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.

Familial caregivers' experiences with home-visit nursing for persons with dementia who live alone.

AIM: The Japanese Comprehensive Strategy to Accelerate Dementia Measures, known as the New Orange Plan, aims to support people with dementia living in their communities. Home-visit nurses (HVN) are expected to play an important role in this comprehensive support system. In this preliminary study, we explored caregivers' experiences before and after implementation of HVN care for persons with dementia who lived alone. METHODS: This study was a qualitative descriptive design using in-depth interviews with five family caregivers of persons with dementia who lived alone while receiving HVN. Thematic content analysis was undertaken. RESULTS: Before receiving HVN, caregivers experienced anxiety and embarrassment due to the occurrence of dementia symptoms, and they also experienced considerable isolation and anguish after hearing the diagnosis. After initiating HVN, caregivers gained a feeling of security and an alleviation of psychological stress. They also gained a deeper understanding of the disease and appropriate care for dementia patients. Notably, caregivers perceived not only positive changes in themselves, but also in the recipients, such as improvements in symptoms and quality of life. Finally, caregivers realized that people with dementia can live alone if appropriate services are provided. CONCLUSION: HVN can have a positive impact on family caregivers involved in dementia care, as well as on the recipients' psychological status. Overall, the experience of HVN made the family caregivers more positive about home care for their family member with dementia. Although further case studies are needed to make definitive conclusions, we believe that HVN could play a key role in the forthcoming New Orange Plan.

Analysis of inedible substance ingestion at a Japanese psychiatric hospital.

BACKGROUND: Inedible substance ingestion increases the risk of ileus, poisoning, and suffocation. Prevention is especially important in a psychiatric setting. This study aimed to analyze the incidence of inedible substance ingestion in a Japanese psychiatric hospital. METHODS: Inedible substance ingestion incidents were extracted from an incident report database spanning 2000-2012 at a 400-bed psychiatric hospital in Japan. We tabulated the frequencies of incidents in accordance with major diagnosis, ingested materials, incident levels, and time of occurrence. RESULTS: The incidence rate was 0.09/1000 patient days, and 149 cases in 105 patients were classified as having experienced inedible substance ingestion. The most common diagnosis was dementia (n = 58), followed by schizophrenia (n = 22). Materials ingested by dementia patients were nappies or gauze attached to the patient's body after medical procedures. Materials ingested by schizophrenic patients were liquid soap, detergent or shampoo, and cigarettes. Inedible substance ingestion among dementia patients occurred mostly before or during meals. Among schizophrenic patients, the peak period of incidents was in the evening. CONCLUSIONS: Dementia patients were overrepresented in the inedible substance ingestion incidents. Items they wore or applied to their bodies were often subject to ingestion, and such behaviours mostly occurred around meal time. Therefore, the nursing staff were able to discover them quickly and treat most of the cases free of serious consequences. In contrast, schizophrenic patients were underrepresented in the incidents, and most cases involved ingestion of detergent powder or cigarettes, resulting in more serious consequences and requiring treatment.

A cross-sectional study on the relationship of job stress with natural killer cell activity and natural killer cell subsets among healthy nurses.

The present study investigated the effects of job stress on cellular immune function, such as NK cell activity and NK cell subsets. The participants were 61 female nurses aged 23-59, who worked in a public psychiatric hospital in Ishikawa, Japan. Each subject completed the Nursing Job Stressor Scale (NJSS) and their NK cell activity and lymphocyte surface antigens (CD16+56+) were evaluated as immune system parameters. The NJSS has seven subscales: conflict with other nursing staff, nursing role conflict, conflict with physicians or autonomy, conflict with death or dying, quantitative work load, qualitative work load and conflict with patients. Factors influencing NK cell activity, and the proportion and cell counts of CD16+56+ lymphocytes were evaluated. Increase in quantitative work load significantly decreased NK cell activity. Conversely, no linear relationship was observed between qualitative work load and immunological variables, with the highest percentage of CD16+56+ lymphocytes observed among participants in the medium work load group. The other five NJSS subscales did not relate to immune parameters. In conclusion, the results suggest that perceived job strains, particularly quantitative work load, decreased NK cell function.