A scoping review was conducted to clarify the risk of severity of COVID. The mechanism of severity, the cytokine storm was summarized and the relationship between COVID and frailty syndrome and dementia in the elderly was considered. Result: The risk of severity was underlying diseases such as respiratory illness, hypertension, diabetes, aging over 80 years, and clinical findings such as NEWS; National Early Warning Score, CRP, ferritin, GPT, eGFR, delirium, and frailty.

  Frailty was an important factor affecting survival even with multifactorial adjustment. On the other hand, there were papers with different conclusions that affirmed delirium as a factor of severity. However, one paper denied it as a factor affecting survival rate, and no conclusion was reached. Nevertheless, delirium is considered to be one of the signs of the severity of dementia, and immediate response to delirium is desired. As measures for facilities for the elderly, it is still important to measure oxygen saturation and supply oxygen as needed, thoroughly manage respiratory organs, take measures such as managing depression in social distance, and take measures against reducing physical inactivity.

[Purpose] This systematic review and meta-analysis evaluated interventions for reducing the use of physical restraints in hospitalized and institutionalized older adults with neurocognitive disorder and dementia.

[Methods] We conducted a literature review according to the Cochrane Handbook. The eligibility criteria were as follows: i) intervention performed for hospitalized or institutionalized older adults with neurocognitive disorder or dementia, ii) studies that included physical restraint as outcome criterion, and iii) randomized controlled trials. Review Manager 5 was used for the data analysis. We applied a random effect model, calculated the risk ratio, and then assessed heterogeneity using I² statistic.

[Result] Fourteen studies fulfilled the inclusion criteria. Four studies suggested a significant decrease in physical restraint by the staff education. The educational programs ranged in duration from 30 minutes to 16 hours, and the contents included the following: philosophical theory, delirium prevention, decision making of the use of physical restraint, care not to use physical restraint, dementia care, and reinforcement of the interaction with residents. Six studies on staff education involving 1,355 participants were identified in the meta-analysis. The intervention of implementing an educational program did not have a significant difference (RR = 0.88, 95% CI = 0.72-1.08 ; I² = 70%), and blinding and case attribution biases were found.

[Conclusion] Staff education suggested an effectiveness in reducing the use of physical restraints for institutionalized older adults with neurocognitive disorder and dementia by the qualitative evaluation. However, the evidence was shown to be limited because statistically significant difference is not found in the meta-analysis.

  Objectives: The study aimed to develop a measurement scale to assess the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals and to examine its reliability and validity by clarifying the factor structure of the feeling of difficulty.

  Methods: We administered a questionnaire survey to 1,731 nurses of acute-care hospitals, using 32 original questions, based on literature available, to select scale items and evaluate the reliability and validity of the scale.

  Results: Among the questionnaires collected, 620 (response rate: 35.8%) were analyzed. Based on the results of item analysis and exploratory factor analysis, 7 factors and 22 items were selected. A confirmatory factor analysis subsequently showed GFI=0.904, AGFI=0.880, CFI=0.900 and RMSEA=0.061, suggesting that any path coefficient for the observed variable was statistically significant (P<0.01). In addition, Cronbach’s alpha of the individual factors was 0.642 - 0.834, and the overall value was 0.864.

  Conclusion: The scale has the structure to assess the feeling of difficulty composed of 7 factors that demonstrate the characteristics of acute-care hospitals. A certain level of reliability and validity of the scale for measurements of the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals was confirmed.

  The aim of this study was to describe practical nursing knowledge about patients with the risk of delirium that is applied regularly by a cultural group of nurses, and to identify cultural themes that serve as the basis for delirium care, using ethnographic methods.

  The study participants were nine nurses working in two general hospitals. Participant observation of practical nursing for patients with the risk of delirium was performed, after which semi-structured interviews were conducted. Verbatim records of the participant observation field notes and interviews were analyzed with the Spradley’s framework for ethnographic data analysis.

  From the results of the analysis, seven elements were identified and structured as nursing practices for patients with the risk of delirium. A cultural theme that synthesized nursing practices for delirium care was “to predict things that are stressful for patients and help them to spend their time comfortably.”

  The present findings suggest the possibility that, based on the delirium care structure and cultural themes identified in this study, perceiving patients as individual, holistic human beings, assessing patients’ stress and basic needs in the hospital treatment environment, and providing assistance to promote comfort based on interactions with patients are important as essential qualities of delirium care.

  This research was conducted to clarify the management practices used by the managers of long-term care insurance facilities to enable nurses and care workers to cooperate and work collaboratively. Five managers of long-term care insurance facilities participated in semi-structured interviews for 60–90 min. Their responses were analyzed qualitatively and descriptively. This analysis generated 10management strategy sub-categories.

  These sub-categories were grouped further into three categories: “Build relationships based on expertise,” “bridge the gap separating occupations,” and “Encourage nurses to be organized at long-term care insurance facilities.” Long-term care insurance facility managers support collaboration and cooperation among nurses and care workers through facilitative management: building mutually supportive interpersonal relationships by coordinating different opinions of nurses and care workers and achieving consensus. Results suggest that they expect active collaboration and cooperation among nurses.

  The purpose of this study was to describe the experience of family caregivers providing at-home care for people with dementia with Lewy bodies (DLB) following a diagnosis. Semi-structured interviews of five family caregivers of people with DLB were conducted. As a result, we identified nine categories for family caregiver experiences. Family caregivers were “continuously overwhelmed due to accumulating fatigue from the amplification of daily care”, while feeling “confusion due to hallucinations”, “managing various other symptoms” and “increasing caregiver burden due to side effects of drugs”. “Correspondence of inappropriate medical professionals who are dissatisfied” perpetuated this negative cycle. To escape this cycle, it is necessary “to seek and accept the cooperation of other supportive people”. These include experienced family caregivers who are able to “predict and respond to various symptoms”, “are aware of the new family roles”, and “have made more informed choices for people with DLB and other family caregivers”. DLB is a systemic disease, affecting multiple organs and presenting a variety of symptoms which make it difficult to understand. Therefore, it was suggested that professionals should first acquire in-depth knowledge of DLB and then support the physical and mental aspects of the family caregiver while collaboratively considering countermeasures.

  This study aimed to clarify how, in day-to-day hospital life, nurses on medical long-term care wards comprehend the medical treatment life wishes of bedridden elderly patients with verbal communication difficulties. Semi-structured interviews were conducted with nine nurses and the responses underwent qualitative descriptive analysis. The analysis revealed six categories: “Engaging with the patient and watching the patient’s reactions based on summaries and information from the family,” “Deliberately make time to interact and talk to patients and look for small signs while touching their bodies and making close observations,” “Sharing signs unique to the patient with the team, including long-term care and rehabilitation staff,” “Confirming the patient’s wishes for their end-of-life care with the team based on information from the family, who know what the patient wished for when he/she was healthy,” “Putting oneself in the patient’s shoes,” and “Encountering things that cannot be expressed in words but that can be understood from a nurse’s intuition.” Nurses deliberately speak to elderly patients and make an effort to comprehend the patient’s wishes by using their five senses. To do this, nurses require well-honed insight and sensitivity. A workplace environment also needs to be created that allows nurses to talk about patients’ wishes that they have comprehended.

  This study assessed opportunities and reasons for nursing professionals’ judgment of when to begin physically restraining elderly patients in general beds at small and medium-sized hospitals. Anonymous self-administered questionnaire survey forms were received from 55 nurses working at three small and medium-sized hospitals. Data were analyzed qualitatively and descriptively.

  All 43 respondents had applied physical restraint for elderly people. We extracted the following as opportunities for them to initiate physical restraint: [Symptoms or behaviors were inferred as leading to the incident.] [No expectation of safe behavior change.] [Too few personnel to accommodate elderly people.]. Furthermore, as reasons for judgment, the following were identified: [Incident occurrence was predicted.] [Risks to treatment and life support were predicted.] [Considerations of safety management were necessary for the entire ward.].

  Results suggest the necessity for reviewing holistic understanding and assessment of elderly people, building nurse awareness of ethical issues related to daily care of elderly people, with building of mutually supportive systems for the environment and education.

  This study aims to identify experiences in daily life of older adults who lived alone with diseases or functional disorders one month after being discharged from hospital to their homes. We conducted semi-structured interviews to 11 people discharged from convalescent rehabilitation wards. The data were analyzed using qualitative and descriptive analysis. The results showed that they experienced “being not too bad, although there are things which are impossible to do now,” “doing what I should do to protect by myself or with help,” “thanking family and relatives and restraining myself from further burdening them,” “having indispensable things and pleasures for life,” “facing and coping with my weakening, death, and disasters that will come someday,” and “finding that living alone enables me to call the shots by myself, but it comes with responsibility and determination.” The older adults also experienced “having belief and carefully doing things good to do and not good to do.” The findings suggested that the need for support to minimize the risks caused by different actions from the instructions given at the time of discharge, while simultaneously respecting the actions of older adults living alone taken based on their beliefs.