Mizue Suzuki

Physical and Psychological Effects of 6-Week Tactile Massage on Elderly Patients With Severe Dementia

Tactile massage is a soft massage that improves physical relaxation and psychological well-being. The purpose of this study was to clarify the effects of a 6-week tactile massage on changes in physical and mental function, symptoms of behavioral and psychological symptoms of dementia (BPSD) among elderly patients with dementia. In addition, chromogranin A (CgA) levels as an index of stress examined the effects of tactile massage intervention. A tactile massage group consisting of elderly patients with dementia received tactile massage therapy a total of 30 times each for about 20 minutes between 16:00 and 17:00 hours. In the control group, the mean scores for ‘‘intellectual’’ and ‘‘emotional function’’ score decreased significantly after 6 weeks (P < .05); however, no change was observed in the tactile massage group. Both the ‘‘aggressiveness’’ score (P < .05) and CgA levels decreased significantly after 6 weeks in the tactile massage group. These results suggest that tactile massage reduces aggressiveness and stress level in patients with dementia.

The Care Dependency Scale for measuring basic human needs: an international comparison

AIM To report a study conducted to compare the utility of the care dependency scale across four countries. BACKGROUND The care dependency scale provides a framework for assessing the needs of institutionalized patients for nursing care. Hendersons components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the care dependency scale items. DESIGN The study used a cross-cultural survey design. METHOD Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch care dependency scale. Psychometric properties in terms of reliability and validity of the care dependency scale have been assessed using Cronbachs alpha, Guttmans lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. RESULTS High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. CONCLUSION Outcomes confirm Hendersons idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patients age, the type of care setting and/or cultural background. The psychometric characteristics of the care dependency scale make this instrument very useful for comparative research across countries.

Impact of Fall-Related Behaviors as Risk Factors for Falls Among the Elderly Patients With Dementia in a Geriatric Facility in Japan:

The purpose of this study was to clarify potential fall-related behaviors as fall risk factors that may predict the potential for falls among the elderly patients with dementia at a geriatric facility in Japan. This study was conducted from April 2008 to May 2009. A baseline study was conducted in April 2008 to evaluate Mini-Mental State Examination, Physical Self-Maintenance Scale, fall-related behaviors, and other factors. For statistical analysis, paired t test and logistic analysis were used to compare each item between fallers and nonfallers. A total of 135 participants were followed up for 1 year; 50 participants (37.04%) fell during that period. Results of multiple logistic regression analysis showed that the total score for fall-related behaviors was significantly related to falls. It was suggested that 11 fall-related behaviors may be effective indicators to predict falls among the elderly patients with dementia.

Developing and validating a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment.

This study aimed to develop a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment (PACSLAC-J) and evaluate the validity and reliability of the scale for use in older patients with dementia in Japan. All patients from 2 dementia wards at a geriatric hospital and 2 aged care facilities were asked to participate. Demographic data, medical prescriptions, Behavior Pathology in Alzheimers Disease Rating Scale (BEHAVE-AD) score, and PACSLAC-J score were obtained from the patients or their medical charts. Researchers used the PACSLAC-J to assess pain behaviors while the patients walked or were transferred between a bed and a wheelchair. Intra-class correlation coefficients (ICC) for inter-rater and test-retest reliability, Cronbachs alpha, and correlations between PACSLAC-J score and other variables were examined. A total of 117 older patients participated. Dementia, including Alzheimers disease (n=54) and/or vascular dementia (n=35), had been diagnosed in almost all of them. The ICC for inter-rater and test-retest reliability were 0.917 and 0.600, respectively. Internal consistency of the entire sample was 0.782. Patients who stated they were experienced pain during movement had higher scores than did patients who stated they had no pain during movement. PACSLAC-J total score was not associated with BEHAVE-AD score. Multiple regression analysis showed that total dependence on assistance during transfer (β=0.32, p=0.001), and psychiatric medication prescription (β=0.26, p=0.003) were independently associated with PACSLAC-J score. We found sufficient evidence of the validity and reliability of the PACSLAC-J.

Effectiveness of educational program using printed educational material on care burden distress among staff of residential aged care facilities without medical specialists and/or registered nurses: Cluster quasi-randomization study

Behavioral and psychological symptoms of dementia are an important source of distress for caregivers. The aim of the present study was to evaluate the effectiveness of educational intervention using printed educational material for reducing distress induced by behavioral and psychological symptoms of dementia among caregivers working at facilities without medical specialists and/or registered nurses.

Relationship between care dependency and behavioral symptoms among elderly in-patients with Alzheimer’s disease in Japan and the Netherlands

Objective: This study investigates the influence of personal characteristics and health-related variables on the care dependency status among elderly in-patients with clinically diagnosed Alzheimer’s disease in two countries. Methods: A descriptive cross-cultural survey was administered to a convenience sample of 137 elderly in-patients. Patients were recruited from a hospital in Japan (N = 77) and from a nursing home in the Netherlands (N = 60). Results: In both countries, almost all participants are assessed on the severity level of care dependency in the range of “completely care dependent” (Japan: 35.1%; the Netherlands: 20.0%), or “to a great extent care dependent” (Japan: 24.7%; the Netherlands: 45.0%), to “partially care dependent” (Japan: 22.1%; the Netherlands: 21.7%). Conclusion: This study demonstrates that there is no interdependence between the severity level of care dependency and personal characteristics of patients with Alzheimer’s disease in both countries. Regarding the interplay of health-related variables on the severity level of care dependency, a difference was found between countries.

Reliability and validity of the Algase Wandering Scale – version 2 for Japanese people with dementia

In Japan, where older people already make up more than 23% of the population and the proportion is still growing, the burden on those caring for people with dementia is an increasing problem. This burden is magnified by wandering behavior, a peripheral symptom. Thus, there is a need for an objective measure of wandering behavior to determine what constitutes effective care. In this study, we translated the Algase Wandering Scale - Version 2 into Japanese, and examined its reliability and validity. Ambulatory residents with dementia were selected from two nursing homes and two wards specializing in dementia care in hospitals in Japan. Nurses and care workers taking care of these residents answered questionnaires regarding the residents. From the results, the Algase Wandering Scale - Version 2, Japanese version, was examined for inter-rater reliability, stability, internal consistency, and concurrent validity. The results of the analysis in the present study demonstrated that the Algase Wandering Scale - Version 2, Japanese version, has reliability and validity, and that it can measure the presence or absence of wandering and its severity. Surveys of residents with various wandering patterns in many facilities and verification of construct validity are warranted in the future.

Effects of 6-week tactile touch intervention on elderly patients with dementia and nurses administering tactile touch

length of stay (LOS) and adverse effects including delirium. The current presentation examines the effects of age upon hospitalisation outcomes. The Hospital Dementia Services Project is exploring service delivery factors that influence outcomes for people with dementia who were admitted at least overnight to a public hospital in the state of New South Wales (NSW), Australia. Methods: We extracted data from the NSW Admitted Patient Care Database for nearly 420,000 multi-day hospital admissions (nearly 260,000 persons) aged 50 years and over from July 2006 to June 2007. Using ICD10 codes for dementia and delirium, we examined the effects of age upon hospital admission. Results: Dementia was age-related with 25% of patients aged 85 years and over having dementia compared with 0.6% of patients aged 50-54 years. The number of admissions was higher for people with young onset dementia (YOD) (mean admissions 50-54 year-olds with dementia 1⁄4 2.81; without dementia 1⁄4 1.46) and declined with age (mean admissions age 90+ with dementia 1⁄4 1.68; without dementia 1⁄4 1.66). Mean LOS for admissions for persons with dementia was 16.4 days; 8.9 days for those without dementia. This difference was more pronounced in YOD with mean LOS for admissions for persons with dementia aged 50-70 years 1⁄4 20.9 days, nearly three times that for those without dementia (7.1 days); while in those aged 85+ LOS with dementia was 15.9 days and 12.8 days for those without. Age had little effect on the rates of comorbid delirium with 14.7% of 50-70 year olds with dementia having delirium compared with 16.6% of admissions 85+ with dementia. Conclusions: Our findings suggest that YOD has a disproportionate effect compared with late life dementia on admissions to general hospitals. Factors contributing to these findings include high rates of alcohol-related dementia (16%) and other types of dementia with physical comorbidity (e.g. Parkinson’s dementia 3%, HIV dementia 2%). Other complications such as behavioural disturbances might have an effect. Further investigation of the reasons for prolonged LOS and increased rates of hospitalisation in YOD is warranted.