Pain Management of Community-dwelling Older Adults with Dementia Practiced by Visiting Nurses

To clarify nursing practices in pain management of community-dwelling older adults with dementia by visiting nurses, we conducted semi-structured interviews with 10 visiting nurses and analyzed their responses qualitatively and inductively. As a result, 24 subcategories and 8 categories were identified. Visiting nurses were found to conduct pain assessment and assessment based on behavioral changes in usual daily life because of characteristics of health assessment in home care, in which the goal is to comprehensively support clients as living people, in addition to standard pain management of older people with dementia. The results suggest that the viewpoint to integrate information from other professionals and family members and assess daily life comprehensively is important, and some mechanism to facilitate multidisciplinary information sharing is required. When visiting nurses were unsure of whether a patient is in pain, they evaluated the patient’s pain on the basis of behavioral changes in his or her normal daily life after medication or nondrug treatment. A nationwide survey is necessary for further clarification.

Intervention and Implementation Studies on Integrated Care Pathway for End-of-Life Care in Long-term Care Facilities: A Scoping Review

Purpose: Integrated care pathway (ICP) is structured multidisciplinary care plan that aim to improve the quality of care. ICP could be effective in providing quality End-of-Life (EOL) care in long-term care facilities (LTCFs). However, the outcomes and components of ICP for EOL care in LTCFs are not clear. Methods: We conducted a scoping review to identify the outcomes and components. We searched electronic databases (PubMed, CINAHL, Cochrane Library, PsycINFO, Ichushi) and conducted an additional hand search for relevant journal articles related to EOL care. We searched intervention and implementation studies for ICP in EOL care in LTCFs. Results: Thirteen papers met the inclusion criteria. We identified the following components of ICP: documents, education regarding EOL care and ICP, support by experts, and regular conferences among care providers. The effects of ICP were reported as reductions in transfers to hospitals and improvement in staff confidence regarding EOL care. Conclusion: With reference to the components of ICP identified in this study, ICP should be developed based on the characteristics of LTCFs, and the effects of intervention or implementation studies using a more robust design should be examined.

Dementia Provision for Elderly Cancer Patients in Designated Regional Cancer Centers

<p>The aim of this study was to investigate the dementia provision for elderly cancer patients in designated regional cancer centers. A survey was mailed to 389 designated regional cancer centers from February to June, 2015. A total of 188 facilities responded (response rate: 48.3%). 5.3% of the respondents used two manuals (on basic dementia care and the behavioral and psychological symptoms of dementia) to check whether these centers were following appropriate measures. About 50% of the respondents performed dementia assessments by the primary care team. 29.3% of the respondents maintained the system of the education and training of dementia care. Therefore, dementia provision for elderly cancer patients in designated regional cancer centers needs to improve the education of dementia care.</p>

The burden of introducing the Japanese language version of the Liverpool Care Pathway（LCP-J）for dying patients in general wards and their families：experience of health care professionals in a university hospital

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

Development and Feasibility of the Japanese language version Liverpool Care Pathway for the Dying Patient－Home

<b>Background:</b> The aim of this study was to develop the Japanese language version of the Liverpool Care Pathway － Home (LCP－H), and to examine the feasibility of the LCP－H in a pilot study. <b>Methods:</b> LCP－H was administered to cancer patients who were predicted to be in their last few days. We evaluated the achieved care goals of LCP－H. A cross－sectional anonymous questionnaire was administered to home nurses who used LCP－H to evaluate usefulness in using LCP－H. <b>Results:</b> LCP－H was used to 35 patients. The care goals of LCP－H were achieved in almost 80%. The nurses evaluated the usefulness of LCP－H: Providing to continuous end－of－life care each staff, Communication well between home nurses and co－medical home staff, and Education for home nurses with limited experience with end－of－life care. <b>Conclusion:</b> The feasibility of LCP－H was confirmed. Therefore, LCP－H should help home nurses to care for dying patients and their families as guide for end－of－life care in home, and improve the quality of end－of－life care in home. However, because the LCP is now being phased out in the UK, it may be necessary to develop an original education tool to assist in care for dying patients and their families in Japan.

Factors affecting death at home

This ecological study revealed the relationship between the percentage of death at home and medical and socioeconomic characteristics. This study was a secondary analysis of national data from the Population Survey Report in 2010 and government statistics in Japan. This data was analyzed by exploratory factor analysis and multiple linear regression analysis. As a result of exploratory factor analysis, medical and social characteristics are classified in three domains, “depopulation and aging”, “hospital and medical facility resources” and “access for home medical care”. By multiple linear regression analysis using results of exploratory factor analysis, cancer death was associated with “access for home medical care” and death from all causes was associated with “hospital and medical facility resources” and “access for home medical care”. In conclusion, death at home in cancer patients was strongly affected by “access for home medical care”. Death at home from all causes was due to poor hospital and medical facility resources and good access to home medical.