It is an essential component for nursing to assess the daily life of home frail elderly, in order to care for them to make the most of their physical ability. The purpose of this study was to know home frail elderlys' time use and find their daily life patterns. And the relationship of their life patterns to ADL (activities of daily living) was explored. Frail elderly was defined as elderly who are independent inside home but need assist when they go out. ADL was measured by Barthel Index and TMIG Index of Competence. Fifty-four home elderlys over 65 years of age were visited by a researcher and detailed time budgets for one full day were obtained from them. The result showed a large proportion of the elderlys' time was spent in resting and watching TV. Five daily life patterns were categorized by their discretionary activity. They were Lying rest pattern, Sitting rest pattern, Hobby pattern, Walking pattern, and Houseworking pattern. The mean score in index of ADL of Houseworking pattern elderly was significantly highest of all, and that of Walking pattern elderly was significantly higher than Lying rest pattern elderly and Sitting rest pattern elderly. The study suggested that it is important for nurses to pay attention to elderlys' discretionary activity and a little change of their daily life patterns to avoid their ADL decline.

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The purpose of this study was to clarify both the current state of elder abuse at home sites and its characteristics varied depending on types of family composition. An inductive qualitative study was conducted on 52 cases cared by nurses of their districts. Those 52 elder abuse cases were collected from the mail survey which was conducted among public health nurses of all districts in Saitama prefecture from May to September 1995. The types of family composition regarding those abuse cases included: 21 families of the elderly, his/her son and the son's wife; 9 families of elderly couple; 5 of the aged living alone; and 17 families of the elderly and his/her single child and other types. The quantitative and qualitative data analysis was made to find out how abuse types were varied due to family composition, and the state of both those abused and being abused. The result showed that the abuse types included: 29 cases of neglect and abandonment; 25 cases of psychological and emotional abuse; and 21 cases of physical abuse. The state of abuse were characterized by both the affectionate state of the family caregivers on the elderly and their capacity for caregiving of each type of families. The result also showed that those cases included four combined patterns of abuse: "neglect", "neglect-isolation", "neglect-isolation-abandonment", "neglect-isolation-abandonment-physical and psychological harm". These findings help nurses support the elderly and their families in order to prevent abuse.

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The purpose of this study is to clarify the relationship between the family caregiver, who is responsible for most of the care burden, and the relatives of the elderly person cared for at home in the urban community. The subujects were comprised of 55 family caregivers of elderly persons at home. The Care Burden Scale (by Nakatani, et al.) was employed to assess the care burden of each family caregiver. The Social support of the Elderly Scale (by Noguchi) was used to assess the degree of positive support in the relationship as perceived by each family caregiver and The Relatives Discord Scale (by Yuki) was used to assess the degree of negative support as perceived by each family caregiver. The results ware as follows: (1) Data documenting perceived positive support showed no significant difference among wife caregivers, daughter caregivers, and daugher-in-law caregivers. (2) The daughter-in-law caregiver group showed significantly higher points, among the three groups in perceived negative support. (3) The relatives discord data demonstrated that as discord among the relatives increased, the care burden for the caregivers also increased. We believe that, in the future, it is necessary to establish a system to support and develop home care for the elderly. The assessment for home care will also be necessary, not only for the care recipient and the care giver, but also to evaluate the family dynamics among the relatives of the elderly.

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The purpose of this study was to clarify the influence of age group of caregiver on stroke victims by investigating family function. A sample of 44 stroke victims with a 2 years disease course and their primary caregivers was obtained. The caregivers were devided into those less than 59 years old (young group, composed of spouses and children), those aged from 60 to 69 years (middle group, mainly composed of spouses), and those over 70 years (old group, mainly composed of spouses). The young age group caregivers were enjoying relative financial conditions. The young group family members helped one another,and this had positive educational effects on the children. The middle group caregivers did not take much advantage of the public support system. The APGAR score was low in the old group caregivers, and especially they enjoyed receiving less emotional support from their neighbors than the other two groups. In conclusion, many changes in family function dependent on the age will occur, therefore we should take this into account when we concerned intervening in case of caregivers to disabled family members.

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A questionnaire survey was given to 138 nursing students to investigate changes in their impressions about elderly people during their clinical practices of geriatric nursing. The questionnaire included 16 questions using the semantic differential (SD) technique aimed at ascertaining students' impressions of elderly people. At the time of our investigation, 27% of the students were living in households containing elderly people. When the students' impressions before clinical practice about elderly people were compared with their impressions after clinical practice, significant differences were seen in their responses to 5 of the 16 questions. The responses to 7 questions suggested that students had more positive impressions about elderly people after clinical practice than before clinical practice. When impressions about elderly people were compared after clinical practice between the students living with elderly people and the students who did not live with elderly people, the differences in impressions between these two groups were significant in four items before clinical practice and in five items after clinical practice. Using the item scores of the impression as dependent variables, the results of an analysis of variance and covariance (ANCOVA) showed that the frequency of the communication with their grandparents was an important factor influencing the nursing students' impression about elderly people before clinical practice. However, the factors were not clear after clinical practice. These results suggest that nursing students' impressions about elderly people changed during their clinical practices of geriatric nursing, and the differences in impressions between these two groups had grown smaller. And these results suggest that making contact with a variety of elderly people will be especially effective for the nursing students in enhancing their understanding of the geriatric population.

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We examined MRSA (Methicillin-resistant Staphylococcus aureus) colonization of the residents, staff and environment at A-Ryo, a home for the aged 3 times. The first examination was performed on 70 residents, 40 staffs and 163 sites of this home on Feb. 13, 1996. All samples were taken by a contact plate method. Of 273 samples, three were MRSA positive, and they had few numbers of MRSA colonies. In addition, all of them were not from persons but from the home environment such as corridor floor. So, the staff stopped doing anything against MRSA contamination on Mar. 1. The second examination was conducted on Mar. 6, and the third on Mar. 13. The MRSA detection rates of the residents and environment were respectively low, and didn't show remarkable change between 2 examinations. However, at the third examination MRSA were detected from the hands of 5 staffs who do bathing for the residents. Therefore, we recommended that staffs should wash their hands and keep bath clean after bathing.

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We conducted a study of eight elderly people at two nursing homes and one hospital to observe their daily rhythms (sleep/activity patterns), and we provided care based on the results of the observation. Four subjects were found to have irregular daily rhythms. We analyzed the characteristics and causes of these irregular daily rhythms, as well as the care provided. The following findings were obtained. (1) There were cases in which the subject's daily rhythm had only slight fluctuations (very little activity). This was characteristic of elderly who are bedridden and totally dependent on others. (2) There were cases in which the cycle of the subject's daily rhythm was disrupted. This is considered to be a common disorder of elderly with dementia. (3) A elderly patient at hospital showed difficulty in forming a regular daily rhythm (set pattern of activity). We believe the patient at hospital have fewer changes and too stimuli in her daily living, and that her physical condition tend to be oversensitive to the hospital environment. (4) We have found that the two nursing homes were offer in good environment for helping elderly people recover their regular daily rhythm. The hospital environment, on the other hand, tends to hamper this recovery. (5) Care which eases pain and provides comfort are considered effective for helping elderly people regain their regular daily rhythms.

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This study examined the relation between characteristics of the care-required aged and home nursing care. Two aims were generated for this study. (1) To consider about home nursing care for the care-required aged. (2) To consider about relation between characteristics of the care-required aged and home nursing care. Subjects were 74 clients who were taking nursing care of visiting nurse station in a prefecture. The results were as follows: (1) Their age was 79±8.3 years; 73% were over 75 years, 58% had cerebral infarction, and 40% were bedbound. And their caregivers age was 61±12.7 years; 60% were over 65 years. Most of the clients and their caregivers were high aged and they have needs for more nursing and home care. (2) Nursing care was related with daily living ability, age of main caregiver and the number of family members. The number of visiting home was correlated with the number of clients with cancer and not the number of family members, daily living ability and a relation of caregiver. It is important that estimating of nursing care from characteristics of their clients and caregivers. Then it will be able to consider about planning care and maintaining the number of staffs.

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The purpose of this study is to assess nursing care among nurses engaged in the care of the elderly in general hospitals. The subjects of the study were 245 nurses in three general hospitals (279 responses; inactive nurses were excluded, leaving 245 registered nurses who were the subjects of this analysis). Three groups were classified among the nurses: A group with less than 3 years experience, B group with 3 to 10 years experience and C group with more than 10years experience. The self-administered questionnaire-survey took place from October to December in 1994 and the following results were obtained: (1) Regular Time Given to Bedpan and Dental Care: Significantly higher results were recorded by C than for A and B. (2) Bed Sore Prevention: Care by keeping the skin clean and dry; results were significantly higher among C than A and B. (3) Patients Welfare: Giving the elderly attention and encouraging their family to visit them in order to support their emotional stability; recorded significantly higher with C than B. (4) Social Welfare: Informing the patient and family about welfare procedures was significantly higher among C than A and B. Recommending the offices of a social worker was common to all. (5) Leaving Hospital: Non-acceptance of discharged patients as the worst problem was reported more significantly among C than A and B group. (6) Nurses' Attitude to Care: Most answered that while there were many difficulties these were not serious obstacles. (7) Further Training: C group wants further instruction in the two categories, the quality of life for the elderly and ADL care, and A and B groups want instruction in many kinds of categories. The results of this questionnaire show that group C (more than 10 years experience) proves that nursing skills are higher with experienced professionals. The necessity to train nurses to be specialists in the many aspects of nursing the elderly, e.g., management, law, coordination, as teaching-staff, etc. is readily observable from the questionnaire answers.

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