The Analysis of the ADL (activities of daily living) and Mental Activities by MMSE and HDS-R of the Patients those can not Turn Over in Bed

The analysis of the ADL (activities of daily living) and mental activities by MMSE and HDS-R of the patients those can not turn over in the bed. 【Background and purposes】Turning over is an indispensable action to prevent the state of being bed-ridden and retention of blood flow resulting in decubitus. This action is a kind of the involuntary movement which is acquired in babyhood and it may be called an instinct. This action may be induced by deterioration of cognition and decrease of the brawn of body and extremities in addition to disuse syndrome. However, up to date, we could not find the reports that analyzed the relations between the impossibilities or possibilities of turning over as the instinct and evaluation of mental activities by mini-mental state examination test (MMSE) or HDS-R (Hasegawa dementia rating scale-revised) eating, communication with others, urinary or fecal incontinence, the change of clothes, walking, decubitus in this objective patients. Initially, we expected that those patients who could not turn over in bed also were not able to eat independently, communicate others, manifest urinary or fecal incontinence and suffer from decubitus. Therefore, we tried to identify those relations. 【Clinical materials and methods】The objective group is consisted of the patients admitted to the Rakuzankai Mishima Hospital on January in 2020. They were males and females. Their ages ranged from 37 years to 101 years (average 84.18士8.33 years, male 172 cases female 200 ones). At this time we divided this object group into two ones as group A and B. Group A is consisted of the patients those who cannot turn over in the bed. Group B is consisted of patients those who can turn over in the bed. Then, in this two group, we analyzed the relations between the impossibilities or possibilities of turning over as the instinct and evaluation of mental activities by MMSE or HDS-R eating, communication with others, urinary or fecal incontinence, the change of clothes, walking bathing by him-or herself and decubitus in these two groups. 【Results】In the group A, those who can eat were cases by themselves were 20 cases, 12.0%, those who can eat with an assistance were 70 cases, 42.1%, those who were underwent hyperalimentation or tube nutritional support 61 cases 36.7%, who can communicate others were 52 cases 31.3%, who manifest urinary or fecal incontinence 161 cases 97.0%, who can walk were 3 cases 1.8% who can perform a change of clothes were 1case 0.06%, who suffer from decubitus were 12 cases 7% and who can undergo MMSE or HDS-R were 46 cases 27.7%. And the data of the former and the latter were 9.63士5.79, 7.33士5.65 respectively. Concerning the bathing, all cases were washed by nursing staffs or clinical helpers to avoid being drowned. Therefore, we could not discriminate whether the patients can have bathing by themselves or not. On the other hand, in the group B, those who can eat independently were 172 cases 83.5%, can eat with an assistance were 34 cases 16.5%, no one underwent hyper alimentation, or tube nutritional support. Those who can communicate others were 179 cases 86.9%, who manifest urinary or fecal incontinence 125 cases 61.2%, who can walk were 179 cases 86.9%, who can perform a change of clothes were 79 cases 38.3%, who suffer from decubitus were 1case 0.49% and who can undergo MMSE or HDS-R were cases 130 cases 63.1%. And the data of the former and the latter were 14.78士7.24, 7.33士5.65, 12.94土8.01 respectively. 【Conclusion】In group A, only a few people can eat independently, can communicated others, can undergo MMSE or HDS-R. compared with B. Almost all cases manifest urinary or incontinence, and few ones can walk. On the other hand, much more patients of group B can eat independently, can communicate others and undergo MMSE or HDS-R. than group A. Almost all cases manifested urinary or fecal incontinence and some cases can perform a change of clothes in group A. —+Then, it is suggested that the patients those can walk be able to turn over in bed because of the high ability of exercise or preserved mental activity. Anyway, those patients who can not turn over in bed are not able to eat independently or dependently, are apt to suffer from decubitus, resulting in serious systemic disorders such as sepsis or aspiration pneumonia. In conclusion, their prognosis is suspected to be markedly poor.