[Barriers perceived by advance care planning (ACP) facilitators in nursing and welfare professions in implementing ACP: An online survey].

AIM: This study aimed to elucidate the barriers perceived by Advance Care Planning (ACP) facilitators in nursing and welfare professions when implementing ACP in practice. METHODS: An online survey using Google Forms was conducted between December 2021 and January 2022. The survey targeted 220 individuals, including 82 who completed the Hiroshima Prefecture ACP Promotion Training in 2020 and 138 ACP Promotion Collaborators in Fukuyama City, Hiroshima Prefecture. In addition to the respondents' attributes, the survey asked about the importance of 37 items related to barriers to ACP implementation, using a 7-point scale. We compared two groups: nurses and physicians ("nurses/physicians") and other medical and nursing care professionals ("nursing care professionals, etc."). RESULTS: Responses were obtained from 67 participants (response rate: 34.4%). The barriers to ACP perceived by nursing care professionals were as follows: 1) lack of knowledge about ACP, 2) belief that other professions are more suitable for implementing ACP than themselves, and 3) difficulty in realizing intentions due to institutional and environmental factors. Nurses and physicians perceived lack of time as an important barrier. Measures such as 1) clarifying how different professions should be involved in ACP, 2) expanding educational opportunities tailored to each profession, 3) utilizing tools to support the decision-making process in ACP, and 4) establishing an information-sharing system infrastructure are considered to be effective in promoting the implementation of ACP by facilitators in the nursing and welfare professions. CONCLUSIONS: By implementing measures to address the barriers identified in this study, it is expected that the practice of ACP by facilitators in nursing and welfare professions will be promoted, and ACP will become more widespread in the community.

Self-reported hearing and vision impairment and incident frailty in Japanese older people: A 3-year longitudinal analysis of the Japan Gerontological Evaluation Study.

BACKGROUND: We examined the associations and interactions of hearing impairment (HI) and vision impairment (VI) with frailty. METHODS: We performed a 3-year longitudinal analysis of the Japan Gerontological Evaluation Study (JAGES), a nationwide prospective cohort study of functionally independent Japanese older people (age ≥ 65 years). Frailty status at baseline and follow-up was defined according to the Kihon Checklist. HI and VI at baseline were self-reported. Logistic regression models were used to examine the main and interaction effects of HI and VI on incident frailty during a 3-year follow-up period. RESULTS: Of the 7,852 participants (mean age 73.2 years, standard deviation 5.6; 50.7% women), 9.7%, 5.3%, and 1.9% reported HI, VI, and concurrent HI and VI, respectively. After adjusting for possible confounders and the other sensory impairment, VI (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.62-3.85, p < 0.001), but not HI (OR 1.29, 95% CI 0.97-1.72, p = 0.081), was significantly associated with incident combined pre-frailty and frailty from a robust baseline. No interaction was observed between HI and VI (OR 0.83, 95% CI 0.38-1.81, p = 0.636). We observed no significant associations between sensory impairments and incident frailty from a pre-frail baseline (HI: OR 1.26, 95% CI 0.88-1.80, p = 0.205; VI: OR 1.44, 95% CI 0.90-2.31, p = 0.127; interaction between HI and VI: OR 1.16, 95% CI 0.53-2.53, p = 0.718). CONCLUSIONS: VI, rather than HI, may be an independent risk factor for frailty, without any interaction between the two.

Family social support and stability of preferences regarding place of death among older people: a 3-year longitudinal study from the Japan Gerontological Evaluation Study.

BACKGROUND: it remains unclear how family relationships could affect stability of end-of-life care preferences. OBJECTIVE: to describe change patterns of preferred place of death (POD) among older people and to examine associations between family social support and stability of preferences regarding POD. METHODS: this longitudinal study of 1,200 noninstitutionalized independent Japanese older people aged over 65 years used panel data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Preference stability was defined as the congruence of preferred POD based on questionnaires between baseline and follow-up. We performed multiple logistic regression analysis and gender-stratified analysis to examine associations between social support (spouse, children living together and children living apart) and preference stability. RESULTS: only 40.9% of participants had stable preferences. For a spouse, both receiving and providing social support was associated with less stable preferences (OR: 0.63, 95% CI: 0.43-0.93; OR: 0.55, 95% CI: 0.38-0.80, respectively), and providing social support to children living apart was associated with more stable preferences (OR: 1.35, 95% CI: 1.03-1.76). In gender-stratified analysis, significant associations between preference stability and providing social support to a spouse among women (OR: 0.53, 95% CI: 0.34-0.82) and providing social support to children living apart among men (OR: 1.72, 95% CI: 1.16-2.55) were observed. CONCLUSIONS: family social support was associated with the stability of preferences, and the associations differed by support resources and gender. Incorporating family members in the process of end-of-life care discussion may be necessary for establishing stable preferences.

[Associations between group exercise and exercise adherence among older community-dwelling adults who attend a community sports club: Resol no Mori Wellness Age Club Longitudinal Study].

AIM: This study aimed to examine the relationship between group exercise and exercise adherence among older community-dwelling individuals who attended a community sports club and to discuss the exercise programs that promoted exercise habits. METHODS: A total of 227 participants (117 women and 110 men), aged ≥ 65 years, who participated in the exercise programs (Wellness Age Club), provided by Resol no Mori, for at least 6 months from June 2017 to March 2019, were included in the analysis. Results obtained from the semi-annual questionnaire surveys, physical fitness tests, and annual medical check-ups were used, along with data on individual participation in programs and dates of participation. "Exercise adherence" was defined as participation in exercise programs for an average of ≥ 2 days per week for at least 24 weeks. "Group program participation" was defined as participation in group programs for an average of one or more times per week. The relationship between group program participation and exercise program adherence was analyzed using Poisson regression analysis. RESULTS: Group program participants were more likely to continue attending exercise programs in comparison to non-participants (Prevalence ratio=3.63 [95% CI: 1.98-6.65], p< 0.01). There was also a significant positive association between group program participation and exercise adherence among women (8.08 [1.94-33.56], p< 0.01) and men (2.84 [1.39-5.78], p< 0.01). CONCLUSIONS: Our results suggest that group exercise programs increased social interaction among participants and promoted exercise adherence. Encouraging older people to attend group exercise may increase the number of older people who regularly exercise.

Streptococcal toxic shock syndrome following group A streptococcal vulvovaginitis in a breastfeeding woman.

Streptococcal toxic shock syndrome (STSS) is a systemic, life-threatening illness usually caused by invasive respiratory tract or skin and soft tissue infections of Streptococcus pyogenes (group A streptococcus, GAS). We report the case of an adult woman with lactational amenorrhea and GAS vulvovaginitis progressing to STSS. She was admitted to our hospital because of fever, lethargy, and a 2-week history of vaginal discharge; she also had hypotension and multiple organ failure. Blood and urine cultures yielded gram-positive cocci and GAS. After 14 days of antimicrobial therapy, she fully recovered without any complications. The vulvovaginitis was most likely the portal of entry for GAS, which is rarely recognized as a causative pathogen of vulvovaginitis. Lactational amenorrhea is thought to be a risk factor for GAS vulvovaginitis. It is important for clinicians to recognize the possibility of GAS vulvovaginitis in breastfeeding women with vaginal symptoms and consider the necessity of prompt antibiotic treatment.