[Purpose] This systematic review and meta-analysis evaluated the effects of Gerontological specialist healthcare team implementations to reduce hospital bed days, and other clinical outcomes for older adult inpatients with dementia and cognitive disorders, and compared them with the effects of conventional standard healthcare. [Method] An extensive literature search of several databases was performed in July, 2014 that included both Japanese and English articles. The articles were categorized as: i) randomized controlled trials, ii) intervention performed in the hospital for older adults aged ≥65, iii) screened subject's cognitive status using MMSE or other scales, or diagnosed dementia, iv) geriatric specialist healthcare team including assessment and implementations with more than two specialists such as gerontologists and gerontological nurse specialists, and were then evaluated. A random effects model was applied. Risk ratio and mean difference were calculated. Heterogeneity was assessed using the I² statistic. [Results] Seven original articles involving 301〜999 participants were identified in the meta-analysis. Geriatric specialist healthcare team implementations for inpatients with dementia and cognitive disorder reduced the mean hospital bed days. However, it did not affect the mortality during admission, use of institutional services at discharge and during one year after discharge, and other clinical outcomes. [Conclusion] It was possible to conclude that Geriatric specialist healthcare team implementations for inpatients with dementia and cognitive disorder significantly reduce the mean hospital bed days; however, the evidence was shown to be limited.

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This study clarified the nursing practice of person-centred care for elderly patients with cognitive impairment and developed a nursing practice self-assessment scale at acute care hospitals. The participants were 283 nurses working on wards in two acute care hospitals in September 2014. Their responses were used for the exploratory factor analysis. Items with low factor loading were deleted. This scale comprised 19 items and four factors. Cronbach's α was more than 0.797 for all four factors and the total items. In test-retest analysis, the correlation coefficients were ≥0.7. Reviewing the covariance structure analysis for construct validity, the best fit indices were GFI=0.912, AGFI=0.863, and RMSEA=0.721. The pass coefficients between potential and observational variables were significantly high from 0.53 to 0.87. The concurrent validity calculated the relationship between the total score of an attitude scale for persons with dementia and this scale; it was significantly correlated to three factors of this scale and the total score. Reliability and validity of this scale were therefore demonstrated.

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The objective of this study was to evaluate the effects of a comprehensive geriatric assessment (CGA) education program on visiting nurses' knowledge of aging, understanding of CGA, intention to practice CGA, motivation for frailty prevention, confidence in executing frailty prevention measures, and care strategies for frail elderly adults. A total of 81 visiting nurses were non-randomly assigned to the intervention (IG: n=40) or the control group (CG: n=41). The education program covered (1) frailty, (2) components of CGA, and (3) nursing approaches to frailty prevention. Participants' knowledge of aging, CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence were measured via self-report questionnaires before and after the intervention. The frail elderly care strategies they employed were determined through their responses in post-intervention group discussions that pertained to a vignette of a frail elderly patient. The IG scores on CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence increased after the intervention. Pre-post intervention changes significantly differed between groups for CGA understanding and intentions (p<.001 for both), and significant group by time interactions were found in frailty prevention motivation and confidence (p=.002, p<.001, respectively). The IG participants' descriptions of care strategies were more specific than the CG participants'. The results indicated that the CGA education program could effectively improve visiting nurses' CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence, as well as the quality of their frail elderly care strategies.

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Objective: The objective of the present study was to clarify nurses' decisions and the factors affecting their decisions regarding the use of 4-point bed-railing restraints for post-operative acute patients diagnosed with dementia. Methods: An anonymous, self-administered questionnaire survey was conducted on nurses working in the surgical wards of hospitals, regarding their understanding of the three major kinds of restraints and the main factors affecting their decisions to use 4-point bed-railing restraints to prevent falls. Results: Responses from 547 participants were analyzed. A total of 170 respondents (31.1%) were able to implement the use of 4-point restraints for patients diagnosed with dementia. About 40% replied that they could not decide and could not be sure when to use 4-point restraints for those diagnosed with dementia who exhibited states of excitement or restless behavior. Factors influencing decisions regarding the use of 4-point restraints for post-operative acute phase patients diagnosed with dementia were "employment in an ICU or HCU", "three-shift system", and "completion of nursing ethics training", with a significantly higher proportion of respondents in these groups agreeing to the use of 4-point restraints. Conclusion: These results suggest that use of 4-point restraints for post-operative acute phase patients diagnosed with dementia varies according to each nurse's work environment.

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This study is a literature review to identify issues in nursing research in Japan focusing on depression among the elderly, and to identify issues that need to be addressed. We searched literature published from 2003 to 2012 in the Ichushi Web database, and selected 125 articles for further analysis. We used the Matrix Method to organize an overview of the articles. The terms 'Utsu' and 'Yoku-utsu' were employed to describe depression in many articles without distinguishing symptoms, states, and illnesses. For the subjects of the research, 'elderly living in the community' was the most frequently employed term followed by 'elderly residents in institutions', and few articles employed terms like 'hospitalized elderly patients'. For further research, we searched with "Verification of depression evaluations" (indexes for intervention effects and scale verification) and "Depression as an index to understand the conditions of the elderly" (factors related to depression and characteristics of depression among the elderly). Considering the high incidence of depression-related disorders among elderly patients hospitalized in general wards, it is necessary to develop and conduct nursing studies of proactive interventions as well as studies to enable early detection of depressed states and depression as a complication for elderly inpatients.

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The purpose of this study was to clarify the impact of lifestyle factors on nighttime sleep by conducting a survey on the state of sleep among long-term care facility residents. Targeting residents who use wheelchairs, we measured nocturnal waking duration, sleep efficiency, and total sleep duration using Actiwatch^® and compared the daytime to the nighttime lifestyle factors. The subjects of analysis were 25 persons with an average age of 83.5±8.7. The total sleep duration of those who got out of bed twice or more during the daytime was 410.6 minutes (median), which was longer than that of those who got out of bed once (p=.034). The sleep efficiency of those who spent one hour or more in bed before sleeping was 66.5% (median), which was less than that of those who spent less than one hour (p=.038), showing a significant difference. Moreover, the sleep efficiency of those who had a preferred recreation was 80.4% (median), which was higher than that of those with no preference (p = .043), thus showing a significant difference. These results suggest that, by choosing the time in bed and lifestyle habits that suit each elderly person and by incorporating their preferences in lifestyle, the sleep and wake rhythm can be adjusted, which will lead to an improvement of the nighttime sleep of residents.

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The objective of the current study was to elucidate the defecation status and the factors relating to diarrhea in elderly patients receiving tube feeding. We conducted a survey on a total of 140 elderly individuals hospitalized in a recuperation ward who had been receiving tube feeding for ≥6 months. A total of 113 patients (80.7%) had diarrhea and 138 (98.6%) had fecal incontinence. Items significantly related to diarrhea were the ability to maintain a seated position, form of nutritional supplements, and infusion volume per hour in patients receiving liquid-form nutritional supplements. Patients with diarrhea had a lower infusion volume per hour than those who did not have diarrhea, indicating that it would be difficult to treat diarrhea by reducing the infusion rate. In addition, many of the patients who did not have diarrhea were receiving semisolid nutritional supplements, confirming that use of semi-solid nutritional supplements is effective in treating diarrhea. Furthermore, diarrhea was associated with an inability to maintain a seated position, suggesting that physical function is an important factor affecting defecation.

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[in Japanese]

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