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Objective: The non-medical needs of patients, such as values and personal preferences, are likely to be omitted from advance care planning (ACP) discussions because of a lack of readiness and awareness on the part of healthcare professionals. The aim of the present study was to identify core components perceived by multidisciplinary healthcare professionals to improve person-centered ACP conversations with older people.Methods: The study participants were healthcare professionals (physicians, nurses, and care managers) working in different cities. This qualitative study was performed online using eight individual in-depth interviews and one subsequent focus group composed of eight healthcare professionals. The interviews and focus group discussion were audio-recorded online and transcribed verbatim. The aim of the analysis of the individual in-depth interviews was to summarize the transcribed results, create a conceptual framework for person-centered ACP conversation, and provide meaningful interpretations of the focus group participant discourse. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach.Results: Five themes capturing the core components for successful person-centered ACP were extracted from the ideas voiced by participants: Placing highest value on patient autonomy and human life; uncovering patient’s true feelings and desires; sharing collected information on patients’ end-of-life wishes with other team members; relaying patients’ wishes to the physician; and handling conflicts among patients, relatives, and healthcare professionals.Conclusion: The results provide guidelines for the future development of novel, value-based, person-centered ACP practice for multidisciplinary healthcare professionals.
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Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions.Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach.Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues.Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.
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Objective: This study aimed to explore the gender differences in wishes and feelings regarding end-of-life care among Japanese elderly people requiring home care services.Patient/Materials and Methods: This study was a secondary analysis of the qualitative data previously compiled from a total of 102 elderly people living at home. The data was retrospectively collected from the participants’ nursing records, which included a designated advance care planning (ACP) form completed between January and July 2015. Out of the 102 participants, 86 men and women who were either living alone or with a spouse were selected for the present analysis. We reviewed the participants’ ACP forms based on which of the sentiments on the following checklist were expressed: anxiety about the future, abandonment of control, clinging to current daily life, inadequate support from spouse, and a tendency to delegate decision-making.Results: The most commonly expressed feeling was abandonment of control, among both men and women. Among elderly people living alone, women were more likely to want to be surrounded by good, caring people when approaching the end of their lives. Among elderly people living with a spouse, women were more likely to want to delegate decision-making to others.Conclusion: Our results pointed to a gender difference in the attitudes of elderly people toward interactions with the people surrounding them during the end-of-life decision-making process. In order to provide better overall care, health care professionals must come to realize the importance of this gender difference, as it has an impact on the ACP choices made by elderly people living in the community.
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Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment.Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50–69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates.Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.
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The aim of this study was to determine the current situation in a rural community that is actively engaged in establishing a community-based integrated care system, especially for dementia, despite the community being at risk of becoming a marginal village. Six medical, longterm care, or welfare professionals in a rural area of City A, Gifu Prefecture were interviewed from May to September 2017 on the current status and challenges faced in establishing a community-based integrated care system for dementia. Qualitative data was structured by thematic analysis. Volunteer activities by long-term care facilities and an Osekkai (unsolicited) network comprising community specialists, social workers, and residents appeared to be foundational to the community-based integrated care system in the area. The key shared concept was that the intentional and proactive involvement of active elderly individuals as volunteers in community activities helps to prevent them from becoming dependent. Challenges to be addressed were providing these elderly individuals with opportunities to discuss their ideal final stage of life and to understand advanced care planning.
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Elderly men living alone are susceptible to loneliness, spiritual pain, and distress. However, previous studies of spirituality have been conducted mostly among women and cancer patients. Therefore, this study sought to structuralize spirituality and distress among elderly men living alone. Thirty care managers across Japan discussed the thoughts and feelings they had when providing livelihood support to elderly men living alone, and the content of discussion was structuralized. The data suggest that these elderly men struggle with loneliness, anxiety, and the need for affection, often living a bitter reality. Also, past events affect their present spirituality. However, many care managers still struggle daily to find ways to support elderly men living alone because some elderly men refuse to accept livelihood support and care managers cannot readily access condominium buildings with installed security systems.
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<p><b>Introduction:</b> High-quality, community-based dementia care requires a comprehensive, holistic approach. This study aimed to identify the barriers to achieving efficient cooperation and coordination among medical professionals, care managers, and medical social workers, and to improve the management model of community-based, integrated dementia care.</p><p><b>Methods:</b> We collected qualitative data through three focus group discussions at JA Konan Kosei Hospital. Thirteen participants (four directors of nursing service departments, three chief nurses, four medical social workers, and two care managers) were recruited for the discussions. The data were analyzed using an inductive, multi-step approach referred to as the qualitative content analysis.</p><p><b>Results:</b> Nine themes arose as follows: little attention given to patient wishes, lack of time and space to provide high-quality care, disturbing hospital environment, poor compensation for staff members, refusing to visit outpatient clinics, declined admission, daily life support by family members and caregivers, dementia care team, and community bonding.</p><p><b>Conclusion:</b> The participants wanted to launch a dementia care team in their hospital to improve the care environment and the quality of dementia-specific care. The study also suggested that advance care planning could be systematically implemented in clinical practice as a way to honor the decisions made by dementia patients.</p>
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Inpatients with dementia are prone to delirium and aimless wandering, and they often become verbally and physically abusive. Thus, caring for these patients places considerable burden on nurses. This article reports on the creation of a strategy for dementia care in a general hospital. Subjects were staff of Konan Kosei Hospital ─ 2 deputy chief nurses, 1 section chief nurse, 3 unit chief nurses, 2 medical social workers, 1 integrated community support social worker, and 1 section chief nurse (home-visiting division) ─ and 2 independent care managers. Focus group interviews were conducted to collect data, and extracted labels were classified into subcategories and categories according to similarity in meaning. A two-dimensional development method was used to prioritize tasks in each category. The highest priority tasks were discussed and sorted using characteristic diagrams. It is necessary for a new team dedicated to dementia care to be created and for education, enlightenment, and training to be provided so as to increase understanding of dementia care and empathy among a wider range of professionals working in the hospital.
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<b>Objective:</b> Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan.<b>Methods:</b> Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (<i>p-</i>value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI).<b>Results:</b> Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99).<b>Conclusion:</b> Receipt of comprehensive medication management services for older people was associated with medication adherence.
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<b>Objective:</b> The aim of the present study was to explore whether the presence of unhealthy eating habits is an effective indicator of anemia among older people or not.<br><b>Methods:</b> We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were 150 users aged 75 years and older who underwent the checkup between January and September 2010. The subjects were first divided by gender and further separated into anemic and non-anemic subgroups according to their estimated anemia prevalences: Hb < 130 g/L for males and Hb < 120 g/L for females. For each category, we compared the subjects’ lifestyles including eating habits between the anemic and non-anemic groups.<br><b>Results:</b> Both among the women and the men aged 75 and over, there were no significant differences in any items including eating habits between the two anemic subgroups.<br><b>Conclusion:</b> Our results suggest that the presence of unhealthy eating habits is not an effective indicator of anemia among older people.
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The purpose of this study was to shed light on the originality of dementia day service center through focus group interviews with the center administrator and caregivers. With the participation of a total of six people, a discussion was held. The participants exchanged views ideas about what day services should be like for the benefit of the elderly with dementia. From the debate, we drew the following conclusions. (1) Given that the level of dementia day service is high in specialty and technicality, it would be possible to admit the patients who were unacceptable to ordinary day care centers. (2) Users, their families and caregivers have vicarious pleasure from the alleviation of BPSD. (3) The delight gives the care staff an incentive to learn more and contributes toward upgrading the technical level further. From the above, we concluded that the specialty and originality of the dementia day service center had been supported by a high quality of life of users, their families and the staff who had experienced in caring old people with severe BPD successfully.
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It is often said that care coordinators without health care background are no good at talking with home-visiting nurses. The communication gap is wide. So, we planned to make textbooks with a view to bridging the gap. To garner some basic data, we sponsored a workshop on “home healthcare nurses’ behavior that troubles care managers.” The contents of the discussion were analyzed using the KJ method, though partially, and obtained the following seven groups: (1) demanding the same level of medical management as that of a hospital from home-visit nursing teams; (2) being not inclined to do only irreducible minimum work; (3) having not enough experience in home-visit nursing service with their knowledge inclining to medical care; (4) intending to control home care teams authoritatively; (5) do not control their emotions in front of clients and families; (6) using technical terms too much: and (7) being eager to change to special instructions. The results of the present study will provide important information to home-visiting nurses and care managers as well.
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Stress that care workers are experiencing inevitably has bad influence on the quality of life of those old people who need nursing care. It is, therefore, a matter of urgency to work out some effective measures to deal with the mental health problems of care workers and others engaged in nursing care services. In view of the circumstances, we hold a workshop for caregivers with an aim at increasing their power to get anger under control. The workshop had four main sessions; (1) Free discussion on anger in general; (2) Distortion of thought; (3) 10 frequently observed irrational convictions; and (4) analysis of anger. Prior to the main sessions, all participants introduced themselves and told their stories about how they work off stress. In the free discussion, a world-cafe style was adopted. In the session (2) on distortion of thought, participants pondered on irrational convictions which had been formed in them on the basis of their experience. In the session (3), each participant gave his or her convictions apt to cause anger and replaced them with rational convictions. In the analysis of anger session (4), participants were asked to recall the scene in which they fumed, and role-play. The questionnaire survey taken after the seminor found that the anger management workshop had a beneficial effect on all the participants.
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The number of geriatric care managers is on the rise. This tendency has given rise to concerns in some quarters over the widening communication gap between care managers and medical professionals. The problem is that already many care managers are taking too much time writing requests to physicians because they do not know how to write them. The situation is such that in concert with care managers we had a workshop to improve in writing to physicians on a case-by-case basis. Cases were presumed by participating care managers. For examples: cases where instructions from doctors concerning home care are needed as bed-ridden patients had serious bedsores;where hard-to-manage behavioral and psychological symptoms of dementia developed in patients have to be reported and at the same time thedoctors’ advice is needed as to whether the patients should be referred to clinics specialized in Alzheimer’s disease; and where it becomes necessary to ask permission from doctors for reduction in the number of times of internal use of prescription medicines by reason of forgetfulness on the part of the patients. With these and other hypothetical cases included, a sort of manual was worked out by the first author of this paper in cooperation with two nurses. We hope that this work will help care managers build up their writing skill and facilitate communication between care managers and physicians.
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Nagoya has seen various educational activities through workshops to build a large-city- type interprofessional network. In this paper, we reported the depth of 21 people’s feelings toward the activities. They took part in the June, 2013, workshop and were all concerned in eldercare. We invited them to a one-hour meeting and talked freely about a workshop with the participation of people engaged in different type of occupation. The arguments were summed up by KJ method. It was suggested that the workshop not only provided an opportunity to learn a lot but also helped promote exchanges of views and ideas between participants. Some argued that whether a workshop ends in success or not would depend on compatibility with other participants.. The author thinks that how to nurture talented people concerned in the planning and management of the workshop and how to invite as many people as possible from various fields are subjects to be grappled with.
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In scenarios developed by a multidisciplinary faculty for interprofessional education, practical problems that emerged included: “medical incident” and “shortage of medical resources” from the perspective of patient and families,” and “information sharing,” “evaluation and feedback,” and “insufficient feeling of accomplishment” from the perspective of health-care professionals. Discussions identified “interprofessional collaboration,” “mutual understanding for professionalism,” and “embodiment of professional culture” as key words for problem solving. Finally, scenarios were developed in the hospital, home-care, nursing, or community care settings that referred to 2 themes, “end of life” and “dementia.” Pilot case studies performed with health care professionals demonstrated the utility of the scenarios and the effectiveness of interprofessional education.
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To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.
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<b>Objective:</b> Multiple studies worldwide have supported the predictive validity of self-rated health (SRH) with regard to disability and mortality among elderly people. Although SRH is an important study topic providing clues to enhance a person’s quality of life, there is currently insufficient data on age- and gender-specific differences among factors associated with SRH in Japan, particularly in rural areas. The present study examined the factors associated with SRH of a segment of Japan’s rural population by age- and gender-specific analysis.<br><b>Methods:</b> We used data from a cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The study subjects were 155 male and 169 female users from June 2009 to August 2010 who agreed to participate in this study. We divided the study subjects into 4 categories as follows: men aged less than 65, women aged less than 65, men aged 65 and over, and women aged 65 and over. The subjects who responded positively to the SRH-related questions were defined as the high SRH group, and those who responded negatively were defined as the low SRH group. We then compared the data between the high and the low groups in each category.<br><b>Results:</b> In all four categories, there were statistically significant differences in regular hospital or clinic attendance between the high and low SRH groups. In all four categories, there were no significant differences in eating or exercise habits between the two SRH groups.<br><b>Conclusion:</b> Because regular hospital or clinic attendance by a subject is indicative of the presence of chronic health problems, it is natural for the subject’s perception of their own health to be negative. However, rural physicians should provide patients with emotional and psychological support to deal with any health-related concerns positively.
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<b>Objective:</b> Japan introduced a new metabolic syndrome (MetS) screening and intervention program. However, the specific benefits of the program have not yet been identified. The aim of our study was to highlight the role of the program in reducing risks related to MetS in a Japanese rural area.<br><b>Methods:</b> We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were all users aged 40-74 years who participated in the MetS program between January and September 2010. We ultimately analyzed a total of 413 subjects followed up 12 months after enrolment. The subjects were divided into two groups based on the need for educational support: support and non-support. In each group, we compared the subjects’ MetS conditions at baseline and 12 months later.<br><b>Results:</b> Thus, 88 subjects out of 413 were assigned to the support group. Among the support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism, blood pressure and accumulation of visceral fat between the baseline and follow-up checkups. Among the non-support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism and blood pressure between the baseline and follow-up checkups, but there were significant changes for the worse in accumulation of visceral fat with time.<br><b>Conclusion:</b> Unfortunately, the metabolic conditions of the rural subjects who participated in a new MetS screening and intervention program did not improve with time. Our findings underscore the importance of developing educational intervention programs to encourage the general population to modify their lifestyle and acquire healthier habits.
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Teaching hospitals play an increasingly important role in clinical training, and improvement of the education system is required. To effectively utilize limited human and material resources for clinical education and to enhance clinical education and medicine treatment throughout a region, cooperation between hospitals is essential. However, cooperation for clinical education training beyond prefectures or training hospitals cannot be said to be sufficient. The Kisogawa Medical Conference, a collaborative system of 5 training hospitals located around the Kiso River estuary, held medical lectures, hands–on seminars, and joint–hospital case conferences. Cooperation in medical education training and exchanges beyond prefectures and training hospitals is expected to lead to substantial improvements, not only in medical education training, but also in medical care throughout a region.