The purpose of our study was to clarify a family's decision-making process for conducting a gastrostomy for an elderly patient in a nursing care home for the aged. Our subjects were 18 families of elderly patients in nursing care facilities, faced with the decision as proxies whether or not to perform a gastrostomy for the patients. Semi-structured interviews were done with all subjects for information on the subjects' decision-making process up to the time of and after their choice to proceed with the gastrostomy for the aged family member. The results were analyzed using the modified grounded theory approach method. The results consisted of 18 concepts, 4 sub-categories, and 6 categories. We noted that the decision-making process of the subjects in choosing gastrostomy was comprised of 6 stages: (1) trying "their upmost to be a responsible proxy" as a relative of the elderly patient, through the (2) "resolution of their inner conflict" which arises from a (3) "feeling of fear of the consequences of the patient's inability to eat". The family could then (4) "sense relief from the heavy feeling of responsibility" to allow them make the decision as proxy, further eased by (5) "receiving support for the decision", and finally acknowledge (6) their "desire to keep the elderly relative alive". Our analyses suggest the importance of a nurse's role in helping reduce the emotional conflicts faced by families who make decisions as proxies of elderly patients who have difficulty in eating, and the importance of supporting these families' responsibility.

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This study was performed to determine the changes in vital functions and the factors affecting them in hospitalized elderly patients. The study population consisted of 176 hospitalized patients, 65 years old and without dementia. Patients' vital functions, i.e., cognitive functions, motivation, and activities of daily living (ADL), were evaluated at the time of hospitalization and discharge. The changes before and after hospitalization, and 12 variables affecting these functions, were examined. The results indicated that cognitive function and motivation decreased after hospitalization, but there were no changes in ADL. The factors affecting the decreased vital functions included age, diagnosis and treatment department, and the number of days spent in the hospital. The results of this study suggested that early evaluation of vital functions, and preventative nursing intervention for high-risk patients may be necessary to prevent decreases in vital functions in the elderly during hospital stays.

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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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[in Japanese]

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