Purpose: To develop effective nursing of delirium in elderly cerebral infarction patients receiving medical management who were hospitalized within the first 7 days of the cerebral infarction, the authors investigated risk factors related to development of a state of delirium on the first day of hospitalization and factors influencing the state of delirium within the first 3 days after hospital admission. Method: Participants comprised 50 patients aged ≥65 years in five hospitals. Inclusion criteria were as follows: receiving medical management of the cerebral infarction, hospitalized within 7 days after appearance of cerebral infarction symptoms, no aphasia, consciousness level on admission of I-3 as classified by the Japan Coma Scale single-digit code range, and agreement to participate in the study. Participants' state of delirium was assessed daily with the Japanese version of the NEECHAM Confusion Scale (evaluation scale). We examined 25 items related to factors of delirium. Results: The incidence of delirium was 22.2%. Results of logistic regression analysis showed that three factors related to incidence of delirium: stroke location in the right hemisphere (OR=7.594, 95% CI=1.287-44.811, p=0.025), a ≥1-day period from the onset of cerebral infarction to hospitalization (OR=0.090, 95% CI=0.110-0.771, p=0.028), and C-reactive protein on admission outside the reference value (OR=8.631, 95% CI=1.244-59.888, p=0.029). Latent Curve Model identified four factors influencing the evaluation scale score: arrhythmia present on admission, C-reactive protein value on admission, manual muscle testing score of ≤2 on admission, and level of pain on admission. The level of pain on admission influenced the slope. Conclusion: The results suggested that cerebral infarction condition immediately after hospitalization, circulatory dynamics, signs of inflammation, and chronic pain contribute to determining aged patients at high risk for onset of delirium, and management of these factors may lead to the prevention of delirium onset and exacerbation of symptoms.

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The purpose of this study was to clarify how nursing staff and care staff recognize the necessity of cooperation in dietary care for the elderly with dementia at a special elderly nursing home (hereinafter called "Tokuyo"). We conducted a survey by interviewing nurses and certified care workers at Tokuyo about their experiences in cooperatively performing dietary care for elderly residents with dementia, and performed qualitative analysis based on the obtained data. Both nurses and certified care workers agreed that cooperation between the two job categories was necessary when working with elderly people who are unable to eat. Nurses recognized the necessity of cooperation by saying, "Care staff members should be advised based on medical assessment by the nursing staff on how to help prevent such problems as aspiration and decreased dietary intake." Meanwhile, some certified care workers indicated the necessity of cooperation by saying, "Those who are unable to eat or sometimes experience aspiration should be cared for based on medical assessment by the nursing staff," but others expressed the opinion that "Since the care staff assumes responsibility for giving help with eating, the nursing staff need not assist them on this job." Cooperation between nursing and care staff is essential for providing care according to the individual needs of elderly residents with dementia, and it is also important to discuss methods of cooperation, based on the mutual understanding of each profession's perception of the issues.

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The purpose of this research is to clarify how nurses perceive the words and behaviors of the elderly with dementia and how nurses behave to care for them, by focusing on the caring scenes and the relationship between nurses and the elderly with dementia. The research was conducted by performing a semi-structured interview survey with 10 nurses working in health care facilities for the elderly requiring care and analyzing the results by qualitative and descriptive research method. The words and behaviors of the elderly in the scenes where nurses recognized that caring was successfully performed, were categorized into "he has strong feelings," "there is some meaning in his words and behaviors," "he has a mind common to human beings," "he does not fully exercise his ability," and "he needs amusement." The caring behaviors of nurses who responded to the above were categorized into "response in complying with his will," "response in caring manner," "response in making him incline to," and "response in leading his will to live." The words and behaviors of the elderly in the other scenes, where nurses recognized that caring was unsuccessfully performed, were categorized into : "there is some reason in his words and behaviors," "he has some feelings," and "persons with dementia can sense others' thinking." Whereas, their words and behaviors were recognized as : "he cannot understand because he has dementia." The caring behaviors of nurses responding to the above were categorized into : "response not complying with his wish", "response by saying he has dementia," "response lacking the sense of dignity as a human being." In the environments where individual needs are observed, such as symptoms of the elderly with dementia, requirements during the night, and not fully respondent in the morning, it is sometimes difficult to react to each of them with respect, thinking that he will forget because he has dementia. In any case, this research suggests the need to cultivate an ethical sense for dementia care.

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[in Japanese]

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[in Japanese]

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