Factors associated with caregiver burden of toileting assistance at home versus in a nursing home: A cross-sectional study.

This study aimed to identify differences in caregiver burden related to toileting assistance, and examine the factors associated with the most burdensome aspects of providing toileting assistance. In 2019, a self-administered postal survey was conducted with 743 caregivers of older adults who received subsidies for continence products in Komatsu City, Japan. Both family caregivers and nursing home staff answered questions regarding older adults' urinary/fecal symptoms, toileting assistance, and perceived caregiver burden. Older adults living at home had less need for toileting assistance than those in nursing homes. However, family caregivers experienced more burden than nursing home staff. The most frequent physical burden associated with toileting assistance for family caregivers was urinary/fecal leakage from absorbent incontinence products. This burden was linked to family caregivers providing care at home, using a combination of urinary pads and diapers, and symptoms that caused burdens on caregivers including urinary/fecal incontinence, nocturia, and no desire to urinate. These results suggest that leakage caused by the inappropriate use of urinary pads combined with diapers is a source of caregiver burden. Continence care experts should provide guidance to family caregivers of older adults, particularly those who are underweight and frail, regarding the selection and fitting of absorbent incontinence products.

Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study.

OBJECTIVES: Stroke patients frequently exhibit loss of independence of urination, and their lower urinary tract symptoms change with the phase of stroke. However, it is unclear whether switching prescribed drugs for lower urinary tract symptoms during hospitalization from acute care wards to convalescence rehabilitation wards affects patients' independence of urination at discharge. It is also unclear whether the impact of switching varies by stroke type. This retrospective cohort study aimed to examine these issues. MATERIALS AND METHODS: We analyzed 990 patients registered in the Kaga Regional Cooperation Clinical Pathway for Stroke database during 2015-2019. Prescriptions for lower urinary tract symptoms from pre-onset to convalescence rehabilitation were surveyed. Logistic regression analysis was performed to examine the association between switching drugs and independence of urination based on bladder management and voiding location at discharge. Stroke types were also examined in subgroup analyses. RESULTS: About 21 % of patients had their lower urinary tract symptoms prescriptions switched during hospitalization. Switching was positively associated with independence of bladder management (odds ratio 1.65, 95 % confidence interval 1.07 to 2.49) and voiding location (odds ratio 2.72, 95 % confidence interval 1.72 to 4.37). Similar associations were observed in different stroke types. CONCLUSIONS: Approximately 20 % of patients had their lower urinary tract symptoms medications switched upon transfer from acute to convalescence rehabilitation wards. Switching was significantly associated with improved urinary independence at discharge. Consistent results were observed across different stroke types, suggesting that switching medications contributes to urinary independence after stroke, regardless of the etiology or severity of stroke.

Relationship between Bowel/Bladder Function and Discharge in Older Stroke Patients in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.

Objectives: : Many stroke patients experience motor and cognitive dysfunctions that make living at home challenging. We aimed to identify the factors associated with hospital discharge to home in older stroke patients in convalescent rehabilitation wards where intensive and comprehensive inpatient rehabilitation are performed following acute-phase treatment. Methods: : A retrospective cohort study was conducted among 1227 older stroke patients registered in the database of the Council of Kaga Local Stroke Network, Japan, between 2015 and 2019. Patients' basic characteristics, discharge destination, type and severity of stroke, cognitive status, and activities of daily living (ADL) including continence were evaluated. Results: : The proportion of subjects discharged to home was 62.3%. The mean hospital stay in the home discharge group was shorter than that in the non-home discharge group (111 days vs. 144.6 days, P <0.001). The following factors were associated with discharge to home: age (adjusted odds ratio [AOR]: 2.801, 95% confidence interval [CI] [1.473, 2.940]; P <0.001), sex (AOR: 1.513, 95% CI [1.112, 2.059]), stroke type (AOR: 1.426, 95% CI [1.013, 2.007]), low cognitive status (AOR: 3.750, 95% CI [2.615, 5.379]), low level of bladder control (AOR: 2.056, 95% CI [1.223, 3.454]), and low level of bowel control (AOR: 2.823, 95% CI [1.688, 4.722]). Conclusions: : Age, sex, stroke type, cognitive function, and ADL scores for bladder and bowel control were associated with discharge to home. Improving continence management regarding both voiding and defecation may be a promising care strategy to promote hospital discharge to home in older stroke patients.

Association of a continuous continence self-management program with independence in voiding behavior among stroke patients: A retrospective cohort study.

AIMS: Many stroke patients cannot urinate independently due to motor and cognitive dysfunctions. This study examined whether a continuous continence self-management program during acute and convalescent phases is associated with independence in voiding behavior. METHODS: A retrospective cohort study was conducted among stroke patients registered in the Council of Kaga Local Stroke Network, Japan, from 2015 to 2019. In the intervention group (n = 941), a multidisciplinary continence care team and ward nurses provided continence care in the acute phase and shared the information with the staff in the convalescent ward. The control group (n = 579) received traditional voiding care from ward nurses. The primary and secondary outcomes were independence in voiding behavior at discharge from the convalescent ward and length of hospital stay, respectively. RESULTS: At discharge from the convalescent wards, the proportion of patients who voided at the toilet or bedside commode was higher in the intervention group than in the control group (76.3% vs. 62.4%, p < 0.001). The continuous continence self-management program was associated with independence in voiding behavior (adjusted odds ratio: 1.801, 95% confidence interval [CI]: [1.102, 2.942]; p = 0.019) and length of hospital stay (ß: -0.178, 95% CI: [-14.320, -7.607]; p < 0.001) after adjusting for other variables. CONCLUSIONS: The program was associated with increasing independent voiding behavior and shortened the length of hospital stay, suggesting the importance of promoting treatments for lower urinary tract symptoms and rehabilitation by a multidisciplinary continence care team for stroke patients.

Residents living in communities with higher civic participation report higher self-rated health.

It has been shown that community-level social capital may affect residents' health. The present mixed ecological study assesses the evidence for an association between the community-level social capital and the individual level of self-rated health. The Hakui City Health Interview Survey targeted 15,242 people aged 40 years and older from 11 communities. Among them, 6578 residents responded to the questionnaire (response rate, 43.2%). We examined whether the community-level social capital (general trust, norm, and civic participation) was associated with the individual level of self-rated health. Overall, 1919 (29.1%) answers of self-rated poor health were identified. Community-level civic participation was negatively associated with poor self-rated health after adjusting for individual demographic factors, individual social capitals, and community-level economic status, whereas community-level general trust, and norm were not significant. The findings suggest the importance of fostering communities with high civic participation to reduce the poor health status of residents.

Presence of a Synergistic Interaction Between Current Cigarette Smoking and Diabetes Mellitus on Development of Dementia in Older Adults.

BACKGROUND: Both cigarette smoking and diabetes mellitus are well-established risk factors for development of dementia. However, the interaction between smoking and diabetes is yet unknown. OBJECTIVE: In this study, we clarify association between smoking, diabetes, and dementia risk in older adults. METHODS: Participants in this study included community residents aged 65 years and older who had participated in a health checkup in 2006, followed for 10 years (n = 9,403) and had long-term care insurance information data. Furthermore, the risk estimates of smoking status and diabetes diagnosis on dementia adjusted for the competing risk of death prior to dementia were analyzed. RESULTS: During follow-up, 2,647 participants developed dementia. The smoking status-diabetes interaction on development of dementia was statistically significant (p≤0.001). Among those patients exposed to both factors, 17% of risk of development of dementia was attributable to the interaction of these factors. Current smokers with diabetes had significantly greater risks of development of dementia than never smokers without diabetes (reference): multivariable-adjusted risk of dementia in current smokers without diabetes (subdistribution hazard ratio [sHR], 1.25; 95% confidence interval [CI], 1.05-1.48); never smokers with diabetes (1.31, 1.16-1.47); and current smokers with diabetes (1.86, 1.39-2.48). However, no such association was noted for former smokers with and without diabetes. CONCLUSIONS: Current smoking, but not former smoking, was associated with increased risk of development of dementia in older adults with and without diabetes. Moreover, the synergistic effect of current smoking and diabetes on dementia was noted.

Evaluation of Regional Vulnerability to Disasters by People of Ishikawa, Japan: A Cross Sectional Study Using National Health Insurance Data.

The 2013 Partial Amendment of the Disaster Countermeasures Basic Law mandated that a roster of vulnerable persons during disasters be created, and further development of evacuation support is expected. In this study, the number of vulnerable people living in target analytical areas are identified in terms of neighborhood units by using the National Health Insurance Database to create a realistic and efficient evacuation support plan. Later, after considering the "vulnerability" of an area to earthquake disaster damage, a quantitative evaluation of the state of the disaster is performed using a principle component analysis that further divided the analytical target areas into neighborhood units to make a detailed determination of the number of disaster-vulnerable persons, the severity of the disaster, etc. The results of the disaster evaluation performed after considering the vulnerability of an area are that 628 disaster-vulnerable persons live in areas with a relatively higher disaster evaluation value.