Use of artificial hydration in patients diagnosed with senility as the cause of death by home care physicians: A cross₋sectional study.

Background: The aim of this study was to investigate the frequency, effectiveness, and reasons for the use of artificial hydration (AH) in senile patients in the last week, and patient-related factors associated with its usage. Methods: Between April and May 2023, I conducted a cross₋sectional study among medical institutions affiliated with the Japan Network of Home Care Supporting Clinics. Eligible cases included those in which senility was listed as the cause of death on the death certificate from January 1, 2022, to December 31, 2022. The questions asked use of AH, reasons for AH, and symptoms that improved or worsened with AH. Patient characteristics, including age, gender, place of death, length of treatment, and complication of dementia, were also asked. Descriptive statistics were performed. Univariate and multivariate analyses were conducted to examine the association between patient characteristics and the use of AH. Results: Eighty-three medical institutions (12.5%) provided responses, contributing a total of 714 cases. AH was administered in 236 cases (33.1%). The most common reason was "due to family preference" in 110 cases (46.6%). One hundred thirty-five cases (57.2%) reported "no improved symptoms," while symptom worsening was reported as "no worsened symptoms" in 176 cases (74.6%). Multivariate analysis on 699 cases using complete-case analysis identified age (risk ratio [RR]:0.98, 95% confidence interval [CI]: 0.96-0.99) and female (RR:0.73, 95% CI:0.58-0.92) as factors associated with the use of AH. Conclusion: This study revealed that AH was commonly used based on family preferences and to alleviate psychological burdens on the family.

Senility deaths in aged societies: The case of Japan.

Senility is now the third largest cause of death in Japan, comprising 11.4% of the total number of deaths in 2022. Although senility deaths were common in the period before the Second World War, they declined sharply from 1950 to 2000 and then increased up to the present. The recent increase is more than what we could expect from an increasing number of very old persons or the increasing number of deaths at facilities. The senility death description in the death certificate is becoming poorer, with 93.8% of them only with a single entry of "senility". If other diseases are mentioned, those are again vague diseases or conditions. Senility, dementia and Alzheimer's disease, sequelae of cerebrovascular disease, and heart failure are the largest causes of death in which senility is mentioned in the death certificate. The period from senility onset to death is often described within a few months, but it varies. In some cases, the deceased's age was written out of a conviction that the ageing process starts from birth. As senility is perceived differently among the certifying doctors, a standardised protocol to certify the senility death is needed. On the other hand, senility death is the preferred cause of death and many people do not wish to receive invasive medical examinations before dying peacefully. Together with other causes of death related to frailty, there would be a need to capture senility as a proper cause of death, not just as a garbage code, in the aged, low-mortality population.

Home death is associated with frequency of physician home medical care visits: a questionnaire survey on communications in home medical care settings.

AIM: To investigate the factors related to communications in home medical care settings, and the association between such factors and a patient's place of death. METHODS: A questionnaire survey of 295 families of patients who had previously received home medical care was carried out in June and July 2011. The response rate was 83.8% (n = 227). Following the exclusion of families where the patient was still alive, or where the place of death was unknown, 143 questionnaires were available for analysis. Logistic regression was used to identify significant associations between possible factors related to communication and occurrence of home death. RESULTS: Home death was observed in 66.4% (n = 95) of the families analyzed. Home death was significantly associated with the frequency of doctor home-visits per week (OR 2.835, 95% CI 1.436-5.597, P = 0.003). There was no statistically significant association between home death and any of the other variables included: malignant tumors as primary disease, independence in daily activity, duration of home medical care, duration of doctor's visits, experience of doctor-patient communication without family, doctor-family communication without the patient or explanation from the doctor on the phone, existence of home-visit nursing services, existence of family's anxieties and/or questions, age of primary caregiver(s) and sex of primary caregiver(s). CONCLUSION: The frequency of doctor home-visits was the only factor identified that was positively associated with the occurrence of home death in home medical care settings.

Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

[A case of ventriculo-atrial shunt infection diagnosed by blood culture and serial cerebrospinal fluid protein measurement].

Ventriculo-atrial shunt infection (VASI) may lead to sepsis and/or nephritis, making early diagnosis critical. VASI is usually diagnosed by cerebrospinal fluid culture conducted after ventricular puncture or shunt removal, both of which are invasive. Non-invasive attempts at diagnosis, however, present a nonspecific clinical picture unless shunt dysfunction is present. A 57-year-old woman treated with ventriculo-atrial shunt 10 months earlier due to hydrocephalus following subarachnoid hemorrhage developed a fever but evidenced no infected organs in general examination although Staphylococcus epidermidis was isolated several times upon blood culture. Enhanced brain computed tomography (CT) showed neither abnormal findings nor changes in ventricular size and no shunt dysfunction was demonstrated clinically. In cerebrospinal fluid examination, the protein level was 137 mg/dL and cell count and bacteriological findings were normal. 10 days later, however, the cell count and bacteriological findings were normal but protein was 180 mg/dL. The cerebrospinal fluid protein increase indicated VASI, and the shunt was removed. The woman's fever was immediately alleviated and Staphylococcus epidermidis was detected in the cerebrospinal fluid culture of the specimen from the shunt tip and its periphery. Blood culture is useful for identifying bacterial etiology of VASI if neither cerebrospinal fluid cell count increases nor abnormal bacteriological findings are observed, provided that cerebrospinal fluid protein increase are observed in serial measurement.