Social functions and adverse outcome onset in older adults with mild long-term care needs: A two-year longitudinal study.

OBJECTIVE: For older adults receiving long-term care (LTC) at home, little is known about the role of social function in the onset of adverse outcomes, such as death, institutionalization, and functional decline. We examined the association between social function and adverse outcome onset among community-dwelling older adults with mild care needs. METHODS: This two-year longitudinal study recruited non-institutionalized older adults, with mild care need levels, in 2003. Participants were followed regarding the onset of death, institutionalization, and functional decline, after two years. Social function was assessed using four items (friendships, emotional support, instrumental support, and intergenerational interactions) and scored from zero (low) to four (high). Multivariable logistic regression analysis estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the onset of adverse outcomes, composite of death, institutionalization, and functional decline. RESULTS: Ultimately, 281 older adults were analyzed. During the observation period, the onset of adverse outcomes was observed in 41.4% of the participants (death, 13.9%; institutionalization, 7.9%; functional decline, 19.5%). Higher social function was inversely associated with adverse outcome onset, even after adjusting for covariates including cognitive function (compared to zero point, ORs [95% CIs] were 0.85 [0.42-1.70] for one, 0.42 [0.19-0.94] for two, and 0.44 [0.20-0.99] for three or more; p = 0.018). Among the sub-items, friendships were associated with lower adverse outcome onset. CONCLUSIONS: Higher social functioning was associated with the low onset of adverse outcomes among older adults under LTC. Enhancing social functions, including friendships, may be crucial for prognosis in LTC.

Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings.

BACKGROUND: There are no studies on how the same psychosocial dementia care program is adapted to both in-home and residential care settings. OBJECTIVE: To evaluate the time investment required by professionals to implement a psychosocial dementia care program to manage neuropsychiatric symptoms. METHODS: A prospective observational study design was used. The program consisted of 1) a one-day training course, 2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment of neuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care management agencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes) in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluated using the Neuropsychiatric Inventory (NPI: 0-144). The time investment was reported by participating professionals. A total of 125 persons with dementia were included at baseline. RESULTS: Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen's drm = 0.44-0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There was a mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower in follow-ups than at baseline assessment. CONCLUSION: The program implementation may incur a substantial time investment regardless of setting. An additional benefit scheme to reward the time investment would be helpful to encourage implementation until the follow-ups.

Care preferences of healthy, middle-aged adults in Japan and the USA if they acquired dementia: A cross-sectional observational study.

AIM: Japan introduced dementia-friendly initiatives into its national policies to help people with dementia remain involved in society for as long as possible. However, some people might choose to live in a nursing home to avoid care burden on family members. Understanding middle-aged adults' preferences for place of care and identifying factors that influence their preferences would help policy decision-makers promote dementia-friendly initiatives. The present study aimed to investigate the care preferences of middle-aged adults if they acquired dementia in Japan and the USA. METHODS: We carried out a cross-sectional observational study using an internet-based questionnaire survey of Japanese residents with Japanese ethnicity, Japanese Americans, and non-Asian Americans aged 40-70 years. A total of 301 participants, including 104 Japanese residents, 93 Japanese Americans and 104 non-Asian Americans, completed the survey. Participants were asked to answer the items based on a hypothetical situation in which they had acquired dementia requiring regular care and supervision. RESULTS: Participants preferred nursing home care (29.9%), followed by professional home care (19.6%), family home care (17.6%) and hospital care (11.3%). Japanese residents had a significantly lower preference for professional home care than did Japanese or non-Asian Americans (adjusted odds ratio 0.28, 95% confidence interval 0.10-0.75). Between-ethnicity difference in care preferences was not observed. CONCLUSIONS: A low preference for professional home care among the middle-aged adults might be influenced by country-specific long-term and dementia care systems. Policy decision-makers should develop professional home care services that are more available for families of people living with dementia. Geriatr Gerontol Int 2019; 19: 829-833.

Dementia Care Competence Among Care Professionals and Reduced Challenging Behavior of Home-Dwelling Persons with Dementia: A Pre- and Post-Intervention Data Analysis.

BACKGROUND: We developed a psychosocial dementia care program to help care managers and professional caregivers manage challenging behavior in home-dwelling persons with dementia in Japan. The program consists of a web-based tool for ongoing monitoring and assessment for challenging behavior, and multi-agency discussion meetings. Results of a cluster-randomized controlled trial indicate a reduction in challenging behavior through this program. OBJECTIVES: The present study aimed to identify a key component of the developed program that is associated with a reduction in challenging behavior. METHODS: We used consecutive data of the intervention and examined the association between challenging behavior in home-dwelling persons with dementia, professionals' competence, and the frequency of revision of action plans. Challenging behavior was assessed using the total score of the Neuropsychiatric Inventory. A baseline and follow-up questionnaire was completed by care professionals using a Japanese version of the Sense of Competence in Dementia Care Staff scale. RESULTS: A total of 86 care professionals completed a 6-month intervention with 219 persons with dementia. The 86 care professionals significantly improved in their dementia care competence. Challenging behavior was significantly reduced among the 219 persons with dementia at follow-up regardless of the level of professionals' competence or the frequency of revision of action plans. Less pain was significantly related to the lower levels of challenging behavior. CONCLUSION: The ongoing multi-agency discussion meetings, with a focus on challenging behavior, may have been the key component in the psychosocial dementia care program. Pain management should be emphasized in action plans for challenging behavior.

Japanese Care Location and Medical Procedures for People with Dementia in the Last Month of Life.

BACKGROUND: Dementia-related societies worldwide have called for palliative end-of-life care for those suffering dementia; meanwhile, the Japanese dementia plan was revised on January 2015 to introduce into its objectives the support for end-of-life care via increased social and health care collaboration. OBJECTIVE: The study focus was the use of medical procedures in the last month of life among dementia patients in different care locations in Japan. METHODS: This study was conducted using a retrospective study design. Data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey of the public long-term care insurance services, were used. The 6,148 patients who received end-of-life care in their own home, nursing homes, or hospitals in September 2007, 2010, and 2013 were included for analysis. The primary disease of each patient was based on the ICD-10 code; a diagnosis of dementia included F00 (Alzheimer's), F01 (vascular), F02 (other), and F03 (unspecified). RESULTS: Of 6,148 patients, 886 (14.4%) had dementia as a primary disease; most received care in the last month of life in nursing homes (48.0%) or hospitals (44.8%) rather than in their own home (7.2%). Patients were less likely to undergo pain management when their primary disease was dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.21-0.91). CONCLUSION: Education and policy efforts are required to provide palliative end-of-life care to people with dementia at home. The national dementia plan should also explore possible approaches regarding pain management for dying people who have dementia.

Discharge Destination of Dementia Patients Who Undergo Intermediate Care at a Facility.

OBJECTIVES: Intermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan. DESIGN: This study was conducted using a retrospective study design for data from 2007, 2010, and 2013. SETTING: We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September. PARTICIPANTS: There were 9992 discharged patients included in the analysis. MEASUREMENTS: Discharge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group. RESULTS: Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25-1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64-2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13-1.89; P = .004) than discharged to home. CONCLUSION: Intermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.

An evaluation of palliative care contents in national dementia strategies in reference to the European Association for Palliative Care white paper.

BACKGROUND: Dementia involves a progressive decline in many functional areas. Policy and practice guidelines should cover the entire course of the disease from early detection to the end-of-life. The present study aimed to evaluate the contents of national dementia strategies with a focus on palliative care content. METHODS: We employed qualitative content analyses. Sixteen national dementia strategies from 14 countries were reviewed. Using open coding, the contents were compared to the domains and recommendations of the palliative care in dementia white paper of the European Association for Palliative Care (EAPC). RESULTS: Although palliative care was not explicitly referred to in eight of the 14 countries and only to a limited extent in three countries, a number of domains from the EAPC white paper were well represented, including "person-centered care, communication, and shared decision making"; "continuity of care"; and "family care and involvement." Three countries that referred to palliative care did so explicitly, with two domains being well represented: "education of the health care team"; and "societal and ethical issues." The strategies all lacked reference to the domain of "prognostication and timely recognition of dying" and to spiritual caregiving. CONCLUSIONS: National dementia strategies cover part of the recent definition of palliative care in dementia, although they do not frequently label these references as "palliative care." In view of the growing numbers of people dying with dementia, preparation for the last phase of life should be added to national strategies.

Phage-display selection of antibodies to the left end of CTX3C using synthetic fragments.

Ciguatoxins (CTXs) are a family of toxins that contaminate a variety of fish and cause ciguatera seafood poisoning. The limited availability of CTXs from natural sources has hampered preparation of antibodies and, thus, the development of immunoassays for these toxins. In the current studies, we utilized synthetic fragments as haptens to prepare antibodies against CTX3C, a congener of CTXs, thereby avoiding the problem of its scarcity. Synthetic ABC-ring fragment (ABC) of CTX3C was conjugated with keyhole limpet hemocyanin (KLH) and immunized on mice. Phage-displayed antibodies were first screened based on affinity to a soluble biotin-linked ABC-ring fragment that was captured on streptavidin-linked magnetic beads. The beads were then eluted with the ABCD-ring fragment (ABCD), and recovered phages were amplified. This elution with a synthetic fragment allowed the preparation of antibodies to ABCD as well as to ABC. Three antibodies with affinities of K(d) approximately 10(-5) M for ABCD were selected and prepared as soluble recombinant Fabs (rFabs). One rFab, 1C49, bound to CTX3C itself, although the binding affinity for CTX3C was weaker than for ABCD.