Relationship between Cognition and Activities of Daily Living in Elderly Women with Mild Cognitive Impairment in Japan

Purpose: This study aims to examine the relationship between cognition and ADL in elderly women with MIC. Methods: Cognitive function was assessed using a 4-item instrument screening for dementia. Each item was scaled from 1 to 4. The Katz Index was used to Participants (N = 680) were asked to return the completed questionnaire in the sealed envelope provided. The study received approval from the human subject’s ethics committee at Osaka University. Results and Conclusion: Participants’ mean age was 78.2 ± 6.5 years old. The age range of participants was 65 to 97 years old. Associations were not statistically significant between cognitive function and family structure. However, associations were significant for ADL items involving excretory failure (OR = 3.5, p = 0.000 in 2004, OR = 2.9, p = 0.000 in 2005;P < 0.05) using a logistic regression analysis adjusted for age. Therefore, we recommend that nurses work to educate the public about treatment-adjusted dementia in the community, teaching family members or caretakers to observe the ADL of the elderly, being watchful for unusual excretory habits, extra clothes, or the smell of elderly persons’ dirty clothing.

Effectiveness of an Educational Intervention for Postpartum Depression in a Pre-Parent Classroom

The global incidence of postpartum depression is estimated at approximately 10% - 20%. A lack of partner support is a key factor associated with perinatal depression. This study examined the effects of an educational intervention that provided information for the prevention and early detection of postpartum depression to first-time mothers and fathers who participated in a “First-Time Parent Class.” The study was utilized quasi-experimental research, conducted first with the control group and followed by an assessment of the intervention group. Mothers were assessed using the Edinburgh Postpartum Depression Scale and the Japan Child and Family Research Institute Child-Rearing Support Questionnaire. Fathers’ assessments were conducted using the Japan Child and Family Research Institute Child-Rearing Support Questionnaire for Fathers and were based on responses to questions regarding their coping strategies. Data were obtained from 158 data (72 interventions, 86 controls) couples analyzed. No significant difference was found between mothers’ child-rearing difficulty and depression score rates in the first month after childbirth. There was a difference among fathers in the control group and those in the intervention group regarding their responses to maternal depression: the “consult family” (p = 0.035), “consult friends” (p = 0.033), and “consult the city health center” (p = 0.047) variables were higher in the intervention group;however, the effect size was small. Providing first-time parents with information during pregnancy to prevent and detect postpartum depression will deepen parents’ understanding and help them cope with postpartum depression.

Ethical Dilemma Factor in Regarding Physical Restraints to Elderly of Female Nurses with the Living Together Experience

Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospitals who also live with elderly adults at home. Method: The study used the questionnaire method with an independently prepared questionnaire. Participants: The objective of the study was explained to the persons in charge of nursing in the selected 17 hospitals, and 1929. Finally, this study of participants were 524 female nurses working in general 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units) at community hospitals who also live with elderly adults at home. Results and conclusions: Cronbach’s overall coefficient for the 20 items of dilemma was high (0.78) and the factor analysis extracted four dilemma factors as having a characteristic value of 1 (Kaiser-Meyer-Olkin measure value = 0.81) with a cumulative contribution ratio of 64.5%. The high Cronbach’s for these items (0.86, 0.88, 0.87 and 0.81) confirmed the internal consistencies. With respect to the dilemma where nurses working in general wards at community hospitals who also live with elderly adults at home are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: accomplishment of medical-treatment and accident prevention, characteristic features in nursing for elderly patients with dementia, healthcare professional relationship in nursing for elderly patients with dementia, and priorities on the accident prevention for elderly patients with dementia. Therefore, the construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to: (i) institution of policies to encourage discussion between nurses and other medical staff to reach consensus on treatment;(ii) allocating elderly care specialists to wards to promote alternatives to restraints;(iii) establishment of safety standards to define nurses’ responsibilities;and (iv) institution of continuous ethical education for nurses.

Measuring the Cognitive Impact of Laughter on Elderly People with Mild Cognitive Impairment in Japan

Objective: To evaluate the effect of laughter on cognition in elderly with mild cognitive impairment (MCI) through an appropriately designed intervention. Methods: The intervention involved watching a Japanese comedy routine (Manzai) for approximately twenty minutes, once a week for ten weeks. Participants were asked to paint, as a simple exercise, in addition to watching the show. Twenty-seven patients with MCI from the convalescent ward of a general hospital in the Kansai region of Japan. We measured cognition by evaluating five cognitive function domains before (baseline) and after the intervention. We used the Wilcoxon signed rank test, a distribution-free method, to compare baseline and post-intervention data. Ethical Consideration: Participants were given a document explaining the study. Only those who officially agreed to participate were enrolled. Results: Mean age of patients was 85.0 ± 2.8 years;average education was 8.6 ± 2.8 years. Three cognitive function domains had significantly different average scores after the intervention: 1) Exercise: 44.4 ± 8.9 points at baseline, 36.3 ± 10.2 post-intervention (p = 0.014);2) Word memory: 40.6 ± 7.2 at baseline, 43.1 ± 8.8 post-intervention (p = 0.002);and 3) Animal name recollection: 35.3 ± 8.4 at baseline, 38.1 ± 9.0 post-intervention (p = 0.003). Discussion: The intervention led to significantly higher cognitive scores in exercise, word memory, and animal name recollection domains, suggesting that interventions focused on laughter and simple exercise may improve cognition in elderly patients with MCI.

Development of ethical dilemma scale Japanese nurse faced physical restraints to elderly patients with dementia

Purpose: This study aimed to develop an ethical dilemma scale for nurses faced with the use of physical restraint when caring for elderly patients with dementia. Methods: We used a previously established 20-item dilemma scale. The objective and method of the study were explained to the head of nursing at 17 selected hospitals, and 121 nurses working in the general wards of 14 hospitals (excluding emergency department wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms and intensive care units) who agreed to participate were enrolled in 2000. Seventy-six nurses from one of the hospitals were selected after eight years (2008) to provide a comparison. Ethical considerations: The study was conducted with the approval of the ethics committee at Meiji University of Integrative Medicine. Results and discussion: Four factors were compared between 2000 and 2008: “execution of treatment and security”, “characteristic features in nursing of elderly patients with dementia”, “cooperative relationship in nursing”, and “priorities in nursing”. The cumulative contribution ratio was 65.3% (KMO = 0.77, p = 0.000) in 2000 and 72.5% (KMO = 0.78, p = 0.000) in 2008. Therefore, the scale dilemma nurse faced physical restraints to elderly patients with dementia in Japan was developed 4 facoters from 17-delremmas items of 20 items.

The effects of ethical dilemmas regarding the use of physical restraints in eldercare on female nurses who care for their relatives in Japan

Purpose: This study sought to clarify the relationship between a nurse’s exposure to elderly relatives and their perspective in using restraints on the elderly in health care situations. Methods: We approached nursing staff supervisors at 17 general hospital wards and explained the objectives of the study. Supervisors at 14 hospitals agreed to participate, giving us a sampling pool of 1929 nurses. We used a chi square test to compare nurses who had spent time with elderly relatives and those who had not on several variables related to using restraints on elderly patients. Results and Conclusion: This study found that nurses who live with elderly family members were significantly more likely to believe that restraints cause diseases (including chronic diseases) based on a chi square test (p < 0.05). Therefore it would be important that essential was the experiences of individuals with elderly family members when making programs of decreasing nurse’s dilemma to restraining the elderly.

Survey on the Use of Information and Communication Technology Tools in Educating Caregivers of Elderly People with Dementia —Analysis from Ichushi and PubMed

This study aimed to clarify the use of computer simulations in educating caregivers of elderly people with dementia. Thesaurus words in articles indexed in Ichushi and PubMed were analyzed using commercially available “Trend Search” text-mining software developed by FUJITSU. The analysis maps relational words in the articles, with line size and distance between words showing the strength of the relation. For ethical purposes, articles were anonymized for analysis. The search was conducted using the query phrases “elderly people with dementia AND simulation”, and retrieved four articles from Ichushi (2007-2010) and 16 from PubMed (1992-2012). The search results revealed that little research has been done on this subject, and highlighted opportunities to further investigate the use of ICT tools in educating caregivers of elderly people with dementia.

A randomized controlled trial of lifestyle self-monitoring for irritable bowel syndrome in female nursing school students

Background: The aim of this study was to verify the efficacy of lifestyle self-monitoring for the improvement of the IBS and reveal what has been changed due to the intervention. Methods: A total of 111 nursing school students were randomized into three groups, two intervention groups (a two-month intervention group, n = 34, and a four-month intervention group, n = 35) and a control group (n = 34). The intervention groups conducted lifestyle self-monitoring in conjunction with a 15-minutes group work for either two or four months. The primary outcome measure was Rome II criteria for IBS. Other outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Symptom Rating Scale (GSRS). They were assessed at the baseline and the end of both of the intervention periods. Analysis was conducted as intention-to-treat. Results: The prevalence of IBS did not change significantly after the intervention in any of the groups. The HAD-A score, a subscale of the HADS score for anxiety, decreased 1.4 points in the two-month intervention group (p = 0.02) and 2.3 points in the four-month intervention group of (p = 0.01) after intervention. The average GSRS decreased 0.2 points in the control group (p = 0.05) and 0.3 points in the four-month intervention group (p < 0.01). Conclusions: Lifestyle self-monitoring for two or four months did not reduce the prevalence of the IBS significantly, but it did decrease anxiety and improved the QOL related to gastrointestinal symptoms in female nursing school students.