The purpose of this research was to identify the risk factors that contribute to the development of delirium among elderly patients in an acute medical setting. Elderly patients in an acute setting have difficulty with environment adaptation. The conceptual framework for this study was based on Roy's Adaptation Model. The subjects were 44 patients with various medical diagnosis admitted to an acute medical unit. Delirium occurred in 8 of the 44 patients (18%) within three days of hospitalization. The process of the development of delirium was classified into three patterns. Also the process of recovery from delirium was classified into three patterns. The risk factors which were significant (p <.05) were : bed rest, number of tubes, hemoglobin value, pulse rate, dry tongue, activities of daily living score, level of anxiety, stubborn or passionate patient personality. This study suggests the importance of nursing assessment of the risk factors for delirium. This assessment will enable nurses to identify patients may have a maladaptive response to acute care hospitalization.

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The purpose of this study was to identify the meaning of their coping behaviors in patients with hip fractures. The subjects were 30 elderly persons, aged 65 to 91, to have surgical treatment. The data were collected from doctors' and nurses' charts, using retrospective methods. These data (their words and behaviors) were analysed by the qualitative research methods. Ultimately, four coping modes and stressors were founded. The results are as follows : 1) Their stressors supposed by four coping modes were a threat to the loss of self-image before they fractured and a threat to have the possibility of functional recovery from hip fracture. 2) Four coping modes were 【preservation of self-identity】, 【self-control】, 【to offer information and to acquire information】, 【challenge and self-integration】. 3) Four coping modes were used to preserve, to protect and to stabilize themselves for a recognized threat in the interaction of them with the environment. Coping modes were used according to own recognized threat and their circumstances. From the above results, dynamic interaction at the back of coping behaviors was supposed in the structure of self-conception.

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Objective : To identify muscle strength in the lower extremities and ultrasound bone densitometry in institutionalized elderly individuals by analyzing their history of falls as well as their sex, age, and transfer ability. Methods : Isometric maximal knee-extension strength was measured by a hand-held dynamometer and ultrasound bone densitometry by Steosgraph Mark-6000. T-test and chi-square test were performed and analyzed. Subjects : One hundred and eighteen elderly individuals in 1997 and 138 in 1998 were examined, and 64 elderly individuals (mean age 83.1 ± 6.8) were followed up for two years in two geriatric institutions. Results : About 30% experienced more than one fall per year. As age increased and transfer and gait ability decreased, the muscle strength and ultrasound bone densitometry significantly decreased (p < 0.05, p < 0.01, p < 0.001). Regardless of sex, age, and transfer ability, the results of all ultrasound bone densitometry tests were under 25 %, indicating osteoporosis. The muscle strength of twenty percent of elderly persons with decreased transfer ability tended to decrease from 6.4 kg to 4.7 kg, and 53% of these experienced falls. Conclusion : The institutionalized elderly showed a remarkable decline in muscle strength and ultrasound bone densitometry because of multiple diseases and limited physical activities resulting from aging, limited moving place, and so on. Also, the results obtained suggested the relationship between proclivity to falling and declined muscle strength and transfer ability.

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To establish an effective discharge guidance plan for fracture prevention, contrast sensitivity was measured to evaluate the cognition of visual sense among hip fracture patients with a mean age of 81 years, and the relationship with life factors was examined. The contrast sensitivity in fracture patients was lower compared to that of the non-fracture patients for 1.5, 3 and 18 cycle/degree frequency domain, respectively. Concerning the life factors, subjects with their fracture history over 50 years of age and those with falling history were relatively more frequent in the fracture patients compared to those of non-fracture patients (p < 0.1). Similarly, subjects with low physical activity were relatively more frequent in the fracture patients than in the non-fracture patients (p < 0.1). The subjects who replied that they recognized no perspective sensation were also more frequent in the fracture patients but not statistical significant. Concerning the physical activity the implemental one was significantly lower in the fracture patients compared to the non-fracture patients. It has been demonstrated that the guidance for preventing the fracture should include countermeasures which induce environmental improvement for the prevention of tipping over and recognization of the shape of things and its distance. Furthermore, the discharge guidance is also important for considering visual information to persons with tipping over experience and fracture history.

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This paper describes the features of "feeding rhythm disorder" according to the severity of dementia as measured by the use of a recording sheet developed in our previous study. The subjects for this study were six elderly patients with Alzheimer's disease (two with moderate, two with severe and two with very severe dementia). Using this sheet, we compared the results of evaluation of feeding rhythm with basically no assistance given to the patient for feeding and evaluation of feeding rhythm with assistance given. The findings were as follows. 1. There was not a great change in the total number of "intervals" that were identified as "feeding rhythm disorder" except for in one patient with severe dementia. However, the total duration of such "intervals" changed significantly in all subjects. 2. In all subjects, the meal time became significantly shorter (75.2 ± 19.9 min to 55.7 ± 17.4 min). There was a strong correlation between the duration of "intervals" and meal time, suggesting that shortening the duration of "intervals" would lead shorter meal time. 3. The rate of self-feeding decreased with progression of dementia severity, indicating the importance of not merely waiting for the restoration of self-feeding in patients with very severe dementia but promoting the restoration of "feeding rhythm disorder" by assisted feeding. 4. "Feeding rhythm disorder" in elderly patients with dementia is a disorder of feeding cycles and is greatly influenced by "intervals".

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The purpose of this study is to improve the educational methods used for gerontological nursing practice. The research looks at identifying how to deal with the researcher's difficulties encountered during contact with the elderly cognitively impaired. Thirty-four of the difficulties were qualitatively analyzed from these eight patterns emerged. There are three patterns in dealing with the difficult situations : "difficulties that were solved because the situation was changed due to nursing care", "difficulties that were solved because the caring direction was chosen", and "difficulties that were solved because the next step was found". Three patterns were also found that appear in dealing with a researcher's perception of difficulties

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The image of the elderly is important in promoting better geriatric nursing. The purpose of this study is to investigate the types of image for the elderly that nursing students have. This report is based on the comparative relationship between a questionnaire and drawing of their image of the elderly. The results show that the subjects had a positive image of the elderly. There was a significant relationship between having a positive image of the elderly and talking with the elderly on a regular basis. In the drawings, over 70% of the subjects included gray hair and wrinkles, and over 30% of the subjects drew baldness and bad posture. Over 60% of the subjects associated the elderly with outdoor activities such as walking, gate ball, shopping, or potted plants. It seems that students did not see the elderly as staying indoors. Students who described the elderly positively in the questionnaire also drew the elderly in a positive manner. As a result of this study, we can see that an intimate relationship with the elderly had an effect on the image of the elderly. The drawings were useful in helping us to understand students' concrete image of the elderly.

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The purpose of this study was to examine factors related to well-being consciousness of elderly patients undergoing chronic hemodialysis. Fourty three hemodialysis patients, all over 60 years old, were used for the study. Well-being consciousness was measured using the Philadelphia Geriatric Center Morale Scale (PGC) and the data was analyzed statistically. The following factors were found out to be significant (p< 0.05) for well-being consciousness : occupation, experience of hospitalization, complications of cataracts, fatigue and its degree, headache, degree of daily movement, supportive family, and having a friend to consult. Further analysis showed that having a friend to consult was the most significant factor, even when we eliminated the influence of the other variables from our analysis. These findings enable nursing staff to practically enhance well-being consciousness of elderly patients with chronic hemodialysis. Further investigation of the related factors will help nurses to clearly understand how the support they give to patients can be most effective.

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The purpose of this study was to make clear the improvement in ADL at stroke patients after dischage, and the factors that contributed the improvement. The registrants of stroke patients in Toyama prefecture were investigated. The subjects were 704 people aged 50 years and over randomly sampled out of 933 people who were alive at March 1995. The questionnaire was send and 504 (71.6%) were withdrawn. The results were as follow. From multiple logistic regression analysis, significant factors affecting the improvement after discharge were ; "69 years and younger", "no dementia", "the patients who had been explained how to take care at home" and "discharged to other hospital or facility" in moving ability, "no dementia" and "admission less than 3 times" in feeding ability, "69 years and younger", "no dementia", "discharged to other hospital or facility" and "admission less than 3 times" in bathing ability, and "no dementia", "the patients who had caregiver", "discharged to other hospital or facility" and "admission less than 3 times" in excretion ability.

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The purpose of this study was to investigate the health and life conditions of temporary house inhabitants who suffered from the great Hanshin-Awaji earthquake. Three hundred and one temporary house inhabitants at chuo-ku in Kobe were obtained through the investigation of the informants. The significant differences among middle-aged (age range : 55-64 years old) inhabitants, aged (age range : 65 years over) ones and young adult (age range : 20-54 years old) ones were showed as follows ; prevalence rate (p< 0.001), drinking person rate (p< 0.001), smoking person rate (p< 0.001), rate of person having bad balance meal (p < 0.05) , rate of person having bad economic state (p < 0.01). The findings of this study suggest that middle-aged inhabitants have more physical, life-style's and economic problems than aged and young adult ones, so we should watch out health and life conditions of middle age as well as the aged after the large-scale disaster.

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Dementia with Lewy bodies (DLB) is the second most common degenerative dementing illness characterized with cortical Lewy bodies. Since 1996, when Consortium on DLB international workshop published the diagnostic criteria for this disease, DLB is getting more acknowledged, however it has not been widely enough recognized by nurses in Japan yet. Because this disease has the distinctive clinical features, the care of the patients with DLB requires the specific care skills. We have admitted and cared about 60 patients with DLB and more than 750 patients with Alzheimer's disease (AD) since 1993 in the Hyogo Institute for Aging Brain and Cognitive Disorders. We have found that DLB patients have much more possibilities to fall, to disturb the other patients, and to need more help in activities of daily living as compared to AD patients due to the cognitive fluctuation, visual hallucinations, delusions, parkinsonism, and visual impairments. Therefore, for the care of DLB patients, nurses are expected to recognize the characteristic clinical features of DLB. They are also expected to share the specific care skills to predict the problems caused by these clinical features and to decrease and manage these problems appropriately.

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