 females with a mean age (± standard deviation) of 83 ± 8.0 years. Sixty-six were in acute hospitals, 195 were in geriatric health services facilities, and 124 were community-dwelling. The mean neck circumference in males and females was 37.1 ± 3.0 cm and 33.3 ± 3.3 cm, respectively. Based on the DSS, 81 participants were within normal limits, 137 had dysphagia without aspiration, and 167 had dysphagia with aspiration. The MNA-SF revealed that 173 were malnourished, 172 were at risk of malnutrition, and 40 had a normal nutritional status. Neck circumference was not significantly correlated with the DSS (r=-0.080) but was significantly correlated with the MNA-SF (r=0.183) in the Spearman rank correlation analysis. In the logistic regression, neck circumference was not independently associated with the DSS after adjusting for the MNA-SF, the Barthel Index, age, sex, setting, and cerebrovascular disorders. However, the multiple regression analysis showed that neck circumference had an independent effect on the MNA-SF after adjusting for the Barthel Index, age, sex, setting and cerebrovascular disorders. Neck circumference is not associated with dysphagia but with undernutrition in elderly individuals requiring long-term care.

Variance of divided step length in relation to walking speed in the elderly in a geriatric health services facility

Variance of divided step length in relation to walking speed in the elderly in a geriatric health services facility

Characteristics of Geriatric Health Service Facilities Designated as Sites of Death

There are many deaths occurring among the aged population in Japan. Geriatric Health Service Facilities (GHSFs) are highlighted as some of the chosen facilities designated as sites of death. The aim of our study was to clarify the characteristics and related factors, including physical signs first noticed by staff at the end-of-life period, in GHSFs designated as sites of death, using a nationwide survey in Japan. We administered a questionnaire to 3971 GHSFs in Japan. Eligible responses for the study were obtained from 854 GHSFs. We found that GHSFs designated as sites of death were more likely to have basic policies and documented preferences regarding end-of-life care. We also found that staff members in GHSFs designated as sites of death were less likely to first notice physical signs of pain. We found that GHSFs designated as sites of death tended to identify earlier symptoms, such as reduced oral intake and less vigor. Our results would enable elderly persons, their families, and staff in GHSFs to prepare for the elderly’s death more efficiently though earlier identification of the end-of-life period. We hope that GHSFs have an important role to play in end-of-life care provision to elderly persons in Japan, through the strengthening of these intermediate facilities.

Efforts made by nurse administrators during end-of-life care at geriatric health service facilities

Efforts made by nurse administrators during end-of-life care at geriatric health service facilities

介護保険施設における腹膜透析療法の受け入れに関する実態調査

介護保険施設における腹膜透析療法の受け入れに関する実態調査

Features of the role definition activity of nurses at geriatric health services facilities

Features of the role definition activity of nurses at geriatric health services facilities

認知症高齢者のBPSDに向き合える力を育むための ケアスタッフの教育に向けて −介護老人保健施設におけるBPSDサポート尺度 簡略版を用いたフィールド調査から−

認知症高齢者のBPSDに向き合える力を育むための ケアスタッフの教育に向けて −介護老人保健施設におけるBPSDサポート尺度 簡略版を用いたフィールド調査から−

施設版FIM（Geriatric Health Services Facility version Functional Independence Measure ; G-FIM）の実用性の検討

〔目的〕施設版FIM（geriatric functional independence measure：G-FIM）を作成し，その実用性を検討することとした．リハビリテーション職と介護職からのアンケート調査を元に行った．〔対象〕老健施設に所属するリハビリテーション職14名と介護職16名とした．〔方法〕両職業において，G-FIMとFIMとの間で，時間の早さ・使いやすさ・理解しやすさ・適切さの4項目の評価得点を比較した．〔結果〕リハビリテーション職ではFIMとG-FIMの間に有意な違いは見られなかったが，介護職では全ての項目でG-FIMの方が有意に高い得点を示した．〔結語〕G-FIMは介護職に対しては施設における利用者のADL評価を実施するうえで実用性をもつ評価尺度であることが示唆される．

PP148-SUN: Activities of Daily Living are Associated with Nutrition Status in the Elderly Admitted to Geriatric Health Services Facilities

PP148-SUN: Activities of Daily Living are Associated with Nutrition Status in the Elderly Admitted to Geriatric Health Services Facilities

Development of a staging classification for leisure activities and social communication in dependent elderly persons

The aim of this study was to develop a simple staging classification to measure leisure activity and social communication among the elderly at geriatric health care facilities. In order to construct a staging scale for measuring the participation of the elderly subjects, we developed a list of 28 items for three domains: leisure activities, social participation and communication. Data were obtained from users of institutional and day care services at geriatric health service facilities. The Rasch model was applied to test the degree of item fit and difficulty. Simple staging scales were constructed based on 12 leisure activity and nine social communication items. The validity and reliability were tested using these newly developed scales according to the Rasch model and assessments of the test-retest reliability. The participants were 3,458 elderly persons, of whom 1,560 were currently using institutional services and 1,898 were using day care services. Among the 28 items, "traveling" was identified as the most difficult and "watching television" was identified as the easiest. Because items related to "social participation," such as volunteer activities, exhibited a low frequency, they were not used in the further analyses. Simple staging scales were constructed by analyzing the remaining items of leisure activities and social communication according to the Rasch model. The thresholds within the scales were determined in order of item difficulty. Cohen's kappa, as assessed by two different evaluators, was 0.75 for leisure activities and 0.77 for social communication. In this study, we developed staging scales for leisure activity and social communication. The construct validity and test-retest reliability were adequate for both scales. Service providers can improve service quality by using these scales for individual case management of elderly persons in conjunction with existing scales of activities of daily living.

Development of an Exercise Support System for the Elderly Which Uses a Small Humanoid Robot

The increasing number of senior citizens who need long-term care or rehabilitation has become a serious issue, especially considering the increasing aging population and declining birthrate. To maintain one’s motor functions and improve one’s muscle strength or range of motion, it is important to continue exercising constantly. We have developed a prototype exercise support system that aim to promote and evaluate exercise of users. This system includes a small humanoid robot presenting the exercises, amotion sensor, a touch panel, a laptop PC to control other devices, and other parts. We propose a method of detecting the specific poses of the users from the skeleton data of the motion sensor. We use a questionnaire to evaluate the system’s effect on the promotion of exercise and the users’ understanding of the movements of the robot, and we use a motion sensor to evaluate motion recognition of the users during the exercises. The system is tested by young people and also elderly staying in a geriatric health service facility. The questionnaire results indicate that the elderly subjects react positively to the exercises. The pose detection method shows a correct answer rate of 94% for the young subjects and 87% for the elderly subjects. It is confirmed that the prototype system can be put into practice use.

介護施設 (老人保健施設、特別養護老人ホーム、有料ホーム、グループホーム等) における胃瘻管理に関する現状と課題:栄養管理と地域の連携 (第1報)

介護施設 (老人保健施設、特別養護老人ホーム、有料ホーム、グループホーム等) における胃瘻管理に関する現状と課題:栄養管理と地域の連携 (第1報)