Geriatric Health Services Facilities Research Articles

Did the Physical and Psychological States of Outpatients Receiving Rehabilitation at a Geriatric Health Services Facility Decline during the State of Emergency Caused by the COVID-19 Pandemic?

Many Geriatric Health Services Facilities in Japan may have continued outpatient rehabilitation by taking measures against infection even during the state of emergency caused by Coronavirus disease 2019 (COVID-19). The present study aimed to determine differences in physical and psychological states in rehabilitation outpatients (age, 83.5 ± 8.4 years) at a Geriatric Health Services Facility between the pre- and post-nationwide state of emergency in Japan. Physical outcomes were assessed with gait speed (GS), timed up and go test (TUG), handgrip strength (HG), and maximum phonation time (MPT). We used the Japanese version of the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) to assess patients’ quality of life (QoL) as the psychological state. The physical (GS, pre, 0.92, post, 0.92 s, p = 0.875; TUG, pre, 14.09, post, 14.14 s, p = 0.552; HG, pre, 19.42, post 19.70 kgf, p = 0.807; MPT, pre, 13.6, post, 13.8 s, p = 0.861) and psychological (EQ-5D-5L, pre, 0.73, post, 0.81, p = 0.064) states of the participants did not change significantly between the pre- and post-nationwide state of emergency. This was likely due to the continuance of outpatient rehabilitation in accordance with the facility’s policy while taking adequate safety precautions against COVID-19 infection.

Effects of a group-based physical and cognitive intervention on social activity and quality of life for elderly people with dementia in a geriatric health service facility: a quasi-randomised controlled trial.

The aim of this study was to assess the effects of group-based motor and cognitive-combined intervention on social activity and quality of life. This quasi-randomised controlled trial included 31 elderly participants with dementia in a geriatric health service facility. Participants were randomly allocated to the intervention group (n = 16) or the control group (n = 15) by stratification of cognitive function. The 8-week intervention program consisted of group exercise and cognitive stimulation twice per week for 45 min per session. Outcome measures were social activity in daily behaviour, cognitive function, apathy, muscle and grip strength, independence of activity of daily living, life-space, and objective quality of life (QOL). Twenty-five participants were analysed (10 in the control group, 15 in the intervention group). Analysis of covariance with covariates of age, gender, and baseline data showed a significant difference in social activity (F = 8.67, P = 0.008; significant decline in control group vs. maintenance in intervention group) and QOL (F = 9.74, P = 0.006; maintenance in control group vs. tendency of improvement in intervention group). A Wilcoxon signed-rank test revealed that helping behaviour (P = 0.035) increased in the intervention group, whereas interest to the surrounding (P = 0.026) decreased in the control group. Group-based combined intervention for dementia is effective for maintaining social activity and QOL in a geriatric health service facility.

Development of an Occupational Therapy Self-checklist for Promoting Information Sharing (SPIS) : Validity of the SPIS among Occupational Therapists working in Geriatric Health Service Facilities in Japan

Development of an Occupational Therapy Self-checklist for Promoting Information Sharing (SPIS) : Validity of the SPIS among Occupational Therapists working in Geriatric Health Service Facilities in Japan

Relationship between cough peak flow and onset of pneumonia in residents of geriatric health services facilities

Sputum expectoration is associated with cough strength, which can be evaluated by cough peak flow (CPF). Since sputum expectoration can be difficult for patients with reduced CPF, they are more likely to have risk factors for pneumonia. We conducted a study to clarify factors contributing to CPF in residents of geriatric health services facilities and to assess the relationship between CPF and the onset of pneumonia. We included 41 male residents of geriatric health services facilities from September to the middle of October 2018. We recorded each subject's age, body mass index (BMI), Performance Status (PS), nursing care level, Functional Independence Measure (FIM), pulse rate, percutaneous arterial oxygen saturation (SpO2), hand grip strength, Charlson comorbidity index, underlying diseases and rales upon auscultation. We also used Pearson's correlation analysis to analyze the relationship between CPF and the above factors. Subjects were assigned to 2 groups according to median CPF to determine the between-group relationships of these factors. Finally, subjects were followed up for 6 to 11 months after CPF measurement to confirm whether or not they developed pneumonia. CPF was positively correlated with BMI (nutritional parameter), hand grip strength (index of systemic muscular strength), and SpO2 The median CPF was 240 L/minute, and subjects were divided into 2 groups based on this valus: CPF ≤240 L/minute group (n=21) and CPF >240 L/minute group (n=20). Subjects in the CPF ≤240 L/minute group demonstrated lower BMI and hand grip strength but more pronounced rales upon auscultation. No statistically significant difference was observed between the 2 groups during the 6-month folloe-up. However, the 11-month follow-up demonstrated a higher incidence of pneumonia in the CPF ≤240 L/minute group. The above findings suggest that subjects with reduced CPF are more likely to develop pneumonia. To increase CPF, muscle rehabilitation therapy and nutrition management should be provided to residents of geriatric health services facilities to prevent pneumonia.

Will the Conversion from Sanatorium Medical Facilities into New Facilities Progress in Japan?

In Japan, under the Long-Term Care Insurance Act of 2018, the Integrated Facility for Medical and Long-Term Care was established as a new long-term care insurance facility into which Sanatorium Medical Facilities could be converted, and this conversion has taken place gradually; in this study, we compared the management policies between existing Sanatorium Medical Facilities and Integrated Facilities. We also examined the management policies of Geriatric Health Services Facilities. For the management policies of individual facilities, published data on the “Long-Term Care Service Information Publication System” website were used; the study included 142 Integrated Facilities, 245 Sanatorium Medical Facilities, and 237 Geriatric Health Services Facilities. The percentage of facilities in each facility group that included specific keywords was compared. There were no significant differences in the percentage of facilities including “Return,” “Long-term,” “Management,” “Care,” and “Coordination” in their management policies between Sanatorium Medical Facilities and Integrated Facilities. Compared with Geriatric Health Services Facilities, Sanatorium Medical Facilities had a significantly lower rate of including “Return” and a significantly higher rate of including “Long-term,” “Management,” “Care,” and “Coordination.” As seen from the above, the management policies of Sanatorium Medical Facilities were similar to those of Integrated Facilities, rather than Geriatric Health Services Facilities. When Geriatric Health Services Facilities and Integrated Facilities were compared as candidates for conversion from Sanatorium Medical Facilities, it was suggested that the barrier to entry is lower for the Integrated Facilities than for Geriatric Health Services Facilities in terms of necessity of major change in management policies.

Ambulance use for low-acuity conditions by long-term care facilities for older adults

Increased ambulance calls affect the timely transportation of patients. Recently, ambulance uses from long-term care facilities (LTCFs) for older adults has been increasing. The aim of this study was to investigate to what extent LTCFs used ambulances for low-acuity conditions. Ambulance records from the fire department of Misato City were used. The participants were patients aged 65years or older transported from all types of LTCFs (including public nursing homes, geriatric health services facilities, private nursing homes, and group homes) and homes. The proportions of ambulance use for low-acuity conditions and their 95% confidence intervals (CI) were calculated and compared by time (daytime and night-time) and day (weekdays and holidays) of ambulance use for each type of residence. Of 12,494 participants, 1336 (11%) were transported from LTCFs, and 326 (2.6%) for low-acuity conditions. Of 326 patients with low-acuity conditions, 69% were transported from LTCFs. The proportion of low-acuity conditions was 17% among those transported from LTCFs, while it was only 1% among those from homes. The proportion of low-acuity conditions was significantly greater during night-time than daytime among those from public nursing homes, geriatric health services facilities, and group homes, while this proportion was greater on weekdays than holidays among those from geriatric health services facilities. This study found a large number of instances of ambulance use for low-acuity conditions by LTCFs. To reduce unnecessary ambulance use for low-acuity conditions efficiently, LTCFs should be assisted in making proper assessments of both patients' conditions and appropriate ambulance use.

Factors related to bereaved family's satisfaction with end-of-life care at geriatric health services facilities

Objectives In Japan, the proportion of older people receiving end-of-life care in geriatric health services facilities (GHSF) is increasing. However, to our knowledge, there have been no previous studies investigating the relationship between the structure of GHSFs and the quality of end-of-life care evaluated by bereaved families.Methods We secondarily analyzed data from the survey done by the Japan Association of Geriatric Health Services Facilities (JAGHSF) in January 2014. Study subjects were 3 recently bereaved family members who had experienced planned end-of-life care at different facilities of the JAGHSF.The dependent variable was the bereaved family members' satisfaction with end-of-life care, which was obtained based on the best answer out of a 5 point scale for the question "Didn't you regret your family member's death immediately after he/she died?" The independent variables included schemes of explanation of patients' conditions at GHSF, management, and education of facilities and staff by doctors. We conducted a univariate analysis, followed by a multivariable logistic regression analysis.Results For the final analysis, we included 363 bereaved family members, of which 250 (68.9%) were satisfied with the end-of-life care. In a multivariable logistic regression analysis, family members' satisfaction was significantly associated with regular medical consultation by doctors for facility users (adjusted odds ratio 2.94, 95% CI 1.52-5.70), explanation about patients' conditions at the time of admission by facility staff other than doctors (2.07, 1.01-4.25), explanation about patients' conditions at the time of deterioration by facility staff other than doctors (3.12, 1.17-8.33), and stress management by doctors for facility staff (3.63, 1.84-7.16).Conclusions Respect for the roles of the facility staff other than doctors, such as the participation of facility staff in explaining situations for facility users and family members and management of facility staff stress, may improve satisfaction with end-of-life care among bereaved family members. More attention is needed for these factors to improve the quality of end-of-life care in GHSFs.

Analysis of the Association between Ageism, Stress and Emotion Work of Nurses and Care Workers at Geriatric Health Services Facilities

Analysis of the Association between Ageism, Stress and Emotion Work of Nurses and Care Workers at Geriatric Health Services Facilities

Validation of the Effects of an Intervention Employing a Fall Prevention Collaboration Program for Nurses and Care Staff at a Geriatric Health Services Facility

Validation of the Effects of an Intervention Employing a Fall Prevention Collaboration Program for Nurses and Care Staff at a Geriatric Health Services Facility

Outcomes of Pharmacotherapeutic Intervention Provided by Hospital Pharmacists for Geriatric Health Service Facility Users

Outcomes of Pharmacotherapeutic Intervention Provided by Hospital Pharmacists for Geriatric Health Service Facility Users

A simple and rapid detection system for oral bacteria in liquid phase for point-of-care diagnostics using magnetic nanoparticles

This study describes a user-friendly and rapid detection system of oral bacteria in the liquid phase for point of care testing based on magnetic immunoassay. We focused on the dependence of the strength of external magnetic field required to switch the magnetic moments of nanoparticles bound to bacteria on the bacteria concentration. The results obtained indicate that the required field strength increases linearly as a function of log concentration of Porphyromonas gingivalis cultured in the range of 103–109 CFU/mL. Similarly, the required field strengths for Streptococcus mutans and Pseudomonas aeruginosa increase monotonically when their concentrations increase, whereas the required field strength for Escherichia coli decreases monotonically when its concentration increases. We then measured the concentration of Porphyromonas gingivalis in the saliva collected from elderly people in a geriatric health services facility and the results using the developed system had a correlation with those using a commercial bacteria counter.

Barriers to continued administration of direct oral anticoagulants between acute hospital and subacute or chronic hospitals and geriatric health services facilities in Japan

ABSTRACTObjectives: To investigate whether direct oral anticoagulant (DOAC) therapy at acute hospitals is continued after transfer to subacute or chronic hospitals and geriatric health services facilities in Japan.Methods: Acute hospitals routinely transfer patients to nearby subacute or chronic hospitals and geriatric health services facilities after acute stroke treatment. To elucidate the status of antithrombotic therapy, particularly DOAC therapy, we conducted a questionnaire survey of chief physicians at 33 subacute or chronic hospitals and geriatric health services facilities in the vicinity of Kawasaki City.Results: Responses were received from 23 hospitals and geriatric health services facilities (5 convalescent and rehabilitation hospitals, 5 chronic hospitals, 13 geriatric health services facilities). The number of convalescent hospitals responding, ‘no problem with DOAC administration’ before transfer to subacute or chronic hospitals and geriatric health services facilities increased from 4 (80%) at the introduction of DOACs to 5 (100%) presently. The number of chronic hospitals and geriatric health services facilities also increased from 1 (20%) to 3 (60%) and 4 (30.8%) to 5 (38.5%), respectively, albeit not significantly. The number of convalescent hospitals, chronic hospitals, and geriatric health services facilities requesting pre-transfer change of oral anticoagulants decreased from 20% to 0%, 60% to 40%, and 69.2% to 61.5%, respectively. All convalescent hospitals continued DOAC therapy after transfer. However, only 40.0% of chronic hospitals and 46.2% of geriatric health services facilities used DOACs in the present period. Warfarin was used instead at 3 (60%) chronic hospitals and 7 (53.8%) geriatric health services facilities and antiplatelet drugs were used at 1 hospital/facility each (20% and 7.7%, respectively). Nine (39.1%) hospitals and facilities cited high DOAC costs for the switch.Conclusions: Convalescent hospitals have incorporated DOAC use and readily accept patients receiving DOACs at transferring hospitals. Conversely, many chronic hospitals and geriatric health services facilities eventually switch from DOACs to warfarin or antiplatelet drugs due to cost. Efforts to resolve these barriers to continued administration of DOACs between acute hospitals and subacute or chronic hospitals and geriatric health services facilities in Japan are needed as soon as possible.

Why Did the Policy to Convert Hospitals Into Facilities Not Work in Japan?

The government of Japan formulated measures to significantly reduce the number of hospital beds for long-term care in 2006. In particular, long-term care hospital beds covered by long-term care insurance (sanatorium medical facilities) were to be abolished in 2012, and existing sanatorium medical facilities were to be converted into long-term care insurance services such as geriatric health services facilities. However, the conversion did not progress in spite of various support measures, and the deadline for abolishment was extended. In order to clarify the reason for this, we selected 28 hospitals with 402 or more long-term care beds and 28 health services facilities with 158 or more beds and examined their management philosophies and analyzed the keywords included. The most popular keyword was “community” in both hospitals and facilities. Hospitals had a significantly higher rate of 60.7% (P< 0.05) of including “trust” or “feeling of relief” in their management philosophies. Facilities had higher rates of including any of the terms “return” or “independence” or “home” (32.1%, P= 0.051), and also of including either “service” or “care” (46.1%, P< 0.05). In conclusion, it is suggested that hospitals with long-term care beds differentiate themselves from neighboring facilities in that they are able to simply accept the situation and be responsible for terminal care whenever inpatients may have difficulty returning home. In addition, it seemed difficult for hospitals to convert into health service facilities, the aim of which is to enable residents to return home.

介護老人保健施設利用者に対する脳活性化リハ 5原則に基づいた 回想法実施充実度と効果の関係 〜効果的なグループ回想法を実施するために〜

介護老人保健施設利用者に対する脳活性化リハ 5原則に基づいた 回想法実施充実度と効果の関係 〜効果的なグループ回想法を実施するために〜

Professional Behaviors of Nurses in Geriatric Health Services Facility in Japan

Background: The characteristics of geriatric health services facilities (GHSFs) in Japan include provision of care focused on the life of the residents, and there is a need for cooperation between care workers and physical therapists responsible for the care. Our goal is to create an organizational system that allows nurses to succeed professionally. To do this, we must first discuss the professional behavior of nurses in GHSFs. Objectives: The aim of the present study was to clarify the professional behavior of nurses in GHSFs using a questionnaire survey. Method: We used a descriptive, cross-sectional design. The study was conducted in 1000 GHSFs all over Japan. The instrument used for data collection was a questionnaire. The questionnaires consisted of 24 items for determining the professional behavior of nurses, the background information of respondents. The professional behavior of nurses was analyzed using principal factor analysis (Promax rotation). Results: A total of 1189 nurses participated. Of those, 91% (n = 1084) were women, and mean age was 48.2 years. Most participants were staff nurses (n = 791; 66%). We extracted 16 items by factor analysis, which were classified into four factors (professional development, autonomy, positive assertiveness to colleagues, and advocating for patient). Conclusion: The professional behaviors as identified in this study are similar to those reported in previous studies of clinical nurses in hospital. However, some subscale results are specific to the characteristics of GHSFs. The ability to understand professional behaviors has significant implications in terms of affirming and identifying sources of quality of care and creating a professional practice environment within GHSFs.

Relationship between the nutritional state of elderly people in need of support or nursing care and jaw-opening force and tongue pressure.

[Purpose] We hypothesized that an association exists between the nutritional state of elderly people and the deterioration in the swallowing function associated with sarcopenia, which is reflected by the strength of the tongue and suprahyoid muscles. Therefore, we conducted a comparative study of the nutritional state and swallowing muscle strength. [Participants and Methods] The participants in this study were 25 elderly people in need of support or nursing care, situated at a geriatric health service facility, who were able to understand instructions and ate three meals per day orally. We evaluated the strength of the tongue muscles using a tongue pressure measurement device and the strength of the suprahyoid muscles by measuring the jaw-opening force. The nutritional state was evaluated using the Mini Nutritional Assessment. [Results] There was a significant correlation between the Mini Nutritional Assessment score and the jaw-opening force. Conversely, no correlation was found between the Mini Nutritional Assessment score and the tongue pressure. [Conclusion] The significant correlation between the Mini Nutritional Assessment score and the jaw-opening force suggests that the strength of the suprahyoid muscles, which reflects the swallowing function and jaw-opening force, deteriorates with age and is affected by the nutritional state. This suggests that the nutritional state could be an important indicator for the evaluation of the swallowing function.

Qualitative study about the role of the rehabilitation staff ata geriatric health services facility: Multi-occupation collaboration for the residents

Qualitative study about the role of the rehabilitation staff ata geriatric health services facility: Multi-occupation collaboration for the residents

Eating situation and blood vitamin concentration in elderly residents of a geriatric health service facility and influence of dietary supplement intake

Eating situation and blood vitamin concentration in elderly residents of a geriatric health service facility and influence of dietary supplement intake

Structure of a Framework to Evaluate Social Work in Discharge Support of Geriatric Health Service Facilities :

Structure of a Framework to Evaluate Social Work in Discharge Support of Geriatric Health Service Facilities :

Life with diabetes in elderly entering Geriatric Health Services Facility for long-term

Life with diabetes in elderly entering Geriatric Health Services Facility for long-term