Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

Background: We examined the effect of gait training on apathy/post-stroke depression (PSD) in patients with walking disorders after stroke, and the effect of apathy/PSD on gait reacquisition in subacute stroke.

Methods: Fifty-five participants with gait disorders after stroke underwent gait training for 6 weeks. Outcome measurements included Apathy Scale (AS), Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, Lower Extremity Function of Stroke Impairment Assessment Set, and Functional Independence Measure-TRANSFER and -WALK scores. These scores of the participants were divided into groups with or without apathy based on AS scores for statistical analysis.

Results: Both groups showed significant differences in all outcomes after gait training. In addition, even if the participants had apathy at baseline, there were no significant differences in outcomes other than AS/CES-D between the two groups after gait training. Logistic regression analysis showed that only Mini-Mental State Examination and Lower Extremity Function of Stroke Impairment Assessment Set scores affected the reacquisition of independent walking (odds ratio: 1.332, P = 0.015; odds ratio: 1.364, P = 0.005, respectively). AS and CES-D scores had no effects on gait reacquisition.

Conclusion: Gait training may be beneficial for both physical impairment and psychiatric symptoms in patients with stroke and may prevent poor functional recovery caused by apathy and PSD. As opposed to previous studies that have shown a negative impact of apathy and PSD on functional recovery, our results suggest that apathy/PSD may not negatively affect functional recovery when gait training is conducted in subacute stroke.

Aim: This study examines whether expressed emotion (EE) mediates the association between caregiver relationship closeness and behavioural and psychological symptoms of dementia (BPSD).

Methods: We recruited 64 families with dementia in Osaka and collected data for 3 months. Caregiver-patient relationship closeness was assessed using the Relationship Closeness Scale (RCS), and BPSD was measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q). EE was evaluated using the Family Attitude Scale (FAS).

Results: The results indicated significant correlations between EE, relationship closeness, and BPSD, showing that higher caregiver intimacy levels were associated with lower aggression in dementia people. Mediation analysis revealed that EE significantly and mainly mediated the relationship between RCS and BPSD.

Conclusions: The findings underscore the importance of interventions focused on improving caregiver-patient relationships and managing caregiver emotional expressions to mitigate BPSD. These insights are valuable for developing targeted support programs for dementia care.

Background: The correlation between diabetes and cognitive frailty is still controversial. The purpose of this study was to explore the related factors of cognitive frailty in older adults with type 2 diabetes, and to provide new ideas for realising healthy ageing of diabetic patients.

Methods: The survey was conducted at Mianyang Central Hospital affiliated to University of Electronic Science and Technology of China from January 15 to June 30, 2024. The subjects were older adults with type 2 diabetes aged 60 years or older. Cognitive frailty was assessed using Fried's phenotype and Mini-Mental State Examination. Statistical analysis and plotting were conducted using SPSS 25.0 and R 4.3.3. Least absolute shrinkage and selection operator (LASSO) regression was used to reduce the dimensionality of 30 clinical features collected, and the unimportant factors were initially screened out. The important factors with non-zero coefficients identified by LASSO regression were included in a multivariate logistic regression analysis to explore the factors influencing cognitive frailty in older diabetic patients.

Results: This study included 301 older persons with type 2 diabetes. Among them, 91 (30.2%) cases of cognitive frailty occurred. Related factors for cognitive frailty in older adults with type 2 diabetes include: age (odds ratio (OR) = 6.417, 95% CI: 1.882-21.876, P = 0.003), hypomnesia (OR = 2,985, 95%CI: 1.143-7.797, P = 0.026), depression (OR = 9.926, 95%CI: 4.117-23.934, P < 0.001), diabetic retinopathy (OR = 6.489, 95%CI: 1.969-21.384, P = 0.002), history of diabetic ketoacidosis (OR = 12.024, 95%CI: 1.724-83.872, P = 0.012).

Conclusion: The prevalence of cognitive frailty in older persons with type 2 diabetes mellitus was higher. It was closely related to age, hypomnesia, depression, diabetic retinopathy and history of diabetic ketoacidosis. Early detection of the risk and effective intervention can reduce the incidence of adverse events and improve the quality of life of patients.

Background: Knee osteoarthritis (OA) is a chronic, long-term disease with both physical and psychosocial consequences. In determining the treatment programs of patients diagnosed with knee OA and ensuring compliance with treatment, it is important to understand the emotional attitudes and experiences of patients regarding the physical and psychosocial effects of the disease. This study aimed to create a scale for evaluating the emotional attitudes of patients with knee OA as they manage and cope with the condition.

Methods: The research was a validity and reliability study designed using methodological methods. Study data were collected from the Department of Physical Therapy and Rehabilitation at a university hospital in Turkey between November and December 2024. The study sample included 90 patients diagnosed with knee OA. To establish the validity of the scale, content validity and construct validity were assessed. Internal consistency was determined using Cronbach's alpha reliability coefficient, item-total score correlations, and the Hotelling T² test. The test-retest method was applied to determine the scale's stability over time.

Results: The content validity index (CVI) values for the draft form of the scale ranged between 0.91 and 1.00. The exploratory factor analysis indicated that the scale consisted of a single factor, which explained 41.62% of the total variance. The scale demonstrated strong reliability, with a Cronbach's alpha coefficient of 0.86, item-total correlations ranging from 0.36 to 0.73, and a significant Hotelling T² value (P < 0.001). Test-retest analysis indicated a positive and highly significant correlation for the overall scale (r = 0.964, P < 0.001).

Conclusion: The knee osteoarthritis emotional meaning scale (KOEMS) was demonstrated to be a valid and reliable instrument for this patient sample.

Natural disasters are large-scale catastrophic events that seriously disrupt the functioning of a community or society. The frequency and severity of disasters are increasing and involve widespread human, material, economic, or environmental impacts that exceed the ability of the society affected by them to cope using its resources. In addition, disasters significantly affect the physical, emotional, and psychological health of individuals and cause numerous deaths, injuries, and economic losses. One of the most vulnerable groups to the negative effects of disasters is the elderly. The increase in the elderly population worldwide brings with it the problems specific to this period and the service needs for these problems. The population consists of older adults, who are among the most vulnerable groups to the negative effects of natural disasters. During the social traumatisation process triggered by natural disasters, elderly people experience intense feelings of anxiety, fear, anger, helplessness, loneliness, hopelessness, futurelessness, and insecurity. Reactions such as unresponsiveness, alienation, inability to focus, and inability to remember are normal during this process. The normality of these feelings and responses in the acute period, which can last up to 3 months, will give way to abnormality unless the necessary physical and psychosocial conditions are provided. When the necessary psychosocial conditions are not provided, elderly individuals who experience a disaster may experience mental problems such as post-traumatic stress disorder, depression, somatisation disorder, anxiety disorders, and substance use disorders. In this context, providing the necessary psychosocial support for older adults to cope with psychosocial problems after a disaster and facilitating access to this support is very important in terms of adapting to the post-disaster period.

Background: Dementia is one of the most pressing health concerns among the ageing population, imposing significant health, financial and caregiving burdens on people with dementia (PWD), their families and caregivers. Building the capacity of nursing students is essential for effectively improving quality of life for affected people. This study aimed to assess nursing students' knowledge and attitudes toward dementia and its associated factors.

Methods: A cross-sectional study was conducted in four medical schools educating 3-year and 4-year diploma nursing students in northern, central and southern Vietnam, who were selected based on convenience. Six hundred full-time diploma senior nursing students were recruited for the survey. A self-administered questionnaire consisted of 34 true-false questions evaluating students' knowledge about dementia (Alzheimer's Disease Knowledge Scale) and 20 items using a five-point Likert scale assessing their attitudes toward dementia (Dementia Attitudes Scale) was used. The tools were validated with 60 students and showed good internal reliability.

Findings: Senior nursing students exhibited insufficient knowledge of dementia (mean score of 20.82 ± 2.96 out of 34) but demonstrated positive attitudes toward dementia care (mean score of 65.54 ± 8.25 out of 90). Engaging in a 4-year diploma program (β = 0.501), being female (β = 0.827), and achieving greater academic performance (β = 0.795) were positively associated with increased knowledge of dementia (P < 0.05). Being female (β = 2.179) and possessing better knowledge of dementia (β = 2.740) also positively affected nursing students' attitudes toward dementia (P < 0.05).

Conclusions: The study is the first to shed light on the gaps in dementia knowledge among senior nursing students in Vietnam. It also provides a comparison in dementia knowledge and attitudes between students enrolling in 3-year versus 4-year nursing diploma programs. Educational strategies are needed to not only equip students with adequate knowledge and reinforced positive attitudes toward dementia, but to strengthen nursing graduates' knowledge and attititudes of dementia to better their capacity in ageing and dementia care.

Implications for nursing practice: The findings highlighted the need to enhance training programs to meet the growing demand for dementia care. Additional post-graduation training activities are also recommended to increase competencies of nurses in caring for PWD.

Introduction: Japan has the fastest ageing population worldwide, with a high prevalence of frailty. This study aimed to investigate the impact of communicative and critical health literacy (CCHL) on the progression of frailty in older adults participating in community-based programs over 1 year, and whether instrumental activities of daily living (IADL) mediate this relationship.

Methods: This retrospective cohort study used data from the Matsumoto City Frailty Prevention Project, involving 373 older adults aged 65 years and over. Health literacy was measured using the CCHL scale, and IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which includes five items of IADLs. Frailty was classified using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. Mediation analysis was used to evaluate the role of IADL in the relationship between health literacy and frailty.

Results: Participants with higher CCHL had significantly better IADL scores (coefficient = 0.127, P = 0.043) and were less likely to progress to frailty (odds ratio: 0.546, P = 0.009). Mediation analysis revealed that IADL accounted for approximately 10.7% of the total effect of health literacy on frailty progression (P = 0.030).

Conclusion: Higher CCHL reduces the risk of frailty progression, with IADL playing a mediating role. Interventions targeting both health literacy and IADL may effectively prevent frailty in older adults.

Background: As cognitive function declines, relatives may restrict the roles and activities they consider older adults unable to continue independently performing. We examined the characteristics of these role and activity restrictions by relatives among older adults prior to their first visit to a memory clinic for an official diagnosis, focusing on gender and the diagnosis of dementia. Additionally, we examined the relationship between role and activity restrictions by relatives and the presence of neuropsychiatric symptoms (NPS) controlling for older adults' gender.

Methods: We retrospectively reviewed the medical charts of 213 older adults. First, we calculated descriptive statistics for the characteristics of role and activity restrictions by relatives. Second, we examined the association between these roles and activity restrictions and NPS using multivariate logistic regression analysis controlling for older adults' gender, diagnosis, and presence of a cohabitant.

Results: The rate of role and activity restrictions by relatives was 21.6%. Of the older adults experiencing these restrictions, 78.3% were women, and 34.8% had mild cognitive impairment. The most common role and activity restriction was money-related. Role and activity restrictions were associated with the NPS of hyperactivity, psychosis. Hyperactivity was related to men.

Conclusions: Hyperactivity psychosis may be more strongly related to family involvement than other NPS. These findings highlight the importance of avoiding premature role and activity restrictions among older adults with suspected dementia.

Background: There is limited quantitative evidence regarding good death for people with dementia.

Aims: To clarify which components of good death are important for people with dementia and to identify the component structure of good death through explanatory factor analysis.

Design: A web-based questionnaire survey was conducted where bereaved family members and professionals were asked to rate the importance of the 44 items identified from previous qualitative interviews as components of 'good death'.

Setting/participants: A total of 618 bereaved family members of people with dementia, and 206 physicians, nurses and care workers, each, involved in dementia care.

Results: A total of 1236 participant responses were analyzed. The exploratory factor analysis identified the following four factors as the concepts of good death for people with dementia: 'Comfort, security, and safety', 'Relationships', 'Independence', and 'Personhood care'. The top five items that bereaved families indicated as important were 'dying at peace' (97%), 'being free from pain and physical distress' (97%), 'being calm' (96%), 'being clean' (96%), and 'receiving necessary daily living assistance' (96%). The items with the lowest scores were 'being cared for by family' (53%), 'living with faith' (54%), and 'remaining in people's memory after one's death' (67%). We found only small differences between the opinions of the bereaved family members and medical professionals.

Conclusions: The components of good death which stakeholders consider important provide useful information for developing care implementation strategies for dying people with dementia.

Background: Dementia is a global health concern which can be mitigated by primary prevention and improved literacy. Effective educational initiatives are informed by studies of dementia knowledge. However, most of these studies are conducted in high-income countries, leaving the Balkan region underrepresented. This study aimed to conduct the first investigation of dementia knowledge among the Bulgarian population, exploring recognition of symptoms, general dementia knowledge, and risk factors awareness.

Methods: Using an online survey we assessed the following components of knowledge: (i) recognition of dementia symptoms from a vignette; (ii) dementia literacy measured with the Dementia Knowledge Assessment Scale (DKAS); and (iii) knowledge about dementia risk factors. Demographic characteristics, previous experience with dementia, and patterns of informing about dementia were also considered in the study.

Results: One thousand, eight hundred and ninety-six adults (mean age = 44.99; 51.79% female) completed the survey. Half of the respondents correctly recognised dementia symptoms from a vignette. The average DKAS score was 9.51. Dementia knowledge was linked to education, marital status, employment, ethnicity, experience with dementia, and informational sources. 56.7% of the respondents thought dementia was a normal part of ageing and 74.8% did not know a healthy lifestyle reduces the risk of dementia. The average number of identified risk factors was eight (out of 17), with many mistakenly citing dental fillings, laziness, and witchcraft as contributors to dementia.

Conclusions: The Bulgarian society has a poor understanding of dementia, highlighting the need for improved awareness and education. Policy-makers should prioritise dementia as a social issue and take coordinated actions to educate society and eradicate harmful misconceptions.