The purpose of this study is to discover the prevalence of pain among the elderly with dementia as measured by an observational tool known as the Japanese version of the Abbey Pain Scale (APS-J), as well as self-reports of pain provided by the subjects. A survey was conducted between August and October in 2012, which enrolled 131 elderly people with dementia who were staying at a long-term care facility (29 males and 102 females). According to the 104 subjects, who were able to provide self-reports regarding their pain, the prevalence of pain was 25.00% (26/104). According to the APS-J, the prevalence of pain was 25.95% (34/131). With regards to the APS-J scores for "facial expression" and "physical changes", there were significantly more subjects who self-reported an "unknown" regarding their pain, as compared to subjects who self-reported an "absence of pain". The dependent variables included "symptoms common in dementia" (one of the subscales of Gottfries-Brane-Steen Scale to evaluate BPSD) as well as items on irritability, anxiety and depressive mood (items listed under this subscale) and a multiple regression analysis was performed, which revealed that APS-J contributed significantly to the variance in BPSD after controlling for age and MMSE. Based on these results, it was suggested that pain among the elderly with dementia who are incapable of verbally expressing their pain, is not sufficiently assessed. Also, it was suggested that pain among the elderly with dementia could increase BPSD.

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The number of elderly people dying in nursing homes is increasing in Japan. Nurses and other health care professionals must support the caregiving family members of dying residents in providing quality end-of-life care. However, little is known about family caregivers coping with bereavement. This study aimed to explore family caregivers' experiences with frail older adults living and dying in nursing homes. Two to 12 months after the death of elderly residents in three nursing homes in a provincial city, semi-structured interviews with family caregivers were conducted. These interviews were audiotaped, transcribed, and qualitatively analyzed using the phenomenological analysis method of Colaizzi. This study was approved by the Ethical Committee for Epidemiology of Hiroshima University. The participants included 15 family caregivers of 11 elderly nursing home residents. Six themes that characterized family caregivers' experiences with frail older adults living and dying in nursing homes were identified: (1) "Feeling of bonding with the resident," (2) "looking for care that can be provided by themselves," (3) "compromising with the staff and other residents," (4) "experiencing difficulties with decision making regarding medical procedures and the place of death for the loved one," (5) "coping with losing the loved one," and (6) "giving significance to the resident's life and end-of-life care." Nurses should understand the family caregivers' efforts and difficulties because of their feelings of bonding with the resident, and support the family caregivers so that they reflect on their caregiving experiences with a sense of satisfaction after the resident's death.

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The purpose of this study was to clarify the usability of the Nursing Quality Indicator for preventing falls as well as to evaluate their nursing teams by comparing the results between acute hospital and long term care insurance facilities by Dementia Nursing certified nurses. 233 Dementia nursing certified nurses as the subjects of this study were sent a self-administered questionnaire of this indicator. The subjects were 105 people (14 Males and 91 Females) with a response rate of 45.1%. Eighty seven (82.9%) of the subjects belonged to Acute Hospitals and 18 (17.1%) belonged to Long-term Care Insurance Facilities. More than 80% of the subjects agreed that, "This indicator covered important points in all practice of fall prevention for dementia nursing", "If nurses would be able to attend trainings, have education about dementia nursing care in their hospitals/facilities and improvement of the system, they could perform nursing care using this indicator". More than 80% of Dementia Nursing Certified Nurses in Long-Term Care Insurance facilities have already conducted the following indicators: [A: assess risk of falls concerning elderly with dementia], [B: consider the perspectives of elderly with dementia when taking care of them]. Five items such as "We draw the sense of values of elderly with dementia and care about the viewpoint of the person in order to reduce behaviors leading to falls" were significantly high. It was suggested that this indicator has a high usability when used in Long-Term Care Insurance Facilities. However, it needs training and education about dementia nursing.

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The present study aimed to compare the physiological responses and subjective assessments caused by environmental stimuli between young adults and the elderly. Research was conducted using a quasi-experimental design with 30 young adults [mean age 23.2 years, standard deviation (SD) = 4.6] and 30 community-dwelling elderly people (mean age 74.6 years old, SD = 5.7). Data were obtained regarding heart rate variability, skin potential response (SPR), comfort level, and other subjective assessments, following six types of auditory stimuli of specific situations. These included exercising to music, conversations taking place in multiple locations in a common room, white noise, etc. Compared with changes in the non-stimulus, SPR significantly increased with common room conversation (p<0.01) and white noise (p<0.01) for the young adult group, and with ball games/recreation (p<0.01) and traffic/ambulance (p<0.01) for the elderly group. Several characteristics of the response to sounds were clarified for the elderly, including sounds that are more likely to be assessed as comfortable and those that are easier to recall. In addition, the elderly and young adults differed not only in autonomic nervous indicators but also in subjective assessments. While providing environmental care, nurses need to make appropriate judgments that are not overly subjective. Analysis of covariance on each auditory stimulus, with age as a covariate, showed that LF/HF in the hearing impairment group was significantly higher than that of the non-hearing impairment group for common room conversation (p<0.01), etc.

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The purpose of this study was to identify the structure of strengths in elderly individuals with rheumatoid arthritis (RA) that serve as competencies for adapting to life events in old age. Interviews were conducted with 14 elderly individuals with RA. Qualitative descriptive analysis of the data extracted 97 key sentences, 26 subcategories and 13 categories, as competencies that elderly individuals with RA use to manage events in their daily lives. These 13 categories were - value of long-term disease, self-awareness, flexibility, gratitude, perseverance, ability to recover, self-determination, verbalized self-expression, improvised self-care, creation of comfort, acquisition of social resources, care giving skills, and nurturing future generations. Moreover, 3 core-categories, pursuing meaning of illness, acceptance, and interdependency were extracted. Structure of competencies, as one of the elements of strengths of elderly individuals with rheumatoid arthritis, are pursuing and accepting the meaning of illness, and interdependence with surroundings.

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The aims of this research were to clarify the actual conditions of subjective health, loneliness and social interaction among the elderly aged 75 or over who underwent a medical checkup to prevent against arterial sclerosis, and to find the factors related to subjective health. Data of 156 participants were analyzed. 94 females (60.6%) served as the subjects. The mean age was 80.1 (standard deviation 3.3) years. The couple households were most numerous (32.7%). The proportion of the subjects who were under severe income situations was 23.7%. The subjects who had diseases were 90.4% and those who had no fitness habits were 44.9%. Subjective physical health was positively related to subjective mental health, total scores of Index of Social Interaction, and scores of its three subscales. It was negatively related to scores of loneliness. To find the factors related to subjective physical and mental health, the multiple regression analysis was used with subjective physical and mental health as the dependent variables and fitness habits, family constitution, total scores and three subscales of Index of Social Interaction, and loneliness as the independent variables. As the results, the factors related to subjective physical health were fitness habits, social concerns, involvement with others and loneliness. No factor was related to subjective mental health. These results suggested that it was important to have fitness habits, to be concerned about the community, such as participation in social activities, and to arrange opportunities to meet friends or neighbors for the purpose of keeping subjective physical health among the participants in the medical checkup.

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Purpose: The goal of the study was to examine the effectiveness of a peer support group program at a community general support center for female family caregivers of the elderly with dementia. Methods: Subjects were randomly assigned to an intervention group (4 centers, n=22) or a control group (4 centers, n=32) based on population aging rate in a community. Subjects in the intervention group participated in a 90-minute-program consisting of listening to the senior caregiver's experience, exchanging feelings and opinions among caregivers, and receiving professional instruction for 2 consecutive months. Results: In spite of the unevenness in characteristics of the subjects in the two groups, the intervention group exhibited positive significant effects on the caregiver's burden and mental health status after 1 month, but no significant effect was observed after 3 months. Conclusion: This study suggests that a peer support group program, consisting of exchanging feelings and opinions, in a community general support center may be effective for the improvement of the caregiver's burden and mental health status in the short-term, and may provide support both for caregivers and professionals.

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The purpose of our study was to clarify viewpoints of nurses on the timing of decisions to cease observation of bowel movement or urination of elderly patients who have undergone surgery after femoral fracture. Qualitative and descriptive analyses were performed by conducting focus group interviews of 14 proficient nurses with over 3 years of experience in providing nursing care for elderly patients having undergone surgery for femoral fracture, in terms of the nurses' points of view in their determination to end their observation. The results noted 15 subcategories, which were summarized into 6 categories: "Having sufficient reserves of vital power", "Having independence of spirit", "Having ability to communicate with nurses", "Having ability to control their own pace", "Having increased alertness", and "Having ability to perform flexible motions". These viewpoints were based on the comprehensive understanding of a patient's condition, including overall daily life care. We consider that these judgment-based points of view offer a guideline for nurses, particularly for recently-graduated or less-experienced nurses, in the decision-making process for determining when to discontinue observation of excretion behaviors of elderly patients after undergoing surgery for femoral fracture.

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