Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study.

INTRODUCTION: Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. DESIGN: This was a retrospective cohort study. METHODS: We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. RESULTS: Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). CONCLUSION: Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. CLINICAL RELEVANCE: When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.

Development of the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to enhance collaboration among health and long-term care providers.

This study aimed to develop the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to create a simple low-burden rating scale for promoting collaboration between health and long-term care providers. A survey was conducted with 151 care providers, obtaining valid responses from 147 (30 nurses, 67 care managers, and 50 care workers; response rate 97.4 %). Through confirmatory factor analysis, we developed a short-version scale consisting of 7 items by selecting one item with the highest regression coefficient from each of the 7 factors in the original 21-item version. The reliability was verified by confirming internal consistency. Regarding construct validity, the goodness-of-fit indices confirmed acceptable fit, and the correlation between the original and the shortened version was 0.98. Convergent validity was found as significant using the collaborative behavior evaluation scale and job satisfaction measure. FACES is considered a useful scale for easily measuring the level of collaboration among various professions in the community.

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor.

BACKGROUND: The present study aimed to explore the association between impending death and continual changes in respiratory and heart rates measured using a non-wearable monitor every minute for the final 2 weeks of life in dying cancer patients. METHODS: In this longitudinal study, we enrolled patients in a palliative care unit and continuously measured their respiratory and heart rates via a monitor and additionally captured their other vital signs and clinical status from medical records. RESULT: A dataset was created comprising every 24-h data collected from every-minute raw data, including information from 240 days prior to death from 24 patients (345,600 data); each patient's data were measured for 3-14 days until death. After confirming the associations between the respiratory and heat rate values on the day of death (n = 24) or other days (2-14 days before death, n = 216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24 h by univariate analyses, we conducted a repeated-measures logistic regression analysis using a generalized estimating equation. Finally, the maximum respiratory rate and mean heart rate were significantly associated with death occurring within the following 3 days (0-24 h, 0-48 h, and 0-72 h), except for the maximum respiratory rate that occurs within 0-24 h. CONCLUSION: The maximum respiratory rate and mean heart rate measured every minute using a monitor can warn family caregivers and care staff, with the support of palliative care professionals, of imminent death among dying patients at home or other facilities.

Care needs level in long-term care insurance system and family caregivers' self-perceived time-dependent burden in patients with home palliative care for cancer: a cross-sectional study.

PURPOSE: Although home care improves patients' quality of life (QOL), several studies have suggested that home care lowers the QOL of family caregivers and decreases their mortality. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the major burden needs to be clarified. METHOD: A survey questionnaire was distributed to 710 family caregivers of patients with cancer in Japan, and 342 valid responses were obtained (valid response rate: 48.2%). The Burden Index of Caregivers was used to identify the major burden on caregivers. To assess the associations of the patients' care needs level and other clinically relevant factors with the major burden, a multivariable-adjusted logistic regression model was used. RESULTS: The time-dependent burden was identified as a major burden. An adjusted model showed a nonlinear association between the care needs level and the time-dependent burden, in which the caregivers of the patients who required moderate care needs level had the highest time-dependent burden [adjusted odds ratio of none, mild, moderate, and severe care needs levels: 0.50 (95% confidence interval 0.07-2.12), 1.08 (0.43-2.57), 1.87 (1.01-3.52), and 1.00 (reference), respectively]. Additionally, older patients and younger caregivers were significantly associated with a time-dependent burden. CONCLUSION: The time-dependent burden was highest in caregivers at the moderate care needs level and younger caregivers. An imbalance between the demand and supply of care services may be improved by considering the clinical characteristics of both patients and caregivers.

Environmental factors related to sleep latency among inpatients in rehabilitation wards according to functional independence measure cognitive scores.

BACKGROUND: No study has investigated sleep-related environmental factors in patients according to their functional independence measure (FIM) cognitive scores. AIMS: The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards. DESIGN: This is a prospective longitudinal study. METHODS: This study measured the sleep state using a bed-based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed-effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores. RESULTS: The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra-individual variance was larger than that of the high group. CONCLUSION: These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score.

Nonwearable actigraphy to assess changes in motor activity before and after rescue analgesia in terminally ill patients with cancer: A pilot study.

AIMS: This study aimed to investigate the usefulness of nonwearable actigraphy to assess changes in motor activity before and after rescue analgesic administration in terminally ill cancer patients. BACKGROUND: Evaluating pain in terminally ill cancer patients is difficult; pain assessment tools are needed. METHODS: This was an exploratory descriptive study conducted within a palliative care unit. A nonwearable actigraph was used to measure the activity score and movement index of terminally ill patients with weeks-long prognosis and pain. The actigraph and medical data were integrated, and data were compared 6 h before and after rescue analgesic administration. RESULTS: Among 10 patients (age: 75.8 ± 12.3 years; six men), we evaluated 28 pain episodes (mean activity score: 130.9 ± 180.5 counts per minute; movement index: 68.8%). When pain was relieved at night following rescue analgesic administration, activity score and movement index decreased significantly (6 h before vs. 6 h after analgesics, respectively: 113.1 to 69.7 counts per minute; 64.3% to 41.8%; both p < 0.0001). With no relief after rescue analgesic administration, activity score did not differ significantly 6 h before and after analgesics: 147.3 to 137.7 counts per minute. CONCLUSION: Pain in terminally ill cancer patients could be assessed using a nonwearable actigraph to capture motor activity and improve pain assessment.

Provision and related factors of end-of-life care in elderly housing with care services in collaboration with home-visiting nurse agencies: a nationwide survey.

BACKGROUND: Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase "Elderly Housing with Care Services (EHCS)", which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS. METHODS: A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing. RESULTS: Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident's physician. CONCLUSIONS: This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

Measuring the Benefits of Respite Care use by Children with Disabilities and Their Families.

PURPOSE: The benefits of respite care in reducing the burden of caregivers of children with disabilities are well known; however, few studies have effectively quantified such benefits. The aim of the present study was to develop and validate a measure for evaluating the benefit of respite care provided to family caregivers of children with disabilities. DESIGN AND METHODS: This was a cross-sectional study. We distributed a survey questionnaire to 465 family caregivers between March and April 2017. Participants were asked to respond to items regarding benefits of respite care for themselves and their children. RESULTS: Data in relation to four domains (Child Development, Sense of Peace and Life Fulfillment among Caregivers, Mental Health Support for the Caregiver, and Expansion of Perspectives and Future Vision) were extracted to assess the benefits of using respite care. The full-scale Cronbach's α coefficient was 0.89 and ranged between 0.73 and 0.88 for each individual domain. CONCLUSIONS: The newly developed measure for assessing the benefits of respite care for family caregivers of children with disabilities was highly reliable and valid. PRACTICE IMPLICATIONS: This objective tool would allow healthcare practitioners to review the quality of respite care they provide and subsequently help them identify ways to improve.

[Feelings of difficulty experienced by home healthcare support workers in collaborative practice with medical professionals: Scale development].

Objective　Healthcare support workers play an important role in team healthcare. The objective of this study was to develop scales for measuring feelings of difficulty among home healthcare support workers when in collaborative practice with medical professionals.Methods　Scale drafts consisting of 10 questions were developed by an expert panel, using qualitative data from previous studies. We conducted a questionnaire survey of 220 healthcare workers in a certain city using the developed scales, and reliability and validity of the scale were examined.Results　An exploratory and confirmatory factor analysis was conducted, after which two factor structures and six questions were selected. The factors were "feelings of disrespect from medical professionals" and "communication barriers between home healthcare support workers and medical professionals". Cronbach's coefficient alpha was 0.77-0.81 for the scale and its two subscales, which demonstrated good internal consistency. Correlation coefficients between the scale and the face-to-face cooperative confidence questionnaire (FFCCQ) and interdisciplinary collaborative practice scales (ICPS) were estimated to examine the criterion-related validity. As a consequence, the score of the scale had a significant negative correlation with FFCCQ and ICPS (r=-0.36--0.42). The two subscales also had negative correlations with FFCCQ and ICPS (r=-0.17--0.42).Conclusion　The scales we developed were reliable and valid for measuring home healthcare support workers' feelings of difficulty in collaborative practice with medical professionals.

Healthcare professionals' competence in digitalisation: A systematic review.

AIMS AND OBJECTIVES: To identify key areas of competence for digitalisation in healthcare settings, describe healthcare professionals' competencies in these areas and identify factors related to their competence. BACKGROUND: Digitalisation requires changes in healthcare practices, policies and actions to revise job expectations and workflows. The aspects of patient safety and integration of digitalisation into the professional context necessitate an assessment of healthcare professionals' competencies in digitalisation. DESIGN: Systematic review. METHODS: A systematic review was conducted following Center of Reviews and Dissemination guidelines, including application of a PRISMA statement. Four databases-CINAHL (EBSCO), MEDLINE (Ovid), Web of Science and Academic Search Premiere (EBSCO)-were searched for relevant original peer-reviewed studies published between 2012-2017. Twelve were chosen for final analysis: five quantitative studies and seven qualitative studies, which were, respectively, subjected to narrative and thematic synthesis. RESULTS: Key competence areas regarding digitalisation from a healthcare perspective identified encompass knowledge of digital technology and the digital skills required to provide good patient care, including associated social and communication skills, and ethical considerations of digitalisation in patient care. Healthcare professionals need the motivation and willingness to acquire experience of digitalisation in their professional context. Collegial and organisational support appear to be essential factors for building positive experiences of digitalisation for healthcare professionals. CONCLUSION: Healthcare organisations should both pay attention to the social environment of a workplace and create a positive atmosphere if they want to improve the response to digitalisation. The successful implementation of new technology requires organisational and collegial support. RELEVANCE TO CLINICAL PRACTICE: Recommendations for clinical practice include the following: development of competence in digitalisation by healthcare professionals when using technological equipment to minimise errors; provision of sufficient resources, equipment and room for technology usage; and provision of regular education that considers the participants' competencies.

Evaluation of the elements of interprofessional education for end-of-life care among homecare nurses, care managers, and head care workers: A cluster-randomized controlled trial.

Our group developed an interprofessional education (IPE) program for home-based end-of-life (EOL) care among health and welfare professionals, with the purpose of understanding professional roles in EOL care and promoting mutual respect among team members. This study aimed to verify the understanding and awareness of the elements of IPE. Seven districts in a city in Japan were cluster-randomized into an education group or a control group. A questionnaire survey using original items to evaluate two purposes of the IPE program was conducted before the IPE workshop and seven months later. In total, 291 professionals participated in the study: 64 homecare nurses, 129 care managers, and 98 head care workers. Care managers and care workers in the education group significantly understood their own and other professional roles in EOL care (p= .01, p < .0001, respectively) and gained confidence in collaboration among health and welfare professionals (p = .02, p < .0001, respectively). Care workers in the education group felt respect for team members (p = .02). For homecare nurses, no significant effects were observed. The IPE was more effective for welfare professionals who had difficulty cooperating in end-of-life care.

Advance care planning and home death in patients with advanced cancer: a structured interview analysis.

BACKGROUND:: Discrepancy between preferred and actual place of death is common in patients with advanced cancer. AIM:: To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer. METHODS:: Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care. The main outcome was the place of death. RESULTS:: Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73). CONCLUSION:: ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.

Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study.

PURPOSE: The aim of this study was to investigate the predictive value of a clinical tool to predict whether discharged cancer patients die at home, comparing groups of case who died at home and control who died in hospitals or other facilities. METHOD: We conducted a nationwide case-control study to identify the determinants of home death for a discharged cancer patient. We randomly selected nurses in charge of 2000 home-visit nursing agencies from all 5813 agencies in Japan by referring to the nationwide databases in January 2013. The nurses were asked to report variables of their patients' place of death, patients' and caregivers' clinical statuses, and their preferences for home death. We used logistic regression analysis and developed a clinical tool to accurately predict it and investigated their predictive values. RESULTS: We identified 466 case and 478 control patients. Five predictive variables of home death were obtained: patients' and caregivers' preferences for home death [OR (95% CI) 2.66 (1.99-3.55)], availability of visiting physicians [2.13 (1.67-2.70)], 24-h contact between physicians and nurses [1.68 (1.30-2.18)], caregivers' experiences of deathwatch at home [1.41 (1.13-1.75)], and patients' insights as to their own prognosis [1.23 (1.02-1.50)]. We calculated the scores predicting home death for each variable (range 6-28). When using a cutoff point of 16, home death was predicted with a sensitivity of 0.72 and a specificity of 0.81 with the Harrell's c-statistic of 0.84. CONCLUSION: This simple clinical tool for healthcare professionals can help predict whether a discharged patient is likely to die at home.

Determinants of financial performance of home-visit nursing agencies in Japan.

BACKGROUND: Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. METHODS: We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). RESULTS: Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. CONCLUSIONS: The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Five types of home-visit nursing agencies in Japan based on characteristics of service delivery: cluster analysis of three nationwide surveys.

BACKGROUND: The number of home-visit nursing agencies in Japan has greatly increased over the past 20 years since the Japanese government first introduced it in 1992 to meet the increased needs of home-bound elderly. Since then, home-visit nursing has come to serve for a variety of populations such as those with terminal-stage cancer, neurological diseases, psychiatric conditions, or children with chronic conditions; currently the number of agencies has reached 6,801 (as of April 2013). Yet little has been known about the details of their characteristics in terms of patient types or differences/similarities across regions. In this study, we developed a method to categorize home-visit nursing agencies throughout Japan based on their actual service delivery, in order to help improve healthcare policies allowing better services by those agencies. METHODS: We performed a cluster analysis on data from two national databases (Survey of Institutions and Establishments for Long-term Care which is annually administered by the Ministry of Health, Labour and Welfare [dataset 1; n = 5,161] and Information Publication System for Long-term Care which is annually reported by home-visit nursing agencies to their respective prefectural governments [dataset 2; n = 4,400, matching rate to data set 1: 84.4%]), in addition to the results from our original nationwide Fax survey of the service delivery system of home-visit nursing agencies (dataset 3; n = 2,049 matching rate to data set 1: 39.3%). RESULTS: The cluster analysis suggested five categories for home-visit nursing agencies based on the type of service delivery system. For deciding of these categories, we held 13 panel discussions with specialists to confirm that the categorization of the home-visit nursing agencies appropriately reflected their actual delivery systems. The five categories were: nurse-centered (560, 10.9%), rehabilitation-centered (211, 4.1%), psychiatric-centered (360, 7.0%), urban-centered (1,784, 34.5%), and rural-centered (2246, 43.5%). CONCLUSIONS: This five categorization system of home-visit nursing agencies could ensure appropriate healthcare policies that will allow agencies to provide better home-visit nursing services based on their patient and staff characteristics and regional needs. The findings would be valuable both in Japan as well as in other countries with rapidly growing aging populations.

[Age differences in decision-making factors on end-of-life care location for Musashino-city residents].

OBJECTIVES: Japan is predicted to continue its fast-aging trend, especially in urban areas. Therefore, promoting end-of-life services in urban areas is an urgent policy issue. In addition, the recognition of end-of-life care greatly varies by age. The aim of this study was thus to clarify the association by age between preferences regarding care location among people in urban communities and their experiences, knowledge, and perceptions related to end-of-life care. METHODS: A total of 1,500 people aged 40 and older in Musashino-city participated in a cross-sectional nationwide survey. We asked about preferences regarding care location, demographic data, experiences, knowledge, and perceptions related to end-of-life care. We used logistic regression analyses. RESULTS: A total of 769 (51.6%) responded. Of those over 65, 40.9% preferred homes and 59.1% preferred places other than homes as end-of-life care locations. For those aged 40-64, 54.1% preferred homes and 45.9% preferred places other than homes (P<0.001). Logistic regression analyses revealed that the following factors affect people's preferences regarding location of care for those over 65: not recognizing that medication use can lead to addiction (odds ratio: 1.90; 95% confidence interval: 1.17-3.08); taking precautions before taking medicine (1.97; 1.21-3.22); volunteering (2.38; 1.34-4.21) ; recognizing that home cost is cheaper than hospital cost (1.82; 1.10-3.03); recognizing that they have health care workers to consult (1.90; 1.06-3.41); and recognizing that end-of-life care at home provides enough treatment (2.30; 1.37-3.87). Factors for the 40-64 year old group were as follows: not wanting informal caregivers to care (2.80; 1.62-4.83); recognizing that they can respond to sudden changes at home (2.97; 1.15-7.66); and want to be free at the end of the life (4.57; 2.43-8.59). CONCLUSION: These results suggest that changing people's thinking about the socialization of care is required to increase preferences of people over 65 for home death. For the 40-64 year old group, developing an awareness of death is required. For all generations, providing appropriate information and educating the people is required.

Patterns of long-term care service use and multimorbidity in older Japanese adults: A cross-sectional study of claim data.

AIM: The long-term care (LTC) insurance system provides a combination of several services in Japan; therefore, it is important to clarify service utilization. Furthermore, it is important to consider multimorbidity among older adults, who frequently present several diseases. This study aimed to clarify LTC service utilization patterns, including those for newly added multifunctional services, and to describe the basic characteristics, including multimorbidity, of these patterns. METHODS: We included 37 419 older adults in care need levels 1-5, living at home, who used LTC services in October 2017. We used LTC and medical claims data that were linked using unique identifiers from the National Health Insurance, Advanced Elderly Medical Insurance, and LTC Insurance of Shizuoka Prefecture in Japan. LTC service utilization patterns were identified using cluster analysis based on service fees. Multimorbidity was analyzed using the Charlson Comorbidity Index (CCI) and compared characteristics in these patterns. RESULTS: Six LTC service utilization patterns were identified: light use (51.0%), intensive use of day care (33.7%), intensive use of short stay (6.3%), intensive use of home help (5.1%), multifunctional LTC in small-group homes (MLS) use (3.7%), and MLS and home-visiting nurses (MLSH) use (0.2%). MLSH use had the highest CCI (3.6 ± 2.3). Intensive use of day care and short stay had the lowest CCI (2.6 ± 1.9). CONCLUSIONS: The characteristics of multimorbidity differed by LTC service utilization patterns. Our findings are useful for considering service utilization that takes into account the characteristics of older adults. Geriatr Gerontol Int 2024; 24: 283-289.

Physical function decline predictors in nursing home residents using new national quality indicators.

AIM: To determine the predictors of physical function (PF) decline among nursing home residents using items from the Long-term care Information system For Evidence (LIFE), a system launched in 2021 to ensure the quality of long-term care. METHODS: The LIFE data of 1648 residents from 45 nursing homes in Japan were retrospectively collected in July 2021 (T0) and January 2022 (T1), including demographics, PF assessed by the Barthel index (BI), nutrition and oral health, and cognitive function. The Dementia Behavior Disturbance scale was used to assess the frequency of certain behaviors, such as "waking at midnight." The predictors of PF decline, defined as a decrease ≥5 in the BI score at T1 compared with that at T0, were determined using mixed-effects logistic regression analyses. PF at T0 was classified into high (>60 BI) and low (≤60 BI) groups. RESULTS: The participants' mean age was 87.2 ± 7.1 years, and 45.3% experienced PF decline. The significant predictors of PF decline were age ≥ 90 years, body mass index <18.5 kg/m2 , dementia diagnosis, moderate and severe cognitive impairments, not vocalizing reciprocal exchanges at will, always "waking at midnight," and high PF at T0. CONCLUSIONS: The LIFE items predicted PF decline among nursing home residents, suggesting that LIFE data can be used to ensure the quality of long-term care. Geriatr Gerontol Int 2024; 24: 123-132.

Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities.

OBJECTIVE: With the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. METHOD: Using the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. RESULTS: Of the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77-1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28-0.89) among the LTCF residents. CONCLUSIONS: Although ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.

Home Care Services in the Last Year of Life by Type of Care Management.

Care management of home-based long-term care is vital for community-dwelling older adults. Regarding care planning, which is a part of care management, appropriate care plans according to individual conditions are extremely important for older adults to continue living independently in their familiar environment for as long as possible. We compared the use of care services in the last year of life between advanced and conventional care management. The results showed that among the older adults with a care-need level of 3, 4, or 5, the advanced care management group had a significantly higher rate of use of home-visit nursing services than the conventional care management group. These differences could be attributed to differences in the care planning knowledge, experience, and the training environment of the care managers' offices.