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BACKGROUND@#Global aging continues to progress. The shortage of human resources involved in long-term care (LTC) is a serious problem worldwide. It is necessary to promote the stable employment of foreign care workers. The purpose of this study was to identify which factors, including well-being, work engagement, and original items, contribute to foreign care workers' intent to continue working.@*METHODS@#We conducted an anonymous self-administered questionnaire survey of 259 foreign LTC workers at LTC facilities in Japan. The questionnaire survey items included the Japanese version of the Subjective Well-being Scale (J-SWBS), the Japanese version of the Utrecht Work Engagement Scale (J-UWES), and original items related to educational needs and issues. We used multiple regression analysis to predict variability from correlations among variables. And after that, we conducted a path analysis using structural equation modeling (SEM), and added that the explanatory variables (IV) were well-being, work engagement, and the original item component, and that the outcome variable (DV) was intention to continue working. We set a hypothetical model based on structural equations, corrected by path analysis, and examined its suitability.@*RESULTS@#The number of returned questionnaires for 259 foreign care workers was 147 (response rate 56.7%), and the number of analyzable questionnaires was 129 (valid response rate 49.8%). For intention to continue working, the results of structural equation modeling showed direct effects for satisfaction with low back pain measure guidance (β = .255), satisfaction with the national examination guidance method (β = .217), well-being (β = .046), and work engagement (β = .026). In work-engagement, there was a direct effect of happiness (β = .715), willingness to learn good care (β = 4.849), and confidence in my ability (β = 2.902,), whilst in well-being, satisfaction with low back pain measure guidance (β = 1.582) and confidence in my ability (β = 1.999) were found to have direct effects.@*CONCLUSIONS@#To increase the intent of foreign care workers to continue working, appropriate guidance should be given related to the development of lumbago. In addition, to provide a place and scene where they can learn good care, having a relationship in practice where foreign care workers can feel that their abilities are being utilized, and developing and maintaining educational support that motivates them to learn good care may be effective.
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Humans , Cross-Sectional Studies , Health Personnel , Intention , Japan , Work EngagementABSTRACT
Introduction: This study assessed the validity and reliability of the Japanese Consultation and Relational Empathy (CARE) Measure in community pharmacist consultations.Methods: We administered an anonymous self-questionnaire about patient consultations with pharmacists to 11 community pharmacies between November 2018 and March 2019.Results: A total of 224 patients completed the questionnaire. Low numbers of missing values and 'not applicable' responses suggested high face validity of the Japanese CARE Measure. Factor analysis resulted in a single solution and internal reliability was high (Cronbach's alpha 0.943). Construct validity was supported by a significant relationship (Spearman's rho 0.43, p<0.01) with the patient's satisfaction with the consultation.Conclusion: The Japanese CARE Measure may be valid and reliable in a community pharmacy setting.
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Introduction: The purpose of this study was to examine the effects of cognitive rehabilitation for depression, cognitive function, ADL, and QOL in patients with post-stroke depression (PSD). In addition, we evaluated the effects of cognitive rehabilitation on customer satisfaction with long-term care facilities and rehabilitation.Methods: This study included 8 participants with PSD who were residents of a long-term care facility located in Ibaraki Prefecture, Japan. In addition to their ordinary rehabilitation (2 sessions per week, 20 minutes per session), participants underwent 36 sessions of cognitive rehabilitation (3 sessions per week, 20 minutes per session, for 12 weeks). Primary outcome measures: Depression severity was measured using the Geriatric Depression Scale (GDS), Zung Self Depression Scale (SDS), and the Depression Scale of the Japan Stroke Scale (JSS-D). Frontal lobe function was assessed using the Frontal Assessment Battery (FAB). Secondary outcome measures: QOL was assessed using SF-8. Customer Satisfaction with the rehabilitation was measured using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS). Assessments were performed before and after the rehabilitation.Results: The severity scores of depression, frontal lobe function, and customer satisfaction with the rehabilitation all significantly improved after the cognitive rehabilitation sessions.Conclusions: The results obtained in this trial indicate that, for patients with PSD depressive symptoms, frontal lobe function, QOL, and rehabilitation customer satisfaction may be improved by the inclusion of cognitive rehabilitation sessions alongside regular rehabilitation.
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Purpose: In this study, we performed a longitudinal examination of the occurrence of homeboundness among community-dwelling elderly individuals and changes in associated factors, including the sense of coherence (SOC).Methods: A questionnaire survey was conducted targeting community-dwelling elderly individuals to evaluate homebound status, a basic checklist (CL), and SOC. Among these individuals, frail elderly people who maintained a non-homebound state were extracted and a follow-up survey was carried out one year later. Those who maintained the non-homebound state one year later were classified into the maintenance group and those who became socially withdrawn were classified into the transition group. Factors predicting the homebound state one year later were examined using multiple logistic regression analysis. Furthermore, the changes in CL and SOC between the transition and maintenance groups were compared.Results: In the transition group, motor function, cognitive function, and sense of manageability on the initial survey were significantly lower than those in the maintenance group. Significant correlations were noted in the homebound transition group with lack of money management (OR: 3.04, 95% CI: 1.19-7.82) and a declined sense of manageability (OR: 0.82, 95% CI: 0.69-0.99). Depression and the sense of manageability had also significantly deteriorated one year later compared with those in the maintenance group.Conclusion: This study suggests that individuals who transition to a state of homeboundness have a slightly lower SOC than those who maintain their non-homebound status.
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<p><b>Introduction: </b>The factors associated with the recovery of activities of daily living (ADL) in elderly inpatients have not been clarified. This study aimed to investigate the factors associated with recovery of ADL in elderly inpatients with acute infectious disease who underwent rehabilitation during their hospitalization.</p><p><b>Methods: </b>The study included patients ≥65 years of age who were hospitalized due to acute infectious disease and had undergone rehabilitation at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL, and the recovery rate of FIM was calculated. Furthermore, the factors associated with the recovery rate of FIM were evaluated by multiple regression analysis. Basic characteristics, length of stay, length from onset to starting rehabilitation, physical status (muscle strength and presence of urinary incontinence), and mental status (cognitive and depression) at the start of rehabilitation were included as the evaluation items.</p><p><b>Results: </b>Among the 124 elderly inpatients with acute infectious disease (mean ± standard deviation age, 82.5±7.7), 56 were male and 68 were female. According to the multiple regression analysis, length from onset to starting rehabilitation (β=-0.03), presence of urinary incontinence (β=-0.29), and cognitive status (β=0.01) were factors associated with the recovery rate of FIM.</p><p><b>Conclusion: </b>The study results suggest that length from onset to starting rehabilitation, presence of urinary incontinence, and cognitive status are important for elderly inpatients with acute infectious disease to return to their ADL.</p>
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<b>Introduction</b>: The present study was conducted to identify the influence of self-efficacy score and having an action plan on “stages of change” for exercise after one year.<br><b>Methods</b>: Physical functions and psychological factors at baseline and after one year in 105 elderly individuals who participated in a preventive care program. The subjects were classified into four groups by using the stages of change scale for physical activity.<br>The cause related to impact on physical activity and action stage change (stage) after one year later with having or not having action plan for preventive care program in elderly at home in community as well as sense of self efficacy was investigated.<br><b>Results</b>: Self-efficacy scored significantly higher in the usual activity group with continuity of stage activity both at baseline and one year later. The relative risk of having an action plan at baseline for exercise after one year was 2 . 90 (95% CI: 1.52-5.55). This value significantly influenced the maintenance of physical activity after one year.<br><b>Conclusion</b>: The results of this study suggest that showing an action plan was effective in maintenance of physical activity.
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<b>Objective</b> : Although current preventative care policies consider the issue of the homebound elderly to be important, effective means of intervention have not been established. Therefore, it is necessary to elucidate the relevant causes of the poorly understood “homebound” problem. As little expertise exists on the social and psychological factors of those who are homebound, this study focuses on the sense of coherence (SOC) —a new estimate of the psychosocial factors involved in being homebound—and examines the connection between being homebound and SOC.<br><b>Methods</b> : A mail survey was conducted among 1,895 elderly adults, none of whom had been issued a Certification of Long-Term Care Need. Survey items included basic attributes, physical characteristics, psychological and socioenvironmental characteristics, and the condition of being homebound. Furthermore, SOC was investigated as part of the psychosocial and environmental evaluation. The 853 respondents chosen for the analysis were divided into three groups depending on their level of homeboundedness, and an ordered logistic regression analysis was conducted using homeboundedness as the dependent variable.<br><b>Results</b> : The following items were found to have a significant association with homeboundedness : age, sex, low motor function, depressive tendencies, low SOC, and the low TMIG Index of Competence.<br><b>Discussion</b> : This study identified a relation between being homebound and SOC, suggesting that in addition to interventions for depression and motor function, new SOC focused aid must be considered in the prevention of homeboundedness.
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<b>Background: </b>The current study aimed to investigate factors associated with the prognosis of activities of daily living (ADL) in elderly patients with pneumonia who had undergone rehabilitation during their hospitalization.<br><b>Methods: </b>The study included patients of age ≥65 years who were hospitalized due to pneumonia and had undergone rehabilitation for disuse syndrome at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL. The participants were divided into a high-recovery group (≥80%) and a low-recovery group (<80%) based on the FIM recovery rate score. Further, factors associated with the prognosis of ADL were evaluated using multivariate logistic regression analysis. Basic characteristics, consciousness, usual mode of transportation, FIM score, grip strength, range of motion, orthostatic hypotension, exercise tolerance (6-minutes walking distance), respiratory disorder (Hugh–Jones classification), constipation, malnutrition (mini-nutritional assessment), cognitive (mini-mental state examination), depression (geriatric depression scale), balance (functional balance scale), urinary incontinence, and pressure ulcers were included as the evaluation items.<br><b>Results: </b>Among the 51 elderly patients with pneumonia (average age ± SD; 82.0 ± 11.3), 34 patients were classified in the high-recovery group and 17 in the low-recovery group. In multivariate logistic regression analysis, it was revealed that the number of days from the onset until the initiation of rehabilitation (days of inactivity) and nutritional status were factors associated with a high-recovery FIM score.<br><b>Conclusions: </b>The study results suggest that days of inactivity and early management of nutritional status after hospitalization are important for elderly patients with pneumonia to return to their ADL.
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<b>Purpose</b> : The purpose of the present study was to examine the relationship between respiratory function and ADL/QOL among community-dwelling elderly requiring support or care.<br><b>Methods</b> : The study included 87 elderly aged ≥65 years who were certified to require support (yousienn)or care (youkaigo)level 1-3 and who used day care at a rehabilitation center. We evaluated their respiratory, mental, physical, and swallowing functions. ADL, IADL, and QOL were estimated using a questionnaire. Spearman's rank correlation test and multiple regression analysis were used to examine correlations of the functions with ADL/QOL.<br><b>Results</b> : Respiratory, physical, and swallowing functions showed statistically significant correlations with ADL/IADL/QOL. Multiple regression analysis showed that forced expiratory volume in 1 second and swallowing function were related to ADL, IADL, and QOL (SF8body & mental).<br><b>Conclusion</b> : ADL and QOL were associated with respiratory function in elderly subjects requiring support or care. Our data suggested that pulmonary rehabilitation to enhance respiratory and swallowing functions in elderly requiring support or care may improve their ADL and QOL.
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<b>Introduction</b> : In recent years, aging of the population and the low birth rate are progressing rapidly in China, resulting in an increase in the number of elderly individuals engaged in the long-term care of an elderly family member (Jap. “Ro-ro kaigo”). We conducted a cross-sectional study to evaluate the current Ro-ro kaigo situation and the factors related to the quality of life of the caregivers in two ethnic groups : Han Chinese and Korean Chinese.<br><b>Methods</b> : Fifty-one Korean Chinese households and sixty-one Han Chinese households (≥60 years old) in Changchun or Yanji of Jilin Province, China, participated. The quality of life of the caregivers was measured using the SF-8 health survey questionnaire. We conducted a multiple regression analysis to investigate the factors related to the caregivers' quality of life.<br><b>Results</b> : There was no significant difference in gender ratio and caregiver age between the two ethnic groups. In both groups, a spouse was often the cargiver. Factors related to the caregivers' quality of physical life were as follows. For the Korean Chinese : the caregivers' subjective feeling of health, and the number of the caregivers' diseases ; for the Han Chinese : the caregivers' subjective feeling of health, the care period, and the frequency of participation in community activities. Factors related to the caregivers' quality of the mental life were as follows. For the Korean Chinese : the frequency of consultation for nursing-care problems ; for the Han Chinese : the care-recipients' educational history, and having assistance on ceremonial occasions.<br><b>Conclusion</b> : The results suggest that good health is important to maintain the quality of physical life of elderly caregivers in both ethnic groups. As factors related to the physical and mental summary scores differed by ethnicity, support for the caregivers that considers their ethnic background is necessary.
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<b>Purpose</b> : The purpose of this study was to examine quantitative activity and determine characteristics using an activity meter in community-dwelling frail elderly people.<br><b>Methods</b> : We monitored 25 community-dwelling elderly of support-requiring condition level1 and 2 by attaching activity monitoring evaluation system (A-MES) and measured physical activity (PA) over 24 hours as well as body information, care information, everyday life function.<br>We examined according to sex / care category using obtained results.<br><b>Results</b> : Women's standing position time and walk time were significantly longer, and men's daytime lying position and sitting position time were significantly longer.<br>Also, in persons of support-required condition level 2 there was a significantly higher number of posture changes from sitting position to daytime lying position.<br>It was suggested that a quantitative evaluation of the PA could lead to discovery of activity decrease in home life in association with each PA item and low rank criteria of the functional independence measure (FIM).<br>Securing of enough walk time and shortening of the lying position time in the daytime tend to be important for self-care ability and maintenance of locomotiveness.<br><b>Conclusion</b> : It was suggested that the evaluation of shortening the lying position time in the daytime and increasing the amount of position changes will supplement a decrease of the PA, which is related to preventing decrease in activity.
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<b>Objective</b> : It is not known whether residents in geriatric facilities are satisfied with the rehabilitation they receive. The purpose of this study was to investigate the relationship between their satisfaction with facility services and their satisfaction with the rehabilitation they receive in geriatric facilities. An additional aim was to identify the factors related to customer satisfaction with rehabilitation.<br><b>Methods</b> : One hundred residents in 19 geriatric facilities participated in this study. After obtaining informed consent from the residents, we conducted semi-structured interviews which included scales for facility services satisfaction, customer satisfaction with rehabilitation, and the Geriatric Depression Scale (GDS). The characteristics and conditions of the residents were investigated by interviewing the facilities' staff. For statistical analysis, we used Spearman's, rank correlation test, and multiple regression analysis.<br><b>Results</b> : Sixty-seven percent of the subjects were women, and the mean age (±SD) was 78.2±10.4 years. Multiple regression analysis revealed that the total customer satisfaction with rehabilitation score was associated with facility service satisfaction (β=0.232, p<0.05). Significant associations were also observed with “female”(β=0.198, p<0.05), “support counselors” (β=0.269, p<0.01), and “GDS” score (β=-0.291, P< 0.01). Customer satisfaction with rehabilitation was associated with “age” (β=-0.296, p<0.01), “BI” (β=0.261, p<0.01), “satisfaction with rehabilitation time” (β=0.254, p<0.01), “satisfaction with the training environment” (β=0.206, p<0.05), “toilet training” (β=0.210, p<0.05), “bathing training” (β=-0.252, p<0.01), and “GDS” score (β=-0.258, p<0.01).<br><b>Conclusion</b> : Customer satisfaction with rehabilitation was significantly associated with facility service satisfaction in geriatric facilities.<br>These data suggest that rehabilitation is an important service in geriatric facilities, and supplying a sufficient number of hours of rehabilitation and having adequate facilities for rehabilitation were important for improving satisfaction with rehabilitation services in geriatric facilities.
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OBJECTIVE : The aims of this study were to clarify the characteristics of outpatients with schizophrenia receiving psychiatric nursing at home and to evaluate factors related to re-hospitalization. <br>METHODS : The subjects were 55 outpatients with schizophrenia who were receiving psychiatric home visits and 31 non-users. An interview was conducted based on a questionnaire on age, gender, family members, psychiatric symptoms, attitude to drug use, and self-assessment of efficacy etc.; and we examined factors related to re-hospitalization. <br>RESULTS : Most subjects (86%) lived with their families. The percentage that lived alone was higher among those receiving nursing visits than non-recipients. Of the average age of the nursing recipients was higher than that of the non-recipients, the mean period of hospitalization was longer and the period after discharge was shorter than for the latter. The self-assessed score for efficacy among the nursing recipients who were re-hospitalized was higher than among those who were not re-hospitalized. <br>CONCLUSIONS : It is suggested that schizophrenia patients with serious symptoms or without family support can live in the community by using home visits by psychiatric nurses. The visiting nurses are requested to advise the patients so that they are able to assess their own capabilities and to control their own condition.
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Purpose<br> Long-term elderly care of the elderly (Jap. “Ro-ro Kaigo”) is a serious problem in Japan. The purpose of this study is to reveal the current state of Ro-ro Kaigo and to evaluate the factors affecting the burden on elderly caregivers. <br>Method<br> Ninety-three households of elderly subjects participated in this study. We conducted semi-structured interviews concerning the life styles of caregivers, the burden on caregivers and the condition of elderly subjects requiring long-term care. <br>Results<br> Eighty percent or more of the caregivers were spouses, and about 40 percent of the households were not supported by family members living separately. <br>Moreover, the burden of care borne by the caregivers was correlated with "hours spent daily providing care", "ADL of elderly requiring long-term care" (p<0.001), "hours of sleep" (p<0.01), "subjective feeling of wellbeing", "support from family living separately", and "behavioral disorders of dementia" (p<0.05). <br>Conclusion<br> These data suggest that supporting "health promotion", "reduction of hours of caregiving", "reduction of amount of assistance with toilet activity of care recipients", and "securing enough hours of sleep" were important for maintaining home care in Ro-ro kaigo.
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<p><b>OBJECTIVES</b>We investigated the association between the fall of nocturnal blood pressure (BP) and cognitive impairment in elderly subjects.</p><p><b>METHODS</b>The study was a cross-sectional survey of 204 elderly subjects who had no cerebrovasucular episodes. Ambulatory BP monitoring and assessments of cognitive functions using the Mini-Mental State Examination (MMSE) were performed at the subjects' homes. We classified, the subjects treated with antihypertensive drugs into three groups: non-dippers (nocturnal fall<10% of the mean day diastolic BP; n=51), normal dippers (10% to less than 20%; n=58), and extreme dippers (20% or more; n=17). The subjects not treated with antihypertensive drugs were also classified as non-dippers (n=40), normal dippers (n=24), and extreme dippers (n=14).</p><p><b>RESULTS</b>The mean age of participants was 75.2±7.2 years, and 126 (61.7%) were being treated with antihypertensive drugs. In the group of antihypertensive drug users, the number with MMSE≤23 was 30 and the adjusted odds ratio for cognitive impairment in those with an extreme dip in diastolic BP (DBP) was 4.18 (95% CI, 1.07-16.40) in reference to the normal dippers. In contrast, no association was observed between cognitive function and nocturnal BP fall in the group no using antihypertensive drugs.</p><p><b>CONCLUSIONS</b>Cognitive impairment was associated with an extreme dip in DBP in the antihypertensive drug users only. It remains to be seen whether careful monitoring of nighttime BP as well as daytime BP may reduce the risk of cognitive impairment in antihypertensive drug users.</p>
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Objectives: We investigated the association between the fall of nocturnal blood pressure (BP) and cognitive impairment in elderly subjects. Methods: The study was a cross-sectional survey of 204 elderly subjects who had no cerebrovasucular episodes. Ambulatory BP monitoring and assessments of cognitive functions using the Mini-Mental State Examination (MMSE) were performed at the subjects' homes. We classified the subjects treated with antihypertensive drugs into three groups: non-dippers (nocturnal fall <10% of the mean day diastolic BP; n=51), normal dippers (10% to less than 20%; n=58), and extreme dippers (20% or more; n=17). The subjects not treated with antihypertensive drugs were also classified as non-dippers (n=40), normal dippers (n=24), and extreme dippers (n=14). Results: The mean age of participants was 75.2±7.2 years, and 126 (61.7%) were being treated with antihypertensive drugs. In the group of antihypertensive drug users, the number with MMSE£23 was 30 and the adjusted odds ratio for cognitive impairment in those with an extreme dip in diastolic BP (DBP) was 4.18 (95% CI, 1.07−16.40) in reference to the normal dippers. In contrast, no association was observed between cognitive function and nocturnal BP fall in the group no using antihypertensive drugs. Conclusions: Cognitive impairment was associated with an extreme dip in DBP in the antihypertensive drug users only. It remains to be seen whether careful monitoring of nighttime BP as well as daytime BP may reduce the risk of cognitive impairment in antihypertensive drug users.
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Blood Pressure Determination , AgedABSTRACT
In 1996 we started an early exposure program of nursing and care for medical school freshmen at University of Tsukuba. The program consisted of out-of-hospital practice and in-hospital practice; 195 medical students completed the program in the 1999-2000 academic year. We analyzed students' questionnaires about satisfaction with the program after each practice and studied better settings for early exposure. Students were randomized to three out-ofhospital settings (nursing home, facilities for the elderly, and home-visit nursing) and also randomized the order of the practice (in-hospital or out-of-hospital first). The mean satisfaction score for setting was the highest for the home-visit nursing and lowest for nursing homes. The mean satisfaction score for order of practice was higher when in-hospital practice was done first.
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<p><b>OBJECTIVES</b>Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population.</p><p><b>METHODS</b>The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)≧140 and/or diastolic BP (DBP)≧90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance.</p><p><b>RESULTS</b>Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%.</p><p><b>CONCLUSIONS</b>Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.</p>
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Objectives: Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population. Methods: The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)³140 and/or diastolic BP (DBP)³90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance. Results: Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%. Conclusions: Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.
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Blood Pressure Determination , AgedABSTRACT
Although attempts to teach medical students about nursing have become more frequent, nurses who have lectured to medical students and have been involved in their practical training have rarely published studies evaluating their training methods and objectives. This study was performed to clarify the significance and problems of such teaching. Nurses now participate in the education and training of medical students in at least half of medical training hospitals and schools. They thought that this is a unique and beneficial educational opportunity and had high expectations. However, four main problems have been identified: the motivation and attitudes of medical students, the time and environment for training, the understanding of clinicians, and the problems of nurses, such as lack of educational experience.