Oxford Hip Scores, Floor-Sitting Score Trajectories, and Postoperative Satisfaction Rates at 10 Years After Primary Total Hip Arthroplasty.

BACKGROUND: Available evidence on outcomes at 5 years and beyond for total hip arthroplasty (THA) is mainly limited to patient-reported outcome measures (PROMs). This study documented the trajectory of functional measurement using the Oxford hip score (OHS) and floor-sitting posture in Japan for up to 10 years post-THA and investigated predictors of dissatisfaction at 10 years with THA. METHODS: Patients scheduled for primary THA at a university hospital in Japan between 2003 and 2006 were enrolled in this prospective study. Overall, 826 preoperative participants were eligible for follow-up, with response rates ranging from 93.6% to 69.4% at each postoperative survey point. The OHS and floor-sitting scores were calculated using a self-administered questionnaire 6 times up to 10 years postoperatively. Patient satisfaction, including general surgery, walking ability, and activities of daily living (ADL), was assessed in the 10-year survey. RESULTS: The linear mixed-effects model demonstrated a postoperative improvement, peaking at 7 years for OHS and 5 years earlier for the floor-sitting score. The postoperative overall surgical dissatisfaction at 10 years with THA was very low (3.2%). No predictors of surgical dissatisfaction were identified in the logistic regression analyses. Predictors of walking ability dissatisfaction were older age, men, and worse OHS at 1 year postoperatively. Predictors of ADL dissatisfaction were poorer preoperative and 1-year postoperative floor-sitting scores and 1-year postoperative OHS. CONCLUSION: The floor-sitting score is a simple PROM suitable for the Japanese population; other populations would require a scale suitable for their lifestyles.

Validation of the LPA-SQUASH in post-liver-transplant patients.

AIM: This study aimed to validate the revised Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) to measure sedentary activity in post-liver-transplant patients. The proposed scale could be useful for transplantation nurses to assess and modify sedentary lifestyles and increase physical activity. METHODS: The SQUASH was modified to include items on sitting time and light-intensity physical activity (LPA-SQUASH). A pilot study was conducted with 20 liver transplant patients, and an expert panel validated the scale contents. Then, post-liver-transplant outpatients at a Japanese university hospital participated in the main study (September-October 2020), in which questionnaires were mailed twice to assess test-retest reliability, and accelerometers used to establish criterion validity. Intra-class correlation coefficients (ICC) were calculated for test-retest reliability. Spearman correlations and Bland-Altman plots were used to assess validity and measurement error. RESULTS: In total, 173 participants returned the questionnaires, and 106 and 71 completed the reliability and validation studies, respectively. The range of LPA-SQUASH correlation coefficients for test-retest was .49-.58. ICCs ranged from .72 to .80 for items other than leisure. Accelerometer data and the LPA-SQUASH total physical activity amount and light-intensity physical activity correlated moderately. CONCLUSION: We modified the SQUASH, which was developed to measure physical activity in healthy adults, to assess light-intensity physical activity in post-liver-transplant patients. The LPA-SQUASH showed acceptable validity and reliability. The questionnaire may be used by transplantation nurses to examine light-intensity physical activity content/duration, deliver patient education considering patients' sedentary lifestyle, and facilitate goal setting for physical activity interventions to prevent metabolic syndrome.

Nurses' perception towards care robots and their work experience with socially assistive technology during COVID-19: A qualitative study.

This study aimed to explore nurses' perceptions towards care robots and their work experiences in caring for older adults who use socially assistive technology. This qualitative descriptive study included 18 nurses who cared for older adults with dementia or living alone at home. Interviews via Zoom were conducted, and the collected data were analyzed using inductive content analysis. The three themes were identified: (1) perceived benefits, (2) perceived challenges, and (3) improvements needed to enhance the quality of care. The participants perceived that the care robot and socially assistive technology were useful in caring for older adults during COVID-19. However, they noted that the limited capabilities of the technology and an increased workload negatively impacted the quality of care for older adults. The findings of this study indicated that socially assistive technology and care robots have potential benefits in assisting older adults with dementia or living alone.

Incidence of severe infection in patients with rheumatoid arthritis taking biologic agents: a systematic review.

OBJECTIVE: The objective of this review was to estimate the population-based incidence and determine the types of severe infection and deaths experienced by patients with rheumatoid arthritis taking biologic agents. INTRODUCTION: Since the late 1990s, various biologic and synthetic drugs have been developed to treat rheumatoid arthritis. In recent years, the incidence of severe infection in patients with rheumatoid arthritis in Western nations has been determined by observational studies; however, no systematic review has been conducted on this topic. INCLUSION CRITERIA: The following inclusion criteria were considered: i) observational studies on patients with rheumatoid arthritis treated with biologic agents; ii) studies reporting the number of severe infections requiring hospitalization for treatment; iii) studies reporting person-years of observation data; and iv) studies based on rheumatoid arthritis registries, medical records from rheumatology centers, or insurance claim databases. METHODS: PubMed, CINAHL, Embase, and Web of Science were searched to identify published studies. The reference lists of all studies selected for critical appraisal were screened for additional studies. Unpublished studies were searched on MedNar and OpenGrey databases. All the searches were updated on December 6, 2021. After removing the duplicates, 2 independent reviewers screened titles and abstracts against the inclusion criteria and then assessed full texts against the criteria. Two reviewers independently appraised the study and outcome levels for methodological quality using the critical appraisal instrument for cohort studies from JBI. Two reviewers extracted the relevant information related to severe infection and drugs. RESULTS: Fifty-two studies from 21 countries reported severe infection rates associated with using 8 biologic agents, plus nonbiologic disease-modifying antirheumatic drugs. In total, 18,428 infections with 395,065 person-years of biologic drug exposure were included in the analysis. Thirty-five studies included infections in outpatients receiving intravenous antibiotic therapy. Fifteen studies reported the first episode of infection, and the remaining studies did not specify either the first or all of the episodes of infection. Inclusion of viral infection and/or opportunistic infection varied among studies. Fifteen studies reported the site of infection; respiratory, skin/soft tissue, urinary tract, and sepsis/bacteremia were commonly reported. Ten studies reported the case fatality rates, ranging from 2.5% to 22.2%. Meta-analysis was conducted for 8 biologic agents and conventional disease-modifying antirheumatic drugs. The infection rate varied from 0.9 to 18.1/100 person-years. The meta-analysis revealed an infection rate of 5.0/100 person-years (95% CI 3.8-6.7) among patients receiving tumor necrosis factor inhibitors (heterogeneity 98.2%). The meta-analysis for the other 3 biologic agents revealed a point estimate of 5.5 to 8.7/100 person-years with high heterogeneity. Sensitivity analysis indicated that registry-based studies were less likely to have very low or very high infection rates compared with other data sources. The definition of infection, the patient composition of the cohorts, and the type of databases appeared to be the primary sources of clinical and methodological heterogeneity. CONCLUSIONS: Due to high statistical heterogeneity, the meta-analysis was not suited to estimating a summary measure of the infection rate. Developing standardized data collection is necessary to compare infection rates across studies. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175137.

Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery.

Extensive gastrointestinal surgery surveillance data in Japan were analyzed to examine the differences in the risk factors for surgical site infection (SSI) between laparotomy and laparoscopic abdominal procedures. Surgical procedures investigated in the study were gastrectomy, cholecystectomy, colectomy, rectal resection, and appendectomy. A total of 32,629 patients were included in the study. The study participants were divided into two groups according to the year of surgery, 2003-2009 (first study period) and 2010-2015 (second study period), due to the increase in the number of laparoscopic surgeries in the second study period. The incidence of SSI was stratified by three SSI classifications (superficial incisional, deep incisional, and organ/space SSI). Multiple logistic regression analysis was performed to predict the risk factors for SSI. The percentage of laparoscopic surgeries performed has increased linearly since 2010. Patients in the second study period were significantly older and had a higher prevalence of SSI risk factors compared with those in the first study period. In addition, the predictive factors changed substantially in most surgical procedures between the two study periods. Wound class ≥ 3 was a ubiquitous risk factor for superficial incisional SSI (SI-SSI) and organ/space SSI (OS-SSI) in both open (laparotomy) and laparoscopic procedures in the first study period. Meanwhile, in the second study period, operative duration was a ubiquitous risk factor in both procedures. The risk factors for SI-SSI differed from those for OS-SSI in the five abdominal surgeries investigated in the study. Periodic examination of risk factors for SSI is recommended in an aging society.

Severe infection risk in patients treated with biologics for rheumatoid arthritis: a systematic review protocol.

OBJECTIVE: The objective of this review is to estimate the population-based incidence and to determine the types of severe infection experienced by patients with rheumatoid arthritis who are taking biological agents. INTRODUCTION: Since the late 1990s, a variety of biological and synthetic drugs have been developed to treat rheumatoid arthritis. In recent years, the incidence of severe infection in patients with rheumatoid arthritis in Western nations has been reported by observational studies; however, no systematic review has been conducted on this topic. INCLUSION CRITERIA: The following criteria will be considered for inclusion: i) observational studies on patients with rheumatoid arthritis who are taking biological agents; ii) studies reporting the number of severe infections requiring hospitalization for treatment; and iii) studies with person-years of observational data. METHODS: MEDLINE, CINAHL, Embase, and Web of Science will be searched to identify published studies. The reference lists of all studies that are selected for critical appraisal will be screened for additional studies. The search for unpublished studies will include MedNar and OpenGrey. Only studies published in English from 1999 to the present will be included. Screening of studies, assessment of methodological quality, and data extraction will be performed by two independent reviewers. If possible, studies will be pooled in statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175137.

Development and evaluation of the sedentary behavior and light-intensity physical activity questionnaire.

[Purpose] To describe our newly developed Sedentary Behavior and Light-Intensity Physical Activity Questionnaire and examine its reliability and validity. [Participants and Methods] We identified and selected self-reported items through a literature review and interviews with 11 inactive individuals. Thirty-one individuals with lower limb prostheses and an expert panel assessed the content validity of the integrated items and identified 17 items. Patients who had undergone lower limb surgeries were regarded as inactive individuals, and 112 patients completed the questionnaire twice for test-retest reliability and wore an accelerometer for criterion validity. The ethics committee of Kyushu University approved this study (2019-126 and 2019-273). [Results] Item analysis was revised to the Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 (six light-intensity physical activity and four sedentary behavior items) because of the floor effect. The test-retest correlation coefficient showed high reliability. Moderate to weak correlation coefficient was observed between the questionnaire and accelerometer (light-intensity physical activity: 0.43 and sedentary behavior: 0.20), and the Bland-Altman plots indicated no bias. [Conclusion] The Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 had acceptable validity and reliability among inactive individuals and it could be used for studying light-intensity physical activity.

Differences in the risk of severe falls between patients aged <65 years and patients aged ≥65 years at a psychiatric hospital based on 12-year incident reports.

PURPOSE: This study compared age differences in risk factors for falls requiring treatment in psychiatric patients. DESIGN AND METHODS: An incident database was used to compare fall incidents in patients aged less than 65 years and those aged greater than or equal to 65 years. FINDINGS: Approximately 30% of fallers were less than 65 years. Mental status and medication were the main risk factors. Decreased activities of daily living were associated with the most falls in patients greater than or equal to 65 years. PRACTICE IMPLICATIONS: Fall risk differed between the two age groups. Medication may play a major role in falls among patients less than 65 years.

Relationships of accelerometer-determined physical activity with obesity, hypertension, diabetes, dyslipidemia, and health-related quality of life in patients after liver transplantation.

The contribution of physical activity (PA) to the prevention of metabolic abnormalities following liver transplantation (LT) has not been well documented. We aimed to assess PA in post-LT patients and to quantify its relationships with the development of postoperative metabolic abnormalities and health-related quality of life (HRQOL). We recruited 111 patients who had undergone LT ≥ 6 months previously. PA was measured by accelerometry, and HRQOL was evaluated using SF-8. PA was quantified as the number of steps per day, and the time spent performing moderate-to-vigorous PA and light PA per week. The prevalence of hypertension, diabetes, and dyslipidemia increased more than twofold following LT. The proportion of the participants with a sedentary lifestyle (<5000 steps/day) was 36%. Logistic regression analysis showed that postoperative hypertension and obesity were associated with preoperative body mass index and the number of steps taken (in 2000 steps/day increments). Preoperative diabetes was associated with obesity, and PA was associated with physical function-related HRQOL scores. Thus, increasing the number of steps taken per day has the potential to reduce hypertension and obesity, and PA could improve physical function-related HRQOL in patients following LT.

Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay.

AIM: The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the postoperative experiences of adult/older patients (age ≥20 years) with osteoarthritis who underwent total hip or knee arthroplasty, focusing on the first 6 weeks following discharge. METHODS: A systematic literature search on qualitative studies was conducted using six databases, such as Medline, CINAHL and Mednar. Verbatim interview data and themes or subthemes related to the patients' experience after discharge were extracted. Content analysis was used to code interview data. Codes similar in meaning were grouped, and subcategories were formed. These subcategories were then grouped into categories. RESULTS: Sixteen qualitative studies with 253 participants were analyzed. In total, 136 codes were generated and formed 29 subcategories. Six categories were generated: (a) postoperative pain and medication; (b) difficulty in performing activities of daily living; (c) appreciation for support and difficulties associated with receiving support; (d) variability in recovery process and information-seeking; (e) lack of patient-centered care; and (f) transportation problems and social isolation. CONCLUSION: Our review suggests that prospective patients and their caregivers need individually tailored presurgical education and advanced planning for postsurgical reduced mobility.

Changes in actual daily physical activity and patient-reported outcomes up to 2 years after total knee arthroplasty with arthritis.

The current study aimed 1) to describe changes in patient-reported outcomes and physical activity measured with an accelerometer preoperatively, 6 months and 2 years postoperatively in older patients undergoing total knee arthroplasty (TKA) for arthritis, and 2) to examine the predictors of the changes in physical activity (PA). This study included 58 patients (mean age 72.6 years, 84.5% women) who completed the Oxford Knee Score (OKS) and the 8-item Short Form Health Survey. Physical activity measured mean steps per day, duration of light physical activity and moderate-to-vigorous physical activity (MVPA) per week. All PA indicators and patient-reported outcomes improved 6 months postoperatively. After 6 months, knee-related pain and function gradually improved, and MVPA increased. The OKS was a sole predictor of improvement in PA during the 2-year study period, suggesting the importance of disease-specific quality of life.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

OBJECTIVES: To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis. DESIGN: A multi-country cross-sectional study. SETTING AND PARTICIPANTS: Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included. METHODS: Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated. RESULTS: Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples. CONCLUSIONS AND IMPLICATIONS: The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.

Prospective study of objective physical activity and quality of life in living donor liver transplant recipients.

AIM: The aims of this study were to: (a) describe the physical activity (PA) and quality of life (QOL) in living donor liver transplant (LDLT) recipients pre-operatively and at 3 months and 6 months post-operatively; (b) compare PA and QOL at 6 months post-operatively with a healthy control group; and (c) explore pre-operative factors that predict PA changes. METHODS: Patients over 20 years of age who were undergoing LDLT were recruited. PA was measured based on the number of steps/day and time spent performing moderate-to-vigorous PA (MVPA) during 1 week using an accelerometer. QOL was assessed based on a physical (PCS) and mental (MCS) component summary of the eight-item Short-Form Health Survey. The LDLT and healthy control groups were matched for age (±3 years) and gender. Pre-operative factors predicting a change in PA were calculated using a generalized linear mixed model. RESULTS: Twenty-four patients completed the study. By 6 months post-LDLT, the MCS and PCS were comparable to those in the control group. The number of steps (3,887 steps/day) and MVPA (29.3 min/week) showed significant improvement by 6 months post-operatively, but remained much lower compared with those in the control group. The multivariate analysis showed that younger age (p < .01, p = .04) and higher skeletal muscle mass (SMM; p < .01, p = .03) were predictors of improvement in number of steps and MVPA. CONCLUSION: This study suggests the need for pre-operative interventions by healthcare professionals that focus on outcomes such as improving low SMM to facilitate post-operative PA recovery.

Three-Year Follow-Up Study of Physical Activity, Physical Function, and Health-Related Quality of Life After Total Hip Arthroplasty.

BACKGROUND: Little is known about the long-term changes in physical activity (PA) after total hip arthroplasty (THA). The purpose of this study is to describe the changes in the number of steps and intensity of PA as measured by accelerometers, patient-reported physical function, and health-related quality of life of THA patient preoperatively and at 1 and 3 years after THA. METHODS: This study included 153 patients (mean age, 61.4 years; 86.3% women) who wore an accelerometer for 10 consecutive days and completed the Oxford Hip Score (OHS) and the Short Form 8 at the 5-year follow-up after THA. PA was evaluated based on the mean steps per day and the time spent performing moderate-to-vigorous PA (MVPA) per week. RESULTS: All 5 indicators had significantly increased at 1 year after THA, although only MVPA and OHS had further increased significantly at the 3-year follow-up. The predictor of improvement in the number of steps from baseline to 1 year post-THA was younger age, while those of improvement in MVPA from baseline to 3-year post-THA were younger age, higher OHS, and better Short Form 8 mental component scores using mixed-model analysis. Participation in the PA measurements was high (69.9%) at the 3-year follow-up. No significant changes were observed for these outcomes in the remaining cohort beyond 3 years after THA. CONCLUSION: In post-THA patients, MVPA continued to increase for 3 years postoperatively. Therefore, PA must be measured over the medium term to long term following THA.

Review of outcome measures in PARO robot intervention studies for dementia care.

The aim of this study was to describe interventions for PARO, as well as the outcomes evaluated and found following use of PARO, and to identify outcome measures in PARO intervention studies for older adults with dementia. Multiple databases (Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane, and Scopus) were searched and eight studies were included in the systematic review. The review demonstrated that interventions using PARO can be beneficial for improving QOL, affect, social interaction, and reducing NPS and psychotropic or pain medication use. This study identified three domains of outcome measures used to assess the effects of interventions using the PARO robot: quality of life, biological and physiological conditions, and medical treatment.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review.

OBJECTIVE: The objective of this systematic review was to identify, evaluate and synthesize evidence of the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and younger. INTRODUCTION: Needle-related procedures (NRPs) are common medical procedures associated with pain. Children, in particular, experience unpredictable and severe pain in response to NRPs. The gate control theory is commonly used to countermeasure this pain. Based on this theory, various types of vibratory stimulation have been used to reduce pain in several clinical studies. INCLUSION CRITERIA: Participants were 0- to 18-year-old children who underwent NRPs for any condition. The intervention included any type of vibratory stimulation during the NRPs. The main outcome was pain measured on any pain scale, including both self-rated and observer-rated pain scales. The secondary outcomes were anxiety, the duration of the procedure and the success rate. All studies were randomized controlled trials (RCTs) or quasi-randomized trials published in English. METHODS: The search strategy aimed to identify both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE and CINAHL was undertaken, followed by a search for unpublished studies. Nine databases were used for the search in October 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data were extracted from papers included in the review using a standardized data extraction tool. Where possible, quantitative data were pooled in the statistical meta-analysis. All results were subject to double data entry. Effect sizes were expressed as risk ratios (for categorical data) and weighted mean differences (for continuous data), and their 95% confidence intervals were calculated for analysis. RESULTS: Twenty-one RCTs involving 1727 children were identified. Blinding of the participants and those delivering the treatment was not achieved in all studies, introducing a potential risk of bias. Overall, the vibratory stimulation was significantly effective in reducing NRP pain in children as shown by measurement of self-rated pain outcomes (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI]: -0.92 to -0.18) and observer-rated pain outcomes (SMD: -0.47, 95% CI: -0.76 to -0.18). Among secondary outcomes, the effect on the child's anxiety (SMD: -1.03, 95% CI: -1.85 to -0.20) was significant. CONCLUSIONS: Vibratory stimulation was effective in reducing NRP pain in children; however, blinding was not possible in the trials. Moreover, heterogeneity was high. Therefore, the confidence in the evidence is low. Personal preference should be a priority when using vibratory stimulation in the clinical setting.

Impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: A systematic review.

BACKGROUND: Immediately after cleft lip repair, breastfeeding and bottle-feeding are generally restricted to avoid placing tension on the surgical incision. However, no consensus about feeding methods after cleft lip repair has been reached. The objective of this systematic review was to examine the impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. MATERIAL AND METHODS: We searched PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Mednar from October to November 2017. Two reviewers independently assessed eligibility for inclusion and checked critical appraisal of the study quality. RESULTS: Three randomized controlled trials and two cohort studies involving 342 infants were included in this review. Two cases of surgical wound dehiscence occurred in the control group of alternative feeding. In three of five studies, surgical wound dehiscence did not occur in either the intervention or control group within the first week postoperatively. CONCLUSIONS: This review showed no increased risk of surgical wound dehiscence in infants with breastfeeding and/or bottle-feeding after cleft lip repair compared with infants with alternative feeding methods. It may not be necessary to restrict breastfeeding and/or bottle-feeding immediately after cleft lip repair.

Prevalence of incontinence among cognitively impaired older residents in long-term care facilities in East Asia: A cross-sectional study.

AIM: The current study was an international cross-sectional study comparing the prevalence of incontinence among cognitively impaired older residents in long-term care facilities in East Asia, including Japan, Korea, China, Taiwan and Thailand between 2015 and 2016. METHODS: Participants were cognitively impaired older residents in long-term care facilities. Demographic data were collected. The Clinical Dementia Rating scale was used to assess dementia severity, and the Barthel Index was used as a surrogate measure of incontinence and toilet use dependence. The prevalence of urinary incontinence and fecal incontinence were examined. Multiple logistic regression analysis was used to predict incontinence and toilet use dependence. RESULTS: We analyzed data from 662 participants (age 82.6 ± 9.9 years, 57.6% women). The prevalence of urinary incontinence ranged from 10.1% in Taiwan to 71.0% in Korea. The prevalence of fecal incontinence varied from 4.0% in Taiwan to 57.0% in Korea. A higher Clinical Dementia Rating score was a significant predictor of urinary and fecal incontinence and toilet use dependence (P < 0.0001). CONCLUSIONS: The current survey showed a high prevalence of incontinence in long-term care residents in East Asia, and identified challenges for future studies. Development of clinical guidelines for incontinence care in cognitively impaired older persons is urgently required. Geriatr Gerontol Int 2019; 19: 444-450.

Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study.

BACKGROUND: The aim of this cross-sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long-term care facilities in East Asia and to explore factors associated with these patterns. METHODS: This study included elderly participants with cognitive impairments residing in long-term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. RESULTS: In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti-dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly-pharmacy was identified as a common problem at all study sites. CONCLUSIONS: Our findings will be beneficial for health-care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly-pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence-based practice.

Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long-term care facilities in East Asia: a cross-sectional study.

OBJECTIVE: The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. METHODS: This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1- 3; clinically significant ≥4). RESULTS: Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. CONCLUSIONS: Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.