[Show abstract][Hide abstract] ABSTRACT: It is often observed that pain causes substantial problems for nursing home residents. However, there has been little research about the prevalence of pain for nursing home residents in Japan. This study aimed to examine the prevalence of pain in older adults living in nursing homes in Japan by using self-reporting and the Abbey Pain Scale-Japanese version (APS-J) and to explore factors related to pain. This is a descriptive study. Residents in two Special Nursing Homes for the Elderly in Tokyo, Japan, were asked to participate in this study, with the exclusion of short-term temporary residents. Data collected from participating residents included their demographics and the results from the Barthel Index, the Folstein Mini-Mental State Examination, the APS-J, and the Verbal Descriptor Scale for pain. The residents were divided into two groups: residents able to report their pain (self-report group) and residents not able to report their pain. The second group was assessed by using the APS-J (APS-J group). The Mann-Whitney U test, the χ(2) test, and logistic analyses were performed to derive factors related to pain prevalence. Data were obtained from 171 residents. The prevalence of pain in the self-report group (n = 96) was 41.7%. For the 75 residents unable to report their pain, 52.0% were assessed by the APS-J to have pain. The overall pain prevalence of all residents was 46.2%. Age, Barthel Index score, and length of time of institutionalization were significantly associated with residents' pain in the APS-J group. Logistic regression analysis showed that contracture (odds ratio 3.8) and previous injury (odds ratio 3.4) were associated with residents' pain in the self-report group, whereas only the length of nursing home stay (odds ratio 1.03) was a predictor for pain in the APS-J group. Nearly one-half of residents had pain when they moved or were moved. Pain assessment and management is needed for residents.
No preview · Article · Jun 2013 · Pain management nursing: official journal of the American Society of Pain Management Nurses
[Show abstract][Hide abstract] ABSTRACT: Background : Although unintentional weight loss is a frequently encountered problem in care settings, little is known about when it starts. The authors observed body weight longitudinally in an elderly population and examined its association with mortality. Methods : Body weight was monitored in residents who lived in a nursing home for the elderly in Tokyo between fiscal years 2002 and 2004, with the final observation date set at October 2008 for survivors and at the date of death for those who died. The 3-year period before the final date was divided into six periods. A linear regression coefficient was calculated as the rate of weight change for each period and compared between survivors and those who died. Results : In the mortality group, significant weight loss was seen from 24 months before death : -0.42kg, -0.62kg, -0.90kg, and -1.78kg in 19-24 months, 13-18 months, 7-12 months, and 1-6 months before death, respectively. In the survival group, there was no significant change in any period. Logistic regression analysis showed that weight change adjusted by sex, age, dementia, and BMI was significantly associated with mortality. The weight loss was large in residents with dementia. Conclusions : Weight loss began 2 years before death. The findings suggest the importance of daily weight measurements to detect changes associated with mortality.
No preview · Article · Dec 2011 · The Kitakanto Medical Journal
[Show abstract][Hide abstract] ABSTRACT: This study aimed to examine the validity and item-response characteristics of the Mini-Mental State Examination (MMSE), which is used for assessing cognitive function, in Japanese older adults.
Factor analysis and item response analysis were carried out for MMSE responses (n = 1971) from older adults living in the community (n = 1339) or in a nursing home (n = 632), including Alzheimer-type dementia (n = 330), vascular dementia (n = 36), frontotemporal dementia (n = 7), mixed Alzheimer-type and frontotemporal type dementia (n = 27), and age-related cognitive decline (n = 29). When choosing the cut-off score of 23 points for the MMSE, sensitivity and specificity for each item were calculated.
A three-factor solution was found to be most appropriate by factor analysis: complex processing, simple processing and working memory. The item characteristics curves showed unidimensionality with high reproducibility. We identified a simplified scale comprising 10 items in all participants: "naming", "three-step command", "registration", "repeat a sentence", "write a complete sentence", "copies drawing of two polygons", "orientation to place", "delayed recall", "orientation to time" and "serial sevens" tasks. Sensitivity and specificity for both "year" task and "day" task were more than 90% ("year": sensitivity 92.5%, specificity 96.3%; "day": sensitivity 92.4%, specificity 91.7%). For the Alzheimer-type dementia patients, the five-factor solution was suggested by factor analysis and the MMSE also had unidimensionality in terms of level of difficulty.
We found that the MMSE had multiple cognitive areas. We showed that the MMSE could be used as an essentially unidimensional measure of cognitive ability and the question about orientation to time might be useful in the simplest assessment to identify cognitive dysfunction.
No preview · Article · Nov 2011 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: Most family caregivers continue their caregiving for frail relatives after admitting them to long-term care facilities. The characteristics of this caregiving differ from those related to caregiving in home-care settings. Thus, a new tool to evaluate the burden of family caregivers in institutional settings is needed. The aim of this study was to develop a new scale, the Caregiving Burden Scale for Family Caregivers with Relatives in Nursing Homes, and to confirm its validity and reliability.
We conducted two cross-sectional questionnaire surveys. The participants were a convenience sample of family members of residents in seven nursing homes for the validation study and in three nursing homes for the test-retest study in Japan. Statistical analyses examined exploratory/confirmatory factor analyses, internal consistency, concurrent/discriminate validity, and test-retest reliability.
A four-factor solution with 16 items was selected as the most interpretable questionnaire. In the confirmatory factor analysis, the indices of fitness highly supported these results. The Cronbach's alpha coefficient for the total score was 0.86 and varied between 0.77 and 0.87 in the four domains. The scale showed moderate correlation with the Nursing Home Hassles Scale, suggesting its concurrent validity. The four domains had only a medium correlation with each other, indicating discriminate validity.
The developed scale has acceptable validity and reliability for measuring the caregiving burden of family members with relatives in Japanese nursing homes. Future studies using the scale might lead to the improvement of care for family members with relatives in a long-term care setting.
No preview · Article · Dec 2010 · Japan Journal of Nursing Science
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to develop and validate the Japanese version of the Abbey Pain Scale (APS-J), to assess pain of older adults who live in nursing homes in Japan.
In this study, the data were collected from residents in two nursing homes in Japan to include: demographics, the Barthel Index, Folstein Mini-Mental Examination (MMSE), APS-J and Verbal Descriptor Scale (VDS) for pain. Two researchers independently assessed the residents' pain using the APS-J while the residents walked or were transferred from bed to wheelchair. Intraclass correlation coefficients (ICC) for inter-rater and test-retest reliability, Chronbach's alpha-value of the APS-J, and correlation between the APS-J and other variables were examined.
Data were obtained from 171 residents. The ICC for inter-rater and test-retest reliability were 0.824 and 0.657, respectively. Internal consistency was 0.645 for the total sample and 0.719 for those with an MMSE score of 0 (n = 58). Multiple regression analysis showed that contractures (P < 0.001), previous injuries (P < 0.001), the MMSE (P = 0.003) and paralysis (P = 0.018) were independently associated with the APS-J. The APS-J and VDS were moderately correlated (r = 0.49; P < 0.01). The APS-J total score and subscales, "change in body language" and "physical changes", were significantly different among subjects with different MMSE score groups.
Findings show some evidence for the reliability and validity of APS-J.
No preview · Article · Apr 2010 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: This study examined factors related to the frequency and duration of family visits to elderly residents of nursing homes in Japan. Data were collected using a self-administered questionnaire from 299 family members of residents of three nursing homes in Tokyo. Almost all family members visited residents more than once a month, and more than three quarters stayed for more than 1h during each visit. These findings confirm that family involvement with the elderly is maintained even after admission to a nursing home. Multiple regression analysis revealed the variables related to a higher frequency and duration of visits. Some factors related to frequent or long visits such as the requirement of higher care or the ability to remember family visits were similar to the findings of other studies conducted in western countries, yet the results need to be understood in a Japanese cultural context. Other factors such as the gender of the visitors, distance to the nursing home, and sentiment about placement were thought to be related to the unique cultural norms of family caregiving in Japan. These findings will be useful for developing effective methods to assist nursing home residents and their families in Japan.
No preview · Article · Jul 2007 · Archives of Gerontology and Geriatrics
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine the mental health and related factors with family caregivers for the elderly in special-care nursing homes for the aged.
We conducted a questionnaire survey among family caregivers for elderly living in three special-care nursing homes in Tokyo. The questionnaire included factors from the General Health Questionnaire-28 (GHQ-28) pertaining to family caregivers, the elderly, and the relationships between them. The GHQ-28 was used to measure the mental health of the caregivers and a logistic regression model was applied for the analysis.
Of the 145 family caregivers surveyed, 59 (40.7%) exhibited low mental health (GHQ-28> or = 7). The logistic regression analysis revealed that family caregivers with low mental health had lower social support (OR: 0.10 (0.03-0.29)) and had longer visiting times (OR: 5.80 (1.79-18.82)).
The results suggested that many family caregivers for elderly persons in institutions may have poor mental health and that it is necessary to provide them with support. It is concluded that self-help groups for families and the promotion of communication between the elderly and their family caregivers might be effective for this purpose.
No preview · Article · May 2005 · [Nippon kōshū eisei zasshi] Japanese journal of public health