Geriatric Health Services Facilities Research Articles

Association between the change in the job facilitating and inhibiting factors of care staff due to the employment of older assistant workers and the emotional exhaustion among care staff

Objectives The mental health condition of care staff in Japan is becoming problematic. Older assistant workers are currently being employed to assist care staff with their jobs and alleviate their job burden. This employment of older assistant workers is drawing attention; however, their influence on the job facilitating and inhibiting factors of care staff and the association with the care staff's emotional exhaustion remains unclear. In this study, we aim to examine how the employment of older care assistant workers relates to the job-facilitating and job-inhibiting factors of care staff and explore that association with the care staff's emotional exhaustion.Methods Data from a mail survey of geriatric health services facilities with older assistant workers were analyzed. Among the answers obtained from the care staff, answers from 5,185 who reported working in facilities that employ older assistant workers (over the age of 60) were analyzed. The Emotional Exhaustion subscale of the Japanese Version of the Burnout Questionnaire was used as the dependent variable. The change in job-facilitating and job-inhibiting factors of care staff due to the employment of older assistant workers (improve, maintain/exacerbate) was explored for nine contents.Results Care staff reported a decrease in the total volume of the task (63.6%), less stress during daily tasks (39.8%), and more concentration on the tasks that require expert care knowledge (38.0%). The results of multiple regression analysis showed that the emotional exhaustion score of care staff was low when the total volume of tasks decreased (β=－0.383, 95%CI=－0.719, －0.047), when less stress was perceived during daily tasks (β=－0.432, 95%CI=－0.796, －0.068), when concentration on tasks that required expert care knowledge increased (β=－0.574, 95%CI=－0.937, －0.210), and when human relationships among staff improved (β=－0.871, 95%CI=－1.263, －0.480). Conversely, an increase in tasks requiring work with regional personnel and organizations (β=0.800, 95%CI=0.162, 1.437) was associated with a high emotional exhaustion score.Conclusion The employment of older care workers was related to the job-facilitating or job-inhibiting factors of care staff, and the change in these factors was associated with lower emotional exhaustion. The employment of older personnel may lower the risk of burnout among care staff.

Examination of the relationship between tasks in geriatric health service facilities and benefits of working for older assistant care workers

Objective In this study, we clarified the characteristics of tasks performed by older assistant care workers at geriatric health services facilities, by individual characteristics and work status. Additionally, we examined the relationship between the tasks and benefits of working for older assistant care workers.Methods A self-administered questionnaire survey was provided to 2,571 elderly care facilities employing assistant care workers aged ≥60. A total of 1,606 responses were obtained, and personal characteristics, working conditions, tasks, and benefits of working for older care assistants were surveyed. Thirteen work tasks were established and categorized into four broad categories; user transfer assistance, facility maintenance, meal-related assistance, and managing and talking to users. Seven benefits of working as care assistants were "contribution to society," "social connection," "purpose of life," "income," "learning from caregiving," "health maintenance and promotion," and "time utilization."Results Most of the respondents were women and relatively young workers. Among tasks, men, younger workers, and those working >5 days weekly represented a high proportion of those performing user transfer assistance tasks. Tasks on managing and talking to users were not correlated with sex, age, and number of days worked, but those with more flexible work patterns were more likely to be engaged in such tasks. Logistic regression analysis showed that user transfer assistance was correlated with benefits of working, such as "contribution to society," "social connection," and "learning from caregiving." Moreover, facility maintenance was associated with "income," "health maintenance and promotion," and "time utilization" and meal-related assistance was associated with "learning from caregiving." Managing and talking to users was associated with "contribution of society," "social connection," "purpose of life," and "learning from caregiving."Conclusion The tasks of the workers were associated with individual characteristics and work status. The perception of benefits between the working tasks that involved frequent contact with users and those that did not were considerably different.

A factual investigation of the information nurses transfer between facilities through nursing summary reports

Objective: To clarify the medical care information nurses share among multiple facilities such as hospitals and visiting nursing stations, specialized nursing homes, and geriatric health service facilities in Japan.Methods: The research design was an exploratory survey study. We administered a questionnaire survey to registered nurses with at least three years of clinical experience from August 2020 to September 2021. Data from 257 participants were analyzed using simple tabulation, chi-square test, and univariate and multivariate analyses. Items that could not be addressed by nursing summaries alone included how to interact with patients and families, activities of daily living, and nursing procedures.Results: The results indicate that nurses require information on nursing procedures, how to interact with patients and their families, and care. Essential nursing summary report items included infectious disease, allergy, medications, final bowel movements, and tube feeding. The essential items that varied across facilities were commissioned physicians, patients’ perspectives on the disease, regular medical examinations, and peripheral symptoms.Conclusions: The summary reports were used to exchange information with other nurses, get confirmation of nursing procedures, and get confirmation of the history of the present illness. In the future, they should include customized content depending on the information requirements of each institution. These results can be used as a reference for the nursing summaries sought by recipients, leading to improved quality of care after a transition.

Relationship between the perceived benefits of working and emotional exhaustion among older assistant care workers: A cross-sectional study

Objectives This study is intended to clarify the perceived benefits of working among older assistant care workers employed in geriatric health service facilities and examine the relationship between perceived benefits and emotional exhaustion.Methods We analyzed data from a mail survey of older assistant care workers employed in geriatric health service facilities that the Japan Association of Geriatric Health Services Facilities conducted in 2020. In this survey, those aged ≥60 were defined as older assistant care workers. Responses were obtained from 1,606 older assistant care workers at 599 facilities. The dependent variable was the emotional exhaustion subscale of the Japanese version of the Burnout Questionnaire. The independent variables were the seven benefits of working as an assistant care worker: 1) I can contribute to society; 2) I am connected to society; 3) I have a sense of purpose in life; 4) I am earning the income I expected since I started working as an assistant care worker; 5) I am learning about care; 6) It has maintained and improved my health; and 7) I can use my time effectively. Latent class analysis (LCA) was performed using these seven benefits as independent variables. Multiple regression analysis was performed using emotional exhaustion and the perceived benefits as dependent and independent variables, respectively. The missing values were supplemented by the multiple imputation method.Results Overall, 1,601 responses were analyzed after excluding 5 respondents who did not answer all the questions. Four patterns were identified from the LCA results: the "benefit-full type," who perceived all benefits; the "benefit-less type," who perceived few benefits; the "benefit-extroverted type," who perceived social contribution and connection as benefits; and the "benefit-introverted type," who perceived health maintenance and improvement and time utilization as benefits. The multiple regression analysis showed that emotional exhaustion scores were higher for the "benefit-extroverted" and "benefit-less" types than for the "benefit-full" type (b=2.465, P<.001 and b=1.931, P<.001, respectively). No difference was found in the case of the "benefit-introverted" type (b=0.050, P=.851).Conclusion The perceptions of diverse and introverted benefits were associated with lower emotional exhaustion scores among older assistant care workers. Future intervention studies are needed to examine whether obtaining diverse or introverted benefits can decrease the emotional exhaustion score.

Changes in cerebrovascular disease–related deaths and their location during the COVID-19 pandemic in Japan

ObjectiveThe COVID-19 pandemic placed an enormous strain on healthcare systems and raised concerns for delays in the management of patients with acute cerebrovascular events. In this study, we investigated cerebrovascular excess deaths in Japan. Study designVital mortality statistics from January 2012 to May 2022 were obtained from the Japanese Ministry of Health, Labour and Welfare. MethodsUsing quasi-Poisson regression models, we estimated the expected weekly number of cerebrovascular deaths in Japan from January 2020 through May 2022 by place of death. Estimates were calculated for deaths in all locations, as well as for deaths in hospitals, in geriatric health service facilities, and at home. The age subgroups of ≥75 and <75 years were also considered. Weeks with a statistically significant excess of cerebrovascular deaths were determined when the weekly number of observed deaths exceeded the upper bound of 97.5% prediction interval. ResultsExcess deaths were noted in June 2021 and became more pronounced from February 2022 onward. The trend was notable among those aged ≥75 years and for those who died in hospitals. With respect to the location of deaths, the excess was significant in geriatric health services facilities from April 2020 to June 2021, whereas no evidence of excess hospital deaths was observed during the same period. ConclusionsBeginning in the late 2021, excess cerebrovascular deaths coincided with the spread of the Omicron variant and may be associated with increased healthcare burden. In 2020, COVID-19 altered the geography of cerebrovascular deaths, with fewer people dying in hospitals and more dying in geriatric health service facilities and at home.

Phase angle as a prognostic factor for one-year mortality in geriatric health service facility residents.

[Purpose] The present study aimed to investigate the association of phase angle with the continuing activities of residents in a geriatric health service facility for one year. We compared the phase angle among current residents in a geriatric health service facility with those who died within one year. [Participants and Methods] This one-year prospective observational study included 149 residents who entered a geriatric health service facility. We divided participants into two groups: an over one-year survival group and a death within one year group. The receiver operating characteristic curves were created to determine the sensitivity and specificity for predicting one-year mortality based on the phase angle. [Results] The phase angle was significantly higher in the one-year survival group than in the death within one year group and was independently and significantly associated with one-year mortality using binomial logistic regression analysis. The phase angle was shown to have predictive power (based on the area under the receiver operating characteristic curve). Based on the calculation for identifying one-year survival, the optimal cut-off value for the phase angle was 2.95° (area under the receiver operating characteristic curve=0.76, sensitivity 55.6%, specificity 83.3%). [Conclusion] The phase angle may contribute to the prognosis of one-year mortality for residents of geriatric health service facilities.

Change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the "My Wishes" notebook

A geriatric health services facility had been working to improve end-of-life care since 2014. In 2017, the facility introduced the My Wishes notebook, which confirms individual's medical choices and distributed the Explaining Practices and Intentions of End-of-life Care book in 2018, in order to help their staff improve care for older adults. Care staff used their learning in caregiving for older adults. This study aimed to clarify the change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the My Wishes notebook. We requested cooperation from all care staff at a geriatric health services facility, and focus group interviews were conducted with 13 staff members over two days in June 2019. The responses in relation to two parameters, the staff members' thoughts and the change in end-of-life care, following the introduction of My Wishes were recorded and qualitatively analyzed. Six categories of responses were extracted from the qualitative analysis: "Difficulty in using My Wishes", "Effects of the use of My Wishes ", "The practice of sought care", "Intentional involvement with patients' families", "Self-confidence in end-of-life care", and "End-of-life care becoming common practice". After the introduction of My Wishes, the care staff found that there were difficulties in using My Wishes, such as writing on paper and difficulties in them hearing. On the other hand, they felt the effects of using My Wishes, such as knowing a new side, feeling further possibilities of care, and activating communication among interdisciplinary healthcare providers. Then, while intentionally engaging with patients' families, they will seek and practice the care that the older adults want. Furthermore, while repeatedly searching for and practicing the care that older adults want, they will gain confidence in providing care and change to normalize these care practices.

Oral and Rectal Colonization by Antimicrobial-Resistant Gram-Negative Bacteria and Their Association with Death among Residents of Long-Term Care Facilities: A Prospective, Multicenter, Observational, Cohort Study

Introduction: The prevalence of antimicrobial-resistant bacteria (ARB) in long-term care facilities (LTCFs) remains unclear. Furthermore, the effect of ARB colonization on the clinical outcomes of LTCF residents has not been explored. Methods: We conducted a prospective multicenter cohort study and investigated the residents (N = 178) of six Japanese LTCFs (three Welfare Facilities for the Elderly Requiring Long-term Care and three Geriatric Health Service Facilities) for oral and rectal carriage of ARB. The clinical outcomes of the residents were evaluated based on isolating bacterial strains and subjecting them to whole-genome sequencing. Results: Of the 178 participants, 32 belonging to Geriatric Health Service Facilities with no information on their clinical outcome were excluded, and the remaining 146 were followed up for at most 21 months. Extended-spectrum β-lactamases (ESBL)-producing Enterobacterales and Pseudomonas aeruginosa were detected in 42.7% (n = 76) and 2.8% (n = 5) of the rectal swabs and 5.6% (n = 10) and 3.4% (n = 6) of the oral swabs, respectively. Detection of ARB in the oral and rectal cavities showed remarkable association with enteral nutrition. Further, P. aeruginosa was significantly associated with an increase in mortality of the residents, but there were not significant association between ESBL-producing Enterobacterales and mortality. Core-genome phylogeny of P. aeruginosa revealed a wide-spread distribution of the isolated strains across the phylogeny, which included a cluster of ST235 strains with substantially higher biofilm formation ability than the other isolated P. aeruginosa strains. Discussion/Conclusion: This study is the first to investigate the carriage of both oral and rectal ARB, genomic relatedness and determinants of antimicrobial resistance in isolated strains, and clinical outcomes of LTCF residents. Our study provides the first direct evidence for the burden of antimicrobial resistance in LTCFs.

Decision-making support for elderly individuals with dementia in a geriatric health service facility: A questionnaire survey on concrete care methods to draw wills of individuals

The purpose of this study was to clarify the care methods used by healthcare staff in service facilities to draw up wills for elderly individuals with dementia in daily life and the final stage in decision-making support. A questionnaire survey was conducted among healthcare staff in a geriatric health service facility in August 2020. There were 45 subjects (16 males [35.6%]; 29 females [64.4%]). The average age was 42.2 (±12.3) years old, and the mean number of years of experience in a geriatric health service facility was 17.4 (±10.7) years. Deathbed care was provided to ≥90% of the subjects. A factor analysis of items related to decision making in elderly individuals with dementia revealed the first factor to be "support and communication to draw wills", the second factor to be "support and communication for expression to realize decision making", and the third factor to be "understanding, communication, and family support for decision-making realization." The totals of each of these three factors and "having confidence in care focusing on the viewpoint of elderly individuals with dementia" were significantly different. The correction between the Personhood of Approaches to Dementia Questionnaire Japanese version and the three subscales of decision making in elderly individuals with dementia had a significant coefficient of correlation. More polite communication methods are necessary for the formation, expression, and realization of the intentions of elderly individuals with dementia to support their decision making.

Statement on falls in long-term care facilities by the Japan Geriatrics Society and the Japan Association of Geriatric Health Services Facilities.

In current clinical practice, when a fall occurs in a long-term care facility, it is often treated as an accident. Falls are classified as one of the most commonly prevalent geriatric syndromes. As their causes are extremely diverse and complex, their occurrence rate depends on individual susceptibility, even if appropriate fall prevention measures are taken. Falls are common among older adults, and fractures and intracranial hemorrhage resulting from falls can lead to the deterioration of activities of daily living and death. For this reason, it is recommended that the risk of falls is assessed in the general population of older adults, and that appropriate interventions are carried out for those at high risk. In response to this situation, the Japan Geriatrics Society and the Japan Association of Geriatric Health Services Facilities have issued the following statements on falls as a geriatric syndrome based on scientific evidence, especially considering the frequent occurrence of falls in long-term care facilities. Geriatr Gerontol Int 2022; 22: 193-205.

The link between factorial invariance and Sense of Coherence associated with the degree of favorability of the organizational climate at Geriatric Health Services Facilities: Simultaneous multiple group analysis of care workers and nurses using a cross-sectional survey

The link between factorial invariance and Sense of Coherence associated with the degree of favorability of the organizational climate at Geriatric Health Services Facilities: Simultaneous multiple group analysis of care workers and nurses using a cross-sectional survey

Nutritional status associated with independence level of older adults in the Geriatric Health Service Facility in Japan and feasibilities of tongue pressure and physical measurement as objective nutritional indices

Nutritional status associated with independence level of older adults in the Geriatric Health Service Facility in Japan and feasibilities of tongue pressure and physical measurement as objective nutritional indices

Nursing practices and tasks for collaboration with care workers for the end-of-life care at geriatric health service facilities in A prefecture

Nursing practices and tasks for collaboration with care workers for the end-of-life care at geriatric health service facilities in A prefecture

Relationship Between Negative Feelings Toward Service Users and the Burnout of Care Staff in Geriatric Health Service Facilities

Relationship Between Negative Feelings Toward Service Users and the Burnout of Care Staff in Geriatric Health Service Facilities

The role and perspective of the geriatric health services facilities

介護老人保健施設の特徴は，利用者の多様なニーズに応える多目的性・多機能性である．

Factors associated with surrogate families' life-sustaining treatment preferences for patients at home or in a geriatric health service facility: A cross-sectional study.

Recently, end-of-life preference in palliative care has been gaining attention in Japan. The Ministry of Health, Labor, and Welfare established the Japanese basic policy in November 2018. Patients' decision-making is recommended; however, patients with dementia or other disorders cannot make such decisions by themselves. Thus, healthcare providers may contact surrogates and consider their backgrounds for better decision-making. Hence, the preferences of home caregivers' and geriatric health service facility (GHSF) residents' families on patient life-sustaining treatment (LST) were investigated. This cross-sectional study involved home caregivers' and GHSF residents' families in Japan. We distributed 925 self-reported questionnaires comprising items, such as the number of people living together, care duration, comprehension of doctor's explanations, the Patient Health Questionnaire (PHQ)-9 and Short Form (SF)-8, and families' LST preference for patients. In all, 619 valid responses were obtained [242 men and 377 women (309 in the HOME Caregivers Group, response rate = 61.1%; 310 in the GHSF Group, response rate = 74.0%)]. LST preference was significantly associated with sex, the number of people living together, care duration, and comprehension of doctors' explanations in the HOME Caregivers Group but was not significantly associated with the GHSF Group. Furthermore, PHQ-9/SF-8 scores were not significantly associated with LST preference. There were many differences in opinions about LST preference between home caregivers' and GHSF residents' families. The results suggested that the burden of nursing care was greater and harder in home caregiver families, and these factors may be related to the LST preference for a patient.

Changes in Physical and Psychological States with Respect to the Gender of Outpatients Receiving Rehabilitation at Geriatric Health Services Facilities during the COVID-19 State of Emergency.

This study was a sub-analysis of 20 consecutive elderly participants who underwent outpatient rehabilitation at a geriatric health services facility from January 2020 to the end of May 2020, based on our previous report. This study aimed to evaluate the longitudinal changes in their physical and psychological states with respect to gender in rehabilitation outpatients between the pre-nationwide (T1) and post-nationwide state of emergency (T2) caused by the Coronavirus disease 2019 (COVID-19). Gait speed (GS), timed up and go (TUG), handgrip strength (HG), and maximum phonation time (MPT) were measured as indices of physical status. The Japanese version of the Apathy Scale and five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) were used to assess the psychological state. Both states were measured in the male and female groups at T1 and T2 and then were compared. The final analysis was comprised of 13 outpatients. In males, the physical (GS, p = 0.463; TUG, p = 0.600; HG, p = 0.753; and MPT, p = 0.249) and psychological (Apathy Scale, p = 0.891 and EQ-5D-5L, p = 0.249) states did not change significantly between T1 and T2. In the females, the physical (GS, p = 0.600; TUG, p = 0.735; HG, p = 1.000; and MPT, p = 0.310) and psychological (Apathy Scale, p = 0.588 and EQ-5D-5L, p = 0.176) states also did not show significant change between T1 and T2. In both sexes, the continuance of outpatient rehabilitation might be recommended as one activity that can maintain physical and psychological states during a COVID-19-related state of emergency.

Characteristics of physicians working at geriatric health service facilities in Japan, 1996–2016

BackgroundIn Japan, which has the most rapidly aging population worldwide, the number of geriatric health service facilities (GHSFs) has been increasing. GHSF physicians play significant roles in integrated care for the elderly. However, little is known about the temporal trends of physicians working in GHSFs.ObjectivesWe aim to examine temporal trends in the characteristics of GHSF physicians and identify physician factors associated with starting work at GHSFs.DesignCohort study.Setting and participantsPhysicians responding to biennial national physician census surveys conducted by the Ministry of Health, Labour and Welfare of Japan from 1996 to 2016. The response rate was approximately 90%.MethodsWe estimated temporal trends in the number, proportion, and characteristics of GHSF physicians. A multivariable logistic regression analysis identified physician factors associated with starting work at GHSFs 10 years after 1996–2006 and 2006–2016 among physicians not working in GHSFs at baseline (1996 and 2006).ResultsGHSF physicians rapidly increased in the first decade from 1,127 (0.47%) in 1996 to 2,891 (1.04%) in 2006; this trend then slowed and was almost proportional to that of all physicians, reaching 3,345 (1.05%) in 2016. GHSF physicians aged ≥65 years increased from 61.2% in 1996 to 68.5% in 2016, while those aged <40 years decreased from 13.8% to 1.9%. The sex ratio (male vs. female physicians) increased from 5.7 in 1996 to 6.4 in 2016. Physician factors associated with starting to work at GHSFs included older age, female sex, rural area, working at hospitals, and majored in internal medicine and surgery specialties.ConclusionsThe proportion of GHSF physicians among all physicians has stagnated, and GHSF physicians are aging. Facilitating the transition of younger physicians from clinical practice in hospitals to GHSFs will increase the number of GHSF physicians and improve the quality of care in GHSFs.

Report of cluster due to COVID-19 in a geriatric health services facility

老人保健施設で新型コロナウイルス感染症（COVID-19）クラスターを経験したので報告する．他院から転入した利用者から利用者25名および職員3名に感染した．利用者26名のうち3名は無症状であった．隔離は最大46日間に及び陽性者のうち4名が転院先で死亡した．体温はコロナウイルス検査日において陽性者でやや高く体温の中央値は37.1℃であった．現在幅広く用いられている37.5℃を用いて施設内スクリーニングを行うことは問題がある．

Application of dementia care mapping (DCM) for one year in a geriatric health services facility: Effects of developmental evaluation based on collaboration by medical and welfare staff aimed at person-centred care

This study aimed to clarify the effects of dementia care mapping (DCM) for one year in a healthcare center for older adults. DCM was conducted between September 2016 and August 2017. The care staff include nurses and caregivers in a narrow sense, medical staff, such as a physician, physical therapists, and occupational therapists worked on DCM as care staff in this study. There were 24 participants, with an average work experience of 7.21 (±4.74) years. In comparison to the baseline evaluation, the final assessment of self-efficacy through person-centred care showed significant improvement in 'Forecasting and Problem Solving on the Job' within 'Perceived Job Competence of Care Workers'. Six main categories of content were extracted from focus group interviews: 'Awareness,' 'Change of Elderly People under the Care of Staff throughout the Development of Mapping', 'Affirmative Feelings of Care Staff for Mapping', 'Negative Feelings for Mapping', 'Need for the Efficacy and Efficiency of the Mapping', and 'Mapping Based on the Age of the Participant and Future Prospects for Mapping'. The results of person-centred care showed that both the older patients and the staff noticed changes through the development of mapping. The developmental evaluation, based on collaboration by medical and welfare staff can improve self-efficacy through the practice of person-centred care and improves the ability to solve problems during the provision of care.