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Objective: We aimed to clarify factors associated with the ability to seek help among older male caregivers who care for women with dementia in their families.Patients and Methods: This information will inform strategies to support their continued provision of long-term care. Participants were 364 male caregivers recruited from three places: The study period was 2017–2018. We obtained ethical approval for this study from the relevant ethics committee.Results: The ability to seek help for care problems among male caregivers was normally distributed. We found that more than 90% of older male caregivers did not actively seek help to resolve care problems, suggesting that older male caregivers had problems with long-term care. In the high score group, health status and the number of emotional support persons in the household were significantly and somewhat strongly positively correlated. The low score group showed a significant and rather weak positive correlation between economic status and health status, and the number of emotional supporters inside and outside the household.Positive correlations for the high score group were self-esteem and depressive symptoms, and self-esteem and resources. Positive correlations for the low score group were self-esteem and depressive symptoms, self-esteem and resources, and resources and depressive symptoms.Conclusion: Male caregivers are more likely to seek help if they are employed or play a role in their community. Nurses also need to support male caregivers with positive words and praise to help them use available support and resources and continue to provide long-term care. It is important for healthcare professionals to observe whether a caregiver presents with depressive symptoms or has long-term care problems because older male caregivers do not seek help. Collaboration between caregivers and medical, long-term care, and welfare professionals is necessary. Direct and timely intervention is needed.
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The purpose of this study was to evaluate the stress accompanying behavioral and psychological symptoms of dementia (BPSD) and to validate the care that brings eustress through physical and emotional interventions. The participants were 57 elderly people with BPSD who used or lived in long-term care facilities, group homes, small-scale multifunctional home care services, and community-based specified facilities in prefecture X. The study included a 2-week control period and a 12-week intervention period in which square-stepping exercise (SSE) was introduced and the validation method was used for communication. Results showed that stress levels were higher when BPSD appeared. After SSE, amylase activity levels decreased in 70% of the participants, although the decrease was not statistically significant, and facial expression significantly improved in Face Scale (FS) assessment. Also, after validation communication, amylase activity levels showed a significant decrease and facial expression significantly improved in the FS assessment. Even though most of the participants in this study were elderly people with moderate dementia, SSE appeared effective for enjoying physical activity and making friends, and validation can be expected to have the effect of sharing time and relieving stress.
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It has been reported that 30% of deaths related to the Kumamoto Earthquakes were among those who had spent nights in the car. Spending nights in the car imposes heavy mental and physical burden, but it has been examined in only a few studies. At 1 year after the Kumamoto Earthquakes, this study examined the factors affecting the mental health of 460 disaster-affected workers at 13 companies who stayed in the car. It was found that 181 workers (72.7%) had spent nights in the car. They had significantly higher scores on the Athene Insomnia Scale, revised Impact of Event Scale (IES-R), and General Health Questionnaire (GHQ) 28 compared with workers who had not stayed overnight in the car. Multiple regression analysis showed that “physical functioning”, “social functioning”, “anxiety and insomnia”, and “staying in the car” were factors affecting the IES-R score, while “vitality”, “avoidance symptoms”, “staying in the car”, and “subjective symptoms” were factors affecting the GHQ 28 score. Mental burden on workers in a natural disaster are imposed in addition to accumulated work burden. Given that mental burden may not ease over a prolonged period, there appears to be a substantial need to urgently discuss how assistance measures should be provided.
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The aim of this study was to clarify the current status of depression among healthy community-dwelling elderly people and to examine the association between depression and their sense of purpose in life. A self-administered questionnaire survey was conducted with 213 elderly people who attended a public lecture at University A. The outcome measures were the Geriatric Depression Scale (GDS), the K-1 Scale for the Feeling That Life Is Worth Living Among the Aged (Ikigai Scale), the Social Support Scale for the Elderly (Social Support Scale), and a basic checklist (Frailty Scale). Using a cut-off of 4/5 points on the GDS, respondents were divided into a non-depressive group (≤ 4 points) and a depressive group (≥ 5 points). Each variable was compared between the two groups. Multiple regression analysis was performed to examine factors associated with depression. Among the 213 people who received the survey, 196 responded (response rate: 92.0%) and 185 provided valid responses after excluding those with missing data (valid response rate: 86.9%). Of these 185 respondents, 80 were classified into the non-depressive group (35 men, 45 women) and 52 into the depressive group (14 men, 38 women), which showed a significant sex difference. Mean age was 73.2 (SD 6.9) years in the non-depressive group and 76.1 (SD 7.74) years in the depressive group, which also showed a significant difference. The Ikigai Scale score was significantly higher in the non-depressive group compared with the depressive group. The Ikigai subscale scores for “self-realization and will”, “sense of life fulfillment”, “will to live”, and “sense of existence” were significantly higher in the non-depressive group. In the multiple regression analysis, factors associated with depression were sense of life fulfillment (β=－0.36), health status (β= 0.24), will to live (β=－0.17), age (β= 0.24), negative support (β=0.18), and healthy habits (β=0.12). These results suggest that depression is associated with self-realization, sense of life fulfillment, will to live, and sense of existence, indicating the importance of activities that create a sense of purpose in life for preventing depression in the community-dwelling elderly people.
ABSTRACT
It has been reported that a comprehensive community support center cannot maintain boundaries between particular specialties (ie, public health nurses, social workers, and the chief care manager), resulting in excessive workload, staff shortages, and resignations. Nurses are beginning to acknowledge poor interprofessional interactions among themselves and are now concerned with improving nursing practice. In this study, we aimed to clearly specify the specialties of nurses in order to obtain relevant basic data for establishing an educational training system for community health nurses. We conducted text mining analysis using KH Coder open source software by targeting 8 community health nurses with over 3 years of experience in Prefecture A. The following 5 clusters of specialties were extracted: “Ability to provide consultation, maintain good relationships, and make good decisions”, “Good knowledge of medical care in general, care of the elderly with dementia and mental illness, and their situation at home”, “Services that prevent the elderly from becoming dependent”, “Collaboration with other professions by participating in home visits or community center visits”, and “Work that requires comprehensive guidance on health within the community”. To clarify the nursing specialty, it is desirable to comprehensively support a team approach by utilizing each specialty in 3 job types. In addition, we suggest that general community nursing roles can be better demonstrated by developing a vision, providing accessible consultation and supervision, and outlining a clear career path as part of the educational system.
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We investigated the effectiveness of hangekobokuto in alleviating dysphagia and aspiration pneumonia attributed to latestage neurosyphilis. Our study subject, a 67-year-old man treated for his leg pain in our department, hoped this treatment would relieve his severe cough and sore throat. According to a neurological investigation and the analysis of blood and cerebrospinal fluid, his symptoms (swallowing disturbance and aspiration pneumonia in the lower lobes of both lungs) led to the diagnosis of cerebral bulbar paralysis caused by latestage neurosyphilis. The patient requested drug therapy ; thus, we prescribed 7.5 g/day of hangekobokuto, to be administered orally, based on his medical findings of qi stagnation and tan yin. Dysphagia was relieved one week after oral administration of hangekobokuto, and after three weeks, the patient's discomfort had almost disappeared. Moreover, aspiration pneumonia was also improved in his chest CT image finding. Late-stage neurosyphilis symptoms usually develop within 20 to 30 years of contracting syphilis, an infection caused by the bacterium Treponema pallidum. Symptoms may include a loss of swallowing reflex and cough reflex due to the paralysis of cerebral basal ganglia. However, hangekobokuto was found to increase the concentration of substance P released in the pharyngeal head and tracheal mucosa, and thus improve swallowing function. We conclude that hangekobokuto is a useful agent for alleviating the swallowing abnormality of late-stage neurosyphilis.
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The use of hearing aids may not be sufficiently helpful for elderly people with advanced bilateral hearing loss when conversing with others. The patient in this case was an 82-year-old man whose main complaint was difficulty in verbal communication with his family despite using hearing aids. He was diagnosed with advanced bilateral sensorineural hearing loss using Western medicine techniques. He was first prescribed the Kampo formulation, ryokeijutsukanto, followed by goshajinkigan. Later, he took a combination of both of these Kampo formulations, and his hearing ability improved. Pure tone audiometry and speech audiometry demonstrated hearing loss ;however, speech audiometry better reflected his improvement in hearing speech sounds after he began taking the Kampo formulations. Thus, in this case, the patient's hearing and communication abilities improved with Kampo formulations combined with the use of hearing aids. In the future, speech audiometry (maximum discrimination score) can be applied to evaluate the efficacy of Kampo treatment for hearing loss.
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The purpose of this study was to clarify the effects of and factors that influence the burden of caregiving in relation to the caregiver's personality and interpersonal trust. The study targeted family members who were primary caregivers of elderly patients with dementia living at home and using care services such as home-visit nursing services and outpatient rehabilitation in Prefecture A. The survey was conducted using a self-administered questionnaire battery delivered to and completed at the subject's home. The battery contained questions about the subject's personal profile, the Interpersonal Trust Scale, Zarit-8 (Japanese version), the Family Adaptation and Cohesion Evaluation Scales (FACES III Japanese version), and the Medical Outcome Study MOS 8-Item Short-Form Health Survey (Japanese version SF-8). We made a comparison of the sense of care burden for elderly dementia patients living at home after dividing the subjects into two groups based on the average caregiver score on the Interpersonal Trust Scale. The group with higher interpersonal trust scores reported a significantly lower sense of care burden. It was speculated that the ability to consult with family and friends about how to build trust with others and cope with the needs of nursing care was related to the caregiver's sense of interpersonal trust. The study found that influencing factors for a sense of care burden were interpersonal trust, supporters other than family members, and family type. The findings also suggest that interpersonal trust could influence the sense of care burden.
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Objective: The present study aimed to examine the role that caregiver burden plays in the familial functioning, social support, and quality of family life (QOFL) of caregivers of elderly family members with dementia. Methods: A survey was conducted with 200 primary caregivers of elderly dementia patients who resided in prefecture “S”. The questionnaire consisted of items that required demographic information, the Japanese versions of the Zarit Burden Inventory (ZBI) and the Family Adaptability and Cohesion Evaluation Scales (FACES II), and scales that measure quality of family life and social support. On the basis of the median ZBI score (i.e., 30.8), participants were divided into two groups: group A (i.e., ZBI score < 30) and group B (i.e., ZBI score > 30). Stepwise multiple regression analysis was conducted with QOFL as the dependent variable. Version 24 of the Statistical Package for the Social Sciences for Windows was used to conduct all the statistical analyses; the statistical significance level was specified as 0.05. Results: Group A and B obtained average ZBI scores of 18.5 and 43.8, respectively. The study targeted 81 patients from group A (average age = 61.0 years) and 77 patients from group B (average age = 61.7 years). Time that was spent on caregiving tasks was significantly higher for group B, when compared to group A. In addition, significant differences in cohesion and adaptability, which are two dimensions that are measured by the FACES II, and QOFL emerged between the two groups. The results of the multiple regression analysis showed that cohesion (β = 0.38), practical support (β = 0.32), adaptability (β = 0.30), and living arrangement (β = −0.12) significantly predicted QOFL. Conclusion: Family cohesion and adaptability are indicators of healthy familial functioning. In order to improve the QOFL of caregivers of elderly dementia patients, it is necessary to strengthen emotional ties, maintain emotional attachment, and flexibly respond to the burden of nursing care and changes in power structures and role relationships.
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<p><b>Object:</b> To clarify the emotional and instrumental support influencing male caregivers for people with dementia living at home.</p><p><b>Patients/Materials and Methods:</b> The subjects were 298 male caregivers. Nursing care burden was assessed using the Zarit Caregiver Burden Scale. Ability to cope with care problems was assessed using the Nursing Care Problems Coping Scale for Male Caregivers for People with Dementia Living at Home (NCSM). Emotional support was assessed using the Emotional Support Network Scale. Instrumental support was assessed using the question “Do you have someone to help when you have a problem with nursing care?”.</p><p><b>Results:</b> There was a significant correlation (P < 0.04) between the point (index) of NCSM and Zarit Caregiver Burden Scale. A positive significant correlation was found in three coping styles. A negative significant correlation was found in one coping style, and no significant correlation in one coping style. The ‘Solve the problem’ coping style was linked to support from both within and beyond the family. Both ‘Emotional avoidance’ and ‘Cognitive transformation’ coping styles were linked to support from within the family, and “Request assistance” style only to external support. There were no correlations between the source of support and the “Careful supervision and waiting” coping style.</p><p><b>Conclusion:</b> Emotional and instrumental support for male caregivers was more than three times more likely to be obtained from within the family than outside it. With families becoming smaller, it is becoming more important for communities and society in general to provide emotional and instrumental support for male caregivers. Male caregivers need support from someone with whom they feel comfortable. It is particularly necessary to consider how to support male caregivers who use the “Emotional avoidance” coping style.</p>
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The purpose of this study is to clarify the depression symptoms of persons, aged 75 and over, and discuss physical and cognitive aspects and impacts on QOL. On the basis of this clarification, furthermore, the authors aim at examining social support to the elderly. The subjects include 122 persons, aged 75 and over, consisting of 24 males (85.7 years old with SD at 5.81) and 98 females (85.34 years old with SD at 5.15) who receive day services at welfare facilities for the elderly in Saga Prefecture. The items checked in interviews consisted of basic properties, geriatric depression scale (GDS), Barthel index, mini-mental state examination (MMSE) and health-related QOL (SF8). As an analytical method, the subjects’ GDS scorewas assumed to be cutoff 5/4. As they were divided into two groups, they were compared item by item in a t test. Ethical considerations: The authors briefed the intervieweeson the purposes of the study and had their consent, both orally and in writing. We also told them that the participation was utterly at their own discretion. The subjects consisted of 48 patients in need of care (39.3%), 38 patients in need of support (31.1%) and 27 “specified” elderly patients (22.1%), among others. It was revealed that 61 patients (50.0%) had mild depression symptoms with the GDS score at 5 to 10 points, eight patients (6.6%) had severe depression symptoms with the GDS score at 11 points, and 53 patients (43.4%) had no depression symptoms with the GDS score at less than 4 points. Depression symptoms were observed in 69 out of 122 subjects, or in excess of half of them, and a significant difference was observed between the two groups in growth hormone (subjective healthy feeling), indicating that the results were similar to those of an earlier study by Nagata et al.
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Objective: This presentation is designed to clarify the sense of satisfaction entertained by home visiting nurses and nosocomial nurses and relations among the “sense of efficiency,” “work stress,” “sense of satisfaction with duty work,&rdquo and “posture toward terminal care.” Methods: The subjects of this study include 106 home visiting nurses and 120 nosocomial nurses and were asked about the factors cited in the Objective. Results: In the group of home visiting nurses, the age and the sense of self-efficacy were high, the number of years in service was great and they had many children. In both groups, significant correlations were observed between the “sense of satisfaction with the delivery of full terminal nursing care to the last moment” and the “yardstick of attitude toward terminal care.” In the home visiting group, significant correlations were noted between the “sense of satisfaction with the delivery of full terminal care to the last moment” and the “sense of self-efficacy.” In the group of nosocomial nurses, significant correlations were witnessed in the “sense of satisfaction with the delivery of full nursing care to the last moment” and the “sense of satisfaction with hospital work.” Discussion and conclusion: Home visiting nurses appeared to have a high sense of self-efficacy as their ages were high and they had many years of experience in nursing care and family life. The sense of satisfaction with the delivery of full nursing care to the last moment was considered high among nosocomial mursesandhome visiting nurses, as they have grappled with the delivery of terminal care in a forward-looking posture. The sense of satisfaction with the delivery of full terminal care was presumably looked upon as having an effect on the sense of satisfaction with nursing care as a line of duty.
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This study was carried out to clarify how health checkup results relate to stages of behavior change and lifestyle in workers in their 30s and 40s. By comparing the findings between the two age group, we considered how health guidance should be given in the workplace. Self-administered questionnaires were used to assess stages of behavior change and lifestyle. Of the health checkup items, BMI, abdominal circumference, blood pressure, blood test values of triglycerides and blood glucose were examined. Among workers in their 30s, men had higher values than women in almost all of these items, suggesting the need to consider gender differences when health guidance is proviede. A look at health checkup results and stages of change showed a link between exercise stages of change and abdominal circumference for workers in their 30s, and between exercise stages of change and BMI and abdominal circumference for workers in their 40s, suggesting that behavior modification may be possible through this “stages of change” approach. A stufy of health checkup results and lifestyle showed a link between health checkup results and such habits as skipping breakfast, snacking, reducing sugar intake, smoking and drinking alcohol among workers in their 30s. These results suggest that health checkup results vary depending on lifestyle habits in workers in their 30s that make up the younger segment, and that health checkup results are reflected in health-related behavior. Assessing health conditions of workers while they are in their 30s and providing early intervention may help prevent future lifestyle-related diseases.
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<b>Objective:</b> The purpose of this study was to clarify burnout and the characteristics of mental health of caregivers of elderly dementia patients, which have been little studied.<b>Methods:</b> The subjects of this study were 107 caregivers who were engaged in the care of dementia patients at 12 facilities in northern Kyushu. We examined age, sex, status of nursing-care related qualifications, kinds of nursing care-related qualifications, years of working experience, physical health (Present state of health and Presence of perceived ill health), status at work (Problems at work and Job stress) and satisfaction with life using the Maslach Burnout Inventory (MBI) and WHO Subjective Well-Being Inventory (SUBI). The period of survey was five months, between June 1 and October 31, 2006.<b>Results:</b> The most severe level of burnout was found in 27.1% of the subjects. When subjects were classified into the burnout and nonburnout groups, the burnout group represented 53.3% of the subjects. In a comparison of the scores of the SUBI subscales between the burnout and nonburnout group, significant differences were observed in almost all subscales without "Deficiency in Social Contacts."<b>Conclusion:</b> This study clarified that self-care of physical and mental health, family support and social support were very important in maintaining mental health and preventing burnout in caregivers of dementia patients. Improvement of working conditions was considered particularly important for social support.
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When participating in international disaster relief operations (IDR), medical staff must work under limited human resources and medical equipment. The actual role of a nurse in IDR has not yet been clarified, while the role of a doctor is relatively clear.<br>In this study, we have examined the actual role of nurses in IDR through a survey by questionnaire to 61 medical staff who have worked in past IDR. Full usable responses were received from 50 (82%) of them. These 50 were consisted of 24 doctors, 17 nurses, and 9 medical coordinators. The questionnaire was distributed from September 1 to December 31 in 2005. We investigated 17 activities reported variously in the literature;-setting up temporary medical facilities, inside arrangements, health care of the medical staff, coordination within the team, keeping medical records, performing triage, wound irrigation, debridement, performing incisions, removing stitches, suturing, reception of patients, medical interview of patients, assisting a doctor performing medical examination and treatment, management of commodities, management of medical waste, management of medical records, and conventional nursing care. The questionnaire asked the respondent to indicate a level of appropriate for a nurse to perform each of the activities in IDR.<br>Provided that the nurse had a basic national licence in nursing and IDR education and training, then triage and wound irrigation were each considered appropriate during IDR with a doctor supervising, beyond the conventional nursing role. But suturing, performing incisions, removing stitches, and debridement were each considered to be problematic for nurses.