[Perspectives of Japanese home care supporting clinics in Tokyo on the conditions needed to continue home care].

We examined the conditions that had to be met to continue home care according to Japanese home care supporting clinics from Tokyo's perspective. Aspects of the conditions for continuing home care were as follows: 1) enhanced partnerships with the hospital and home-visit nursing stations, 2) a reduced burden on 24-hour-a-day home care, 3) promotion of training and education of medical personnel in the home care setting, 4) training and education of caregivers to provide direct care to the patient, and 5) reduced caregiver burden.

[Analyses of the activities of home care supporting clinics in Tokyo from the standpoint of place of death].

We examined the activities of home care supporting clinics (HCSC) in Tokyo, Japan, from the standpoint of the place of death. The number of HCSCs in Tokyo was 1,246 in 2010. Fifteen HCSCs cared for > or = 50 patients who died at home in a year. In contrast, the 19 HCSCs in the top 10 percentile for the number of patients (> or = 176) did not have any patients who died at home. Their patients died at hospitals or facilities. These results suggest that the activities of HCSCs in Tokyo are diverse.

[Applicability of the scale for measuring the quality of end-of-life home-care services provided by home-care supporting clinics in Japan(HCSC-J)].

We examined the applicability of the home-care supporting clinics in Japan(HCSC-J)scale to measure the quality of home-care services provided by HCSC. We conducted an anonymous mailed survey of 349 bereaved family members who received home-care services in 23 wards of HCSC in Tokyo, Japan. Of 143 responders, 77(clinic A: 44; clinic B: 33)were finally evaluated. The total scores of the HCSC-J subscale revealed a significant correlation with the overall assessment of home care. Our results suggest that the HCSC-J scale is effective for measuring the quality of home-care services of HCSC in Japan.

Trends associated with Home Care Supporting Clinics (HCSCs) in Japan.

AIM: HCSCs were introduced in Japan in April 2006 with the aim of playing a central role in providing end-of-life care at home. However, it is unclear how the HCSCs are operated because statistical data regarding their activities have not been disclosed to the Japanese public. The purpose of this study was to describe the trends associated with the HCSC activity in Tokyo, Japan. METHODS: We submitted an application to the relevant government ministry to disclose the annual activity reports from 2008 to 2010 of the HCSCs located in Tokyo. Reports from each HCSC contained information on the number of patients, the number of deceased patients, their place of death and the number of home visits by physicians and nurses. RESULTS: The number of HCSC activity reports for each year was 1166 (2008), 1209 (2009) and 1246 (2010), while the total number of patients for each year was 67,765 (2008), 67,094 (2009) and 83,486 (2010). Patients who died at home each year under the care of HCSCs was 4431 (2008), 4786 (2009) and 5234 (2010). It is of note that in 2010 about 87% of patients were cared by HCSCs that cared for >50 patients a year and as many as 26.9% of patients who died at home utilized clinics that cared for >50 deceased patients a year. CONCLUSION: The advent of HCSCs caring yearly for >50 patients and deceased patients has led to a shift in the location in which patients receive end-of-life care.

[Yearly change of the relationship between the place of death and activity of home care supporting clinics in Tokyo, Japan].

We examined a yearly change of the relationship between the place of death and the activity of home care supporting clinics(HCSC)in Tokyo, Japan. The number of HCSCs by the Japanese Ministry of Health, Labor and Welfare has edged up slightly from 1, 166 in 2008 to 1, 246 in 2010. The number of total patients provided the care by HCSC has increased by 24. 4% from 2009 to 2010. There was a 9. 3% increase in the patients provided the care by HCSC, and died at home from 2009 to 2010. These results suggested that the home care support system has proceeded gradually in Tokyo, Japan.

Factors influencing home death in a Japanese metropolitan region.

To examine factors influencing home death, an anonymous survey was mailed to 998 home care supporting clinics (HCSCs) in the 23 wards of Tokyo, Japan. We classified the HCSCs into two types (single physician practice and multiple physician practice) and identified factors of each type of practice that predict home death. The factors associated with a greater probability of dying at home were as follows: in the multiple physician practices, collaboration with hospitals and teaching coping skills to the family members and, in the single physician practices, collaboration with clinics. Our findings suggest that home end-of-life care services are unlikely to be achieved without cooperation among service providers and without improvement of the family members' coping skills.

Characteristics of home care supporting clinics providing home care for frail elderly persons living alone in Japan.

To explore the characteristics of home care supporting clinics providing home care for frail elderly persons living alone (EPLA), a self-administered questionnaire was mailed to 998 home care supporting clinics in the 23 wards of Tokyo, Japan between July and August 2009. Clinics providing home care for the frail EPLA significantly collaborated with 4 or more home visit nursing stations (42.5%) and 4 or more care managers (58.7%) and had sufficient medical care equipment, such as an oxygen inhaler, ventilator, and intravenous hyperalimentation. Sixty-one percent of the clinics which provided care for the 18 patients who died at home collaborated with 4 or more care managers. Our findings suggest that the factors enabling home care for frail EPLA are as follows: (1) collaboration with care managers, (2) collaboration with home visit nursing stations, (3) sufficient medical care equipment.

Issues facing home-based medical support services.

The first part of the present review describes the current status of elderly people with behavioral and psychological symptoms of dementia (BPSD) in the community and basic viewpoints for differentiating between different forms of dementia. Specifically, it focuses on four points among the data and research related to determining the current status of elderly people with BPSD. We also propose basic concepts for differentiating between the core symptoms of dementia and BPSD, BPSD and delirium, and agitation and delirium. In the second part of the present review, various aspects of the symptom 'agitation' are discussed based on the experience of our home visit medical service for people with dementia by describing two cases. In cases such as Case 1, where the subject was given high doses of antipsychotics, we believe the problem was that the physicians immediately abstracted all of the abnormal behavior in the subject's life as 'agitation', and provided treatment to the subject accordingly. In Case 2, where the subject had dementia with Lewy bodies (DLB), we propose that it is crucial to differentiate clearly between agitation and delirium. Both of these cases show the risks of focusing treatment simply on agitation. When BPSD occurs in a person with dementia, the burden on caregivers increases. At such times, physicians tend to side with the family rather than with the patient. However, medical care is intended to be for the afflicted person, and physicians should base their plans for medical intervention on this principle.

The Tokyo Oldest Old survey on Total Health (TOOTH): a longitudinal cohort study of multidimensional components of health and well-being.

BACKGROUND: With the rapid worldwide increase in the oldest old population, considerable concern has arisen about the social and economic burden of diseases and disability in this age group. Understanding of multidimensional structure of health and its life-course trajectory is an essential prerequisite for effective health care delivery. Therefore, we organized an interdisciplinary research team consisting of geriatricians, dentists, psychologists, sociologists, and epidemiologists to conduct a longitudinal observational study. METHODS/DESIGN: For the Tokyo Oldest Old Survey on Total Health (TOOTH) study, a random sample of inhabitants of the city of Tokyo, aged 85 years or older, was drawn from the basic city registry. The baseline comprehensive assessment consists of an in-home interview, a self-administered questionnaire, and a medical/dental examination. To perform a wide variety of biomedical measurements, including carotid ultrasonography and a detailed dental examination, participants were invited to our study center at Keio University Hospital. For those who were not able to visit the study center, we provided the option of a home-based examination, in which participants were simultaneously visited by a geriatrician and a dentist. Of 2875 eligible individuals, a total of 1152 people were recruited, of which 542 completed both the in-home interview and the medical/dental examination, with 442 completed the in-home interview only, and another 168 completed self or proxy-administered data collection only. Carotid ultrasonography was completed in 458 subjects, which was 99.6% of the clinic visitors (n = 460). Masticatory assessment using a colour-changeable chewing gum was completed in 421 subjects, a 91.5% of the clinic visitors. DISCUSSION: Our results demonstrated the feasibility of a new comprehensive study that incorporated non-invasive measurements of subclinical diseases and a detailed dental examination aiming at community-dwelling individuals aged 85 years or older. The bimodal recruitment strategy is critically important to capture a broad range of health profiles among the oldest old. Results form the TOOTH study will help develop new models of health promotion, which are expected to contribute to an improvement in lifelong health and well-being.

[Relationship between the activity of home care supporting clinics and the place of death in Tokyo, Japan].

We examined the relation between the activity of home care supporting clinics and the place of death in Tokyo, Japan. Of 1,209 clinics certified home care supporting clinics by the Japanese Ministry of Health, Labor and Welfare, 9.1% were not functioning for a year and 34.7% of them did not deal with patient's home death. Of patients who died at home, 64.3% utilized home care supporting clinics which dealt with 11 or more patient's death at home per year.

[A newly opened palliative care ward and the nursing of terminal patients with gynecological cancer at our Department of Obstetrics and Gynecology in Tokyo Women's Medical University Hospital].

Seventy-nine terminal patients with gynecological cancer treated in the past 5 years in our hospital or their families were interviewed on where those patients died and the reason why they chose to die in the place. Fifty-two patients (65.8%) were died at our hospital, 18 patients (22.8%) at other hospitals, 5 (6.3%) at other hospice and 4 (5.1%) at home. The 52 patients who died at our hospital were asked why they chose to die there. 42 of them (80.8%) wanted care at our hospital to the death. 10 (20.2%) had no time to think of home care or other institutions because of the sudden change of the condition. The 18 patients who died at other institutions were also asked about the reason. 9 of them (50%) wanted to die in their hometown or close to their home. 5 of them (27.8%) were referred to other hospitals due to brain metastasis or the necessity of undergoing dialysis. 2 of them (11.1%) were referred to the institutions which provide long-term care. 2 of them (11.1%) were brought into a nearby emergent care hospital and died after the sudden change of the condition. The palliative care ward in our university hospital can provide continued relationship with cancer patients. We had time to talk enough with carcinoma patients and their family in the ward, which widened choices of their death place, including home death.

[A newly opened palliative care ward and the nursing of terminal patients with gynecological cancer at our Department of Obstetrics and Gynecology in Tokyo Women's Medical University Hospital].

Seventy-nine terminal patients with gynecological cancer treated in the past 5 years in our hospital or their families were interviewed on where those patients died and the reason why they chose to die in the place. Fifty-two patients (65.8%) died at our hospital, 18 patients (22.8%) at other hospitals, 5 (6.3%) at other hospice and 4 (5.1%) at home. The 52 patients who died at our hospital were asked why they chose to die there. 42 of them (80.8%) wanted care at our hospital to the death. 10 (20.2%) had no time to think of home care or other institutions because of the sudden change of the condition. The 18 patients who died at other institutions were also asked about the reason. 9 of them (50%) wanted to die in their hometown or close to their home. 5 of them (27.8%) were referred to other hospitals due to brain metastasis or the necessity of undergoing dialysis. 2 of them (11.1%) were referred to the institutions which provide long-term care. 2 of them (11.1%) were brought into a nearby emergent care hospital and died after the sudden change of the condition. The palliative care ward in our university hospital can provide continued relationship with cancer patients. We had time to talk enough with carcinoma patients and their family in the ward, which widened choices of their death place, including home death.