BPSD (behavioral and psychological symptoms of dementia) can manifest as a result of many intertwining factors in the elderly with dementia, and it is not at all rare that it manifests in response to the interaction with caregivers. We suspected some kind of behavioral signs may be seen in the elderly with dementia after interaction with caregiver. And we named these behaviors such as anxiety, confusion, restlessness, and giving-up as Disagreement behavioral messages. The characteristics of Disagreement behavioral message were identified and the reactions of caregivers that resulted avoiding BPSD when Disagreement behavioral message occurred were examined. Five disagreement behavioral messages; obeying caregiver, apologizing to caregiver, blaming it on something/someone, shutting-down, and indignation were identified. Behaviors such as obeying caregiver, apologizing caregiver, and blaming it on something/someone are difficult to be read as refusal behaviors, and they were often undetected and let to result in BPSD. BPSD were avoided when those Disagreement behavioral messages were detected by caregivers in early stage of interaction, and care givers shifted interaction approach to "change direction of care," "wait and see mood changes," and "suggest excuse."

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[in Japanese]

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In the present study, we investigated the risk factors and course of postoperative delirium in 144 patients who underwent either carotid endarterectomy or superficial temporal artery to middle cerebral artery bypass for ischemic cerebrovascular disease. We collected information from medical records on 34 items related to the risk factors and course of postoperative delirium. The onset and severity of delirium were determined using the Japanese version of the NEECHAM Confusion Scale. The mean age of the subjects was 65.9±9.1 years, and the incidence of delirium was 33.1%. Analysis using the Akaike information criterion was performed with the onset and severity of delirium as dependent variables for 121 patients. The results suggested that effective explanatory variables for onset of delirium, were the effects of facilitating factors as well as the preoperative status of cerebral blood flow, which is a predisposing factor. On the basis of these findings, we think that nursing intervention can be effective for patients with brain diseases who are considered to have the precipitating factors of delirium physical restraint, the number of catheters, and sleeplessness after the operation. In addition, the effects of disease severity and the extent of surgical invasion were suggestive of the severity of delirium. Delirium is an indicator of somatic abnormalities, and postoperative management of physical health is important for preventing exacerbation of delirium.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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