Aim: The purpose of this study was to clarify the relationship between physical restriction as a nursing practice and the perceived extent of person-centered care towards elderly patients with cognitive impairment in acute care hospitals (SSNPEC).
Research methods: This study was conducted on ward nurses in 4 hospitals (nursing staff ratio of 7:1; >500 beds) in H city from April 2016 to March 2017. The evaluation of physical restriction in the hospital comprised the following six items: the use of trunk belts, wearing of mitten-type gloves, the use of shoulder harnesses (such as for patients in wheelchairs), wearing care clothes, the use of a bed fence, and psychotropic drugs. In the multiple regression analysis, the total physical restriction score was the dependent variable. Results pertaining to the prediction of physical restriction were as follows: "Care that values psycho-social approaches based on predicted potential problems", "Care that is tailored to the individual and their cognitive function", and "Improvement in the quality of the care" significantly decreased physical restrictions.
Conclusion: This study showed that nursing practices in acute care hospitals that are based on person-centered care emphasizing clinical ethics decreased the application of physical restrictions. A balance existed between safety management through nursing practices and respect for patients in acute hospitals.
Aim: To demonstrate the usefulness of a virtual reality device that authentically portrays the emotions of dementia patients and their families (VR Dementia Experience) for encouraging an understanding of and reducing and eliminating prejudice towards dementia patients among local residents.
Method: In Prefecture T, Town N, 85 residents of Neighborhood A were chosen as the intervention group, and 95 residents of Neighborhood B were chosen as the non-intervention group. The VR Dementia Experience was provided only to the residents of Neighborhood A. Residents of both neighborhoods completed a 35-item questionnaire regarding their degree of understanding and prejudice towards dementia patients before and after the intervention.
Results: Seventy-seven residents of Neighborhood A and 82 residents of Neighborhood B were analyzed. Their gender, age, and pre-intervention test baseline values were equivalent in the degree of understanding and prejudice. Significant increases were observed in 9 of 35 items for Neighborhood A residents (7 understanding-related, 2 prejudice-related) and 2 items for Neighborhood B residents (1 understanding-related, 1 prejudice-related). To ascertain the usefulness of the VR Dementia Experience, we compared the number of items with a significant increase: 9/35 (25.7%) in Neighborhood A and 2/35 (5.7%) in Neighborhood B. An effect (≥ 20%) was observed among the residents of Neighborhood A. Furthermore, after exposure to the VR Dementia Experience, the connection between understanding, prejudice, and dementia was strengthened among the residents of Neighborhood A compared to the residents of Neighborhood B.
Conclusion: The VR Dementia Experience is a useful tool for encouraging an understanding of and reducing and eliminating prejudice towards dementia patients among local residents. However, to encourage the widespread usage of the technology, we should compare results with other public awareness campaigns as well as make improvements to the device and its VR content.
Aim: There are few studies concerning the classification of fall risk by nurses without established fall risk assessment tools. In the present study, clinical classification of fall risk using visually obtained information was compared with the assessment of fall risk in order to evaluate the rationale and validity of the clinical classification of fall risk by nurses.
Methods: New patients who visited the center of comprehensive care and research for memory disorders at the National Center for Geriatrics and Gerontology were enrolled in the present study.
Day-shift nurses separately recorded the clinical classification of fall risks through visually obtained information during the 10-minutes waiting time for outpatients.
Fall risk assessments such as the Fall Risk Index and Timed Up & Go test, were performed by non-nurse medical staffs. Data were analyzed by an independent researcher who was not involved in obtaining clinical information.
Results: Nurse's clinical classification of fall risk using visually obtained information correlated well with Fall Risk Index, Timed Up & Go test, One-leg Standing test and Dorsiflex meter. In addition, subjects classified as having high fall risk were more frequently judged to be frail than classes of moderate or little fall-risk.
Conclusion: Nurse's clinical classification of fall risk using visually obtained information was judged on their integrated impression including their evaluation of the muscle strength, gait speed and balance.
Aim: The effect of polypharmacy on the surviral-time in patients with dementia has never been fully elucidated.
Methods: A retrospective study was conducted in a hospital in Aichi, Japan, by reviewing the medical charts and autopsy reports. Patients were hospitalized and neuropathologically diagnosed with dementia. The data on medication was collected from the prescribed drugs taking right before the admission. Patients were divided into two groups according to the number of prescribed drugs: ≥ 5 drugs (polypharmacy) vs. ≤ 4 drugs (non-polypharmacy). "Drugs to be prescribed with special caution" were defined in accordance with the guidelines for medical treatment and its safety in the elderly (2015).
Results: Seventy-six patients were eligible, and 39.5% of patients had polypharmacy. The Kaplan-Meier method showed that the polypharmacy group tended to have a shorter survival-time than the non-polypharmacy group (p=0.067). A Cox proportional hazard model showed that the polypharmacy group tended to have a higher risk for a reduced survival-time than the non-polypharmacy group, and this tendency was more prominent after adjusting for sex and age at admission (adjusted hazard ratio, 1.631; 95% confidence interval, 0.991-2.683; p=0.054). "Drugs to be prescribed with special caution", including hypnotic-sedative drugs, antianxiety drugs, antipsychotics, and benzodiazepines, were not found to be risk factors for a reduced survival-time.
Conclusions: The present study showed that polypharmacy in terminal patients with dementia tended to carry a risk for reducing their remaining lifespan. The results warrant further additional study.
Purpose: The aim of this study was to determine the reference values for diagnosing sarcopenia using the five-repetition sit-to-stand test in elderly inpatients with cardiac disease.
Methods: We studied 71 inpatients with cardiac disease ≥65 years of age (mean age 78.0±7.9 years, 42.3% women) who were admitted between April 2015 and March 2016. Patients were assessed for sarcopenia, and we performed the five-repetition sit-to-stand test. We defined sarcopenia using the Asian Working Group for Sarcopenia-suggested diagnostic algorithm. A logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationship between sarcopenia and the five-repetition sit-to-stand test. A multivariate analysis showed that the age, admission diagnosis, the New York Heart Association classification, the Charlson comorbidity index, and the ratio of extracellular to total body water were relevant covariates. The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was determined using a receiver operating characteristic curve.
Results: Sarcopenia was diagnosed in 25 patients (35.2%). A multivariate logistic regression analysis showed that the five-repetition sit-to-stand test was significantly associated with sarcopenia (p=0.024), and the OR (95% CI) was 1.31 (1.04-1.65). The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was 10.9 s (sensitivity 80.0%, specificity 70.0%, area under the curve 0.83).
Conclusions: The five-repetition sit-to-stand test is a useful screening tool for sarcopenia in elderly inpatients with cardiac disease. The cut-off value to diagnose sarcopenia was 10.9 s in this study.
Aim: We aimed to investigate the relationship between the frequency at which patients went out and the reduction of meal intake among older outpatients who did not require care.
Methods: The subjects were outpatients of ≥65 years of age who visited the department of geriatric medicine in our hospital for the first time. We analyzed 463 subjects (male, n=184; female, n=279), after excluding patients who had dementia, required care, lived in a nursing home, or had an acute disease.
The outcome measure was the reduction of meal intake (a moderate or higher decrease in the patient's meal intake in the past 3 months). The independent measure was homebound status (going-out less than once a week). The covariates were sex, age, number of medications, and Kihon Checklist (categories of undernutrition, oral function, physical function, and mood). A logistic regression analysis was performed.
Results: The average age was 79.6±5.9 years in men, 79.9±6.1 years in women. Among the participants, 104 (22.5%) had a homebound status. In the logistic regression analyses, a homebound status was significantly associated with a reduction in meal intake, even after adjustment for potential confounding factors, including depressive mood and a low physical function (OR: 2.0; 95% CI: 1.1-3.6).
Conclusions: A homebound status in older outpatients was related to a decline in their meal intake, independent of depressive mood and a low physical function. A reduction in meal intake leads to a lack of energy and results in malnutrition. Our results suggest that assessing the frequency at independently living older outpatients go out is important for the early prevention of malnutrition.
Objective: Evaluation the activities of the dementia support care team (D-CAST).
Method: A total of 350 patients received intervention from the D-CAST from January 1, 2017, to December 31, 2017. At the beginning and end of the team intervention, the following items were evaluated: changes in the degree of life independence, period (days) from hospitalization to team intervention, request for team intervention, and duration of hospitalization.
Results: The average age of the 350 patients in this study was 81±9 years old. The major diseases causing hospitalization were heart failure in 94 patients (27%) and aortic valve disease for transcatheter aortic valve implantation (TAVI) in 45 patients (13%). The main reasons for requesting team intervention were cognitive impairment in 40% and delirium (prevention included) in 36%. Regarding the change in the degree of life independence, 29 people saw improvement (16%), 165 maintained their degree of independence (66%), and 46 experienced a decrease (18%). The team intervention was delayed as criteria for degree of independence of everyday life was lower for mild patients.
Conclusion: We need to learn how to assess dementia patients with relatively mild life independence (potentially including mild cognitive impairment).
Coagulation disorders due to some antibiotics containing N-methyl-thiotetrazole group and vitamin K (VK) deficiency by microbial substitution in the intestinal flora can occur. We report a case of coagulation disorder under fasting with conventional antibiotics which are not containing N-methyl-thiotetrazole. A 91-year-old man was hospitalized for diagnosis of acute exacerbation of chronic heart failure because of bronchitis. He received treatment of fasting, fluid replacement, antibiotics, and a diuretic. On the 3rd day, left frontal lobe bleeding occurred. We performed conservative treatment with central venous nutrition not containing VK. Administration of antibiotics was completed after 14 days. On the 28th day, catheter-related bloodstream infection developed. Vancomycin and cefazolin were administered. The prothrombin time-international standard ratio (PT-INR) on the 1st day of administration was 1.2; however, it gradually increased to 7.4 on the 7th day of administration. Menatetrenone and fresh frozen plasma were administered as symptomatic treatment. Vancomycin was discontinued because a blood culture was positive for methicillin- susceptible coagulase negative Staphylococcus (CNS). After the 8th day of administration, the PT-INR improved to 1.1, but it increased to 1.9 on the 14th day. VK deficiency due to the antimicrobial drug was predicted. Therefore, VK and fresh frozen plasma were re-administered to improve the PT-INR. The PT-INR returned to normal after administration of cefazolin was terminated. Antimicrobial administration in the long term under the fasting condition can suppress endogenous production of VK by changing intestinal bacteria. And it has been reported that cefazolin which containing Methyl-thiadiazole thiol inhibits VK metabolic cycle and causes coagulation disorder. These reasons seems to a coagulation disorder. Therefore, physicians should monitor the coagulation system in this situation.