Etsuko Tadaka

Comprehensive assessment of nutritional status and associated factors in the healthy, community-dwelling elderly.

Background:  Malnutrition among the elderly has become a serious problem as their population increases in Japan. To approach the risk of malnutrition in the healthy, community‐dwelling elderly is important for early prevention of malnutrition. The nutritional status and mutable associated factors with poor nutritional status specific to the healthy elderly were examined comprehensively.

Effects of reminiscence group in elderly people with Alzheimer disease and vascular dementia in a community setting

This study reports the effects of a reminiscence group program on elderly people with two major types of dementia, Alzheimers disease and vascular dementia, in a randomized controlled clinical trial with a 6‐month follow up. The subjects were 24 participants with Alzheimers disease and 36 with vascular dementia, and were randomly assigned to an intervention group or a control group. The intervention group followed a reminiscence group program in a geriatric health facility for 8 weeks; the control group followed a routine daycare program. The primary outcome was level of daily life activities (i.e. self‐care, disorientation, depression, irritability and withdrawal) measured by the Multi‐dimensional Observation Scale for Elderly Subjects. The second outcome was level of cognitive function measured by the Mini‐Mental State Examination. For participants with Alzheimers disease, the intervention group exhibited significant improvement of withdrawal compared with the control group immediately after intervention (P < 0.05). For participants with vascular dementia, the intervention group exhibited significant improvement of withdrawal and cognitive function compared with the control group immediately after intervention (withdrawal, P < 0.05; cognitive function, P < 0.05) and after 6‐month follow up (withdrawal, P < 0.05; cognitive function, P < 0.05). The reminiscence group program is an effective means of enhancing the remaining capacity and the adaptation to a daily life in elderly people with Alzheimers disease and vascular dementia. However, it is also suggested that sustained intervention may be necessary to maintain the effect over time, especially in elderly people with Alzheimers disease.

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel.

OBJECTIVE We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well. DESIGN Quasi-experimental clinical trial. SETTING AND SUBJECTS Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 ± 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 ± 1.1). Informed consent was obtained from all the patients. A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used. METHODS The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points. RESULTS The mean interface pressures with the PPD and the film dressings were 70.7 ± 16.5 and 70.2 ± 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 ± 1.4 and 11.7 ± 5.8 N, respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Quantitative evaluation of elderly skin based on digital image analysis

Background: The evaluation of the skin state when it is healthy at the time of examination, but predisposed to disease, is based solely on the subjective assessment of clinicians. This assessment may vary from moment to moment and from rater to rater.

Incontinence Induces Stratum Corneum Vulnerability and Impairs the Skin Barrier Function in the Perianal Region

Background: Incontinence leads to a reduced skin barrier function, while also increasing the risk of skin breakdown. Aim: To investigate the perianal skin barrier function of elderly patients with or without incontinence. Methods: We compared the skin barrier function by investigating the skin hydration, the skin pH, the amount of ceramide and by making a dermatological skin inspection of the perianal region in patients with and without incontinence. Results: Twenty-one incontinent patients (70.0%) showed a glossy skin, which indicates impairment of the skin barrier while none of the patients in the continence group did so. In the incontinence group, those who had a glossy skin showed a significantly greater skin pH and total amount of ceramide than those with a normal skin (p = 0.0099, p = 0.0179, respectively). Conclusions: These results demonstrate that a glossy skin may be a useful indicator of a reduced perianal skin barrier function.

Illness experience of adults with cervical spinal cord injury in Japan: a qualitative investigation

BackgroundThere is growing recognition that healthcare policy should be guided by the illness experience from a layperson’s or insider’s perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals’ sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan.MethodsSemi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach.ResultsFive core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society.ConclusionsThe results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care.

Loneliness and related factors among people with schizophrenia in Japan: a cross‐sectional study

UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT?: Loneliness among people diagnosed with schizophrenia is a serious problem. Recent studies have focused on the loneliness; however, no study has examined the relationships between loneliness and both individual and environmental factors comprehensively. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The main results indicated that the community-dwelling people diagnosed with schizophrenia in Japan as well as in other countries experienced higher levels of loneliness. Both individual and environmental factors were related to loneliness. Increasing the self-efficacy for community life and self-esteem of individual factors, and not being socially isolated and increasing community integration of environmental factors would improve their loneliness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Health practitioners, in particular, public health nurses in mental health care, should work to develop a partnership with people diagnosed with schizophrenia, their family members, friends and other community-dwelling people in order to decrease and prevent loneliness. For individuals diagnosed with schizophrenia, interventions by cooperating with community resources and using the technique of nurses to assist them with continuous community activity could be useful. For environmental interventions, population approach such as developing daily programmes which family members can participate in, and cooperating with educational institutions and community events could have a positive effects. ABSTRACT Introduction Loneliness among people diagnosed with schizophrenia living in communities can decrease quality of life and may contribute to suicide. Aim The aim of this study was to examine the levels of loneliness among Japanese people diagnosed with schizophrenia and to identify individual and environmental factors related to their loneliness. Method A cross-sectional survey was conducted with 264 people diagnosed with schizophrenia who use local activity support centres in urban areas. The self-administered questionnaires included questions on loneliness, demographic characteristics, individual factors including self-efficacy for community life and self-esteem, and environmental factors including social isolation, community integration and service use. Results The study results indicated that people diagnosed with schizophrenia in Japan experience higher levels of loneliness, corroborating results from other countries. Multiple regression analysis showed that a lower level of self-efficacy for community life, self-esteem, community integration and social isolation predicted a higher level of loneliness, accounting for 55.3% of variance. Implications for Practice Public health nurses in mental health care in Japan can work with individuals diagnosed with schizophrenia and communities using the technique to assist them with continuous activity and cooperating with community resources and educational institutions in order to decrease and prevent loneliness.

The meaning of self-care in persons with cervical spinal cord injury in Japan: a qualitative study

BackgroundProfessionals in Japan tend to regard the individual contexts of persons with spinal cord injury (SCI) as the cause of their passive participation in self-care activities or self-management. However, the meaning of self-care involves variables that interrelate with sociocultural factors. Thus, it is necessary to uncover its meaning in the perceptions of persons with cervical spinal cord injury (CSCI) in order not only to implement better rehabilitation but also to understand the sociocultural constraints that determine the injured person’s attitudes to self-care and long-term health outcomes.MethodsSemi-structured interviews with 29 CSCI participants from fourteen municipalities of Osaka, Hyogo, and Ehime prefectures were conducted. Participants contributed diverse perspectives on rehabilitation, lay-professional and family relationships, health promotion, and body conceptions. Interviews were recorded, transcribed and analyzed using the grounded theory approach to inter-relate categories and to develop theoretical constructions.ResultsFour main themes emerged from the data: rehabilitation for independence in ADLs; detachment from the body and self; embodiment; and self-management. From the participants’ point of view, rehabilitation programs in Japan aim at improving body functions for ADL performance, but provide little health education. These rehabilitation values might hinder some participants from developing self-esteem for their bodies. Moreover, socially-shaped family caregivers’ active engagement in the participants’ self-care allowed many participants to entirely rely on them for care. Through embodiment, participants found that self-care was not merely a means of independence in ADLs but also of self-management to enhance health and well-being, requiring collaborative relationships with caregivers.ConclusionPersonal factors such as low motivation for self-care might be in part a reflection of social expectations of dependence for persons with CSCI. However, the shift in the meaning of self-care from ADLs to self-management implies more active participation in health care needs, shaped through social exchanges. Not only personal factors but also sociocultural factors influence the injured person’s valuation of self-care. There is a need for further research to better understand sociocultural influences on illness behaviors among persons with CSCI, so that clinical and community practice can develop accordingly.

Development of a Community Commitment Scale with Cross-sectional Survey Validation for Preventing Social Isolation in Older Japanese People

BackgroundElderly social isolation could be prevented by facilitating communication or mutual helping at the neighborhood level. The helping of elderly neighbors by local volunteers may relate to their community commitment (CC), but ways to measure CC have not been identified. The aim of the present study was to develop a Community Commitment Scale (CCS) to measure psychological sense of belonging and socializing in the community among local volunteers, for research in prevention of elderly social isolation. We also tested the CCS in a general population of the elderly.MethodsA pilot test of 266 Japanese urban residents was conducted to examine face validity for 24 identified items, of which 12 items were selected for the CCS, based on a 4-point Likert-type scale. The CCS was developed via self-report questionnaires to 859 local volunteers in two suburban cities and to 3484 randomly sampled general residents aged 55 years or older living in one of the cities. To assess concurrent validity, data were collected using the Brief Sense of Community Scale (Peterson; 2008) and two types of single questions on self-efficacy for helping elderly neighbors.ResultsItem analysis and factor analysis identified 8 items, which were classified between two datasets under the domains of “belonging” and “socializing” in the local volunteers and the general residents. Cronbach’s alpha (which conveyed the internal consistency of the CCS) was 0.75 in local volunteers and 0.78 in general residents. The correlation coefficients between the scores of the CCS and BSCS were 0.54 for local volunteers and 0.62 for general residents. ANOVA comparing the CCS between the confidence levels of the two types of single question of self-efficacy on helping elderly neighbors showed a strong relationship in the volunteers and residents.ConclusionsThese results demonstrate acceptable internal consistency and concurrent validity for the CCS, with the two dimensions “belonging” and “socializing”, among the local volunteers and general residents in urban Japanese areas. Community commitment measured by the CCS was related to the degree of confidence for self-efficacy in helping elderly neighbors to prevent elderly social isolation.

Interface pressure distribution of elderly Japanese people in the sitting position

Aim. To investigate the characteristics of elderly Japanese people sitting in a wheelchair using pressure mapping and an objective method to classify sitting patterns. Method. This descriptive observational study was conducted in a senior care facility and a geriatric hospital, with 107 elderly subjects (37 group A (house-bound), 34 group B (chair-bound) and 36 group C (bed-bound)) and 36 able-bodied. Maximum pressure, total support area, distance from backrest to coccyx and sitting pattern were collected by using a pressure mapping system. Results. Maximum pressure was significantly lower for able-bodied than groups B and C (p < 0.001 and p = 0.024, respectively). Total support area was significantly larger for able-bodied than each elderly group (group A p = 0.014, group B p = 0.021, and group C p < 0.001). Distance from backrest to coccyx was significantly longer for group C than able-bodied (p < 0.001). The occurrence of proper sitting pattern significantly decreased as the degree of independence reduced (p < 0.001). Conclusion. Elderly people with disabilities have high interface pressure on a small support area, malposition, which is confirmed by longitudinal and lateral supporting balance indices, and imbalance in a wheelchair. The following concepts for developing cushions should be considered: low interface pressure with large support area, individual adjustment of sitting position and stability of body trunk.