Changing trends in health orientation among older adults: A scoping review.

Older people's health condition is not uniform, and the components of their health are interrelated. Concepts regarding the health of older people have emerged and changed over time. However, the transition of concepts and influencing factors are not well examined through research. We have conducted a scoping review of the changes over time in the concept of health for older people and the factors influencing these changes. The public websites of international organizations and academic societies related to older people's health and research paper database were searched, and the extracted data were summarized in a chronological table. Consequently, this study revealed changing trends in health orientation after health had been defined by WHO, namely, successful aging, productive aging, active aging, and healthy aging, and their components, not the concept of health. The emergence and changes of health orientation among older people may have accompanied proposals and measures of international organizations and academic societies developed in response to changes in the demographic structure, and changes in how society perceives and supports older people. With the changing eras that bring about advances in health technology, prolongation of life expectancy, and changes in lifestyles, the needs of older people, society's perceptions of aging and older people, and how to support them will also change. Our findings may provide a valuable basis for understanding aging and older people, reconsidering their health orientation based on the health issues of older people and their significance, and formulating policies for older people in the future. Geriatr Gerontol Int 2024; 24: 5-17.

Development, reliability, and validity of a self-assessment scale for dementia care management.

BACKGROUND: This study aimed to develop a self-assessment scale for care management of people with dementia and examine its reliability and validity. METHODS: Based on Bloom's Taxonomy, previous research, and experts' opinions on dementia and care management, a scale consisting of 18 items was developed to assess care managers' attitudes, knowledge, and skills in their management of people with dementia. To examine the scale's reliability and validity, data were collected from 638 care managers. Construct validity using exploratory factor analysis, known-group validity, and internal consistency reliability of the scale were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a four-factor model and explained 59.1% of the total variance. Following were the four factors: Factor I 'Person centred care'; Factor II 'Understanding of disease characteristics, treatment and care'; Factor III 'Understanding of people with dementia and care management according to their characteristics'; and Factor IV 'Utilization of local resources surrounding people with dementia'. Regarding the known-group validity, results showed that the group with a qualified chief care manager scored significantly higher than the group without one on Factors I (P = 0.013) and III (P = 0.026). Cronbach's alpha coefficient for the 18 items was 0.928. CONCLUSIONS: The findings prove that the scale has acceptable reliability and validity, and can help care managers reflect on their practice. Future research is desirable to measure the validation of change in the scale.

Spatially heterogeneous associations between the built environment and objective health outcomes in Japanese cities.

The built environment is a structural determinant of health. Here we reveal spatially heterogeneous associations of built environment indicators with objective health outcomes (morbidity) by combining a random forest (RF) approach and a multiscale geographically weighted (MGWR) regression method. Using data from six Japanese cities, we found that the ratio of morbidity has obvious spatial agglomerations. The mixed land-use diversity with 1000 m buffer, distance to hospital, proportion of park area with 300 m buffer, and house price with 2000 m buffer, negatively affect health outcomes at all locations. For most locations, high PM2.5 or high floor area ratio with 2000 m buffer are linked to a high ratio of morbidity. Our findings support the use of such data for long-term urban and health planning. We expect our study to be a starting point for further research on spatially heterogeneous associations of the built environment with comprehensive health outcomes.

Development of a predictive model using the Kihon Checklist for older adults at risk of needing long-term care based on cohort data of 19 months.

AIM: This study developed a risk scoring tool and examined its applicability using data from the Kihon Checklist cohort dataset for 19 months to predict the transition from no certification for long-term care to long-term care level 3 or above. METHODS: Data were collected from 26 357 functionally independent, community-dwelling older adults in a Japanese city who answered the Checklist in 2014 and were followed for 19 months. Individuals certified for long-term care during the follow-up period were classified into three levels depending on their certification status: low, moderate, and high long-term care levels. Relationships between the Kihon Checklist domains and high long-term care levels were examined using the logistic regression model. A score chart predicting incidents of high long-term care levels was created to facilitate its applicability. RESULTS: As of 2016, 971 participants were certified for long-term care (3.7%), of which 168 (0.6%), 357 (1.4%), and 446 (1.7%) were certified as high, moderate, and low long-term care levels, respectively. Variables associated with the certification of high long-term care level included difficulties in activities of daily living, a decline in locomotor and cognitive function in the Kihon Checklist domains, and age. The score chart was created based on these variables and demonstrated excellent discriminatory ability, with an area under curve of 0.817 (95% confidence interval: 0.785-0.849). CONCLUSIONS: The Kihon Checklist can predict the future development of a high degree of dependency. The score chart we developed can be easily implemented to identify older adults at high risk with reasonable accuracy. Geriatr Gerontol Int 2022; 22: 797-802.

Factors Affecting Employees Work Engagement in Small and Medium-Sized Enterprises.

BACKGROUND: Improving the labor productivity of small and medium-sized enterprises (SMEs) is essential because of the aging population and predicted reduction in the labor force. Therefore, it is necessary to ensure that employees are in good health to work for long times. In this regard, the purpose of the study is to investigate the relationship between work engagement (WE) and related variables among SME employees. METHODS: A cross-sectional study was conducted using the baseline data of the prospective cohort study, which included 377 employees from three SMEs headquartered in Hiroshima Prefecture, Japan. RESULTS: A multiple regression analysis was performed to see the associations between Utrecht Work Engagement Scale (UWES) scores and other variables. Significant associations were found with job satisfaction, age, health literacy (HL), and quality of sleep (all, p < 0.05). Additionally, there was a statistically significant difference observed in WE, quality of sleep, concern for own body, job satisfaction, and family life satisfaction (all, p < 0.001) with respect to high and low HL levels. CONCLUSIONS: The results of this study reveal that while implementing health and productivity management in SMEs to increase WE, it is best to concentrate on raising HL, job satisfaction, and sleep quality. To increase generalizability, further research could be conducted with more SMEs companies.

Long-term impact of the COVID-19 pandemic on facility- and home-dwelling people with dementia: Perspectives from professionals involved in dementia care.

AIM: The present study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on facility- and home-dwelling people with dementia (PWD). METHODS: This observational study included two anonymous online survey questionnaires to explore the impact of the first wave of the COVID-19 pandemic in Japan and the long-term impact during the 2 years from the onset of the pandemic. The participants were medical and long-term care facilities representatives for older people (945 facilities in the first survey, 686 in the second), and care managers (751 in the first survey, 241 in the second). A χ2 -test was carried out between the two surveys. RESULTS: For facility-dwelling PWD, activities that stimulate cognitive and physical functioning increased significantly compared with the first wave of the pandemic (P < 0.05). Also, a decline in cognitive and walking functions and falls increased in the second survey compared with the first (P < 0.01). For home-dwelling PWD, the broader impact of the pandemic on support for activities of daily living, social interaction and provision of medical care did not mitigate. The high prevalence of cognitive and physical functional decline in the first survey was similar in the second. CONCLUSIONS: The prolonged COVID-19 pandemic produced changes in the lives of home- and facility-dwelling PWD, with widespread negative consequences for them. Our findings are useful to consider preventive supports to mitigate or avoid functional decline and symptom exacerbation in PWD due to changes in their living environment and the care they receive in the COVID-19 era. Geriatr Gerontol Int 2022; 22: 832-838.

Efficacy of care manager-led support for family caregivers of people with dementia during the COVID-19 pandemic: a randomized controlled study.

BACKGROUND: A prolonged COVID-19 pandemic could exacerbate the risk of infection and undesirable effects associated with infection control measures of older people with dementia (PWD), and the care burden of families. In this study, we examined the efficacy of care manager-led information provision and practical support for families of older PWD who need care, regarding appropriate infection prevention, prevention of deterioration of cognitive and physical functions, and preparedness in cases of infection spread or infection during the pandemic. METHODS: Fifty-three family members (aged ≥20 years) who were primary caregivers living with older PWD using public long-term care services were enrolled in an one-month randomized controlled trial. This duration was set based on behavior modification theory and with consideration of ethical issue that the most vulnerable people not benefiting from the intervention. The intervention group (IG) received care manager-led information provision and practical support, and the control group (CG) received usual care. Care burden (primary outcome) was measured using the Zarit Caregiver Burden Interview, and secondary outcomes were analyzed using Patient Health Questionnaire-9 (PHQ9), the Fear of COVID-19 Scale, and salivary α-amylase activity. Data were collected at baseline and after 1 month. Multiple regression analysis was conducted to examine the efficacy of the intervention. The participants evaluated the care managers' support. RESULTS: The participants were randomly divided into IG (n = 27) and CG (n = 26) groups. After the intervention, compared with the CG, there was a decrease in PHQ-9 (ß = -.202, p = 0.044) and α-amylase activity in saliva (ß = -.265, p = 0.050) in IG. IG also showed an increased fear of COVID-19 after the intervention (ß = .261, p = 0.003). With the care managers' support, 57.2% of the participants felt secure in their daily lives and 53.1% agreed that they were able to practice infection prevention suitable for older PWD. CONCLUSIONS: Our findings suggest that the care manager-led intervention may be useful for families of older PWD to enhance behavioral changes in preventing COVID-19 infection and improve their psychological outcomes in the COVID-19 era. TRIAL REGISTRATION: This study was registered on April 2, 2021 (No. UMIN000043820).

Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study.

This longitudinal study aimed to evaluate a community-based and nurse-led advanced case management model centered on disease management. Participants were chronically ill patients aged 20 years and older who were highly dependent on medical care. The case management group (CMG) received nurse-led advanced case management, and the comparison group (CG) was selected by matching estimated propensity scores with the CMG. We compared the changes in medico-economic indicators between the two groups and analyzed the physical and psychological indicators of the CMG over time. The CMG comprised 51 participants, of which eight dropped out by 12 months after registration. After 1:1 propensity score matching, there were 40 participants in the CMG and CG, respectively. At 12 months after the registration, there was no significant difference between the two groups and no change in the CMG. At 24 months after the registration, the CMG's medical and long-term care costs decreased significantly, while the CG's costs increased. Moreover, there was a significant reduction in the number of hospital days and hospital admissions in the CMG. Our findings revealed that nurse-led advanced case management could be useful for patients with complex needs to avoid hospitalization due to exacerbations.

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan.

BACKGROUND: Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. METHODS: Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. RESULTS: The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. CONCLUSIONS: The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

Assessing Burden, Anxiety, Depression, and Quality of Life among Caregivers of Hemodialysis Patients in Indonesia: A Cross-Sectional Study.

Family caregivers endure the burden of caring for patients receiving hemodialysis, which can affect their psychological status and may disrupt the care process. This study aims to assess the level of burden, anxiety, depression, and quality of life (QOL) among family caregivers, to investigate the influence of caregivers' sociodemographic factors and patients' clinical conditions on the level of burden, and investigate how burden affects anxiety/depression and QOL. A descriptive, cross-sectional study was conducted from September to October 2020. A total of 104 caregivers with a mean age of 44.4 ± 12.7 years (63.5% women) in the hemodialysis department of a hospital in Indonesia were examined. Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale, and WHOQOL-BREF were used. Descriptive analysis was conducted to assess the level of psychological status, and multiple regression analysis and path analysis were performed to evaluate the association among all factors. As result, regarding burden, 10.2% had a moderate-to-severe burden, and in terms of anxiety and depression, 25% and 9.6% showed abnormal cases; the mean scores of 4 domains of QOL were about 60 points. Burden and anxiety/depression were significantly negatively associated with all domains of QOL (p < 0.001); however, sociodemographic and clinical factors were not associated with any of the QOL domains. The path analysis results showed that burden positively correlated with anxiety/depression and negatively correlated with QOL via anxiety/depression. In conclusion, family caregivers' QOL was found to be indirectly influenced by burden through anxiety/depression. Further evaluation of clinical significance and implications for caregiver's lifestyle regarding anxiety and depression, which result in caregiver burden, is warranted.

Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study.

We aimed to clarify the regional cultural characteristics in areas with different death rates at home, and to identify factors that influence the discussion and documentation of end-of-life care (EOLC) among community-dwelling older adults. This study was a cross-sectional study using a self-administered questionnaire survey, and participants were Japanese older adults. A chi-square test and multiple regression analysis were conducted. Among the 227 respondents, 143 were analyzed. There were no statistical differences by area. Participants who had intentions to discuss EOLC tended to discuss EOLC with their families and family doctors and tended to create documents to show their wills on EOLC (p < 0.05). The following factors that influence the intentions to discuss EOLC were extracted: experience in providing EOLC; information on EOLC; having religious and spiritual beliefs, and not avoiding the subject of death as part of beliefs related to life and death. These results indicate that beliefs and intentions regarding EOLC may be similar across Japan. Moreover, our findings suggest that to increase the interest of older adults on EOLC, it is important to provide opportunities for older adults to share and discuss information about EOLC with healthcare professionals and others who have experience providing EOLC.

Characteristics of early-career nurse researchers negatively impacted during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: This study aimed to identify typical patterns and determinants of early-career nurse researchers (ECNRs: age ≤45 years) who reported that their research activities were negatively impacted during the COVID-19 pandemic, using a data mining methodology. To gain a deeper understanding of the characteristics of these ECNRs, we compared them with the characteristics of senior nurse researchers (SNRs: age ≥46 years). DESIGN: A cross-sectional study. PARTICIPANTS: 1532 nurse researchers. DATA COLLECTION AND ANALYSIS: We conducted an anonymous online questionnaire survey that assessed individual and professional attributes of nurse researchers and their experiences from April to June 2020. We analysed the association between the impact on research activities and the individual and professional attributes using cross-tabulation, and employed the chi-square automatic interaction detection technique to perform population segmentation. RESULTS: We found that difficulties in research management, an increased burden of student education and organisational management, and organisational management position were relatively important factors for determining the negative impact of COVID-19 on the research activities of ECNRs (p<0.05). For both ECNRs and SNRs, the most relevant determinant of disrupted research activities was 'difficulties in research management' (χ2=34.7 and 126.5, respectively, p<0.001 for both). However, only ECNRs yielded 'position in organisational management' and was extracted only for ECNRs (χ2=7.0, p=0.008). CONCLUSIONS: Difficulties in research management and an increased burden of student education and organisational management had an unfavourable impact on the research activities of ECNRs. To ensure quality of nursing care and nursing science development during and after the COVID-19 era, it is important to support ECNRs in their nursing research activities and career development. Our findings could contribute to the prioritisation of interventions and policymaking for ECNRs who are particularly at risk of being negatively affected by the pandemic.

Undergraduate nursing students' learning experiences of a telehealth clinical practice program during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Against the backdrop of the COVID-19 pandemic, nurse education institutions are required to create innovative and diverse educational methods to ensure the continued learning of undergraduate nursing students. We developed a telehealth clinical practice program to address this challenge. OBJECTIVES: We explored the students' learning experiences of our telehealth clinical practice program by qualitatively analyzing student reports. METHODS: The participants were fourth-year undergraduate students who had taken the telehealth clinical practice program at Hiroshima University. Data were collected as reports from the participants during clinical practice and analyzed using thematic analysis. RESULTS: Of the 59 students who completed the practical training, 26 agreed to participate in the study (consent rate: 44.1%). Sixteen themes emerged from the analysis as the students' learning experiences, and were classified into four thematic categories: (1) recognition of continued self-improvement required to become a nurse and development of a sense of ethics, (2) improvement of knowledge and practical skills in chronic care nursing, (3) acquisition of telehealth skills, and (4) learning through modeling and teamwork, and improvement of self-efficacy. Interacting with persons through telehealth provided an opportunity to learn directly about persons' lives and their experiences of illness, and helped participants develop a sense of responsibility and ethical nursing. CONCLUSIONS: Our study findings indicate that undergraduate nursing students perceived that their attitude, knowledge and skill acquisition improved through this program. We believe that telehealth can have a place as a teaching strategy and this telehealth clinical practice program can be further enhanced the learning effects by combining it with face-to-face training and multidisciplinary education in the future.