Takaya Kimata

End-of-life experience of demented elderly patients at home: findings from DEATH project

Background:  As the number of demented elderly patients choosing to die at home continues to rise, it is important to ascertain how cognitive impairment is associated with symptom experience and end‐of‐life care received at home. A number of studies have suggested that patients with dementia often receive poor end‐of‐life care, with inadequate pain or other symptom control, so far however, very little research has dealt with community settings. The aim of the present study is to compare symptom experience and end‐of‐life care received by home patients based on cognitive function.

Factors Associated with Self-rated Health in the Rural Population: Age- and Gender-specific Analysis

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Factors Associated with Self-rated Health of Rural Population: A Report from the Prospective Observational Study

Self-rated health (SRH) is a single question asking people to assess his or her overall health status, and is a widely used indicator of person’s perception of his or her own health1, 2). Although a number of studies have focused on the topic3,4,5,6), SRH is still an important study topic to enhance the quality of life among people. Especially, there are not sufficient data on factors associated with self-rated health in rural areas in Japan. Therefore, we previously performed a pilot retrospective study on the topic by using the Kyusyu Asakura Project (KAP) data7). The KAP is an observational cohort study of all users who underwent an annual health check-up at a public clinic in Asakura City (Kyushu region, Western Japan) from 2009 to 2016. KAP included a questionnaire survey, and the items were age, sex, somatometry, family budget conditions, family structure, SRH, whether or not attending a hospital or clinic regularly, medication related to life-related disease, eating habits, exercise habits, Geriatric Depression Scale 5 (GDS5) 8). As the results of the pilot study, there were statistically significant differences in regular hospital or clinic attendance between the high and low SRH groups, while there were no significant differences in eating or exercise habits between the two SRH groups. To confirm the results of the retrospective analysis7), we revised the questionnaire adding additional items such as subjective symptoms, comorbid diseases, smoking habit, and drinking habit, and performed the prospective study by using the KAP data from April 2012 to January 2013. As the same as the retrospective study, we defined the subjects who responded yes to the above-mentioned SRH related question as high SRH group, and no as low SRH group. And then, we compared the data between high and low SRH groups. We used t-test for continuous value, and chi-square test for discontinuous value. A P-value less than 0.05 was considered statistically significant. We used IBM SPSS statistics 20 as statistics software. After excluding one hundred fifty five subjects whose SRH related data was missing from the present analysis, we analyzed the data of 818 subjects (155 men aged less than 65, 189 women aged less than 65, 230 men aged 65 and over, 244 women aged 65 and over). The characteristics and results of the study subjects are shown in Table 1. Two thirds of the subjects have a high SRH (67.4%). More subjects in high SRH group were involved in farming. The subjects in low SRH group were more likely to have some subjective distress symptoms including headache, dizziness, general fatigue, pain in the lower back, shoulder or neck, insomnia, or constipation. The subjects in low SRH group were likely to have heart disease, diabetes mellitus, hypertension or hyperlipidemia. Although there were no significant differences in eating, smoking or drinking habits between the two SRH groups in all the four categories, the subjects in high SRH group had exercise habits. There are statistically significant differences in GDS5 scores between high and low SRH groups. Table 1 Characteristics and lifestyle-related habits of study participants according to self-related health (SRH) (n=818) Our results of the prospective study added several new evidences to the retrospective study. As mentioned above, there are significant differences in the prevalence of some subjective distress symptoms including headache, dizziness, general fatigue, pain in the lower back, shoulder or neck, insomnia, or constipation between high and low SRH groups. Paying attention to and controlling such distress symptoms possibly contributes to good SRH and quality of life. Also, our results suggested that the presence of chronic health problems for the persons is strongly related to low SRH. It is natural that the persons think their own health conditions are not good. As previously stated in the retrospective study7), there are some previous studies to support our results. Our results confirmed proceeding studies results and implied that rural physicians should give their patients not only an explanation of health conditions but also emotional or psychological support to deal with their own health problems positively. Although we observed in the retrospective study7) that there were little relation between healthy life habits and good SRH, there were relation between exercise habits and good SRH. In addition, Igarashi and Iijima suggested that the persons’ SRH is not affected by each life-style factor such as diet or exercise habits, but by mental factors such as life satisfaction or general health image9). It seems controversial whether there is relation between exercise habits and good SRH or not so far. Additional studies are needed to confirm our results. Our results suggested that depressive mood shown by GDS5 scores is negatively related to good SRH. In our retrospective study, the relation was observed only among the female population aged less than 65 years old. Although we do not show the results, our results of the present study suggested that depressive mood shown by GDS5 scores is negatively related to good SRH in all age- or gender- categories (men aged less than 65, women aged less than 65, men aged 65 and over, women aged 65 and over). Thus, by the present study which is larger scale than the retrospective study, we can confirm that depressive mood shown by GDS5 scores is negatively related to good SRH regardless of age or gender. In conclusion, we conducted the larger-scale study than our retrospective study7), including several important factors possibly associated with SRH, such as history of smoking. Because the study was biased because only a portion of Asakura city’s population underwent a check-up and was therefore included in the data, our results should thus be generalized with caution. However, by the present study, we finally responded several questions which arose from the retrospective study and remain unanswered.

Qualitative Modeling of Burden and Distress among Home Helpers in Japan

Although a number of studies have explored the issue of home help service for elderly care, very few studies have deeply investigated the emotional or psychological wellbeing of home helpers; in Japan specifically, the burden and distress of home helpers is still unknown. The present study aims to reveal the emotional and psychological profile of home helpers.

Short- and Long-Term Effects of Workshop-Style Educational Program on Long-Term Care Leaders ’ Attitudes toward Facility End-of-Life Care

Background: Although the proper training of caring staff is required, very few studies have actually focused on the effects of caring staff educational programs on end-of-life care at long-term care facilities. The aim of the present study was to test a pilot caring staff education program emphasizing quality end-of-life care for elderly residents at long-term care facilities. Method: The workshop program was designed by an expert panel made up of long-term care educational leaders from 8 selected long-term care facilities. The topics of the program were: (1) definition of end of life of the elderly, (2) signs and symptoms of imminent death, (3) advanced care planning, (4) issues related to tube feeding, (5) communication with family members of end-of-life residents, (6) communication with bed-ridden elderly, and (7) staff education concerning key elements in the provision of end-of-life care for elderly residents. Study questionnaires were administered to participants both before and after the educational intervention. The questionnaires included two major sets of questions: the Frommelt Attitude toward Care of the Dying scale, Form B, Japanese version and the Death Attitude Inventory. Six months after the intervention, the same questionnaire was mailed to the participants. Result: A total of two hundred and forty seven care leaders participated in the program. Two hundred and forty care leaders completed pre- and post-questionnaires. Out of these, 226 completed a follow-up questionnaire six months after the program. Our six month follow-up data confirms improvements in the participants’ attitudes toward end-of-life care provision at long-term care facilities. Our data also indicates an improved outlook on caring for the dying patient and the maintenance of a positive perception of patient- and family-centered care. Conclusion: Our workshop-style educational program had positive short- and long-term effects on long-term care leaders’ attitudes toward facility end-of-life care.

Influence of nutritional status on early outcomes of elderly patients admitted with acute myocardial infarction

Background:  The impact of malnutrition on early outcomes has not been studied widely in acute myocardial infarction (AMI). This study aimed at determining the effect of malnutrition on in‐hospital mortality or duration of hospital stay in the elderly AMI patient.

Current Challenges in Home Nutrition Services for Frail Older Adults in Japan—A Qualitative Research Study from the Point of View of Care Managers

Preventive care for frail older adults includes providing tailor-made diet information suited to their health conditions. The present study aims to explore the current situation and challenges of home nutrition advice for Japanese frail older adults using qualitative data from a ten-person group discussion among care managers. As the results of our analysis, nine themes were identified: (1) Homebound older adults develop poor eating habits; meals turn into a lonely and unpleasant experience; (2) With age, people’s eating and drinking patterns tend to deteriorate; (3) Many older adults and their family know little about food management according to condition and medication; (4) Many older adults do not understand the importance of maintaining a proper diet; (5) Many homebound older adults do not worry about oral hygiene and swallowing ability; (6) Some older adults are at high risk for food safety problems; (7) Only a limited range of boil-in-the-bag meal options are available for older adults; (8) Many older adults feel unduly confident in their own nutrition management skills; and (9) For many family caregivers, nutrition management is a burden. We conclude that the provision of tailor-made information by skilled dietitians and high-quality home-delivered meal service are essential for the successful nutrition management of the older adults.

Age-related differences in clinical characteristics, early outcomes and cardiac management of acute myocardial infarction in Japan: Lessons from the Tokai Acute Myocardial Infarction Study (TAMIS)

Recent data suggest substantial variations in the treatment strategies for patients with acute myocardial infarction (AMI) based on age. This study aimed to compare the management and early outcomes of AMI across age groups in Japan. Data from 13 acute care hospitals that were included in the Tokai Acute Myocardial Infarction Study sample were used. This is a retrospective study of all patients admitted to the hospitals with the diagnosis of AMI from 1995–1997. We abstracted the baseline and procedural characteristics from detailed chart reviews. Patients were stratified into four age categories: up to 64; 65–74; 75–84; and 85 or more years of age. A total of 966 patients were aged up to 64 years, 608 were 65–74 years, 365 were 75–84 years, and 79 were 85 or more years. The rates at which the treadmill test, coronary angiography and percutaneous coronary intervention were performed decreased with advancing age (−14%, P < 0.01; −55%, P < 0.01; and −42%, P < 0.01, respectively, for the up to 64‐year‐old vs 85‐year‐old or more groups). Thrombolytic therapy was less often prescribed in the older groups (P < 0.01). At discharge, aspirin, β‐blockers, angiotensin‐converting enzyme inhibitors, nitrates, calcium antagonists, and anti‐hyperlipidemics were prescribed less often in the older groups (P < 0.01, <0.05, <0.01, <0.01, <0.01, <0.01, respectively), while diuretics were prescribed more often in the older groups (P < 0.01). Our results suggest that fewer elderly patients were under‐treated and had a significantly higher risk of in‐hospital mortality.

Factors associated with change in walking ability in very elderly patients hospitalized for acute myocardial infarction

Background:  The aim of this substudy was to identify the predictors of a lesser ability to walk in very elderly patients with acute myocardial infarction (AMI).

Factors associated with use of percutaneous coronary intervention among very elderly patients with acute myocardial infarction: Lessons from the Tokai Acute Myocardial Infarction Study (TAMIS)

Background:  Although prior studies have shown that older patients with acute myocardial infarction (AMI) are less likely to receive percutaneous coronary intervention (PCI) than younger patients, the predictors of PCI use among the very elderly are unknown. We identified the predictors using data from the Tokai Acute Myocardial Infarction Study (TAMIS), a multi‐hospital retrospective study performed in Japan.