Posters
Social Support Provision for the Aging and Associated Health and Socioeconomic Effects on the Providers
Poster/Exhibit Session Paulchris Okpala
Little has been done to assess the effects of social support provided to the aging on the providers. This study assesses how the provision of social support to the aging affects the health and socioeconomic status of the providers in the US. A mixed study approach was used, which involved quantitative evaluation of a total of forty-three existing articles and an online survey study that involved 301 respondents (28% whites, 37% Blacks and 35% Latinos). The respondents were recruited from the general population. Validated questionnaires were used and the data were analyzed using ANOVA, regression, and correlation statistics. Logistic regression showed that mental health disorders were significantly reduced among the respondents involved in the provision of social support (F=1.344, P=0.022). The providers also reported enhanced relationship within their families. However, the provision of social support was shown to be associated with significant reduction in financial stability among the providers (p<0.001), which was observed to vary based on ethnic background. This study advocates for the adoption of social support as a means of enhancing the health of the providers. The study also calls for financial support for the social support providers.
College Students’ Cultural Orientation, Aging Attitudes, and Anxiety: Japan, China, and the United States
Poster/Exhibit Session Hiroko Tomioka, Ginny Zhan, Sharon Spearcey
A total of 1136 college students (357 Japanese, 434 Chinese, and 345 American) filled out a questionnaire that included an IC scale (Cultural Orientation Scale), Kogan’s attitudes toward old people scale, and a modified aging anxiety scale, in addition to demographic information. Cronbach’s alphas indicated satisfactory reliability on all three scales for the three cultural groups. The results indicate that overall, the three groups scored higher on collectivism than individualism, suggesting a more collectivistic cultural orientation for all three groups. However, the Chinese and Japanese students were more likely to accept hierarchy and inequality than the American students. Findings also show that the American and Japanese participants held significantly more positive attitudes toward aging and were less anxious about aging than their Chinese counterparts. For all three groups, collectivistic cultural orientation is found to be positively correlated to attitudes toward aging and negatively related to anxiety level. These findings will be discussed in the context of culture, globalization, and the evolving nature of both Western and Eastern traditional values.
Perspectives on Age and Aging among Graduate Social Work Students: Using Photography for an Online Pedagogical Activity
Poster/Exhibit Session Jill Chonody
Strategies that can be incorporated into the health and social service curriculum are needed to improve student interest in gerontological practice in order to help address the growing need for more practitioners. Past research indicates that students rank gerontology as the least preferred practice area, but a systematic review of the literature points to the potential of pedagogical interventions to change attitudes. A pilot study of one method used in an online graduate social work practice course focused on working with older adults is introduced. In two semesters of the same course taught by the same instructor, a critical deconstruction of aging using photography was implemented (N = 33). Positive aspects of aging were predominately featured in the photographs, but aging fears were also raised. Quantitative and qualitative results suggested that these activities helped students’ process their aging views, and most students reported some attitudinal change. The development of innovative ways to engage students online by repurposing technology that they are already using can advance online pedagogy and facilitate critical thinking. Future research should seek to test other methods to influence gerontological interest, including online strategies given the prominence of this modality.
Environmental Design and Quality of Life of Older Adults: Dementia Care in a Japanese Group Care Unit
Poster/Exhibit Session Sumiyo Brennan, Yumiko Hashimoto
A homelike environmental design is shown to have a positive effect on quality of life (QoL) as well as the functionality of older adults with dementia. This study examines the relationship between environmental design in a long-term care (LTC) facility in Japan and its effect on residents with dementia’s daily activity patterns and QoL. In February 2018, data were collected at a group care (GC) facility for Japanese seniors. The GC facility was comprised of several units, each with up to ten residents. Four GC units were selected to determine the effects of environmental design on QoL using four different environmental scales. Then, four to eight residents per unit were evaluated to determine the effects on QoL using dementia care mapping and the QoL-AD scales. We hypothesize that a unit scoring high in physical environment attributes would have a positive impact on the older adult residents’ QoL. An environmental audit tool-HC is more appropriate to measure Japan’s GC units. Higher mood and engagement values were reflected through daily activity programs and socializing with others. QOL-AD scores obtained from LTC residents were higher than the QOL-AD scores from the LTC staff. Our findings help determine the relationship between environment design and QoL of older adults; higher environmental scores would indicate a higher QoL. For further study, we are going to assess the same environmental and QoL scales at different facilities and compare the results to determine effective design of the LTC physical environment in order to improve LTC residents’ QoL.
The Components of the Advance Care Planning Process for People with Dementia in a Facility-based Setting: A Scoping Review
Poster/Exhibit Session Seira Takada, Yasuko Ogata, Yoshie Yumoto, Noriko Morioka
There is growing interest in advance care planning (ACP) for people with dementia. ACP is defined as a process, yet there is no consensus regarding the components of the process. This study identifies the components of the ACP process for people with dementia in a facility-based setting. We conducted a scoping review. A search of the literature for the years 2007 to 2017 was conducted using several electronic databases (PubMed, CINAHL, Cochran Central Register of Controlled Trials, PsycINFO, ICHUSHI). Two independent reviewers checked the search results in both the first and second screenings. Fifteen relevant articles were identified. Eleven ACP process components were extracted and sorted along a time axis. They were then categorized as “main steps” (seven) or “additional steps” (four). The main steps included evaluating the resident’s cognitive capacity, checking the resident’s knowledge and providing information, confirming the resident’s preferences, involving the family and those close to the resident, completing documentation, sharing, and providing the opportunity to review. The additional steps were evaluating the facilitator’s competence, checking the resident’s readiness, being involved with the family in daily care, and linking the resident’s preferences to an appropriate program of care. Eleven steps in the ACP process were identified. Determining the resident’s preferences is an important step but properly following the steps before and after that determination is also essential to the process. Further studies are needed to investigate the effectiveness of the ACP process using these steps.
Cooperation-promoting Activities for Home Care and Long-term Care to Create Community-based Integrated Care Systems
Poster/Exhibit Session Yuko Goto
This study analyzes the cooperation-promoting activity stages for home medical care and long-term care in an integrated community care system. As these difficult-to-visualize qualitative changes and activity processes lead to regional changes, a soft systems methodology (SSM) approach was attempted. From January 2014 to March 2015 (fifteen months), a collaborative-base project (tweleve bases) was conducted in Prefecture Z in Japan, in which the activities were summarized from status report records and telephone consultations. Information about the cooperative processes at two different bases (Bases A and B) were then extracted and compared. Base A was able to share problem solving and directionality between different professionals and organizations, and Base B was not. A seven-stage SSM was used to analyze the development of the regional cooperative system. Using thought analysis, the SSM also allows for a visualization of the systematic efforts and experiences to identify the initial regional challenges, the implementation and evaluation efforts, and the subsequent regional challenges. Based on the SSM analysis, the activities that contributed to the regional development at the bases are visualized.
The Impact of the New Super Visa Program on the Lives of Immigrants in Canada and Their Aging Parents
Poster/Exhibit Session Sepali Guruge
In November 2011, Citizenship and Immigration Canada announced a new Super Visa program to facilitate reunification of immigrants in Canada with their aging parents who live outside of Canada. Limited information is available about how this new program affects the lives of immigrant families. We conducted a qualitative descriptive study to understand the experiences of older adults and their adult immigrant children with the Super Visa program. The study addresses the following research question: What are the experiences of immigrant families using the Super Visa program as an alternative process to facilitate family reunification? In total, nineteen semi-structured interviews were conducted in Toronto with Chinese immigrants who had sponsored their parents, as well as parents who had come to Canada on a Super Visa. The findings revealed that the Super Visa program is helpful for family reunification because of its easier application process and higher approval rate. Participants noted that improvement to the program should include requiring fewer documents and less information from parents, making the application simpler, and providing more flexible and affordable options for private medical insurance. A Super Visa is a temporary visa, and as such, does not meet all the needs of immigrant families. However, it does appear to help facilitate family reunification, especially for families who cannot get a regular visa.
Burnout Study of Clinical Nurses in Vietnam: Development of Job Burnout Model Based on Leiter and Maslach’s Theory
Poster/Exhibit Session Huong Nguyen
This study aimed to create a Vietnamese version of both the Maslach Burnout Inventory-General Survey (MBI-GS) and Areas of Worklife Scale (AWS) to assess the burnout state of Vietnamese clinical nurses and to develop a causal model of burnout of clinical nurses. Methods: We conducted a descriptive design using a cross-sectional survey. The questionnaire was hand-divided directly by nursing departments to 500 clinical nurses in three hospitals. Vietnamese MBI-GS and AWS were then examined for reliability and validity. We used the revised exhaustion + 1 burnout classification to access burnout state. We performed path analysis to develop a Vietnamese causal model basing on the original model by Leiter and Maslach’s theory. Results: We found that both scales were reliable and valid for assessing burnout. Among nurse participants, the percentage of severe burnout was 0.7 %, burnout was 15.8% and 17.2% of nurses was exhausted. The best predictor of burnout was “on-duty work schedule” that clinical nurses have to work for 24 hours. In the causal model, we also found similarity and difference pathways in comparison with the original model. Conclusions: Vietnamese MBI-GS and AWS were applicable to research on occupational stress. Nearly one-fifth of Vietnamese clinical nurses were working in burnout state. The causal model suggested a range of factors resulting in burnout, it is necessary to consider the specific solution to prevent burnout problem.
The Comprehensive Environmental Questionnaire: Application for Older Adults with Social Care Services for Community-living
Poster/Exhibit Session Hiromi Nakamura, Makoto Kyougoku, Kenji Yabuwaki
The Comprehensive Environmental Questionnaire for the Elderly (CEQ) was developed to measure satisfaction levels among community-dwelling older adults regarding their environment. The CEQ comprises 14 question items grouped into three factors, which are rated on a four-point Likert scale. To expand the applicability of the CEQ to community-dwelling older adults requiring support from long-term care and family members for their community-living, this study examined the factorial structure and scale system of the CEQ to verify its validity and reliability. Data were collected individually from 218 participants who receive no rehabilitative services but require homemaking services and/or support from family members. The factorial structure and scale system were examined using structural equation modeling and an item response theory (IRT) approach, respectively. We obtained values between 0.93 and 0.66 for factor loadings, 0.98 for comparative fit index, and 0.97 for Tucker–Lewis index, which indicated a good to adequate fit. The value of root mean square error of approximation was 0.094, indicating a mediocre fit. The IRT analysis showed an accurate description of item function of the CEQ. The CEQ was applicable to the present study population. Although the CEQ concept was confirmed, the questionnaire warrants further improvement.
Peer-to-Peer Support Between Older People: Care as an Everyday Practice
Poster/Exhibit Session Elin Siira
In order to develop innovative peer-to-peer care services for older people, a better understanding and conceptualization of the heterogenic nature of informal peer-to-peer care practices is vital. Less traditional ways of accommodating care for older people are put forward in this poster. Peer-to-peer services enabled through digital technology, which connects older people and enable mobilizing their resources is one innovative creation for care provision. In developing services to enhance already existing informal care structures among older people, a better understanding and conceptualization of such peer-to-peer care practices are vital. This study explores peer-to-peer care practices between older people from the perspective of older individuals. Semi-structured interviews ranging from 30-120 minutes (mean= 59 minutes) were carried out with total of 30 participants (17 women and 13 men) aged 67-93 years (mean= 76 years) in one larger city and two smaller towns/rural municipalities in Sweden. Tentative findings indicate that peer-to-peer care practices between older people entails a range of different actions of support and care, and not solely hands on care. Instead, everyday peer-to-peer care practices may be understood as providing a highly flexible recognition of varied care needs. For peer-to-peer care services aimed to enhance already existing informal care structures to be successful, the heterogenic nature of both need and ability among older people to provide and receive peer-to-peer care must be considered.
Cross-cultural Validation of the Japanese Version of Adult Social Care Outcomes Toolkit for Carers: Application for Working Adults Who Take Care of Family Members
Poster/Exhibit Session Hiromi Nakamura, Mai Yamaguchi, Ikushi Yamaguchi, Akemi Matsuzawa, Machiko Ohara, Keiko Hirose, Kamilla Razik, Stacey Rand
This study aims to examine cross-cultural validation of the Japanese version of Adult Social Care Outcomes Toolkit for Carers, originally developed in the UK to measure quality of life among caregivers who took care of others, including family members, partners and friends, requiring rehabilitation and/or welfare services, without wages. It has seven question items with the four-response style. Data were collected from 600 working adults who took care of community-living family members through an internet survey. Among them, there were 374 men and 226 women, the mean age was 51 years old (ranged between 24 and 69 years old). We investigated the factorial structure and the scale system of the Japanese version, using Structural Equation Modeling (SEM) and an Item Response Theory (IRT) approach. The SEM provided the following values: 0.901-0.652 for the factor loadings, 0.847-0.597 for path coefficient, 0.982 for the Comparative Fit Index, and 0.063 (95% Confidence Interval: 0.040, 0.087) for the Root Mean Square Error of Approximation. Those values were within the acceptable range. The IRT analysis identified that values in item discrimination and item difficulty were within the acceptable range. The analysis revealed low validity in one question item. This study confirmed the factorial structure of the Japanese version.
Family Carers’ Opinions on Dignity for People with Dementia: Differences of Sex, Age, and Relationships
Poster/Exhibit Session Katsuo Yamanaka, Nana Ohara, Dai Noguchi, Tatsuji Uchida
Maintenance of dignity is important for dementia care. However, the concept seems to be different from each viewpoint. This study surveyed family carers’ opinions and revealed the differences from the views of sex, age, and relationships. The subjects were family carers who accompanied outpatients with dementia at three geriatric clinics in the south area of Ibaraki prefecture, Japan. The questions asked were about the concepts and practices of dignity for people with dementia (PWD). We obtained opinions from 114 carers by a free answer method. We analyzed the text of their answers using correspondence analysis. As a result, the words’ plots near each independent variable (sex, age, and relationships) suggested that practices to maintain the dignity for PWD are different from each viewpoint. For instance, an analysis for the relationships extracted two dimensions: inner world and expressed behaviors, and distance of the relationship. From the words’ plots near “spouses” and “daughters”, they had a trend to value their PWD’s feelings and thoughts and want to regard their PWD as the same family member they had always known. Daughters-in law had a tendency to be considerate of the PWD (e.g. for the PWD not to be upset during the cleanup of excretion). On the other hand, sons tended to think about the causes of a PWD’s symptoms or behaviors and cope with them carefully. The findings concluded that people working in dementia care should know different views of dignity for PWD, which will positively influence their daily care.
Relationship Between Self-assessment Skill and Self-regulation in Japanese Older Drivers
Poster/Exhibit Session Ritsu Kosuge, Kazuko Okamura, Yukako Nakano, Goro Fujita
Previous studies have pointed that older drivers tend to regulate their driving behaviours based on self-assessment of driving. Therefore, it is important to assess their own driving correctly as well as reflect self-assessment in self-regulation of driving. The aim of the present study was to investigate the relationship between self-assessment skill and self-regulation in older drivers. Forty Japanese drivers aged 70 years or older were asked to respond to a questionnaire, including self-rated items of own driving, and scales of beliefs about driving. Participants were also asked to undergo an on-road driving evaluation. In the driving evaluation, participants were equipped with sensors for recording driving behaviours and driving instructors in the passenger seats rated participants’ driving. Participants also completed functional tests. To score self-assessment skill, self-rated scores of driving were subtracted from scores rated by instructors. We found that self-assessment skill was associated with driving behaviours at certain intersections. However, overestimators tended to employ some reckless behaviours such as looking less frequently to the right, although they tended to employ some cautious behaviours such as obeying stop regulation more than underestimators did. Results suggested that overestimation of own driving might result in not performing some aspects of self-regulation, while employing other self-regulation aspects might lead to overestimation of own safety.
A Study of the Functional Color Association of Prescription Pills
Poster/Exhibit Session Hui Chun Hsiao
The demand for health care products has increased in the modern and aged society. More than half of chronic patients need to take more than four to six different kinds of medication each day, especially prescription drugs. Therefore, how to distinguish the right drugs has become a big issue for patients. At present, the appearance of pills is still highly dependent on the shape and color to identify, in which the color of the pills served as the easiest feature to distinguish the differences from each other. In addition, color can also effectively disseminate a function or effect of associated messages that relieves patients’ confusion and uneasy emotions. In this study, the researcher starts from the collation of related literature such as color perception, functional association color, and drug color design at home and abroad, and carries on the research in two phases. In phase I, the researcher, applied the experimental investigation method through a color association survey of eight general health concepts, nine human functional systems, and twelve organ health functions to different age groups of seventy-eight research participants. The outcome provides the basic understanding of local people’s perception of the medication effectiveness and pill color. In phase II, the researcher conducts a larger survey with 600 participants based on the outcome of phase I. The data collection and cross-analysis of variables (age, gender, and region) reveals important factors of local people’s perception of medication effectiveness related to pill color.
A Survey on the Effects of Music in Nursing Homes with the Concept of Community Music Therapy
Poster/Exhibit Session Jizhou Duan, Mayumi Kato, Miho Shogenji, Sanae Miyatani
We expected that music would make connections among residents, families, and staff, which is important for promoting good quality of life for residents. This study investigated not only effects of music on physical and psychological conditions, but also connections among residents, families, and staff in nursing homes based on the recognition of staff in charge of activities. The study design was national and cross-sectional. Connections among people in nursing homes, as a concept of community music therapy, were examined. Questionnaires on the implementation of music activities were sent to 517 facilities through the mail. Music activities were provided by 80.2% of nursing homes. There were no significant differences in types of nursing home and the number of beds between facilities providing and not providing music. On the other hand, the charge staff of facilities that provided music activities had learning experience of musical instruments (p=0.000) and showed interest in musical activities (p=0.002). No significant differences were found in the effects of music on physical conditions. In contrast, “feelings of happiness increases” (p=0.013), and variables related to connections were shown to be significant; “residents have a feeling of staying at their home” (p=0.015), “residents reduce their refusal of staff care” (p=0.046), “nursing homes have a homey sense of family” (p＝0.025), “staff connection with residents is increased” (p=0.040), and “staff members increase residents’ feelings of dignity” (p=0.021). In conclusion, we found that music could promote personal interaction among residents, staff, and family in nursing homes.
Understanding Education Needs of Stroke Care in Discharge Planning Among Family Caregivers in Indonesia
Poster/Exhibit Session Wahyuni Fauziah, Mayumi Kato, Miho Shogenji, Taniguchi Yoshimi
The aim of this study is to identify characteristics of family caregivers of post-stroke patients and consider their understanding of stroke care in discharge planning. A cross-sectional study was conducted. Participants included 115 (65.3%) females and 61 (34.7%) males assuming the main caregiver role for patients discharged from a stroke inpatient unit. Participants completed questionnaires by face to face interviews, which were used to describe the demographics of the caregivers and their educational needs regarding stroke care. The duration of caregiving was 12.4 hours on an average day, with 74 (42%) having to assist ADL at a high level. One hundred and nine caregivers (61%) were extended family. Forty-four (25%) family caregivers were not in good health. One hundred and twenty-one (68.8%) family caregivers did not receive stroke care education. Managing medications was reported to be the most common education received by caregivers (151, 85%). Other education, such as methods of assisting ADL and preventing falls, was rarely given by health professionals, whereas information related to rehabilitation and nutrition of stroke patients at home was reported as most needed by family caregivers (58.8% and 21.6% respectively). Family caregivers were given insufficient education regarding the rehabilitation of stroke patients at home. This may affect caregivers’ physical and psychological status and affect the functional status of stroke patients. Future research related to effective discharge planning for family caregivers is needed to assist family caregivers in providing comprehensive home care for post-stroke patients.
Characteristics of Information Seeking Through Eye Movement of Expert Nurses During Home Visits to Older People: Focusing on Observation of Health Conditions
Poster/Exhibit Session Atsuko Shimamura, Suwa Sayuri, Nakahata Keigo, Yu Wenwei, Matsushima Eisuke
It is important for visiting nurses to gather necessary information in a limited time to support older people’s day-to-day lives. This study clarified the characteristics of information seeking by expert visiting nurses during repeated observation of a scene. This was accomplished through a comparison with novice visiting nurses and nursing students. Photos were created for four scenes (greetings, conversation, observation of health-conditions, exiting the room) of visiting nursing for two cases of older people living at home (Case A: An older person living with family; Case B: An older person living alone). Each scene was presented for ten seconds, and the participants’ eye movements were measured using a Tobii ProX2-60. Only the observation of health-conditions scene was presented twice. Statistical analysis used SPSS Statistics Ver. 24. This study was approved by the Ethical Review Board. There were thirty-four female participants comprised of thirteen expert nurses, eleven novice nurses, and ten nursing students. When Case A was presented the second time, the fixation duration and fixation count during observation of the older person’s expression were significantly higher for the expert nurses compared to the nursing students (p<0.05), and were greater than during the first presentation for the expert nurses only (no significant difference). When reshown the observation of health-conditions scene for the older person living with family, it was clear that the expert nurses’ attention was placed on the older person. This study is a part of a doctoral dissertation for the Graduate School of Nursing, Chiba University.
Unpreventable Falls Recognized by Clinical Nurses
Poster/Exhibit Session Mayumi Kato, Kiyoko Izumi, Mizue Suzuki, Eiichi Ueno, Miho Shogenji
The concept of unpreventable falls is controversial; can falls in hospitals be reduced to zero for patients with high risk of falling? We identified falls considered by clinical nurses to be unpreventable. Twenty-six clinical registered nurses in three general hospitals who had at least five years of nursing experience were included. Qualitative data were collected through semi-structured interviews. Categories were extracted based on the context. Nurses’ average number of years (standard deviation) of experience was 21.7 (8.6), and the average number of falls experienced was 12.4 (10.3). Categories of unpreventable falls were “falls caused by high risk fallers with lack of information related to individual fall risks,” “falls caused by older patients who were not diagnosed but who had decreased cognition,” “falls caused by inactive patients who were not identified as high risk fallers,” “falls during the process of changing abilities of activities of daily livings (ADL),” and “falls caused by patients whose health conditions suddenly and unclearly changed.” Nurses stated that “unpreventable falls occur when we cannot predict who falls and how they fall,” such as in emergency admission and during transitions of ADL changes. It is considered that older patients with dementia and post-stroke patients with disabilities can be involved in the unpreventable falls. It is well-known that preventing seemingly unpreventable falls is extremely difficult. Such falls can be reduced by use of sensor monitoring if nurses cannot identify who falls and how they will fall.
Can Executive Functioning Tests Predict the Occurrence of Lower Urinary Tract Symptoms in Elderly Individuals?
Poster/Exhibit Session Kaori Harano, Sawada Yoichi
The purpose of this study is to investigate the relationship between the occurrence of lower urinary tract symptoms (LUTS) and performance on dimensions of executive functioning in elderly individuals. The participants were elderly individuals aged ≥ 75 years with a Barthel Index of ≥85 points and a Mini-Mental State Examination score of ≥24 points. The present study included a questionnaire survey regarding LUTS and the following executive functioning tests: Behavioral assessment of performance dysfunction syndrome (BADS), Verbal fluency test, Trail making test, Stroop color-word, Frontal assessment battery, Counting (forward and backward), and Counting backward test. The relationship between LUTS and executive functioning was analyzed using Categorical Data Analysis Program (CATDAP), a statistical program that searches for the best explanatory variable of a categorical response variable of a dataset comprising both categorical variates and continuous ones. The results showed that the Modified Six Elements test of BADS had the greatest predictive power for LUTS (AIC = −8.57). In conclusion, the occurrence of LUTS may be predicted by performing executive functioning tests.
Factors Related to Family Caregiver Self-efficacy Regarding the Care of Elderly with Diabetes Mellitus
Poster/Exhibit Session Thi Thu Huong Pham, Mayumi Kato, Miho Shogenji, Yoshimi Taniguchi
This study examines factors related to caregiving self-efficacy among family caregivers of elderly with diabetes mellitus. This cross-sectional study was conducted from April to June, 2018, in a general hospital in northern Vietnam. The characteristics of demographics, diabetes knowledge, and self-efficacy were determined in a questionnaire that was delivered to 151 family caregivers of elderly with diabetes mellitus. An analysis was performed using IBM SPSS statistics software. Of a total of 151 participants, 25.8% were men and 71.2% were women; the mean age was 52±12.5. Patients with low ADLs represented the caregiver with low self- efficacy of 38, 49.9% and high self- efficacy of 18, 24.3%. The analysis showed 75.7% of caregivers did not receive care-giving education, which was significantly associated with low self-efficacy status at 85.7% (p<.05). Diabetes knowledge was a significant factor of self-efficacy with OR (95%CI) at .779 (.635–.956), which showed a lack of knowledge corresponded to lower self-efficacy status. The number of patient hospitalizations, chronic diseases of caregivers, and hours of hospitalization were all related to caregiving self-efficacy (p<.05). In conclusion, this study found that the lack of both knowledge of diabetes and education for caregivers regarding care for elderly patients with diabetes were related to lower caregiving self-efficacy status.
Comfort in the Daily Life of People with Dementia: A Concept Analysis
Poster/Exhibit Session Yukie Suzuki, Shizuko Tanigaki
The living environments surrounding people with dementia, such as promotion of community-based integrated care systems are rapidly changing. With that background, how can people with dementia live comfortably in the community? We explore what is comfort in the daily life of people with dementia. The purpose of this study is to clarify the concept. We conducted a search using ICHUSHI Web Ver.5 and CiNii Articles, PubMed, MEDLINE, Psyc INFO. The keywords used were “dementia,” ”comfort.” We searched for original articles that were published between 2000 and 2018 (since the beginning of the Japanese long-term care insurance system). Twenty-seven literatures were analyzed data with reference to Rodgers' concept analysis. Results revealed the following nine types of categories: (1) preceding necessary conditions: condition in which comfort in daily life of people with dementia is threatened, (2) attribute: security of needs fulfillment, “understanding me” by others’, treatment to avoid mental confusion, appearance of mental stability shown through facial expressions, place oneself in a familiar environment, peaceful living, (3) result: increasing motivation in life, ease of living. Categories were divided into elements related to individuals such as “appearance of mental stability shown through facial expressions” and elements related to the environment such as “living without anxiety”.
Learning Needs of Nurses Who Support the Discharge of Elderly Cancer Patients
Poster/Exhibit Session Tomoko Sugimoto, Chikako Takayanagi, Mikiyo Torita, Kazue Mori, Kyoko Saeki
The purpose of the study is to describe the learning needs of nurses who support the discharge of elderly cancer patients after their classification as palliative care patients (hereinafter, elderly patients). From October 2017 to February 2018, semi-structured interviews were conducted with eighteen nurses. We asked nurses, “what is the content you would like to learn to support elderly patients?” We focused specifically on four nurses who supported the discharge of elderly patients, analyzed the data gathered from the interviews inductively, and described the categories that were generated. Further, research began following approval from the Research Ethics Review Committee. As a result of the analysis, two categories related to the learning needs of nurses were found: “collaboration with professionals supporting home care and the social security system” and the “need for paradigm shifts in home care.” Additionally, three categories concerning the method of learning were found, which were “strengthening home care,” ”fostering knowledge accompanying the accumulation of experience in discharging support,” and “feedback on results for supporting discharge.” Discharging elderly cancer patients to their home is influenced by family factors, such as the presence or absence of a caregiver, or patient factors such as the presence or absence of medical care. It became clear that nurses wished to learn about the changing value of home care rather than the factors mentioned above.
Competencies of a Nurse Medical Safety Manager in Responding to Medical Accidents
Poster/Exhibit Session Noriyo Yuno
This study assesses the competencies of a nurse medical safety manager based on the nurse’s account of her experiences, involving mental exhaustion of responding to medical accidents in which the nurse experienced difficulties. A nurse medical safety manager received the consent of health service manager to participate in the study. In an unstructured interview, the subject was asked to talk freely about her experiences including mental exhaustion in responding to the medical accident that she found most challenging in the past. A narrative analysis of the verbatim record of the interview was performed to extract factors associated with nursing competencies. 1.The subject was a female in her fifties with twenty-nine years of experience in nursing and two years of experience as a medical safety manager. 2. Extracted competencies included “remaining level-headed in performing the duties even as a less-experienced manager,” “arranging opportunities to experience the patient’s fortitude to live and his/her frustration, and to share the suffering,” “having sympathy in responding to the patient and family members despite the struggle of not being able to gain understanding,” “taking effective actions in building a trusted relationship,” and “preparing to communicate to a junior the value of nurses assuming the role of safety management.” Results suggest that the nurse safety manager’s competencies in responding to a challenging medical accident are founded on her own nursing philosophies and her nursing management experiences as a chief nursing officer.
Creating a Questionnaire to Understand the Dynamics of Caring Relationships Between Elderly Dementia Patients and Nurses
Poster/Exhibit Session Misa Komatsu, Seisuke Hayakawa, Norikazu Ohnishi, Kazunari Takemura, Makoto Tabata, Ritsuko Shimizu, Tsutako Miyazaki
The purpose of this study is to create a questionnaire to understand the dynamics of a mutually supportive relationships between elderly dementia patients and nurses. The study participants were ten nurses, of which six underwent a focus group interview and four underwent individual interviews. Qualitative inductive analysis was conducted on the interview results, from which the questionnaire items were extracted. This study was implemented upon receiving approval from the affiliated university’s research ethics committee. The results of the analysis showed eight categories and forty subcategories. From these results, thirty-seven questions were created to understand the dynamics of caring relationship between elderly dementia patients and nurses. The questions consisted of the following categories: the situation of the elderly dementia patients; the nurses’relationship with others; the nurses’ actions that lead to building a trusting relationship with elderly dementia patients; the changes in nurses due to building trusting relationships with elderly dementia patients; the changes in elderly dementia patients due to building trusting relationships with nurses. The caring relationships between elderly dementia patients and nurses are dynamic wherein each complements the other. The questionnaire was made with these results as the foundation, and in the future, we plan to conduct a survey of nurses using this questionnaire and connect this to the development of a caring model. This study has received a grant from JSPS KAKENHI JP16K12210.
Working Conditions and Mental Health of Professionals in Integrated Community Care Support Centers in Japan
Poster/Exhibit Session Junko Wake, Hikaru Shinozaki
Integrated community care support centers conduct preventive care management as well as various supportive interventions for frail community-dwelling elderly people. Three professionals, namely, a chief care manager, a social worker, and a public nurse, should be placed at each center, working in collaboration. Given the increasingly complex needs in the community and their multiple duties, these professionals may suffer from enormous stress, which is an emerging concern. This study investigates their current working conditions and status of mental health. A mailing survey was conducted among all support center professional workers (N = 150) in A-City in Tokyo in early 2018. The response rate was 49%. Quantitative analyses indicated that 1) three-fourths of the respondents feel they are overworking, 2) more than half of them consider case work with complex needs and advocacy as difficult tasks, 3) dissatisfaction with working environments is lower compared with other job satisfaction dimensions, and 4) poor health and excessive duties tend to bring significant harm to their mental health. Improving the working environment of the professionals at integrated community care support centers is crucial to constructing and maximizing the function of the integrated community care system in Japan.
A Case Report of an Elderly Male Patient with Humeral Shaft Fracture Malunion
Poster/Exhibit Session Kengo Usuki, Hiromi Nakamura, Riho Kondo, Motoi Miyabe, Keita Kuwabara
This study reports on an occupational therapy intervention for an elderly man with a Distal Femoral Bruise (DFB) and Humeral Shaft Fracture (HSF), showing reduction of nursing burden by providing an assistive technology. The patient was a 70-year-old man who lived with his wife. He previously performed self-care activities independently by using a wheelchair. He went to a hospital because of walking problems, being diagnosed a right DFB in April 2018. He additionally had a right HSF due to an accidental fall during toileting with a help in May within a hospital. A typical surgical treatment was difficult because of his health status and financial burden. His cognitive issues at a high-level didn’t let his Occupational therapist (OTR/L) administer any standardized examinations. His left arm showed limitations of mobility, finger contracture, and edema. His goals were establishing functional brace after fixation with hanging cast, and improving ROM after confirming callus formation. During interventions, his cognitive issues were deteriorated at the four-week post-injury, resulted in requiring infusion managements. The priority was changed to eating with a second-hand Portable Spring Balancer (PSB), his OTR/L obtained, helping an upper extremity movement with spring power, rather than improving bodily functions. Obtaining ability for eating improved his motivation for living and cognitive status, resulting decreasing nursing burdens, letting him transfer to a nursing home, meeting his satisfaction. The second-hand PSB eased his financial burden and improved his health status, suggesting the effectiveness of the PSB.
Observational Understanding of Older Adults by Care Workers in Japan: A Literature Review
Poster/Exhibit Session Akemi Sueyasu, Chiharu Yamada, Akihiro Nishiyama
This literature review aimes to evaluate care worker’s viewpoints of older adults in Japan. We searched “Ichushi”(Japan Medical Abstracts Society database) to identify relevant articles. Keywords used for the search were: “care worker” and “observation”.The eligibility criterion was original studies involving older adults that related to key points of observation by care workers. We identified 146 papers; however, most (n=128) were not focused on understanding and care of older adults based on observation by care workers. The remaining eighteen papers were selected and separated into two categories: “Observation viewpoints by care workers” and “Intention or consideration in observation by care workers.” “Observation viewpoints by care workers” described how patients’ behavioral abnormalities and changes were identified through observation, compared with usual behavioral indications (e.g., basic activities of daily living, living conditions, aging symptoms, symptoms due to diseases/disabilities, and feelings). “Intention or consideration in observation by care workers” described how observation was an important tool to provide information on care content and methods, such as health conditions, evaluation of activities of daily living, and judgments related to mental health. Our study suggests that care workers develop their understanding of the physiological and psychological aspects of older adults based on information obtained through daily observation. Care workers use this information to judge and decide how best to care for the older adult. Effective inter-professional work for older adult care needs further exploration from the perspective of detailed observation.
Demographics and Urbanization Level Variations in Incidence and Prevalence of Alzheimer's Disease in Taiwan: A National Population-based Study, 2004-2010
Poster/Exhibit Session Liu Chih-Ching, Yu Sun, Chung Yi Li, Susan C. Hu
Identifying variation in the demographics and residential areas of the incidence and prevalence for Alzheimer's disease (AD) has public health applications for projecting the future burden of disease and for planning medical services. However, very few nationwide studies have been conducted on this topic in Asian countries. This study describes a secular trend in AD incidence and prevalence in Taiwan as well as assesses the disparity of demographics and urbanization on the incidence and prevalence of AD. The data of AD were acquired from the Taiwan National Health Insurance Research Database entries between 2004 and 2010. The calendar year, sex, and age-specific rates were standardized, and the differences of the demographics and urbanization on AD were assessed using Poisson regression analysis. Over seven years, the incidence of AD per 1,000 population was 4.9 in 2004 and 4.6 in 2010 with a stable trend (b＝-0.0078, p=0.0974). Conversely, the prevalence of AD significantly has increased from 3.2% in 2004 to 6.9% in 2010 (b＝0.1152, p<0.0001). Noticeably, the AD incidence and prevalence increased with age and were higher in women than in men. Also, significantly higher AD incidence and prevalence were noted in areas with more urbanization. Given the significant demographics and urbanization variations in AD incidence and prevalence, further studies are warranted to investigate whether such findings can be attributed to specific occupational and environmental factors most relevant to the incidence and prevalence of AD in Taiwan.
Benefits of Community Living in Japan: Lecture and Questionnaire on Dementia Prevention
Poster/Exhibit Session Kaori Yamaguchi
There is an increasing number of people suffering from dementia following global population aging. In Japan, the number of people with dementia over sixty-five years old was 4.62 million in 2012 and the number is estimated at seven million in 2025. Recently, a community-based integrated care system, which provides seamless healthcare to population, was implemented by the government. Considering care prevention, the system emphasizes prevention through community based activities. The government suggests the activities should be mainly managed by aged people in community themselves independently. In terms of this concept, recognition of each aged individual for their health care is important. We held a lecture about dementia prevention and conducted a survey of elderly living in specific area where people positively and independently manage various activities in community on their own. Twenty-nine elderly participated in the lecture and all participants answered the questionnaire. As a result of questionnaire, taking enough rest and sleep, taking a medical examination etc. were obtained as answer to what habits helped keep their health. The main reasons for participating in activities in community were pleasure and relationship with others. There are still many regions which have few community activities in Japan. According to these results, it is suggested that a system which enables people living in community to provide joyful activities and make good relationships is helpful to achieve effective prevention among healthy aged people.
Process of Creating Community Activities by Elderly Men Retired From a Small or Medium-sized Company After Moving From a Large Enterprise
Poster/Exhibit Session Taeko Shimazu, Junko Yoshino, Shigeaki Watanuki, Noriko Nishikido
This study aims to elucidate the process of creating community activities by elderly men who retired from a small or medium-sized company after moving from a large enterprise. Semi-structured interviews were conducted with two elderly men creating community activities who had retired from a small or medium-sized company after moving from a large enterprise. Data were collected in February and March, 2018 and analyzed qualitatively. This study was approved by the research ethics committee. The men’s process of creating community activities was as follows. They ‘became relaxed after moving to a small or medium-sized company, which was evident in how they conducted community activities’ and ‘planned how to live their own life before and after retirement’ using skills they learned at work. They concentrated on ‘ascertaining the goals and methods for developing community activities’, and ‘grew attached to their community as they learned about local activities’. Even if they encountered unexpected difficulties, their ability to ‘get along with community members’ was helpful. The process revealed by this study suggests the importance of understanding how elderly men who retired from small and medium-sized companies after moving from a large enterprise plan their lives before and after the retirement to achieve self-actualization at the end of life.
Status of Health Habits of Residents of City A
Poster/Exhibit Session Miyuki Chida, Chitose Kikuchi, Masako Yamaji, Hitomi Nishioka, Takae Machida, Mari Noda, Hisako Uchida
This study seeks to ascertain the health habits of city A residents. From the resident registry network, we chose a random sample of 3,000 individuals aged twenty years or older as of August 2016, from different gender and age groups. We asked them to answer anonymously a questionnaire on health habits. The participants were provided with an overview of this study, and their data have been carefully stored. A total of 1,248 individuals responded (response rate: 41.6%). Among the participants, 7.4% self-evaluated their health habits as “very healthy,” whereas 71.1% deemed their habits as “relatively healthy.” Regarding exercise, 54.8% preferred to use elevators and escalators over stairs, whereas 70.5% were aware they did not exercise enough. Regarding eating breakfast, 88.9% ate almost daily, and 42.6% ate vegetables almost daily. Only 29% were aware of the recommended daily vegetable intake. Meanwhile, only 22.8% weighed themselves almost daily and 48.4% knew their BMI. In the past year, 57.8% underwent a health checkup. In terms of pre-existing conditions, 30.6% had hypertension and 14.7% had a lipid metabolism abnormality. Health issues were discussed by 61.3% with their families and by 39.5% with friends. Many of the participants felt subjectively healthy. Although aware of the need to and their lack of exercise, many could not exercise regularly. Many were unaware of the recommended daily vegetable intake. Few weighed themselves daily, knew their BMI, or undergo regular medical checkups. Thus, health experts need to do more to educate residents about healthy habits.
Process of Relationship Building Among Retired Japanese Men and their Non-Family Members in Tokyo
Poster/Exhibit Session Junko Yoshino, Taeko Shimazu, Shigeaki Watanuki, Noriko Nishikido
This study aims to explore factors related to the process of how retied men from small-to-medium-sized companies build new relationships with non-family members in a community. This was a qualitative study. Participants were eleven Japanese men of the Tokyo Metropolitan Area who retired completely from small-to-medium-sized companies and had participated in activities with non-family members of the community. Data were collected through semi-structured interviews from August 2017 to March 2018. The process by which retired men construct relationships within a community were found to involve the following: the way of working creating an attitude towards the second life; to be perplexed how to adapt himself to the new community; finding means of new communications with people through trial and error; having the courage to express interest and proactively step forward to community; having someone close by boost his courage to step forward; increasing his spiritual richness through community activities; and cherishing people and opportunity that keep resident motivation. Related factors identified were: to have some interests other than one’s work experience and poor condition and feeling of burden making it difficult to continue activities. In men who retired from small-to-medium-sized company, the way of working and the level of satisfaction before retirement greatly affected life after retirement. These results also suggest that creating a new place for dialogue that can be shared in the community is important for retied men to find a comforting place in their community after retirement.
Literature Review on Caregivers with Multiple Care Responsibilities
Poster/Exhibit Session Kazuko Horiguchi, Noboru Iwata, Yuzu Taki, Yukie Suzuki, Mami Kubota, Sumiko Kobayashi
In Japan, the number of elderly people who require care has been increasing. Due to improvement of medicine and longevity, many families remain in caregiving roles longer than before. Also decreasing birthrate reduces number of people who can take responsibilities of caregiving, which force more family members look after not only their own parents but also other intimate family members. This review of literature was conducted to clarify what problems they face in taking multiple caregiving responsibilities. Electronic databases of MEDLINE, PubMed, Japanese Central Review of Medicine were used with the following key words: compound caregiver, compound caregiving role, multiple caregiving roles. Five English articles published between 2000 and 2018 were reviewed. In the most literature, several problems relating to stressors were found: reduction in social network and support, difficulty of prioritizing caregiving demands, and reduction in stress resiliency, and little personal time. Five literatures focus on caregivers taking care of their adult children with intellectual/developmental disabilities and their elderly family members at the same time. On the other hand, no literature focuses on those who take multiple care responsibilities for their elderly parents or/and relatives. It is necessary to conduct additional research and explore stressors and burden of caregivers with multiple responsibilities for more than two intimate family members.
