Home and social role as factors leading to health maintenance among the elderly living in rural Japan: A longitudinal study.

Purpose: Our study aimed to clarify home and social factors by gender that lead to maintenance of health in the elderly, such as taking care of others and having social activities. Methods: A total of 14,712 and 14,799 respondents to the "Survey of Needs in the Spheres of Daily Life" conducted in Nanto City, Toyama Prefecture in 2017 and 2020, respectively, who were aged 65 years or older (recovery rate was 78.5 %) were enrolled. Of these, 4,322 people who answered that they did not receive long-term care in 2017 survey and who also responded to the 2020 survey or were confirmed dead by the time of the survey were included in the analysis. The status of health maintenance was the outcome and those who answered the 2020 survey saying they did not receive long-term care were defined as health maintained. Those who answered that they did receive long-term and those who died were defined as health lost. Results: After adjusting for variables such as basic attributes, health status, and functional capacity, the elderly who had persons whom to they provided care (excluding long-term care) had health maintenance rate higher at 3 years than those who did not provide care or long-term care. In addition, the results showed that men who had job with income and women who participated in neighborhood associations had higher rates of health maintenance. Conclusion: This study showed that older adults who take on roles at home and in society are more likely to maintain their health.

Clinical Presentations of Teenage Outpatients Encountered by General Internists in Japanese Hospitals: A Cross-Sectional Study.

Introduction General internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. Methods This study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data. Results The number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms. Conclusions The potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments ("Sogo-Shinryo") in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.

[Do elderly people providing nursing or caring for others help the providers maintain their health?]

AIM: The present study clarified the relationship between elderly individuals providing nursing or caring for others, including their spouses, and their own health maintenance over three years. METHODS: Study participants were those who had completed the "Survey of Needs in the Spheres of Daily Life" distributed to all elderly individuals ≥65 years old in Nanto, Toyama Prefecture, Japan, in both 2014 and 2017. We evaluated data from 6,088 individuals after excluding those with insufficient data. Detailed responses were analyzed in order to understand the situation of the people to whom the respondents were providing nursing or care (e.g. spouses or others), the presence or absence of providing this nursing or care, and the relationship between these factors and the providers' health maintenance over a period of three years using multiple logistic regression analyses. RESULTS: Even after adjusting for critical variables, including basic attributes, overall health, and functional capacity in elderly men, among the subjects who had partners to whom they provided nursing or care, including a spouse, the number of individuals whose own health was maintained 3 years later was higher than among those who did not provide such nursing or care (odds ratio [OR], 1.67; P = 0.004). Furthermore, compared to women who did not provide nursing or care, the OR for women who did provide care for people others than their spouses was 1.44 (P = 0.045). CONCLUSIONS: Our results suggest that providing nursing or caring for others (including a spouse for elderly men; excluding a spouse for elderly women) has a positive impact on health maintenance among the elderly.

What are the factors that cause emergency home visit in home medical care in Japan?

BACKGROUND: In the home medical care setting, the factors causing emergency home visits (EHV) remain unclear. This study aimed to determine those factors and examine their relationship with EHV requests. METHODS: This is a single-center retrospective observational study from data obtained from a home medical care clinic. We assessed the association between frequency of EHV and age, gender, level of care-needed, cancer, and medical device in use with using Poisson regression analysis. RESULTS: A total of 608 EHV in 214 patients were analyzed. Common chief complaints were fever, death, and dyspnea. As factors that affect frequency of EHV because of fever, higher care-needed level (RR: 3.35; 95% CI: 1.95-5.74, P < .001), urinary catheter use (RR: 1.94; 95% CI: 1.22-3.08, P = .005), and central venous port use (RR: 2.39; 95% CI: 1.44-3.96, P = .001) showed significant correlation. Regarding EHV because of dyspnea, lung tumor (RR: 2.71; 95% CI: 1.26-5.84, P = .011) and home oxygen use (RR: 3.96; 95% CI: 2.05-7.68, P < .001) showed significant correlation. Regarding EHV because of all chief complaints, higher care-needed level (RR: 1.59; 95% CI: 1.12-2.26, P = .009), urinary catheter use (RR: 1.78; 95% CI: 1.13-2.93, P = .014), and central venous port use (RR: 1.75; 95% CI: 1.04-2.93, P = .034) showed positive correlation. CONCLUSION: The factors associated with frequency of EHV because of fever or all chief complaints were urinary catheter use, central venous port use, and higher care-needed level. As for dyspnea, they were lung cancer and home oxygen use. Our study suggests that the burdens on medical staffs, patients, and their families can be reduced through recognizing these risk factors.