• 성인간호학회지
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• 제28권2호
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• pp.213-225
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• 2016

Purpose: The purpose of this study was to provide basic data about agitation in patients with dementia by surveying the literature. Method: Key words used for search through hand-search and electronic database (CINHAL, Pubmed, Google scholar, Riss, Kiss, DBpia) included 'dementia', 'Alzheimer disease', 'agitation', 'aggression or aggressive behavior', 'problem or disruptive behavior', and 'abnormal behavior.' Seventeen studies met the inclusion criteria for the Meta-analysis and 'R' version 3.2.2 was used to analyze the correlated effect size. Results: Study results showed that variables related to agitation were identified as the demographic (age, gender), dementia-related (cognition, medication uses), physical (Activity of Daily Living [ADL], pain), psychological (depression, psychotic symptom, caregiver burden) and environmental (psychosocial environment) factors. The effect size between the correlated variables and agitation were low to moderate (caregiver burden .36; ADL -.24; psychotic symptom and depression .21; pain .19; cognition -.15; medication uses .12; and psychosocial environment -.12). Conclusion: Based on the findings of this study, strategies to improve patients' depressive and psychotic symptoms and ADL and to reduce caregivers' burden are needed for prevention and management of agitation in patients with dementia.

• 한국산학기술학회논문지
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• 제17권9호
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• pp.253-264
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• 2016

본 연구는 요양병원 간호사의 치매환자 통증관리수행에 영향을 미치는 요인을 규명하기 위한 서술적 조사연구이다. 대상자는 B시 소재 30개 요양병원의 간호사 168명이며, 자료 수집기간은 2016년 6월 25일에서 7월 15일까지였다. 수집된 자료는 SPSS/WIN 22.0 통계 프로그램을 이용하여, 빈도와 백분율, t-test, ANOVA, Scheff's test, Pearson 상관계수, 다중회귀분석을 시행하였다. 연구 결과 대상자의 치매환자 통증에 대한 지식은 18점 만점에 10.73점으로 낮았으며, 통증관리태도는 평균 $2.98{\pm}0.27$점, 자기효능감은 평균 $3.34{\pm}0.61$점으로 중간보다 높았다, 장애요인은 평균 $2.90{\pm}0.51$점으로 중간 정도였으며, 통증관리수행은 평균 $4.09{\pm}0.52$점으로 높은 수준이었다. 대상자의 특성에 따른 통증관리수행 정도는 연령(p=.046), 요양병원경력(p=.009), 통증교육(p=.004)에 따라 유의한 차이가 있었다. 대상자의 통증지식, 태도, 자기효능감, 장애요인과 통증관리수행의 상관관계를 분석한 결과 태도(r=.21, p=.006), 자기효능감(r=.51, p<.001)과는 양의 상관, 장애요인(r=-.16, p=.035)과는 음의 상관관계를 보였다. 통증관리수행에 영향을 미치는 요인은 자기효능감, 요양병원경력, 통증교육 순이었고 전체 설명력은 30.1%이었다. 따라서 요양병원 간호사의 치매환자 통증관리수행을 높이기 위해서 정확한 통증지식과 자기효능감을 높일 수 있는 프로그램을 개발할 필요가 있다.

• 지역사회간호학회지
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• 제31권2호
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• pp.130-142
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• 2020

Purpose: The purpose of this study was to verify the validity and reliability of the Korean version of the Pain in Older Adults Knowledge Survey (K-POAKS) to assess knowledge of pain in older adults including people with dementia for use in long-term care hospital nurses. Methods: Survey data were collected from a convenience sample of 179 nurses who have worked in long-term care hospitals in B, D and U cities. The Kuder-Richardson Formula 20 for internal consistency for test reliability was conducted. The content, criterion-related and construct validity were evaluated using SPSS/WIN 22.0. Results: The KR 20 was .75 and Content Validity Ratio (CVR) was a range of 0.84~1.00. The criterion-related validity was positively correlated with attitudes (r=.28, p<.001) and performance (r=.21, p=.004). The construct validity of K-POAKS was analyzed by conducting the principal component method using the exploratory factor analysis varimax rotation, and seven factors were derived above the eigenvalue of 1.0. The seven factors explained 58.5% of the total variation. Conclusion: The Korean version of the POAKS showed satisfactory internal reliability, content validity, criterion-related validity and construct validity. These results suggest that the K-POAKS could be used as a suitable tool to measure the knowledge of the aged people's pain, including that of dementia patients for long-term care hospital nurses.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.461-469
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• 2021

Background: The global population is aging rapidly, and accordingly, the number of patients with dementia is increasing every year. Although the need for dental treatment increases for various reasons in patients with dementia, they cannot cooperate during dental treatment. Therefore, behavioral management, including sedation (SED) or general anesthesia (GA), is required for patients with dementia. Thus, this study aimed to investigate the trends and effects of SED or GA in patients with dementia undergoing dental treatment in South Korea based on the Korean National Health Insurance claims data. Methods: This study utilized customized health information data provided by the Health Insurance Review and Assessment Service. Among patients with records of using sedative drugs during dental treatment from January 2007 to September 2019, patients with the International Classification of Diseases-10 code for dementia (F00, F01, F02, F03, and G30) were selected. We then analyzed the full insurance claims data for dental care. Age, sex, sedative use, and dental treatment of patients were analyzed yearly. In addition, the number of cases of GA or SED per year was analyzed, and changes in behavioral management methods with increasing age were investigated. Results: Between January 2007 and September 2019, a total of 4,383 (male, 1,454; female, 2,929) patients with dementia received dental treatment under SED or GA. The total number of SED and GA cases were 1,515 (male, 528 ; female, 987 ) and 3,396 (male, 1,119 ; female, 2,277) cases, respectively. The total number of cases of dental treatment for 4,383 patients with dementia was 153,051 cases, of which 2.22% were under GA and 0.98% were under SED. Midazolam was the most commonly used drug for SED. Conclusion: Although gingivitis and pulpitis were the most common reasons for patients with dementia to visit the dentist, GA or SED for patients with dementia was frequently used in oral and maxillofacial or periodontal surgery.

• 한국전자통신학회논문지
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• 제8권10호
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• pp.1601-1608
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• 2013

의학계는 2020년 국내노인성 치매환자가 60만명을 넘을 것으로 예상하고 있다. 현재 연령별 치매 환자 비율은 70대 3%, 85~89세 23%, 95세 이상이 58%로 나이에 따라 급격히 증가한다는 것도 주목해야 할 일이다. "21세기의 병"이라 불리우고 있는 치매는 환자 자신뿐 아니라 가족들의 삶까지도 심각한 영향을 미치고 있으며 삶의 질을 떨어뜨려 결국은 가족을 황폐화시킬 정도로 많은 부담과 고통을 동반하고 사회적으로도 심각한 문제가 되고 있다는 지적도 있다. 본 논문은 치매예방센터를 운영하는 대학의 치매예방센터의 프로그램에 참여하여 일정기간 노인들과 함께 프로그램에 참여하며 치매예방 프로그램에 대한 적극적인 개발과 치매예방 인력의 전문화를 위해 노인들과 함께 했다.

• Journal of Korean Neurosurgical Society
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• 제43권3호
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• pp.143-148
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• 2008

Objective: Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods: Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results: POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 mini, and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion: Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

• Journal of Korean Dental Science
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• 제16권2호
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• pp.128-148
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• 2023

Dementia is an umbrella term that describes the loss of thinking, memory, attention, logical reasoning, and other mental abilities to the extent that it interferes with the activities of daily living. More than 50 million individuals worldwide live with dementia, which is expected to increase to 131 million by 2050. Recent research has shown that poor oral health increases the risk of dementia, while oral health declines with cognitive decline. In this narrative review, the literature was based on the "hypothesis" that dementia and oral health have a close relationship, and appropriate oral health and occlusal rehabilitation treatment can improve the quality of life of patients with dementia and prevent progression. We conducted a literature search in PubMed and Google Scholar databases, using the search terms "dementia," "major neurocognitive disorder," "dentition," "occlusion," "tooth loss," "dental prosthesis," "dental implant," and "occlusal rehabilitation" in the title field over the past 30 years. A total of 131 studies that scientifically addressed dementia, oral health, and/or oral rehabilitation were included. In a meta-analysis, the random effect model demonstrated significant tooth loss increasing the dementia risk 3.64-fold (pooled odds ratio=3.64, 95% confidence interval [2.50~5.32], P-value=0.0348). Tooth loss can be an important indicator of cognitive function decline. As the number of missing teeth increases, the risk of dementia increases. Loss of teeth can lead to a decrease in the ascending information to the brain and reduced masticatory ability, cerebral blood flow, and psychological atrophy. Oral microbiome dysbiosis and migration of key bacterial species to the brain can also cause dementia. Additionally, inflammation in the oral cavity affects the inflammatory response of the brain and the complete body. Conversely, proper oral hygiene management, the placement of dental implants or prostheses to replace lost teeth, and the restoration of masticatory function can inhibit symptom progression in patients with dementia. Therefore, improving oral health can prevent dementia progression and improve the quality of life of patients.

• Physical Therapy Rehabilitation Science
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• 제6권2호
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• pp.59-64
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• 2017

Objective: Elderly people with dementia experience not only cognitive dysfunction but also motor function deficits, such as balance and gait impairments. Recently, transcutaneous electrical nerve stimulation (TENS) has been used to reduce pain as well as to control muscle spasm, spasticity and motor performance in various types of subjects. The purpose of this study determined the effect of a single trial TENS on balance and gait function in elderly people with dementia. Design: A randomized controlled trial. Methods: Twenty-two subjects with dementia were assigned to the TENS group (n=12) and ten subjects were assigned to the control group (n=10) randomly. Subjects were classified into two groups: the TENS group (n=12) and the placebo-TENS group (n=10). The TENS group had electrical stimulation applied on the calf muscle for 15 minutes, while the placebo-TENS group had not received real electrical stimulation. The timed up and go test (TUG) and functional reach test (FRT) were used to measure the balance function, and the 10 meters walk test (MWT) and 6MWT were used to assess gait ability. All tests were performed before and after intervention under a single-blinded condition. Results: After intervention, there were significant improvements in TUG, FRT, 10MWT, and 6MWT results in the TENS group (p<0.05), while the placebo-TENS group did not show significant changes in all outcome measurements. There were also differences in all tests between the two groups at post-measurements (p<0.05). Conclusions: This study demonstrated that a single trial TENS application on the calf may be used to improve balance and gait function in elderly people with dementia.

• 한국산학기술학회논문지
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• 제15권11호
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• pp.6728-6738
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• 2014

본 연구는 노인요양시설 입소 노인의 통증, 우울 및 일상생활활동의 관계를 확인하고 통증의 영향요인을 파악하기 위하여 수행되었다. S시의 노인요양시설 4개소에서 2013년 1월부터 2월까지 구조화된 설문지를 이용하여 자료를 수집하였다. 자가보고 통증평가 도구인 NRS(numeric rating scale)와 행동관찰 통증평가 도구인 DS-DAT(discomfort scale-dementia of the Alzheimer's type)를 사용하여 통증을 측정하였고, GDSSF-K(Geriatric Depression Scale Short Form-Korea Version), BADL(Barthel activities of daily living)로 우울과 일상생활활동 수준을 측정하였다. 수집된 자료는 SPSS PC 20.0 program을 이용하여 Pearson's correlation coefficient, 위계적 다중회귀분석을 실시하였다. 연구결과는 NRS와 DS-DAT 모두 일상생활활동과는 음의 상관관계를 보였으며, 우울과는 양의 상관관계를 보였다. 회귀분석을 통하여 성별, 관절염, 우울, 일상생활활동이 NRS를 28.1% 설명하는 영향요인이었고, DS-DAT에서는 우울과 일상생활활동이 21.5%를 설명하는 영향요인으로 확인되었다. 이상의 결과를 바탕으로 노인요양시설 입소노인의 통증관리에 있어서 우울을 완화하고 일상생활활동 능력을 향상시킬 수 있는 프로그램의 개발과 적용이 요구된다.

• 동의신경정신과학회지
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• 제30권2호
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• pp.47-58
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• 2019

Objectives: To conduct and report the results of a public health promotion program in Korean medicine (KM), namely the KM Visiting Care Service for Solitary Elderly, from November 2018 to April 2019. Methods: Six elderly people living in a rural area received the KM visiting care service, twice a week, for four months. This service consisted of acupuncture, auriculotherapy, and supportive counseling to manage their musculoskeletal pain, cognitive impairment, and/or depression. The changes of symptoms were assessed using Numeric Rating Scale (NRS), Korean version of Mini-Mental State Examination for Dementia Screening (MMSE-DS), Korean version of Montreal Cognitive Assessment (MoCA-K), and Geriatric Depression Scale-Short form Korean (GDS-SF-K). Results: Through the 4-months KM visiting care service, the overall subjects' NRS-rated pain decreased slightly. Most showed improvement in MMSE-DS and/or MoCA-K, except one subject who was diagnosed with Alzheimer's disease. Depression assessed by GDS-SF-K showed improvement in a few subjects who were unable to walk independently. Satisfaction assessed through survey was generally high in all subjects. Conclusions: This KM Visiting Care Service for Solitary Elderly may help improve the pain and cognitive function of frail solitary elderly in rural areas. However, the protocol need to be improved to optimize the effect.