Attitudes to oral care among caregivers in Japanese nursing homes

Objectives: The purpose of this study is to investigate oral care practice and awareness of it among caregivers in Japanese nursing homes. Methods: Caregivers were surveyed by means of a self‐administered questionnaire designed to elicit the following information: awareness of oral care, its importance, the burden involved in oral care, and systemization of oral care. Results: The results showed that most caregivers are adequately informed of the importance of oral care, but are inadequately educated in oral care and have little training in systematic oral care. Conclusion: The importance of providing appropriate and systematic oral care training must be stressed among caregivers along with the need to develop equipment to simplify and support oral care.     

Premorbid personality and aggressive behavior in residents of psychogeriatic nursing homes

In the present study, the correlation was examined between pre-morbid personality traits and the occurrence of aggressive behaviour in residents of a psychogeriatric nursing home. The participants in the study were the close relatives of 39 residents of a psychogeriatric nursing home. These residents were selected on the basis of two subscales of the BOP assessment scale for elderly patients: Aggressive and annoying behaviour, and mental disability. Residents were divided into two groups: one group did not display aggressive behaviour, the other group displayed a great deal of such behaviour. The groups were comparable with regard to the degree of mental disability. To ascertain pre-morbid personality traits, use was made of the hetero-anamnestic personality questionnaire (HAP) and the Quick Big Five (QBF). We found no significant differences in any of the premorbid personality traits between the two groups. We could not confirm the conclusion of other authors that emotional lability (neuroticism) is a personality trait which makes people susceptible to developing aggressive behaviour. In conclusion, our study did not confirm the hypothesis that pre-morbid personality traits are useful to explain the occurrence of aggressive behaviour in residents of a psychogeriatric nursing home.     

The legal position of psycho-geriatric patients in nursing homes and residential homes

Recently the Law on Formal Admission to Psychiatric Hospitals was evaluated for the second time. This law aims to protect the legal position of psychiatric patients, who have been involuntarily admitted. This patient group includes psycho-geriatric patients who are admitted to residential and nursing homes for which this is indicated. In this article the part of the evaluation concerning the internal legal position of psycho-geriatric patients is reported. This part of the study investigated both the knowledge of the law in practice and its correct application, as well as the suitability of the law for this domain of health care. The conclusion can be drawn that residential and nursing homes are aware of the laws purposes, but health care practitioners find it hard to follow certain aspects of the law's procedures, especially regarding the use of restraints. The main reason for this is that the Formal Admission Law was designed for a psychiatric setting, which cannot easily be translated to the position of psycho-geriatric patients. The suggestion is made that the Government will develop new legislation, which reflects special characteristics of psycho-geriatric care. Meanwhile health institutions have to take measures in order to improve the legal position of patients in this sector.     

Non-verbal communication of the residents living in homes for the older people in Slovenia

Aging of the population is a growing problem in all developed societies. The older people need more health and social services, and their life quality in there is getting more and more important. The study aimed at determining the characteristics of non-verbal communication of the older people living in old people's homes (OPH). The sample consisted of 267 residents of the OPH, aged 65-96 years, and 267 caregivers from randomly selected twenty-seven OPH. Three types of non-verbal communication were observed and analysed using univariate and multivariate statistical methods. In face expressions and head movements about 75% older people looked at the eyes of their caregivers, and about 60% were looking around, while laughing or pressing the lips together was rarely noticed. The differences between genders were not statistically significant while statistically significant differences among different age groups was observed in dropping the eyes (p = 0.004) and smiling (0.008). In hand gestures and trunk movements, majority of older people most often moved forwards and clenched fingers, while most rarely they stroked and caressed their caregivers. The differences between genders were statistically significant in leaning on the table (p = 0.001), and changing the position on the chair (0.013). Statistically significant differences among age groups were registered in leaning forwards (p = 0.006) and pointing to the others (p = 0.036). In different modes of speaking and paralinguistic signs almost 75% older people spoke normally, about 70% kept silent, while they rarely quarrelled. The differences between genders were not statistically significant while statistically significant differences among age groups was observed in persuasive speaking (p = 0.007). The present study showed that older people in OPH in Slovenia communicated significantly less frequently with hand gestures and trunk movements than with face expressions and head movements or different modes of speaking and paralinguistic signs. The caregivers should be aware of this and pay a lot of attention to these two groups of non-verbal expressions. Their importance should be constantly emphasized during the educational process of all kinds of health-care professionals as well.     

Care quality: reliability and usefulness of observation data in bench marking nursing homes and homes for the aged in the Netherlands

Before including quality of care indicators in the Benchmark of Nursing Homes and Homes for the Aged in the Netherlands the reliability of the patient data collection, and usefulness had to be established. The patient data items were derived from the Resident Assessment Instruments (RAI) and a questionnaire on social interaction in elderly people. Three nursing homes and three homes for the aged participated in the test with 550 patients. 279 x 2 assessments were collected by independent raters for an inter rater reliability test; 259 x 2 by the same rater for a reliability test-retest; and 24 by a single rater. The scores on paired assessment forms were compared with the weighted Kappa agreement test. The test results allowed 10 of the 13 quality indicators from RAI to be retained. In addition new quality indicators could be defined on 'giving attention' and 'unrespectful addressing'. We estimate on the basis of a questionnaire for the raters that on average 9 to 12 minutes per patient are needed to collect and enter data for the resulting 12 quality indicators.