Community-based Integrated Care System Research Articles

Individualized treatment of diabetes mellitus in older adults.

The population of older adults with diabetes mellitus is growing but heterogeneous. Because geriatric syndromes, comorbidity or multimorbidity, the complexity of glucose dynamics, and socioeconomic conditions are associated with the risk of severe hypoglycemia and mortality, these factors should be considered in individualized diabetes treatment. Because cognitive impairment and frailty have similar etiologies and risk factors, a common strategy can be implemented to address them through optimal glycemic control, management of vascular risk factors, diet, exercise, social participation, and support. To prevent frailty or sarcopenia, optimal energy intake, adequate protein and vitamin intake, and resistance or multi-component exercise are recommended. For hypoglycemic drug therapy, it is important to reduce hypoglycemia, to use sodium glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, taking into account the benefits for cardiovascular disease and the risk of adverse effects, and to simplify treatment to address poor adherence. Glycemic control goals for older adults with diabetes should be set according to three categories, based on cognitive function and activities of daily living, using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items. This categorization can be used to determine treatment strategies for diabetes when combined with the Comprehensive Geriatric Assessment (CGA). Based on the CGA, frailty prevention, treatment simplification, and social participation or services should be implemented for patients in Category II and above. Measures against hypoglycemia and for the prevention of cardiovascular disease and chronic kidney disease should also be promoted. Treatment based on categorization and CGA by multidisciplinary professionals would be an individualized treatment for older adults with diabetes. Geriatr Gerontol Int 2024; ••: ••-••.

Spatial accessibility of home visiting nursing: An exploratory ecological study.

Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community-based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities. We estimated the population-weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two-step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables. The PWSAI was median 9.0 [interquartile range: 6.2-11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015-1.076] and 1.021 [1.006-1.036], respectively. The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.

Usefulness of assessment of the Clinical Frailty Scale and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items at the time of initiation of maintenance hemodialysis in older patients with chronic kidney disease.

We examined whether the Clinical Frailty Scale (CFS), a widely adopted tool for stratifying the degree of frailty, and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21), a simple tool for simultaneous assessment of impaired cognition and impaired ADL, at the time of initiation of hemodialysis is useful tool of older patients for the outcome and prognosis. Data for 101 patients aged 75 years or older (mean age, 84.3 years) with ESRD who were initiated on hemodialysis and could be followed up for a period of 6 months were reviewed. The 6-month survival curves showed a significantly higher number of deaths in the frailty (CFS≥5) group than in the normal to vulnerable (CFS<5) group (p<0.01). The CFS level was also significantly higher (6.5±1.5) in patients who died within 6 months of dialysis initiation as compared with that (4.6±1.7) in patients who survived (p<0.01). On the other hand, the total score of DASC-21 was related to need for inpatient maintenance dialysis (p<0.01). The total score on the DASC-21 were found as showing significant correlations with the CFS level. The IADL outside the home was identified in the DASC-21 sub-analyses as being correlated with CFS. The CFS and the DASC-21 appeared to be a useful predictive tool of outcome and prognosis for older patients being initiated on hemodialysis. Assessment by the CFS or the DASC-21 might be useful for selecting the renal replacement therapy by shared decision-making and for advance care planning.

The relationship between DASC-8 categories and the effectiveness of education on insulin self-injection techniques in elderly patients with diabetes.

Education on insulin self-injection techniques is important for good glycemic control, but its effectiveness in some elderly patients is limited due to loss of cognitive function and impaired activities of daily living. We hypothesized that classification using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) would help identify elderly patients with diabetes who effectively learn self-injection techniques. Diabetes patients aged ≥ 65years who used a self-injection insulin pen were administered the DASC-8 and a questionnaire to evaluate insulin self-injection techniques, and then received technical education. The questionnaire was administered again 4months later, and patients were classified into the education-effective and education-ineffective groups. The achievement of HbA1c targets defined for each patient according to guidelines based on DASC-8 category was examined over 12months. 76 Japanese patients (median age 72.0years and 53.9% female) with DASC-8 categories I (n = 55), II (n = 13), and III (n = 8) were enrolled. In the education-effective group, the percentage of patients in category I was significantly higher than that of patients in category II or III (92.0% to 23.8%, P < 0.001). Category I was independently associated with education effectiveness (odds ratio 14.50, 95% confidence interval: 2.110-100.0, P = 0.007). Category I patients in the education-effective group showed significantly improved achievement of target HbA1c from baseline to the 12th month (from 27.6% to 62.1%, P = 0.008). The DASC-8 was a useful indicator for identifying elderly patients who would benefit from education on self-injection techniques. The online version contains supplementary material available at 10.1007/s13340-024-00710-z.

Challenges and solutions for discharge support of elderly people in the acute care ward: Interviews with community-based integrated care supporters and patients in Tokyo, Japan.

Japan, which has become the country with the longest-living people in the world due to rapid population aging, has an insurer function for each local government and socialized long-term care under a public system. Japan aims to build a Community-based Integrated Care System (CICS) for each municipality with the goal of integrating medical care and long-term care. However, despite the policy and management studies, the challenges and solutions for discharge support by the parties have not yet been clarified. This study aimed to obtain suggestions on challenges and solutions for discharge support in the acute care wards for the elderly for community-based integrated care support providers and patients in Kita Ward, Tokyo. Semi-structured interviews were conducted, and the obtained data were a priori analyzed by a deductive thematic analysis using a conceptual framework for integrated care based on the integrative functions of primary care. The challenges were found to include: i) disparity between medical and lifestyle perspectives, ii) competencies of medical and care workers at homes, iii) discharge support challenges related to the elderly themselves, iv) nursing care dependent on family; and v) the impact of payment of medical service in the health insurance system and payment of long-term care services. The solution that can be applied at the local government level was community connection. While aiming to build a CICS for each local government, there was a contradiction in that the challenges and solutions required examination at the national and prefectural levels.

Helping the Elderly Live Better With Dementia: Recent Developments in Japan’s Adult Guardianship System and Its Role in Geriatric Social Work Practice

With the rapid aging of Japanese society and increasing concerns over the welfare of people with psychiatric disorders, intellectual disability, and dementia, a renewed adult guardianship system based on the notion of respect for self-determination, the practical use of one’s remaining abilities, and re-socialization, has now been in place for 20 years. Japanese adult guardianship practices are understudied in English language literature; thus, this article presents an overview of recent developments in Japan’s adult guardianship system and geriatric social work initiatives adopted in Japan’s adult guardianship practice. The authors found that the guardianship system not only helped the elderly live better with dementia but also contributed to the realization of “ageing in place” in the community-based integrated care system.

Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital.

This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.

Development and verification of community development index for improving functioning of aged people in rural districts (third report): data collection and analysis system on social mutual aid are desired for community development for elderly persons living in rural districts.

The author conducted a survey on social mutual aid and the social stimulative effect of older adults living in a rural district, and compared young old and old-old persons to clarify the roles of public health nurses in promoting community development. A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted with 2,500 residents aged 65 years or older of City A in Akita Prefecture. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on "social mutual aid in the rural district". Responses were recorded on a Likert scale. As a result of factor analysis, the following four factors were extracted; [Blessing of a rural district and mutual help and assistance unique to a rural district], [Closeness of healthcare welfare service and family doctors in conjunction with their own health], [Decline of culture and community unique to rural districts accompanied by depopulation] and [Closeness of the town where they live]. Differences were observed in the closeness of social mutual aid and local societal stimulative effects, even between generations of old and old-old persons. In young-old persons, a negative correlation was observed between [Closeness of the town where they live] and other factors. In old-old persons, a negative correlation was found between [Decline of culture and community unique to rural districts accompanied by depopulation] and other factors. Since not only individual health indices but also local social mutual aid, which relates to individuals' influence on the construction of a Community-based Integrated Care System in a rural district, the author posits that a data collection and analysis system on social mutual aid would be beneficial for community development for older adults living in rural districts.

On-scene time delays for epileptic seizures in developed community-based integrated care system regions

BackgroundDelayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging. AimThis study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System. MethodsThis population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds (“Reduced region” and “Preserved region”, as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays. ResultsThis study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86–2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions. ConclusionOptimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.

Categorization using the Dementia Assessment Sheet for Community-Based Integrated Care System 8-items (DASC-8) based on cognitive function and activities of daily living predicts frailty, disability and mortality in older adults.

This longitudinal study aimed to determine whether categorization by the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is associated with risk of frailty onset, disability, and mortality. We analyzed longitudinal data from outpatients aged 65 years and older evaluated for the DASC-8 at the Frailty Clinic. The outcomes during the 3-year follow-up period were (Study A) frailty onset (Kihon Checklist ≥8) and (Study B) disability (new certification of nursing care needs) or mortality. Multivariate Cox regression analyses were performed to examine independent associations between the DASC-8 category and outcomes, and hazard ratios and 95% confidence intervals (CIs) were calculated after adjustment for age, sex, and the presence or absence of diabetes, hypertension, and dyslipidemia. (Study A) Out of the 216 patients without frailty in Categories I or II at baseline, 40 (20.4%) and 11 (55.0%) developed frailty, respectively. The adjusted hazard ratio was 3.62 (95% CI: 1.69-7.76, P < 0.001). (Study B) Out of the 350 patients who did not require long-term care at baseline, disability or death occurred for 20 (7.3%) in Category I, 14 (23.0%) in Category II, and 9 (56.3%) in Category III. The adjusted hazard ratios were 2.40 (Category I vs. II; 95% CI: 1.13-5.11, P = 0.023) and 5.43 (Category I vs. III; 95% CI: 2.23-13.3, P < 0.001). Categorization according to DASC-8 is associated with the risk of frailty, disability, and mortality in older patients. Geriatr Gerontol Int 2024; 24: 150-155.

Measurement of Five Emotions Defined by Traditional Chinese Medicine With a Focus on Preventing Mild Cognitive Impairment.

Objectives: This study aimed to develop a novel Measurement of the Five Emotions (MFE) based on traditional Chinese medicine for assessing cognitive impairment in elderly individuals. Methods: Surveys were collected from 184 participants, over 65years of age, who were residents of Kyoto City, Japan. The surveys included the Measurement of the Five Emotions (MFE) and the Dementia Assessment Sheet for the Community-based Integrated Care System (DASC-21). Item-total reliability and internal consistency reliability were assessed using Spearman's correlation test and Cronbach's alpha coefficient analysis. Factor analysis was conducted to identify the main factors related to the theoretically constructed emotional reaction patterns. Criterion-related validity was examined by investigating the correlation between the scores of the 2 surveys (MFE and DASC-21). Results: The factor analysis revealed that the final version of MFE consisted of 5 factors, which accounted for a cumulative contribution rate of 57.71%. The Cronbach's alpha coefficient reached .71, indicating satisfactory internal consistency. There was a negative correlation between the MFE and DASC-21 scores with a correlation coefficient of -.3149. Furthermore, when comparing participants with lower cognitive function (DASC-21 score >26) to those with higher cognitive function, MFE subscale scores in the emotions of "Sorrow" and "Thought" were significantly lower, suggesting that these particular emotions are related to cognitive impairment. These findings confirmed the reliability and the construct validity of the MFE. Conclusion: The criterion reliability and validity tests provided evidence for the construct validity of the MFE. The negative correlation (coefficient = -.3149) between MFE scores and DASC-21 scores suggested that MFE can serve as a scale for detecting cognitive impairment.

The framework for modern community medicine in Japan.

Along with the transition to depopulation and an aging society in Japan, the modification of community medicine and its related systems is required. With this in mind, the Japanese government has recently advocated two major plans: 'Community Healthcare Vision' and 'Community-based Integrated Care System'. This paper proposes a theoretical framework to understand modern community medicine based on the ongoing government plans. The key viewpoints consisting of the framework are 'community and/or region', 'care systematization,' and 'coworking with residents (citizens)'. This is expected to be useful for capturing and monitoring the whole picture of modern community medicine in Japan. Such modeling might aid in the future development of medicine and medical science, as in other developed countries.

End-of-life care management for older adults at home by multidisciplinary professionals in Japan.

Population aging is a global phenomenon, and there is an urgent need to establish community-based integrated care systems for a sustainable society. In particular, the needs of home-dwelling older adults are multifaceted, encompassing areas such as medical care, nursing care, and welfare. Therefore, it is necessary to implement comprehensive care management that utilizes social resources suitable for diverse needs. This study aims to comprehensively describe care management practices by various professionals for home-dwelling older adults in the end-of-life (EOL) period. This study adopted a qualitative analysis method using conventional content analysis. We conducted semi-structured interviews of 20 multidisciplinary professionals from February to March 2020. Multidisciplinary professionals ensured continuity of care by implementing care management as necessary when providing care to older adults who desired to stay at home until the end. Seven categories of EOL care management practices for home-dwelling older adults by multidisciplinary professionals were generated: (1) support to enable discharge to home; (2) decision-making support that captures the intention of the older adult without missing opportunities; (3) building a team system to realize the desired life and EOL; (4) family support for the entirety of the EOL period, (5) symptom control aimed at the realization of wishes; (6) emotional support for acceptance of the EOL period; (7) spiritual support. Multidisciplinary professionals, including care managers, collaborating in a mutually complementary manner by sharing a comprehensive understanding of care management might prevent knowledge fragmentation and ensure that older adults receive home-based EOL care.

Future perspective of psychiatric home-visit nursing provided by nursing stations in Japan.

Psychiatric home-visit nursing supports the lives of people with mental disorders in the community and plays an important role in the "community-based integrated care system" which is rapidly being implemented in Japan. Although the number of responsive home-visit nursing stations (HVNS) is increasing, the current situation of service provision has not yet been clarified. This study aimed to investigate the characteristics and difficulties of psychiatric home-visit nursing provided by HVNS. We further discussed future care provisions and service improvements. We conducted a questionnaire survey of 7,869 member stations of the National Association for Visiting Nurse Service; of this number 2,782 facilities (35.4%) responded. Of the 2,782 facilities, 1,613 (58.0%) provided psychiatric home-visit nursing. The HVNS that provided psychiatric home-visit nursing were diverse, and the percentage of users with mental disorders ranged widely. Majority of the HVNS reported having "difficulty in caring for users/families who refuse care" (56.3%), "difficulty in care for psychiatric symptoms" (54.0%), and "difficulty in assessment of psychiatric symptoms" (49.1%), with differences in difficulty depending on the percentage of psychiatric users. As user needs and HVNS characteristics diversify, it is necessary to take advantage of the characteristics of each station to develop consultation and training systems and collaborative network platforms within each community for future sustainable service provision.

Family caregiver’s concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment

BackgroundAlthough people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers’ anxiety over the individual’s unaccompanied out-of-home activities.MethodsIn December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers’ concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety.ResultsThe study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers’ no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81–10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97–5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72–7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06–57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87–5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43–4.72) and minor BPSD (OR 1.43, 95% CI 1.05–1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23–0.43).ConclusionsThe study found that family caregivers’ anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers’ anxiety and the individual’s engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual’s behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

Evaluation of Everyday Living Areas for Deinstitutionalized Community-Living People with Mental Illness

Deinstitutionalization of psychiatric care has been associated with increased homelessness, crime, and suicide, partly owing to insufficient, adequate, and accessible community resources. Therefore, appropriate resource placement is a key deinstitutionalization issue. The study’s aim was to identify residential group homes for people with mental illness in Kochi Prefecture, Japan, and the social resources necessary for social reintegration using a geographic information system (GIS). Everyday living areas (ELAs), as defined by the Japanese Community-Based Integrated Care System for People with Mental Illness (CICSM), were assessed using ELA location simulations. We used GIS to determine the spatial distribution of group homes, visiting nursing stations, psychiatric hospitals, daycare centers, and employment support offices. Following the CICSM definition of ELAs, we identified areas that people with mental illness could reach within 30 min on foot/by bicycle and counted the number of social resources in them. The ELA location simulation results suggest that policymakers should avoid uniform distribution of ELAs according to the CICSM definition. Establishing ELAs in suburban areas requires careful consideration of the available community resources, number of people with mental illness, existing support systems, and feasibility of the location.

Association of functional and cognitive impairment severity with discharge to long-term care facilities in older patients admitted to a general acute care hospital from home

BackgroundThe early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. MethodsIn this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. ResultsWe analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452–5.449). ConclusionPatients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home.

Predicting three categories of Dementia Assessment Sheet for Community-based Integrated Care System 8-items score-based glycemic targets using the number of animal names recalled.

The Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) assesses memory, orientation, instrumental activities of daily living and basic activities of daily living. Category I (DASC-8 score ≤10), category II (11 ≤ DASC-8 score ≤16) and category III (DASC-8 score ≥17) have been defined. Based on these categories, the glycemic targets in diabetes patients aged ≥65 years have been proposed by the Japan Diabetes Society and the Japan Geriatrics Society Joint Committee. DASC-8 is difficult to apply to patients without family members or supportive persons. We propose a verbal fluency test as the screening tool. We enrolled 69 inpatients aged ≥65 years with type 2 diabetes, who were administered the DASC-8 and VF tests, which included recalling animal names and common nouns starting with a specified letter in 1 min. The relationship between DASC-8 and verbal fluency test scores was investigated. Animal fluency correlated with DASC-8 scores after adjustment for patient characteristics. Animal scores correlated with orientation, instrumental activities of daily living and basic activities of daily living scores of DASC-8, and tended to show a relationship with DASC-8 memory scores. An animal score ≥8 predicted category I with a sensitivity of 89% and a specificity of 57%. An animal score ≤6 predicted category III with a sensitivity of 85% and a specificity of 67%. Animal scores would be useful in predicting the categories of DASC-8. Animal fluency could be a screening tool of DASC-8 when a patient's family member or supportive person is absent.

A Nursing Approach Toward Family Caregivers of Older Patients Suffering from Stroke at Home

Older patients who have experienced a stroke often suffer from after-effects and stay at home for long periods of time while undergoing treatment. In order for patients to continue living at home, they need not only appropriate medical nursing care but also support from their families. This study examined nursing approaches for family caregivers to enable older patients who have experienced a stroke to continue living at home while being cared for by their families. The Japanese Ichushi-Web database was searched, and 58 studies were analyzed. Two findings were obtained. The first was that one of the success factors for home care is getting a good grasp of family caregiving ability. This consists of “understanding of the high significance of existence of the family caregivers” and “recognizing the need to maintain and improve good family relationships”. The second was to provide specific support to ensure family caregivers’ abilities that can help with continued home care. This consists of “providing knowledge about illness and disability and teaching appropriate caregiving skills”, “providing emotional support and decision-making support for family caregivers” and “strengthening multidisciplinary cooperation and effective use of social resources”. With the community-based integrated care system underway, the results of this study on securing family caregiving abilities may contribute to improving the quality of life of older patients suffering from stroke living at home. Keywords: older patients with stroke, living at home, family caregiving ability, nursing approach

高齢期の地域居住継続における生活支援ハウスの役割

In order to establish “community-based integrated care systems”, housing for those who find it difficult to remain in their homes should be provided. This study focused on Life Support House (LSH). Based on results, the role of LSH for residents to live continuously in their communities can be properly assessed. Questionnaire surveys of LSH and municipalities and interview survey on 12 LHS were conducted. Responses were analyzed by population scale. In smaller population areas, LHS cover shortage of welfare facilities and senior housing. In larger population areas, LHS provide residences to people in low-income.