Japanese Journal of Geriatrics最新文献

Aim: To explore the factors associated with the quality of life among institutionalized elderly people with dementia.

Methods: The subjects included 68 elderly patients with dementia who had lived in a nursing home for at least three consecutive months. The Japanese version of the Quality of Life in Late-stage Dementia (QUALID-J) scale was used to measure the quality of life (QOL). In addition, information on their backgrounds, as well as physical, psychological, and social data, were collected. Spearman's rank correlation coefficients between the QUALID-J scores and each data point were calculated. In addition, a multiple regression analysis was conducted using the QUALID-J score as the dependent variable, and variables identified as significant in the correlation analysis as independent variables.

Results: The following factors were identified as being significantly correlated with the QUALID-J: the number of comorbidities, BMI, grip strength, calf circumference, eating pattern, Barthel Index (BI), Clinical Dementia Rating (CDR) scale, Neuropsychiatric Inventory-Nursing Home result, communication level on the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, the number of days in the facility, the frequency of visitors, the number of times in which the subject positively participated in leisure activities, and the total number of times the subject participated in leisure activities. BI, the total number of times the subject participated in leisure activities, grip strength, and CDR were included in the multiple regression analysis model as independent variables.

Conclusion: Higher BI values (ADL), stronger grip strength (muscle force), greater participation in leisure activities, and lower CDR scores (severity of dementia) were associated with a higher QOL.

Aim: When elderly people return to their daily lives after inpatient treatment, they may be offered a chance to change the residence to which they are accustomed. The present study clarified the changes in the residence of elderly patients through an Integrated Community Care Ward (ICCW).

Subjects and methods: Patients were admitted to and discharged from the ICCW (53 beds) of Hospital A, located in a city with a population of 30,000 and an aging rate of 37%, for 2 years from April 1, 2018, to March 31, 2020. Patients ≥65 years old were included in the study. We conducted a retrospective survey of information recorded in the electronic medical record system and collected information on activities of daily living, medical procedures at the time of discharge, residence before and after hospitalization, and intentions regarding discharge destination within seven days of hospitalization.

Results: Of the 735 patients ≥65 years old who were admitted to the ICCW, 608 were included, excluding 127 patients admitted for scheduled surgeries. The average age was 82.9 years old, with 52% being over 85 years and 26% being over 90 years old. Of the 465 people hospitalized from home, 64% were discharged, 23% changed to a facility or hospital, and the remaining 13% died. More than 80% of the 143 discharged from facilities or hospitals returned to facilities, but 36 (25%) were discharged to a different facility from before admission. Of the 404 patients who were admitted from home and discharged alive, independence in eating, independence in movement, and having family members living with them were independently related factors for achieving discharge home. Regarding the intended discharge destination within 7 days after hospitalization, of the 246 hospitalized patients who wished to be discharged home, 56 said they wanted to be discharged to a facility or hospital, showing a discrepancy of 23%.

Conclusions: Many elderly people changed their residences after admission to the ICCW. While coordinating disagreements within families as well as navigating medical and nursing care constraints, dialogue across multiple professions should be continued to help elderly patients live their own lives.

Purpose: We aimed to develop a simulation program for physicians and nurses involved in virtual reality (VR) and augmented reality (AR) treatment and care from the perspective of these professionals and older adults with dementia who developed delirium, and to test the effectiveness of the program.

Methods: effectiveness of the program was analyzed through free-response statements from 67 nurses (84.8%) and 12 doctors (15.2%) who participated in the program between February 16 and April 18, 2023.

Results: Regarding the experience of delirium from the perspective of older adults with dementia (personal experience), the following statements were extracted "1. I do not understand where I am, the situation, and the treatment/care that is about to be given"; "2. I want the situation to be explained to me so that I can understand the reasons for my hospitalization and the treatment/care I am receiving"; "3. The eerie environment of the hospital and the high pressure of the staff made me feel anxious and fearful"; "4. Please respect my existence as I endure pain, anxiety, and loneliness"; "5. I feel relieved when doctors and nurses deal with me from my point of view"; and "6. I feel relieved when there is a familiar presence, such as a family member or the name I am calling on a daily basis".

Conclusion: Specific categories of self-oriented empathy were extracted from the experience of physical restraint at night using VR and the experience of delirium using AR. This suggests the possibility of objective effects on treatment and care in future practice.

Aim: The purpose of this study was to examine the relationship between health-related quality of life (QOL) and swallowing function among independent community-dwelling older Japanese adults aged 65 years or older.

Methods: A total of 500 participants (250 males and 250 females) were surveyed about BMI, dysphagia and eating disorders (Dysphagia Risk Assessment for the Community-dwelling Elderly [DRACE]), quality of life (QOL; SF-8 Physical and Mental Summary Score), sleep (Pittsburgh Sleep Questionnaire Japanese version [PSQI-J]), and depression (Geriatric Depression Scale [GDS]).

Results: Participants were divided into two groups based on risk of aspiration and data between the groups were compared. Logistic regression analysis revealed that the SF-8 physical component summary score (PCS) and mental component summary score (MCS) were associated with aspiration risk. In the multiple regression analysis, the SF-8 related to eating and swallowing function and PSQI-J were extracted.

Conclusions: The risk of aspiration among the older adults in this study was found to be associated with health-related QOL, sleep quality, revealing a wide-ranging impact on physical, mental, and social functioning. These associated factors may pose a risk for community-dwelling independent older adults, suggesting the need to focus on eating and swallowing function for frailty.

An 87-year-old woman was admitted to our hospital with general fatigue, anorexia, nausea, and chest pain, and was diagnosed with Takotsubo cardiomyopathy and a stomal ulcer. Pseudohyperchloremia and a negative anion gap were detected in laboratory tests. She was continuously taking commercially available analgesics, including bromvalerylurea. On the 11th day of hospitalization, her bromide concentration was high (331.2 mg/L). She was readmitted with fatigue and anorexia one and a half years after her last hospitalization. On admission, her serum chloride and bromide levels were also high. Despite being instructed to stop taking analgesics after the first hospitalization, she was unable to stop taking the medication. It took more than two years for her blood bromide concentration to decrease and the withdrawal of the medication to be confirmed. Clinicians should consider bromide intoxication in patients with unclear neuropsychiatric symptoms and high chloride levels.