[Effects of a fall intervention program for elderly patients with dementia based on person-centered care on care staff].

AIM: This study aimed to clarify the effects of a fall prevention intervention that focused on the characteristics of falls among elderly patients with dementia and was based on person-centered care in geriatric facilities on care staff. METHODS: This study was conducted between May 2016 and January 2017, and the subjects were classified into two groups: the intervention group, consisting of members who had participated in a three-month education training program, and the control group, consisting of members who provided the usual care. The study period was nine months divided as follows: training period (three months), fall prevention practice (three months), and follow-up period (three months). The quality of care was measured using the Nursing Quality Indicator for Preventing Falls (NQIPFD), and the assessment scale of health care professionals' recognition of the successful Interdisciplinary Team Approach in Health Care Facilities for the Elderly was also used. In total, the care staff members were evaluated four times: once to obtain baseline values before training, and again after the training period, after the fall prevention practice, and after the follow-up period. The results were analyzed using an analysis of variance (fixed factors = group and time, random factor = subjects, and covariance = years of experience working at the geriatric facility and type of job). RESULTS: There were 50 care staff subjects in the intervention group and 69 people in the control group. The results of the analysis of variance indicated that there was a significant difference in the NQIPFD between baseline 68.60 (±9.09) and follow-up 70.02 (±9.88) in the intervention group. With regard to the differences by intervention, the effect size of the dementia knowledge scale scores was 0.243 higher than the others, which was significant (p<0.01). CONCLUSIONS: The results showed that the participation of care staff in a fall intervention program to support elderly patients with dementia based on person-centered care significantly improved the NQIPFD and other measured factors. These findings suggest that the program fostered positive effects among the care staff.

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

PURPOSE: The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). METHODS: Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. RESULTS: The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. CONCLUSION: When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

Developing and validating a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment.

This study aimed to develop a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment (PACSLAC-J) and evaluate the validity and reliability of the scale for use in older patients with dementia in Japan. All patients from 2 dementia wards at a geriatric hospital and 2 aged care facilities were asked to participate. Demographic data, medical prescriptions, Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) score, and PACSLAC-J score were obtained from the patients or their medical charts. Researchers used the PACSLAC-J to assess pain behaviors while the patients walked or were transferred between a bed and a wheelchair. Intra-class correlation coefficients (ICC) for inter-rater and test-retest reliability, Cronbach's alpha, and correlations between PACSLAC-J score and other variables were examined. A total of 117 older patients participated. Dementia, including Alzheimer's disease (n=54) and/or vascular dementia (n=35), had been diagnosed in almost all of them. The ICC for inter-rater and test-retest reliability were 0.917 and 0.600, respectively. Internal consistency of the entire sample was 0.782. Patients who stated they were experienced pain during movement had higher scores than did patients who stated they had no pain during movement. PACSLAC-J total score was not associated with BEHAVE-AD score. Multiple regression analysis showed that total dependence on assistance during transfer (ß=0.32, p=0.001), and psychiatric medication prescription (ß=0.26, p=0.003) were independently associated with PACSLAC-J score. We found sufficient evidence of the validity and reliability of the PACSLAC-J.