Factors associated with decreased physical activity levels among community-dwelling residents during the coronavirus disease 2019 pandemic: a long-term observational study.

[Purpose] The purpose of this study was to determine the factors associated with decreased physical activity levels among community residents over a long-term observation period during the coronavirus disease 2019 (COVID-19) pandemic. [Participants and Methods] We conducted a cross-sectional study using a self-administered questionnaire and daily steps as an indicator of physical activity levels. The study population consisted of 704 community-dwelling residents aged 40 years and older who participated in the health program from 2019 to 2020. We compared the daily steps from March-December 2019 to March-December 2020 and performed multivariate analysis to identify the factors associated with decreased daily steps. [Results] Of all participants, 447 (63.5%) returned the questionnaire and 309 (43.9%) were included in the analysis. During the COVID-19 pandemic, 133 (43.0%) respondents had decreased physical activity levels. The multivariate analysis showed that working (odds ratio, 2.08; 95% confidence interval, 1.10-3.94) was significantly associated with decreased daily steps during the COVID-19 pandemic. [Conclusion] There was a significant association between decreased physical activity levels and working during the COVID-19 pandemic. When restrictive measures such as teleworking are implemented, it may be necessary to take measures to prevent a decline in physical activity levels.

Descriptive Study of Patients Treated in a Psychosomatic Internal Medicine Declared by Japanese Family Medicine Clinic.

Background: Psychosomatic internal medicine (PSIM) assesses psychosocial factors and provides holistic consideration. In Japan, PSIM physicians seem to be recognized as providers of mental health services, but family medicine did not so. When family physicians confront with psychological problems, high dropout rate is reported so it is needed to reveal factors related to dropouts, The purpose of this study is to describe characteristics of patients, treatment dropouts and its related factors in PSIM practice by family physician. Methods: This cross-sectional study used data from the medical records of the Kitaibaraki Center of Family Medicine located in Kitaibaraki City, Ibaraki, Japan. The study included all new patients who made an appointment and visited the PSIM in this clinic from January 2020 to December 2022.Chief complaints and diagnoses were coded based on the International Classification of Primary Care, version 2 (ICPC-2). Results: In total, 377 new patients were included in this study. The mean age was 39.9 ± 20.2 years. We found that 69.2% of patients who visited the clinic had a psychological chief complaint and 84.1% of primary diagnoses consisted of a psychological problem. One hundred sixty-five patients (43.8%) were still receiving treatment 6 months after the initial visit. Of the patients who ended treatment within 6 months after the initial visit, 84 patients (39.2%) dropped out. In multivariate analysis, the dropouts were less likely to occur patients with primary diagnosis of psychological problem (odds ratio (OR): 0.35, 95% confidence interval (CI): 0.19 - 0.67). Conclusions: Patients who visited a PSIM wanted consultation about psychological problems. Patients with a diagnosis of a psychological problem at the initial visit were less likely to drop out.

Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study.

INTRODUCTION/OBJECTIVES: There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. METHODS: We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate). RESULTS: In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009). CONCLUSIONS: The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.

Frailty and social participation in older citizens in Japan during the COVID-19 pandemic.

Background: This study examined the frailty status of older individuals in Japan at 1 year after the onset of the coronavirus disease 2019 (COVID-19) pandemic based on involvement in social activities before and during the pandemic. Methods: This cross-sectional study analyzed citizens aged 65 and 84 who did not require long-term care in January 2021. A self-administered questionnaire was mailed to 3000 citizens in Kitaibaraki City, Japan. The questionnaire included social participation status in January 2020 and January 2021, the Kihon Checklist, working status, and economic status. We classified the respondents into the following groups: Nonparticipating, no participation at either time point; Discontinued, participation only in 2020; and Continued, participation at both time points. We compared the Discontinued and Continued groups in terms of Kihon Checklist items using the t-test. Results: Of 2963 individuals who received the questionnaire, 1307 (44.1%) returned it, and 1047 were analyzed. Of the respondents analyzed, 586 (56.0%) were in the Nonparticipating group, 254 (24.3%) were in the Discontinued group, and 207 (19.8%) were in the Continued group. On the Kihon Checklist, oral function and mood differed significantly between the Discontinued and Continued groups. The proportion of those with impairment in multiple categories of the Kihon Checklist was 12.3% in the Nonparticipating group, 5.5% in the Discontinued group, and 3.4% in the Continued group. Conclusions: Older individuals who continued participating in social activities at 1 year into the COVID-19 pandemic might have a lower risk of frailty in terms of oral function and depressed mood.

COVID-19 Vaccination Willingness and Associated Factors in Japanese Primary Care Patients: A Cross-Sectional Study.

INTRODUCTION/OBJECTIVES: COVID-19 vaccination is important to stop the pandemic. It has been reported that willingness to be vaccinated is associated with system factors as well as individual attitudes and beliefs. Primary care patients include individuals at increased risk of poor outcomes after COVID-19 infection, such as elderly people and those with comorbidities. This study investigated attitudes in this population toward COVID-19 and COVID-19 vaccination, including willingness to be vaccinated and associated factors. This study was conducted in Japan, where the population has low vaccine confidence, during the initial phase of COVID-19 vaccination. METHODS: Patients from 1 primary care clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study from March to April 2021. They were administered a self-reported questionnaire exploring factors such as willingness to undergo COVID-19 vaccination, perceived susceptibility, and perceived vaccine efficacy. Multivariable logistic regression analysis was conducted to identify factors associated with vaccination. RESULTS: Of the 717 patients (response rate, 88.3%), 512 (70.0%) reported they were willing to be vaccinated for COVID-19. Multivariate analysis revealed that vaccination willingness was associated with older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), male gender (OR 1.95, 95% CI 1.15-3.30), influenza vaccination in in the 2020/2021 season (OR 2.54, 95% CI 1.49-4.32), recommendation from others (OR 3.11, 95% CI 1.58-6.18), high perceived susceptibility (OR 2.51, 95% CI 1.45-4.33), belief in vaccine efficacy (OR 3.83, 95% CI 1.54-9.56), high perceived susceptibility to vaccine-related adverse events (OR 0.37, 95% CI 0.22-0.64), and high espousal of social norms (OR 8.00, 95% CI 2.78-23.0). CONCLUSIONS: COVID-19 vaccination was widely acceptable to Japanese primary care patients. In addition to factors such as vaccine efficacy, and past influenza vaccination, social norms may be important in determining COVID-19 vaccination willingness.

Gender-Related Differences in Social Participation Among Japanese Elderly Individuals During the COVID-19 Pandemic: A Cross-Sectional Survey.

INTRODUCTION/OBJECTIVES: The health of elderly individuals is known to benefit from maintaining societal involvement and relationships with other people, such as through social participation. We aimed to determine trends in the percentage of Japanese elderly people who engaged in social participation before and during the coronavirus disease 2019 (COVID-19) pandemic in one municipality in Japan, and compared differences in this status by gender. METHODS: We conducted a cross-sectional questionnaire survey. Questionnaires were sent by mail to 3000 people aged 65 to 85 years who were randomly selected by the administrative staff of the city. Participant characteristics (age, gender, working status, residential status) and their economic status, daily physical activity, and social participation status were obtained at 3 time points: (1) before the COVID-19 pandemic in January 2020; (2) immediately prior to the declaration of a state of emergency in April 2020; and (3) in January 2021, 1 year after (1). RESULTS: A total of 1301 people responded to the survey. The mean age was 73.3 (SD 5.5) years, and 690 (53.0%) were women. There were significant gender differences in terms of living alone, employment status, and amount of physical activity. The number of people reporting social participation gradually decreased from 543 respondents (41.7%) at (1) to 319 (24.5%) at (2) and 251 (19.3%) at (3). Women were more likely to demonstrate reduced social participation. CONCLUSIONS: Elderly individuals, particularly women, reported decreased social participation during the pandemic.

What Affected Primary Care Patients' Decisions to Receive the Seasonal Influenza Vaccine in the 2020 to 2021 Season?

INTRODUCTION/OBJECTIVES: A primary care patient's decision to undergo seasonal influenza vaccination may have been different during the global COVID-19 pandemic in the 2020 to 2021 season. The purpose of this study is to investigate what affected primary care patients' decisions to undergo seasonal influenza vaccination in the 2020 to 2021 season. METHODS: Semi-structured interviews were conducted in a primary care clinic in Ibaraki, Japan. We used a purposive sampling strategy to reach individuals aged 20 years or older who underwent influenza vaccination. The transcripts were analyzed using thematic analysis. RESULTS: Twenty-one patients completed the interview. Two main themes emerged: the desire to avoid risks to one's health and being a part a community in coexistence with others. The first theme included desire to avoid influenza and expectations that vaccination will prevent severe disease. The second theme included concerns about the consequences of one's own influenza infection on others in the community and necessity of vaccination based on the surroundings and others. CONCLUSIONS: Raising awareness of risk factors such as older age and comorbidities, and the expectations of community members might be effective in promoting influenza vaccination.

Evaluation of changes in prescription among Japanese elderly patients before and after transition to home care.

Background: Most patients receiving home care have multimorbidity and tend to be prescribed multiple drugs with the complicated regimen. Family physicians (FPs) are responsible for patients' prescriptions after transition to home care. This study aimed to assess changes in medication regimen complexity and potentially inappropriate medications (PIMs) made by FPs before and after transition to home care. Methods: A retrospective cohort study was conducted in six home care clinics in Ibaraki Prefecture, Japan. Data from patients aged 65 years and older taking any medication who initiated home care between April 2018 and March 2019 were collected using medical records. The medication regimen complexity index-Japanese version (MRCI-J) score and the presence of PIMs were assessed before and 3 months after transition to home care. Results: The mean age of 169 patients was 84.0 years. MRCI-J score and percentage of PIMs remained unchanged between before and 3 months after home care initiation. However, MRCI-J score significantly decreased among patients with polypharmacy, but significantly increased among patients with nonpolypharmacy. In multiple regression analysis, a greater number of medications before home care initiation was associated with a decreasing MRCI-J score, but pharmacist home visit services were not associated with changes in MRCI-J score. Conclusions: Our results suggest that FPs involved in home care are trying to adjust prescriptions by simplifying the medication regimen of patients with polypharmacy, and adding symptomatic drugs to those with nonpolypharmacy.

Challenges in the Management of Home-Based Care Experienced by a Caregiver with Autism Spectrum Disorder.

We describe the case of a 37-year-old woman with autism spectrum disorder (ASD) who lived with a mother with end-stage breast cancer and a visually impaired father. She was the main caregiver for her mother, who was receiving home-based palliative care. The caregiver needed training on communication and task management so that she could manage the communication with home care staff and perform more house chores. It was also necessary to share information with home care staff about ASD and how to treat her with understanding and respect. Although most support for people with ASD focuses on schools and workplaces, to offer successful end-of-life care at home, medical and home staff need to understand and communicate well with people with ASD and provide multiple types of support. Research, guidebooks, and visuals about main caregivers who have ASD and improving the inclusivity among staff members are necessary for providing successful home care and meeting caregivers' and patients' needs and expectations.

Factors associated with influenza vaccination in Japanese elderly outpatients.

BACKGROUND: Elderly patients benefit from influenza vaccination, but the number of Japanese elderly patients who are vaccinated is insufficient. Several factors are associated with influenza vaccination acceptance, but little is known about Japanese elderly outpatients. The purpose of this study was to examine factors associated with influenza vaccination in elderly outpatients in Japan. METHODS: During the 2017-2018 influenza season, outpatients from one hospital and one clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study. Patients answered a self-report questionnaire exploring factors such as their vaccination status during the 2017-2018 season, past influenza vaccination, perceived susceptibility to influenza and adverse events of the vaccine, perceived vaccine efficacy, physician recommendations. Multivariable logistic regression analyses were conducted to identify factors associated with vaccination. RESULTS: Of 377 patients, 316 (83.8%) responded, and the vaccination rate was 57%. Eighty-three patients (27.0%) reported that their physician recommended the influenza vaccine. In multivariate analysis, influenza vaccination was associated with higher age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), physician recommendations (OR 2.49, 95% CI 1.18-5.25), low perceived susceptibility to vaccine-related adverse events (OR 0.33, 95% CI 0.15-0.74), and belief in vaccine efficacy (OR 4.73, 95% CI 2.08-10.8). CONCLUSIONS: Influenza vaccination was associated with belief in vaccine efficacy, perceived susceptibility to vaccine-related adverse events, physician recommendations, and older age. Increasing the frequency of physician recommendations may lead to increased vaccination coverage.

Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

BACKGROUND: The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. METHODS: A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. RESULTS: Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. CONCLUSION: A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

BACKGROUND: Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. AIM: This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. METHODS: We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. RESULTS: The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. CONCLUSION: Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

A Brief Survey of Public Knowledge and Stigma Towards Depression.

BACKGROUND: The burden from depression is affected by the public's beliefs, stigma, and resulting behavior. Lack of knowledge, misunderstanding, and stigma about depressed people and their surroundings are barriers to improving their mental health. This study aimed to examine public beliefs regarding depression, especially how to recognize depression, treatment, and stigma. METHODS: A self-administered questionnaire was distributed to participants receiving an annual health checkup. We asked whether they agreed with four short sentences: "it is not necessary to worry about depression in a person behaving brightly" (misunderstanding about the behavior of depressed people), "rest is important for treating depression" (belief about the necessity of rest), "medicine is effective for treating depression" (belief about the effectiveness of pharmacotherapy) and "a weak personality causes depression" (stigma about the cause of depression). We also analyzed the association between these beliefs and factors such as health literacy, regularly visiting an outpatient clinic, history of depression, and demographic variables. RESULTS: Among 1,085 respondents (75.0% response rate), 54.5%, 75.6%, 58.9%, and 70.8% responded appropriately to the "misunderstanding about the behavior of depressed people", "necessity of rest", "effectiveness of pharmacotherapy", and "stigma about the cause of depression" items, respectively. Regarding stigma about the cause of depression, 30.7% of respondents agreed that a weak personality caused depression. Female sex and younger age group were associated with appropriate answers. Health literacy was only associated with appropriate beliefs about the effectiveness of pharmacotherapy. CONCLUSIONS: Thirty percent of participants had the stigmatizing belief that a weak personality causes depression and only 58.9% believed in the effectiveness of pharmacotherapy for depression. Over 70% understood the necessity of rest and knew that depression is possible in those who act brighter. General health literacy alone might not improve knowledge and beliefs about depression. An educational intervention or campaign to reduce stigma toward depression and improve knowledge about the treatment of depression is needed.

Identification of prognostic factors for activities of daily living in elderly patients after hospitalization for acute infectious disease in Japan: A 6-month follow-up study.

AIM: We investigated factors that predict the prognosis of activities of daily living (ADL) in elderly patients who had undergone rehabilitation during hospitalization for acute infectious disease. METHODS: The present prospective cohort study included 131 patients who were hospitalized due to acute infectious disease and who had undergone rehabilitation during hospitalization. Patient characteristics collected from medical records included age, sex and comorbidity score. The level of ADL 2 weeks before admission was assessed by interview at the start of rehabilitation. Grip strength testing, Short Physical Performance Battery as an assessment of lower limb function and the Mini-Mental State Examination as an assessment of cognitive status were carried out at the time of hospital discharge. The level of ADL at 6 months after discharge was assessed by telephone interview. Multivariate logistic regression analysis was used to identify factors that independently predict ADL dependence (defined as being dependent in one or more ADL items at 6 months after discharge). RESULTS: The average age of participants was 81.5 years, and 52.7% were women. A total of 22.1% of patients showed dependence in an ADL at 6-month follow-up. Factors that predicted an ADL dependence were comorbidity score (OR 4.19, 95% CI 1.19-14.69) and lower limb function (OR 0.51, 95% CI 0.36-0.72) at discharge. CONCLUSIONS: The present findings have implications for the healthcare planning and well-being of elderly patients during hospitalization and after discharge. Geriatr Gerontol Int 2018; 18: 615-622.

Describing the factors that influence the process of making a shared-agenda in Japanese family physician consultations: a qualitative study.

BACKGROUND: Patients cannot always share all necessary relevant information with doctors during medical consultations. Regardless, in order to ensure the best quality consultation and care, it is imperative that a doctor clearly understands each patient's agenda. The purpose of this study was to analyze the process of developing a shared-agenda during family physician consultations in Japan. METHODS: We interviewed 15 first time patients visiting the outpatient clinic of the Department of Family Medicine in the hospital chosen for the investigation, and the 8 family physicians who examined them. In total we observed 16 consultations. We analyzed both patients' and doctors' narratives using a modified grounded theory approach. RESULTS: For patients, we found four main factors that influenced the process of making a shared-agenda: past medical experiences, undisclosed but relevant information, relationship with the family physician, and the patient's own explanatory model. In addition, we found five factors that influenced the shared agenda making process for family physicians: understanding the patient's explanatory model, constructing the patient-doctor relationship, physical examination centered around the patient's explanatory model, discussion-styled explanation, and self-reflection on action. CONCLUSIONS: The findings suggest that patient satisfaction would be increased if family physicians are proactive in considering these factors with respect to both the patient's agenda, and their own.

Open-ended questions: are they really beneficial for gathering medical information from patients?

Open-ended questions, which allow patients to discuss their concerns freely, are widely considered an efficient method gathering medical information from patients during a medical interview. However, few studies have examined the relationship between the use of open-ended questions and the amount of information obtained from patients during the medical interview. This study examines this relationship using a relatively large sample size under more standardized conditions than in previous studies. The Japanese Group for Research on the Medical Interview undertook this research in 2002-2003. A total of 1,527 medical students conducted medical interviews with standardized patients, and 1,220 met the inclusion criteria for this study. The interview was limited to five minutes. Evaluators (medical school faculty physicians) evaluated the use of open-ended questions during the medical interview. The reliability of the evaluation sheet was also examined. The amount of information obtained was measured through the medical interview evaluation sheet. The use of open-ended questions was positively related to the amount of information elicited from the patients (F = 41.0, p < 0.0001). This study provides data to support the hypothesis regarding the favorable relationship between the use of the open-ended questions and the amount of information from the patients.