Yuichiro Masuda

Underuse of medications for chronic diseases in the oldest of community-dwelling older frail Japanese

OBJECTIVES: To test the following hypotheses: (1) the rate of polypharmacy, defined as six or more prescribing medications, is lower in the oldest old (≥85) than in younger older people (65–84); (2) beneficial medication use is lower in the oldest old; (3) the underuse of these medications in the oldest old is associated with physical or cognitive impairment or comorbid conditions.

Day Care Service Use Is Associated with Lower Mortality in Community‐Dwelling Frail Older People

OBJECTIVES: To clarify the association between day care service use and 21‐month mortality in community‐dwelling frail older people.

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.

Director perceptions of end-of-life care at geriatric health services facilities in Japan

Geriatric health services facilities (GHSF) are expected to assume a greater role in caring for the dying elderly in the future. However, very little research has dealt with the topic. The aim of this nationwide study is to clarify current end‐of‐life care policies and practices of GHSF. The subjects were 2876 managing directors of GHSF. Data was collected through mailed questionnaires in 2003. The content of the questionnaires included: (i) general characteristics; (ii) end‐of‐life care policies; (iii) available medical treatments; and (iv) staff education. To evaluate the factors associated with end‐of‐life care policies at GHSF, we divided the facilities into two groups, according to whether their policy toward end‐of‐life care was progressive or regressive. The response rate was 40.3%. The results indicated that a total of 513 GHSF implemented progressive policies for end‐of‐life care. The factors associated with a progressive policy for end‐of‐life care were: (i) availability of medical intervention within and outside of the facilities; (ii) staff education; and (iii) discussion about end‐of‐life care policy with residents and family. Duration of stay also was positively associated with a progressive policy. Our study highlights the need for a national consensus on reforming the end‐of‐life care system of long‐term care facilities.

Regional variations in medical expenditure and hospitalization days for heart attack patients in Japan: evidence from the Tokai Acute Myocardial Study (TAMIS)

In Japan, the use of percutaneous transluminal coronary angioplasty (PTCA) for the treatment of acute myocardial infarction (AMI) is extraordinarily frequent, resulting in large medical expenditure. Using chart-based data and exploiting regional variations, we explore what factors explain the frequent use of PTCA, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving PTCA is affected by the density of medical resources in a region. Moreover, expenditure is higher for treated patients while there are no significant differences in hospitalization days, implying that the frequent use of PTCA is economically motivated.

Effect of death education on self-determination in medical treatment in university students

Background:  Young people have little opportunity to acquire knowledge about or to determine in advance their medical preferences regarding their own end‐of‐life situation, including diagnosis disclosure and/or organ donation. Therefore a 90 min university‐level death education lecture was presented, which was designed to allow students to examine their attitudes regarding medical autonomy and to prepare themselves to make realistic decisions.

Non‐medical palliative care and education to improve end‐of‐life care at geriatric health services facilities: A nationwide questionnaire survey of chief nurses

Background:  Geriatric health services facilities (GHSF) are expected to assume a growing role in caring for the dying elderly. However, research in this area has so far been scant. The purpose of the present study is to reveal the status of non‐medical palliative care and staff education aiming at improving and enhancing end‐of‐life care at GHSF.

Philadelphia Geriatric Center morale scale in a Japanese nursing home for the elderly

In Japan, nursing homes for the elderly are operated under the Elderly Persons’ Welfare Law. According to a 2002 Social Welfare Facilities Survey, 63 780 residents were living in nursing homes for the elderly in Japan. However, little information about the well-being of residents living in the homes has been reported so far. We interviewed nursing-home residents about their basic activities of daily living (ADL), cognitive impairment, depression and quality of life (QOL). Their basic ADL and cognitive impairment were assessed using the Barthel Index and Mini-Mental State Examination (MMSE). 1,2 The degree of depressive mood was assessed by a shortened version of the Geriatric Depression Scale (GDS-15). 3 QOL was evaluated by the Philadelphia Geriatric Center (PGC) morale scale. 4 Scores on the revised PGC morale scale were also calculated for comparison with previously reported results. 5 In addition, the residents were asked about their families and preference for some activities of life. Fifty residents in a municipal nursing home for the elderly were asked to participate. Data were collected from interviews with 44 residents; five of the other residents were absent at the time of interview and one declined to participate. The mean age of participants was 82.3 ± 6.2 SD, and 76.7% were female. The mean Barthel Index and MMSE scores were 18.7 ± 2.4 SD/20 and 23.2 ± 5.8 SD, respectively. The mean GDS-15 score of all patients was 6.7 ± 3.4 SD, and 47.7% of the patients scored above six. The mean score on the PGC morale scale was 12.8 ± 3.8 SD, and that on the revised PGC morale scale was 10.0 ± 3.3 SD. Table 1 shows the Pearson’s correlation coefficients among age, Barthel Index, MMSE, GDS-15 and the PGC morale scale. The PGC morale scale score correlated significantly with the Barthel Index and GDS-15 scores, but not with the MMSE score. Twenty percent of the residents had children, and 32% of them had grandchildren. Eleven percent of the interviewed residents had a living brother or sister. Only one resident had a spouse at the time of the interview. PGC morale scale scores did not differ significantly between residents who did or did not have children, grandchildren or siblings. The rates of the participants who prefer each activity and the contributions of their preferences to the PGC morale scale are shown in Table 2. Watching TV and listening to the radio were the most commonly enjoyed activities. There was no significant difference in the PGC morale scale scores between residents who enjoyed these activities and those who did not. Although the PGC morale scale has been used in many studies as an index to assess overall satisfaction of life, there are only a few articles in Japanese reporting on the PGC morale scale of residents living in nursing homes for the elderly (Asano & Tniguchi 1981; Hamada 1997; Shibuya & Mizutani 2001). The overall mean PGC morale scale score in the above three reports was 13.5 ( n = 464), being slightly higher than the results of this study. The mean score on the revised PGC morale scale was comparable to the score of 10.0 observed among the Japanese elderly living in a special nursing home, 6 but it was lower than the scores observed among community-dwelling elderly in other reports (in Maeda et al ., 5 Yasunaga et al ., 7 Nagata et al . 8 and Fukuda et al . 9

Influence of diabetes mellitus on caregiver burden in home care: A report based on the Nagoya Longitudinal Study of the Frail Elderly (NLS‐FE)

Background:  Because little attention has so far been paid to the impact of diabetes mellitus (DM) on caregiver burden in community settings, we sought to confirm the influence of DM on perceived caregiver burden among caregivers providing care to a home elderly person using data from the Nagoya Longitudinal Study of the Frail Elderly (NLS‐FE).

Age-related differences in care receipt and symptom experience of elderly cancer patients dying at home : Lessons from the DEATH project

Background:  Data on the differences between older and younger elderly cancer patients dying at home is sparse. To clarify age‐related differences in symptom experience and care receipt of elderly cancer patients at end‐of‐life, we conducted a subanalysis study of the Dying Elderly at Home (DEATH) project, a multicenter study of 240 elderly aged 65 and older dying at home.