Postoperative delirium (POD) and subsyndromal delirium (SSD) among older patients is a common, serious condition associated with a high incidence of negative outcomes. However, there are few accurate methods for the early detection of POD and SSD in surgical wards. This study aimed to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward. This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Delirium symptoms were assessed using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint and bed sensor were collected from medical records. Multiple logistic regression analyses were conducted to identify the risk factors for both POD and SSD. A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD (n = 4) and SSD (n = 15). The use of bed sensors (odds ratio 10.2, p = .001) was identified as a risk factor for both POD and SSD. Our findings suggest that the use of bed sensors might be related to the development of both POD and SSD among older patients in surgical wards.

Background: Japan and other nations are experiencing rising demands for care, owing to declining birth rates and aging populations. This particularly affects compound caregivers, people who provide informal care for multiple individuals. Compound caregivers face unique challenges and higher risks of physical and mental health problems. However, existing self-care scales do not cover their needs. This cross-sectional study aimed to develop and validate the Self-Care Scale for Compound Caregivers (SCSCC) to assess specific self-care practices and promote targeted support. Methods: A cross-sectional study was conducted through an online survey of 400 compound caregivers. Reliability was assessed via item analysis, exploratory and confirmatory factor analyses, and Cronbach’s alpha. Criterion validity was evaluated using a self-rated health scale. Results: Overall, 400 compound caregivers participated in the study. After item analysis, we excluded nine items, leaving eight for factor analysis. Exploratory factor analysis revealed a single-factor structure explaining 51.5% of the variance. Confirmatory factor analysis showed a good model fit after modifications (goodness of fit index = 0.964, adjusted goodness of fit index = 0.932, comparative fit index = 0.980, root mean square error of approximation = 0.054). The final version of the SCSCC demonstrated strong internal consistency (Cronbach’s alpha = 0.859) and was positively correlated with self-rated health (r = 0.387, p < 0.001). Conclusions: The SCSCC is a reliable tool for assessing self-care in compound caregivers, supporting health promotion, interventions, and policies to improve their health within the community care system.

Objectives To develop a simple screening scale to predict depression after discharge in patients with acute coronary syndrome after percutaneous coronary intervention (ACS-PCI) and to verify its reliability, validity and cutoff value. Design Prospective longitudinal study was conducted 1 week and 3 months after discharge. Setting Two hospitals where PCI is performed in Japan. Participants A total of 183 patients were potential candidates for the survey, of whom 42 provided valid responses (response rate: 23.0%). Results The number of items was reduced from 14 to 12 with item-total correlations and principal component analysis. Cronbach’s alpha coefficient was 0.832 and the intraclass correlation coefficient (1, 2) was 0.811 (95% CI 0.650 to 0.898). Significant correlations were observed for concurrent validity (r=0.699, p<0.01) and predictive validity (ρ=0.538, p<0.01). The area under the receiver operating characteristic curve was 0.799 (CI 0.629 to 0.970). A cut-off value of 28 points was obtained from the Youden index and demonstrated a sensitivity of 1.000, specificity of 0.553, positive predictive value (PPV) of 0.190 and negative predictive value of 0.000. Conclusions This study developed a simple screening scale for predicting postdischarge depression in patients with ACS-PCI (SDACS-12) and demonstrated its reliability, validity and predictive ability with 12 items. Nevertheless, its results should be interpreted cautiously given the moderate variance explained by PCA and the low specificity and PPV.

Nursing management activities are important in influencing staff nurses’ action to prevent or withdraw physical restraints. However, limited studies have been conducted empirically to determine the nursing management activities required for minimizing physical restraints. Therefore, there is a need for basic standards of nursing management activities to minimize physical restraints in acute care settings. This study aimed to develop nursing management indicators to minimize physical restraint (MaIN-PR) in hospitalized older adult patients in an acute care setting. It was conducted between June and October 2021 in Japan using a Delphi consensus approach. Fifty nurses working at top or middle management levels or as certified nurse specialists in gerontological nursing enrolled as participants. The potential indicators obtained from the literature review and interviews were organized inductively to develop two types of draft indicators: (1) 35 items for top management and (2) 33 items for middle management. We asked the nursing managers and certified nurse specialists in gerontological nursing to assess the validity of each indicator in three rounds. Of the 50 initial panelists, 12 from top management and 13 from middle management continued till the third round. MaIN-PR contained 35 indicators for top management and 28 indicators for middle management and were classified into the following six metrics: planning, motivating, training, commanding, organizing, and controlling. To the best of our knowledge, the current MaIN-PR are the first set of nursing management indicators for minimizing physical restraint, including perspectives on geriatric nursing in acute care settings. These indicators could guide both top and middle nursing management, thus supporting staff nurses’ judgment in minimizing physical restraints to enhance the quality of older adult patient care.

Background: Postoperative delirium (POD) among older patients is a common, serious disease and is associated with a high incidence of negative outcomes. For early detection of POD and subsyndromal delirium (SSD), this study was conducted to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward.Methods: This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Both POD and SSD were assessed by using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for POD and SSD.Results: A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD and SSD. The use of bed sensors (odds ratio 10.2, p=.001) were identified as risk factors for POD and SSD.Conclusions: Our study shows that the use of bed sensors might be related to the development of POD and SSD among older patients in surgical wards.