Objective: To show the actual conditions of frail elderly people who use lifts and wheelchairs and to investigate differences in the types of lifts and wheelchairs used. We examined both demographic characteristics and the primary diagnoses of patients as they related to the frequency with which lifts and wheelchairs were used. We also considered situations in which lifts and wheelchairs are used to prevent patients from remaining bedridden. DESIGN: A descriptive correlational study. Setting: The data was collected from two visiting nursing service station in Tokyo. Thirty-five elderly people who were users of lifts and wheelchairs and who were visited by nurses from these stations were selected for the study. The interview survey consisted of semi-structured questionnaire which we administered ourselves. Results: Half of the elderly patients were over 80 years old. The disease which had most frequently caused the patient to become bedridden was a cerebral infarction (71.4%). Of the patients surveyed, 60.0% required in-home help to assist them in their daily activities. Differences were also observed in the amount of time that the lifts and wheelchairs were used according to the characteristics of the individual patients. The group which was users of wheelchairs had a higher number of total points for abilities of daily living (ADL), The Quality of Life Scale (QOL-Scale; by Matsubayashi, et. al) and modified The Care Burden Scale (by Mizoguchi, et. al). The patients could be divided into 4 different types according to their level of wheelchair usage. There were "indoor types", "outdoor types", "indoor-outdoor types", and "no-use types". Conclusions: We intend to do a prospective study about the way in which the use of lifts and wheelchairs relate to ADL, QOL, and modified The Care Burden Scale. This could allow for a system of support services related to these care devices, including guidelines for the use of the devices and information which could be made available to expert nurses caring for the to elderly and to places which provide new care devices to patients.

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The purpose of this study was to describe the frequency of difficulty in toilet activities with female rheumatoid arthritis patients and examine the relationship between the degree of difficulty and six predicting variables. We conducted the structured interview and physical examinations to 51 female RA outpatients who were 50 years old and over in an university hospital. 88% of these patients were having some kind of difficulty in a series of toilet activities. The most difficult movement was "bending over the Japanese-style toilet", and then "putting on the clothes", "taking off the clothes" was also the difficult movement. The degree of difficulty in each movement and the total score of difficulty in toilet activities was examined with the 6 predicting factors of age, mobility in the outpatient unit, degree of deformity and swelling in hands, pain score, standing up test, and grip strength. The total score of difficulty was significantly related with standing up test, pain score and mobility. Three of the most difficult movements described above was significantly related with the grip strength.

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It is important to maintain independent life for house-bound home care elderly. We followed up 58 house-bound home care elderly persons to clarify the change of the severity in their disability with FIM (Functional Independence Measure) for 18 months. Futhermore, the change of their each performance level in the activity of daily living (ADL) were examined with FIM. 1. At the second survey, 43.5% in the 46 house-bound home care elderly could improve their disability for 5 months. At the third survey, 50.0% in the 32 house-bound home care elderly could improve their disability for 18 months. 2. Among the each performances of the ADL with FIM in the 32 house-bound home care elderly, sphincter control; urinary bladder management and bowel management items, mobility on bed, chair or wheelchair and locomotion with walk or wheelchair changed the most remarkable for 18 months. Based on these findings, house-bound home care elderly are aged people who hold the potential ability to improve their disability. To support their independent life, it is the most important to maintain ability of sphincter control as well as locomortion.

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The purpose of this study is to investigate feeding difficulties in elderly patients with dementia and the factors affecting these difficulties, and to describe the perspectives of care. A questionnaire survey was conducted in September 1994 on feeding difficulties experienced by 30 nurses working in a geriatric hospital in Sapporo in their care of 60 patients over 65 years old. Survey data on 48 dementia patients of the 60 patients with feeding difficulties were analyzed. The following results were obtained: 1) Feeding difficulties in elderly patients with dementia were classified into three items: difficulties in hand movement for eating, disorder of eating rhythm and choking. 2) Difficulties in hand movement for eating were related to the severity of dementia and functional disorder of the hand used for eating. Among these difficulties, movement taking food from the plate were correlated with the severity of dementia, sitting posture and the shape of food. 3) Disorder in eating rhythm such as interruption of feeding was mainly seen in actions by the patient during feeding; e. g., turning his/her head away while being fed, refusing to open his/ her mouth, refusing to swallow food, and stopping hand movement. 4) Choking was strongly related to the shape of food, the severity of dementia and sitting posture. This study shows that many of the factors involved in feeding difficulties in elderly patients with dementia are related to the type of care given and that these feeding difficulties can be partially resolved by providing appropriate care that takes into account the characteristics of feeding difficulties in elderly patients with dementia.

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The purpose of study was to clarify the course of falls among elderly people with dementia and progression of disorders in relation to the falls. Data on cases of falls by 44 residents of a nursing home over a period of 3 years were used for the analysis. The subjects were divided into three groups according to the repeatability of falls: frequent (>4 times per 6-month) falls (n=20) , occasional (<3 times) falls, and no falls (n=8). "Frequent falls" group had more advanced dementia and lower ADL than those of the other two groups. Although the state of dementia and ADL disability in "occasional falls" guoup were not severe, the progression of these was rapid. Ten of the subjects who died during the 3-year period were experienced falls (9 were in the "frequent falls" group). These subjects were bedridden for up to 7 months before death, during which time complications such as physical signs, urinary incontinece and dysphagia. The results suggest that the frequency of falls may be a sign of atrophy.

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The purpose of this study is to clarify the facts concerning the self-determination process of elderly persons regarding admission to a health services facility for the elderly. Semi-structured interviews was conducted with 32 elderly persons and their families. The findings provided seven types of "self-determination processes regarding admission". (1) by one's own decision 【independent decision】, (2) by affirmative agreeing to the given choice 【adapt to the given choice】, (3) by trusting the decision made by the family and following that decision 【entrust to the family's decision】, (4) by abandoning one's own wishes and obeying the family's decision 【submit to the family's decision】, (5) by processing the matter rationally by oneself and deciding to concede to the family's decision 【yield to the family's decision】, (6) by being unable to come to one's own decision and doing as the family decided 【unable to decide】, (7) without having any chance to participate in the decision making process 【not consulted regarding the decision (no self-determination process/completely decided someone else) 】.

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The purpose of this study was to clarify the relationship of 'sekentei' to utilization of health, social and nursing services, and care burden for family caregivers of the impaired elderly. 'Sekentei' is the level of a person's self-consciousness of others observing one's behavior and endeavoring to meet the perceived norms of behavior. We analyzed 45 caregivers who answered the questionnaires. The results of this study were as follows: (1) Caregivers who had a higher 'sekentei' score showed a tendency to have a sense of resistance concerning the use of services. (2) The 'sekentei' score of caregivers who utilized the bathing service was higher compared with caregivers who did not utilize this service. (3) The 'sekentei' score was related to the total score and category scores for caregiver burden. These results indicate that effective nursing intervention for individual and community must be considered to facilitate use of services and alleviate the care burden related to individual consciousness of 'sekentei'.

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