スライド 1

スライド 1

Elderly speech duration in speech duration in duration in in in 1 day day speech duration in Average speech duration: 247.4 sec. (4.12 min.) SD: 171.06 Minimum: 1.0 sec. Maximum: 936.0 sec. Speech duration in duration in in in 1 day-min in . interva in in terva ls 18.92 0 13.51 16.22 50 13.51 8.11 29.73 100 (%) 3 INTRODUCTION Background 1st Stage 2st Stage Present study The 1st stage Fukaya, et al., 2004 Aim To clarify Types of communication between caregivers and elderly residents

THE TYPE OF COMMUNICATION category Type communication 6 Talk for Promotion of behavior Talk for Assistance behavior Questions and explanations about daily schedule and activities Secondary category Questions and explanations about physical condition Questions on wishes and desires Warning to be careful Calling out Others Type communication communication Greetings Topics from residents life history Topics on social and natural surroundings and events Topics on psychological state Others The second stage Fukaya, et al., 2009 Ai To conduct an education intervention (lecture and group discussion) with the aim of making caregivers aware of the need for Type II communication to the elderly To discover practical measures to increase

Type II communication of caregivers after an education intervention Study Design First Survey Educational Intervention for Facility Caregivers Second Survey Third Survey Quantitative survey of caregivers speech and elderly utterances Lecture The importance of type communication communication ( 30 minutes) group discussion Critical Reflection ( 90 minutes) 1week later 3 month later 8 Results Type II talking increased significantly (p<.05) from 226.5 sec (SD126.5) before intervention to 390.1 sec (SD274.0) 1 month after intervention, and it maintained an increased level after 3 months 9 Aims 1. of Present Study To investigate the effect of educatio

nal intervention on duration and freq uency of elderly utterances 2. To investigate the influence of chang es in duration of Type II speech on elde rly self-initiated utterances 10 3. To investigate the influence of cha nges in duration of Type II speech on secondary categories of elderly Type II utterances 11 Definition of Terms Type I utterances(Task-oriented): Utterances by the elderly during communication with caregivers about various nursing and caregiver activities in order for th e elderly to pursue daily living. Type II utterances(Life-Worldly): Utterances by the e lderly during communication with caregivers about fa mily, work and social events that occur in normal soci al life. Self-initiated utterances: Utterances self-initiated t owards another person. 12 Survey Participants 37 elderly persons (Facility A15 , Facility B10 Facility C12) GENDER 11 males, 26 females AGE 72 100 years old a mean age of 84.6 years old Activities of daily life (ADL) 11 bedridden (30.6%), 21 in whe elchair(58.3%), 4 ambulatory (11.1%) one unknown. Cognitive impairment 6 persons (16.2%) lightness dement ia , 25 persons (67.6%) moderate dementia, 5 persons (13.5%) se vere dementia . 240 nurses and other caregivers (Facility A: 69 caregivers, Facili ty B: 89 caregivers, Facility C: 82 caregivers) 13 14

Each two syllables in transcript were counted as 1 second when calculating the utterance duration for each type. These codes were allocated to each type of subcategory based on the category tables for the type of elderly utterances from the previous studies Each sentence from transcript of recorded scenes was coded Counti ng Clasification Coding Analysis Method (1) Analysis Method (2) Statistical analysis Changes in the duration of caregivers Type II speech were compared before an d after educational intervention . Increase Group 7711 second increase in speech duration 21 residents (56.8%) Decrease Group 6897 second decrease in speech duration 16 residents (43.2%) Evaluating the relationship between caregivers Type II speech and elderly utte rances and self-initiated utterances before and after educational intervention in the two groups (Increase Group/Decrease Group). Conducting t-tests,ANOVA and Bonferroni analysis, by using SPSS v.18 15 RESULTS 16 Table Effect of Educational Intervention on the Duration and Frequency of Elderly Utterance s. Facility A

and C Elderly Utterance Utterance duration Type I Type II Utterance frequency Intervention Before After Before After Before After Before CI n 22.00 22.00 22.00 22.00 22.00 22.00 22.00 M 212.00 299.18 155.41 190.64 56.59 108.57 78.23 SD 185.71 259.10 146.56 168.23 54.98 122.46

50.84 LL -186.76 UL t p 12.40 -1.82 0.08 -105.86 35.41 -1.04 0.31 -98.64 -5.31 -2.32 0.03 -36.47 2.65 -1.80 0.09 After 22.00 95.14 67.48 Type I Before 22.00 66.00 45.63 -21.82 12.73 -0.55 0.59 After 22.00 70.55 51.88 Type II Before 22.00 12.23 11.24

-22.03 -2.70 -2.66 0.02 After 22.00 24.59 24.39 Note. Type I = Task-oriented . Type II = Life-worldly. SD = Standard deviation. CI = Confidence interval. LL = Lower limit. UL = Upper limit. 17 Table2 Change in duration and frequency of elderly self-initiated utterances due to Type II caregiver speech duration Elderly subjects self-initiated utterance Change in self-initiated utterance duration Caregivers' Type II speech Increase n M (sec) 21 27.76 Decrease 16 21 16 -19.13 7.33 0.81 Increase 21

20.43 Decrease 16 -19.94 Increase 21 4.48 Decrease 16 -2.38 Increase 21 2.14 7.46 0.73 -2.82 5.99 Decrease 16 0.56 5.06 -2.61 5.77 Increase

21 2.33 5.90 2.86 1.53 9.01 Decrease 16 -2.94 5.05 1.61 8.94 Decrease Type I self-initiated utterance Type II self-initiated utterance Change in self-initiated utterance frequency Type I self-initiated utterance Type II self-initiated utterance CL Increase SD t 69.75 2.20 LL UL

p 3.51 90.26 .04 56.44 4.75 89.03 33.49 0.56 -17.27 30.32 37.62 -17.79 30.84 .58 52.00 2.59 8.66 72.07 .01 39.51 9.82 70.91 10.11 2.31 0.84 12.86 7.04 1.12 12.58 .03 .47 .01 Note. Type I utterance = Task-oriented utterances. Type II utterance = Life-worldly utterances. 18 SD = Standard deviation. CL = Confidence interval. LL= Lower limit. UL= Upper limit. Table 3 Change in frequency of elderly Secondary category

utterances due to Type communication Caregiver speech duration Elderly subjects Caregivers' Secondary category TypeII utterances speech Social events Life experience Psychological state/knowledge Greeting Other CL n M(sec) SD t 2.66 Increase 21 5.10 12.43 Decrease 16

-4.81 9.42 Increase 21 4.48 7.86 Decrease 16 -2.25 4.39 Increase 20 0.60 7.38 Decrease 16 -7.94 13.39 Increase 21 0.10 1.97 Decrease

16 -0.88 1.71 Increase 21 5.24 10.55 Decrease 16 0.06 12.14 3.07 2.43 1.57 1.39 LL UL 2.33 17.48 2.61 17.20 2.28

11.17 2.58 10.87 1.40 15.67 0.80 16.27 -0.29 2.23 -0.26 2.20 -2.41 12.76 -2.60 12.96 p .01 .004 .03 .13 .18 Note. SD = Standard deviation. CL = Confidence interval. LL = Lower limit. UL = Upper limit. 19

Conclusions when the duration of Type II speech by caregivers increased, the duration and frequency of Type II utterances by the elderly tended to increase. when the duration of Type II speech by caregivers increased, the duration and frequency of selfinitiated utterances by elderly residents also increased. 20 21 Table Change in elderly utterance duration and frequency due to Type II caregiver speech duration Elderly subjects utterance Change in utterance duration Type I utterance Type II utterance Change in utterance frequency Type I utterance Type II utterance Caregivers' Type II speech duration CL n M (sec) SD t LL Increase 21

112.64 224.48 2.71 43.25 300.29 Decrease 16 -59.13 133.18 51.30 292.23 Increase 21 55.17 170.77 -48.16 158.87 Decrease 16 -0.19 127.29 -44.13 154.84

Increase 21 61.38 111.57 55.38 243.70 Decrease 16 -88.16 170.25 48.43 250.64 Increase 21 28.43 44.60 36.75 94.60 Decrease 16 -37.25 40.60

37.09 94.26 Increase 21 16.10 42.04 17.22 66.97 Decrease 16 -26.00 28.73 18.44 65.75 Increase 21 13.24 22.59 8.22 38.63 Decrease 16 -10.19

22.54 8.18 38.67 1.09 3.22 4.61 3.44 3.13 UL p .01 .29 .01 .001 .002 .004 Note. Type I utterance = Task-oriented utterances. Type II utterance = Life-worldly utterances. SD = Standard deviation. CL = Confidence interval. LL = Lower limit. UL = Upper limit. 22 Table1 Descriptive Statistics about Utterance duration n minimum maximum M(sec) % Total

% SD Total utterance duration 37.00 1.00 936.00 247.42 Type I utterance duration 37.00 1.00 622.50 161.57 100.00 37.00 0.00 567.00 130.12 80.53 121.44 Self-initiated utterance 37.00 0.00 147.50 31.45 19.47 41.78 Type II utterance duration

37.00 0.00 664.00 85.85 100.00 Replied utterance 37.00 0.00 559.50 63.08 73.48 118.79 Self-initiated utterance 37.00 0.00 104.50 22.77 26.52 30.10 Replied utterance 100.0 222.91 65.3

146.18 34.7 133.89 23 Table Difference among facilities in changes in elderly utter ance duration CI Elderly subjects utterance Change in utterance duration Type I utterance duration Type II utterance duration Facility n M (sec) SD F LL UL p A 10 124.60 253.93

1.68 -57.05 306.25 .20 B 15 -26.50 164.20 -117.43 64.43 C 12 47.58 201.25 -80.28 175.45 A 10 75.90 146.65 -29.01 180.81 B

15 26.43 135.47 -48.59 101.46 C 12 0.00 183.81 -116.79 116.79 A 10 57.25 138.56 -41.87 156.37 B 15 -84.33 186.79 -187.78

19.11 C 12 47.58 73.42 0.93 94.23 0.66 3.92 .52 .03 Note. Type I utterance = Task-oriented utterances. Type II utterance = Life-worldly utterances. SD = Standard deviation. C = Confidence interval. LL = Lower limit. UL = Upper limit. 24 Table7 Change in utterance duration according to elderly attribute Impairment Cognitive II IV Auditory No Yes Verbal No Yes Utterance duration n(%) M (sec) SD 617 94.50 285.61 3083 18.52 189.04

3184 11.81 172.33 6 (16 75.58 221.26 2978 44.48 232.57 822 16.19 56.45 t p 0.82 0.42 - 1.8 0.83 0.59 0.74 Note. I =mild cognitive impairment. IIIV =moderate and more severe cognitive impairment. SD =Standard deviation. 25 Long-Term Care Insurance System in Japan Not certified Levels of the certified care (support) and services available Level of support Level of care need Those who need no continuous Those who need continuous care but need some care because of being support in bedridden, dementia, etc. the daily life 1 2 1 2 3 4 Preventive benefits service Long-Term Care Prevention Services in a Community Support Project 5

Care benefits service 26 Table 4 Change in frequency of elderly Secondary category utterances due to Type communication Caregiver speech duration Elderly subjects Caregivers' Secondary category TypeII utterances speech Social events Life experience Psychological state/knowledge Greeting Other CL n M(sec) SD t Increase 21 5.10 12.43

Decrease 16 -4.81 9.42 Increase 21 4.48 7.86 Decrease 16 -2.25 4.39 Increase 20 0.60 7.38 Decrease 16 -7.94 13.39 Increase 21 0.10

1.97 Decrease 16 -0.88 1.71 Increase 21 5.24 10.55 Decrease 16 0.06 12.14 LL 2.66 3.07 2.43 1.57 1.39 UL p 2.33 17.48

2.61 17.20 2.28 11.17 2.58 10.87 1.40 15.67 0.80 16.27 -0.29 2.23 -0.26 2.20 -2.41 12.76 -2.60 12.96 .01 .004 .03 .13

.18 Note. SD = Standard deviation. CL = Confidence interval. LL = Lower limit. UL = Upper limit. 27 ; 24.09% ; 75.91% Table5 Change in utterance duration according to elderly attribute Impairment Cognitive II IV Auditory No Yes Verbal No Yes Utterance duration n(%) M (sec) SD 617 94.50 285.61 3083 18.52 189.04 3184 11.81 172.33 6 (16 75.58 221.26 2978 44.48 232.57 822 16.19 56.45 t p 0.82 0.42 - 1.8 0.83 0.59 0.74

Note. I =mild cognitive impairment. IIIV =moderate and more severe cognitive impairment. SD =Standard deviation. 29 Typecommunication Primary Category Utterances about promotion of behavior Secondary Category Acknowledge action instructions/urging Confirm instruction/urged behavior Instruction/request urging behavior Indicate difficulty of instruction/urged behavior Refuse instruction/urged behavior Indicate action completion Utterances about assistance behavior Evaluate action and receive praise Acknowledge/reply to explanation of assistance action Acknowledge/reply to assistance behavior start Acknowledge/reply to assistance behavior finish Evaluate assistance behavior Utterances about physical condition and daily routine Explain schedule/acknowledge or reply to instruction Confirming wishes and desires Express will Reply confirming wish/desire Warning to be careful Acknowledge warning Indicate difficulty in complying with warning Ask question about schedule explanation/instruction Reply to question about completed daily schedule Receive evaluation of completed daily schedule Reply to question about physical condition

Acknowledge explanation about physical condition Reply confirming state of illness 30 Type communication communication life experience Talk about past experiences Talk about hobbies and tastes Talk about family, friends, acquaintances, pets social events psychological state/ knowledge Talk about social events Express psychological state (emotions) Reply about psychological state (emotions) Reply confirming knowledge or memory Greetings Other Greetings Talk about the weather, express doubt, talk to oneself, etc. 31 Measurement Framework Measurement of wo times -Before the education intervention -one week after the intervention a total of two days Observation period AM 9.00 hours PM 17.00 hours Observation content All verbal communication between elderly resident and caregivers 32 Educational Intervention

for Facility Caregivers Lecture promoting 'critical review' and group discussion (Total 90 minutes) ) First Survey Qualitative survey of talking by caregivers and utterances by elderly residents One week later Fig. 1 Survey Design Second Survey Qualitative survey of talking by caregivers and utterances by elderly residents Home Care Service Costs to Be Paid by the User As for the home care service (services other than the facility services stated in the left page), the user has to pay 10% of the costs. Cost for meals, for room, and for daily necessities are borne by the user. 34

Staff placement standard Doctor Nurse Care staff A specialist in therapy and rehabilitation Care manager Welfare facility for the elderly requiring care(special nursing home for the elderly) Health service facility for the elderly requiring Care Sanatorium type medical care facility for the elderly requiring care The staff who is necessary per 100 residents The staff who is necessary per 100 residents patient staff One or more One or more or more

One or more The number needed One or more The number needed 35 Results Caregivers talking duration in a day =38.1 minutes Elderly Utterances duration in a day=4.1 minutes Typecommunication = 75.9% Typecommunication communication = 24.1% 36 Contents of group discussion Current conditions Type I talking (around work) Being busy with care, time constraints for Type II communication While thinking about the next work Talking without awaiting an answer Must be a short conversation, otherwise obstruct duties Some Type II talking When there is time Finding topics to talk about Use Type II communication when providing care 37 18.92 0 10

13.51 20 16.22 30 40 13.51 50 8.11 60 5.41 70 24.32 80 90 100 Contents of group discussion Background to current talking situation Talking to the selected elderly Not necessary for caregiver to talk to independent elderly No need to talk to elderly who have many family visits Infrequent talk to elderly unable to convey their wishes Working conditions Too much work to accomplish Unwillingness to impose on colleagues due to staff shortages Prioritization of work in accordance with the work function Communication consciousness and skills Typetalking is labeled negligenttalking is labeled negligent

Communication is not regarded as work No conversation topics in common with the elderly No interest in the elderly Not knowing much about the elderly 39 Contents of group discussion Improvement measures Revision of duties Setting a target conversation time per day Setting a target for planned conversation with elderly residents Increase the number of recreational opportunities Include verbal communication in a daily action plan Understanding the elderly Sharing information about the elderly Not discriminating among the elderly based on conversational ability and degree of independence Knowing background of the elderly Consciousness reform regarding communication Regard communication as part of duties Change the viewpoint that conversation while working is not good Normal conversation based on person to person relations Have peace of mind Communication inventiveness Not holding preconceptions about elderly Talk about nature and incidents in society as conversation topics Provide more opportunities for interaction between elderly residents sharing similar interests 40

Recently Viewed Presentations

  • Who Wants To Be a Millionaire - RRCS

    Who Wants To Be a Millionaire - RRCS

    A. digestion, in which starch is broken down into simple sugars B. respiration, in which oxygen is used and carbon dioxide is given off C. fermentation, in which sugar is broken down and alcohol is given off D. photosynthesis, in...
  • Revue dhistoire ecclsiastique Bibliography (RHE)  Initial information drawn

    Revue dhistoire ecclsiastique Bibliography (RHE) Initial information drawn

    Revue d'histoire ecclésiastique - Bibliography (RHE) Initial information drawn from a famous printed series In april 2010: more than 130,000 records available (1991-2009)
  • on gins ager g i an le H

    on gins ager g i an le H

    Objectives. Gauge current perceptions of the Service among the general population. Understand current public expectations of the Service. Understand how members of the public would prefer to receive information about the Service in order to better inform an overall communications...
  • Unit D - Science 10

    Unit D - Science 10

    Unit D . Energy flow in Global Systems. ECOLOGY. A study of Life on Earth. What is this unit about? How does climate affect the species of Earth. What is the biosphere? What are the different parts of it? How...
  • UNIT II: Bioenergetics and Carbohydrate Metabolism CHAPTER 10:

    UNIT II: Bioenergetics and Carbohydrate Metabolism CHAPTER 10:

    glucose 6-phosphate translocase, which transports glucose 6-phosphate across the endoplasmic reticular (ER) membrane, and the enzyme glucose 6-phosphatase (found only in gluconeogenic cells), which removes the phosphate, producing free glucose (see Figure 10.6).
  • IPCC Model Projections of North Pacific Climate Variability

    IPCC Model Projections of North Pacific Climate Variability

    Expected Changes in the Climate Forcing of Alaskan Waters in Late Summer/Early Fall Nicholas A. Bond1 James E. Overland2 and Muyin Wang1 1 University of Washington/JISAO 2 NOAA/PMEL Analysis of Model Output Ascertain parameters crucial to the ecosystem and/or the...
  • BMC for Universal Branching-Time Logic

    BMC for Universal Branching-Time Logic

    BMC for Universal Branching-Time Logic. M.Sc. Thesis. Rotem Oshman. Supervisor: Orna Grumberg
  • Policies & Procedures Why we do what we

    Policies & Procedures Why we do what we

    Policies & Procedures Why we do what we do. Gordon Adams Systems Development Division Rationale Security Efficiency Compatibility Source Department of Commerce NOAA NOS NGS Systems Development Division Policies & Procedures Why we do what we do.