In this study, we aimed to investigate the nighttime sleep-wake patterns of institutionalized elderly people with cognitive dysfunction, and to clarify the relationship between sleep disorders, activities of daily living (ADL), and behavioral and psychological symptoms of dementia (BPSD). Nighttime sleep was measured using a sensor mat sleep meter in 39 elderly participants with cognitive dysfunction living in a facility covered by public aid providing long-term care to the elderly (an intensive care home for the elderly). Furthermore, we assessed the association of our sleep-wake results with ADL and BPSD.

  Our results showed an average sleep time of 503.3 min (±122.3) and a mean sleep efficiency of 75.0 % (±17.6). The more active our participants were (higher ADL), the shorter was their sleep time. However, we did not observe any associations between ADL and the total sleeping time or sleep efficiency. Moreover, the sleep time of participants with a higher level of BPSD was shorter than those with lower levels of BPSD. In addition, high BPSD participants had lower sleep efficiency, longer sleep latency, and more wake time after sleep onset.

  It is suggested that elderly people with cognitive dysfunction and a high incidence or frequency of BPSD may have comorbid sleep disorders. We believe that the results of this study will help inform better sleep care practices for older people with dementia and cognitive dysfunction.

  While the use of hearing aids is recommended for moderate or higher levels of hearing loss, many elderly people exhibit poor individual awareness of symptoms. Moreover, despite diabetes being a risk factor in hearing loss, clinically it has received little attention.

  The purpose of this study was to investigate the frequency of moderate or higher hearing loss defined by pure tone audiometry in elderly diabetes outpatients, and to validate the usefulness of the finger friction test (FFT) in screening for moderate or higher hearing loss, by comparing hearing evaluation using patient history inquiry. The participants were 150 elderly diabetes patients with an average age of 75.1 ± 5.8 years. Forty-nine individuals (32.7%) presented with moderate or higher levels of hearing loss, and within the hearing loss group, the frequency of having no dependents was significantly high. Sixty-one individuals (40.7%) presented with hearing loss based on the FFT. The frequency of detection based on patient history inquiry, such as individual awareness of symptoms and others, suggesting possible hearing loss, was lower than the number of cases detected by the FFT.

  The sensitivity of the FFT in detecting moderate or higher levels of hearing loss was 71.4%, and specificity was 74.3%. The sensitivity was higher than that of the patient history inquiry, but specificity was lower.

  As such, for elderly populations, the FFT is considered to be suitable to screen for moderate or higher hearing loss, due to its convenience and superior objectivity as compared to those of patient history inquiry.

  We clarified the state of seating practices and perception among nurses, caregivers, and physical or occupational therapists working at long-term care insurance facilities that practice seating in pursuit of spreading seating practices.

  We obtained the cooperation of four special nursing homes for the elderly and three health care facilities for the elderly (a total of seven facilities). The facilities implemented seating practices as a result of issues including postural problems, pressure sores, unwillingness to be physically restrained, and difficulty sitting due to contracture. The effects of seating were classified into changes in elderly people, changes in staff, and changes in families and facility operation. Changes in elderly people that were described included improvements in postural problems and a reduction in pressure sores.

  At facilities that practiced seating, staff felt the potential danger of the effects on elderly people arising from unnatural sitting postures, and physical or occupational therapists took the lead in promoting seating. Staff also felt that seating had an effect on staff as well as elderly people.

  This study was conducted to examine quality indicators of geriatric nursing in hospital settings. Quality indicators of 17 categories and 80 items were made. Nine gerontological certified nurse specialists evaluated the items by RAND/UCLA appropriateness method. Questionnaires were mailed twice to the nurses. Each quality indicator was assessed on 9-point Likert-type scales: 78 of 80 items were rated as “appropriate” with a median of over 7 points, 2 items were rated as “intermediate” with a median of 4-6 points, and no items were rated as “inappropriate” at the first round evaluation. Second round evaluation was conducted using the same 80 items, and all of the 80 items were rated as appropriate. Additionally, categories such as prevention of pressure ulcer, comprehensive geriatric assessment, pain management, delirium prevention and management, physical restraint reduction and management, and discharge planning were rated as “high” with a median of over 7 points.

[Purpose] The purpose of this study was to clarify reliability and validity of Evaluation Index for Level of Understanding regarding configured items of care protocol for removal of percutaneous endoscopic gastrostomy among the elderly.

[Methods] Self-reported questionnaires were sent to the nurses in recuperation bed groups and geriatric health services facilities. The survey consisted of items regarding evaluation criteria of starting oral feeding, face sheet, assessment sheet, and care sheet. The survey was conducted twice between November 2008 and January 2009. Responses to level of understanding about items of care protocol were measured using a 4-point Likert scale. The data were analyzed using item analysis, test-retest reliability, Item-Total correlations, Cronbach’s α as reliability, and content validity and known-groups method as construct validity. This research was approved by the ethical review board of Chiba University.

[Results] There were 389 valid responses. Mean value, standard deviation, kurtosis, and skewness were analyzed statistically and there were no exclusions. Each item of the 1^st and 2^nd survey showed significant correlations in test-retest analysis, and scores of IT correlation analysis were r＝0.424～0.914. In this result, there were no exclusions Cronbach’s α ranged from 0.776 to 0.982. These results led to content and construct validity.

[Discussion] The results showed reliability and validity of evaluation index of understanding level regarding configured items for removal of percutaneous endoscopic gastrostomy. In the future, education or study to verify the effects of practical intervention using the results in this study will be needed.

  The purpose of this study was to clarify the psychological process in family caregivers who make proxy decisions on percutaneous endoscopic gastrostomy (PEG) from its selection to after end-of-life care for the elderly with dementia. Semi-structured interviews were conducted with seven main family caregivers who had selected gastrostomy and cared for the elderly patient until the end of life. Data were then analyzed using the modified grounded theory approach. Family caregivers considered gastrostomy to be “a type of food form” and “the gastric fistula to be natural,” therefore considering it “a natural progression rather than a life extension.” However, the elderly patients and their family caregivers underwent psychological and physical changes; therefore, the family caregivers “felt that the patient was being kept alive by the gastric fistula” and that they were “gradually drifting into a life of caregiving.” As the end of the patient’s life drew near, they felt “the urgency that the patient’s life was in their hands” and strongly felt that “the PEG is life-prolonging treatment.” Although they felt “a sense of relief that they were able to care for the patient until the end of life” when the end finally came, they felt “a sense of achievement in performing caregiving to the best of their ability” and “regret that they couldn’t let the patient pass away naturally.” The results suggest that during the end-of-life care for the elderly with a PEG, it is important to provide support for family members in order to enable them to engage in care with sufficient understanding of the patient’s physical status while preventing the development of guilt regarding feeding reduction or discontinuation.

  The purpose of this study is to explore the perceptions of individuals aged 75 or more (hereinafter termed ‘older people’) who require long-term care and live alone: what do they regard as hardships in everyday living as their activities of daily living (ADL) declines, and how do they try to cope with the hardships? The subjects are three older people at Care Level 2-4 who are using home-visit nursing care. Participant observation and semi-structured interviews were conducted, after which the data was analyzed qualitatively and descriptively.

  There were four hardships that the three older people experienced. Three of them were attributed to their deterioration of physical activities: these were the states that they are unable to act, unable to control their health condition, and unable to find the meaning of life. The fourth hardship could be seen in the complicated relationships with care providers. Owing to differences of opinion, older people could not always be content with the service.

  For the solutions to these hardships, although many of the ways they coped with these hardships included simply giving up or enduring them, there were cases where older people tried to adjust their activities to fit within the range of their capability in a search for better conditions. However, it could also be recognized that older people impose an enormous burden on their own body.

Purpose: This study was conducted for the purpose of examining the intervention effects of a combination program for the prevention of home-visit care on the homebound elderly.

Method: Home visits and telephone intervention were conducted on four occasions with eight homebound elderly subjects using a combination program combining improvement of motor and oral function and improvement of nutritional status. The subjects were evaluated before and after intervention and three months after completion of intervention based on measurement of vital functions, self-efficacy with respect to going outside, mental health status, subjective health status and frequency of going out.

Results: Results for standing on one leg (left·right) with the eyes open as an indicator of motor function and a repetitive saliva swallowing test and oral diadochokinesis (/pa/·/ta/·/ka/) as indicators of oral function improved following intervention (p＜0.01), and oral diadochokinesis (/pa/·/ta/) also improved three months after completion of intervention (p＜0.05). Self-efficacy with respect to going outside (p＜0.05), mental health status (p＜0.05) and subjective health status (p＜0.01) improved following intervention. Frequency of going out increased in 5 of 8 of the subjects (62.5%), and that frequency was able to be maintained three months after completion of intervention. There were no significant changes in grip strength and BMI used to evaluate nutritional status after intervention.

Conclusion: Motor, oral functions and psychosocial aspects could be maintained and improved through intervention using a combination program for the prevention of home-visit care.