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PATIENT CARE


ID03 and ID11. The falling asleep rate and the cumulative sleeping time were calculated separately for the days receiving day care and the days without day care. The results are shown in Table 1. The results suggest that day care serves as a factor in improving the sleep by patients and caregivers. Then, analysis was made of short stay


care. Patient ID02 was receiving short stay service periodically and had short stay during the study period. Figure 3 compares the falling asleep rate for the caregiver ID02 between the period of living with the patient (without short stay) and the period of living alone (during the short stay of the patient). This comparison suggests that the


caregiver can lead daily life freely and take rest during the short stay period (not living with the patient) and that the daily life of the caregiver is determined by the presence of the patient. Periodical short stay was thus suggested to alleviate the mental/physical fatigue of the caregiver and to serve as a factor facilitating continuation of home care of the patient with dementia. Discussion with the two physicians of ‘Clinic 2’ endorsed the validity of these two findings, allowing us to confirm that the falling asleep rate can be utilised as an indicator of sleep quality.


Indicator of failure in home care Patient ID11 required care at night. The falling asleep rate for this patient was second lowest among the 14 subjects studied, and the falling asleep rate for this patient’s caregiver was lowest among all caregivers (less than 70 per cent for both the patient and the caregiver). In two caregivers with the falling asleep


rate between 70 per cent and 80 per cent, the rating by GDS was “depressive tendency” or worse at both of two sessions of evaluation (at start and end of the study). These results suggest that the reduction in falling asleep rate can serve as an indicator of failure in home care. Validity of this finding was endorsed by the discussion with two physicians of ‘Clinic A’.


1.0


0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0


12:00 15:00 18:00 21:00 0:00 3:00 6:00 9:00 12:00 Time


Patient: Home Caregiver: Home


1.0


0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0


12:00 15:00 18:00 21:00 0:00 3:00 6:00 9:00 12:00 Time


Patient: Out of home (period of short-stay) Caregiver: Home


Figure 3. Comparison of falling asleep rate of the caregiver (ID02) between living with the patient and living alone (during short stay by patient).


Conclusion If signals of failure in home care are detected and appropriate intervention from outside is provided before failure actually occurs, it will support continuation of home care of patients with dementia. On the basis of the data collected from this study, we propose the first draft criterion for judgement of intervention. Considering that the falling asleep rate


was suggested to serve as an indicator related to continuation of home care, that the falling asleep rate was 80 per cent or less in more than half of all dementia patients and that depressive tendency or worse condition was seen in caregivers with the falling asleep rate lower than 80 per cent, it seems rational to propose ‘less than 80 per cent falling asleep rate by family caregivers’ as an initial criterion for introduction of appropriate intervention. In this study, sleep indicators for the


evaluation of fatigue by family caregivers for dementia patients were developed through analysis of objective sleep data, and values of indicators for judging the necessity of intervention have been proposed.


What is needed from now is to refine


the screening and status evaluation through acquisition, analysis and


Table 1. Comparison of falling asleep rate and cumulative sleeping time between available and unavailable day care.


Falling asleep rate (%)


ID02 patient ID02 caregiver ID03 patient ID03 caregiver ID11 patient


ID11 caregiver 112


Available 89.0 90.0 69.7 92.3 71.3 65.8


Unavailable 87.9 86.4 66.8 89.8 67.3 58.3


Cumulative sleeping time (h:min) Available 09:03 07:20 08:42 07:04 08:11


04:23


Unavailable 08:30 07:02 08:14 07:01 07:51 03:41


interpretation of further data and repetition of PDCA (plan-do-check-act) cycles.


IFHE


References 1 Ninomiya T. Study on future estimation of the elderly person population of dementia in Japan. Research report of NHLW GRANT 1-19, 2015.


2 Sato R, Kanda K, Anan M, Sleep patterns of middle-aged and older female family caregivers providing routine nighttime care for elderly individuals at home. Japan Academy of Nursing Science 2000; 20 (3): 40-9.


3 Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep 2003; 26: 342-92.


4 Ancoli-Israel S. Actigraphy. In: Kryger MH, Roth T, Dement WC eds. Principles and Practice of Sleep Medicine 4th edn. Philadelphia: Elsevier Saunders, 2005: 1459– 67.


5 Pollak C, Tryon WW, Nagaraja H, Dzwonczyk R. How accurately does wrist actigraphy identify states of sleep and wakefulness?. Sleep 2001; 24: 987–65.


6 Tryon WW. Issues of validity in actigraphic sleep assessment. Sleep 2004; 27: 158–65.


7 Youngstedt SD, Kripke DF, Elliott JA, Klauber MR. Circadian abnormalities in older adults. Journal of Pineal Research 2001; 31: 264–72.


8 Cole RJ, Smith JS, Alcala YC, Elliott JA, Kripke DF. Bright-light mask treatment of delayed sleep phasesyndrome, Journal of Biological Rhythms 2002; 17: 89–101.


9 Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep 2003; 26: 342–92.


10 Kogure T, Shirakawa S, Shimokawa M, Hosokawa Y. Automatic sleep/wake scoring from body motion in bed: validation of a newly developed sensor placed under a mattress. Journal of physiological Anthropology 2011; 30: 103–9.


IFHE DIGEST 2021


Falling asleep rate


Falling asleep rate


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