Geriatric Health Services Research Articles

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.

Experiences and Needs of Caregivers of Persons With Dementia in India During the COVID-19 Pandemic—A Qualitative Study

ObjectiveTo describe the experiences and needs of caregivers of persons with dementia during the COVID-19 pandemic and lockdown in a city in India. DesignQualitative study using a telephonic semistructured interview. SettingA specialist geriatric outpatient mental health service based in a nongovernmental organization in Chennai, India. ParticipantsA purposive sampling of family members of persons with dementia registered in the database and seen within the previous 6 months. ResultsThirty-one caregivers participated. Thematic analysis of the data showed two sets of issues that the caregivers of persons with dementia faced in their experiences during the pandemic. The first set was unique to the caregivers that directly related to their caregiving role, while the second set did not relate directly to their caregiving role. These two sets also appeared to have a two-way interaction influencing each other. These issues generated needs, some of which required immediate support while others required longer-term support. The caregivers suggested several methods, such as use of video-consultations, telephone-based support and clinic-based in-person visits to meet their needs. They also wanted more services postpandemic. ConclusionCaregivers of persons with dementia had multiple needs during the pandemic. Supporting them during these times require a pragmatic multilayered approach. Systemic changes, policies and frameworks, increased awareness, use of technology, and better access to health are necessary.

RELATION BETWEEN DEPRESSION AND NUTRITIONAL STATUS AMONG ELDERLY AND IMPLEMENTATION OF GERIATRIC PROMOTIVE SERVICES IN PRIMARY HEALTH CARE

There is accelerating growth in elderly population worldwide. Depression and malnutrition are main problems among elderly. They are strongly related.The study aimed firstly, to determine prevalence of depression among elderly. Secondly, find out the relation between depression and malnutrition. Thirdly introduce geriatric promotive, preventative and curative unit in the family health center (FHC).In this experimental study conducted in a FHC included 356 elderly considering the inclusion and exclusion criteria. The data was collected using geriatric depression scale 15 (GDS-15 ) questionnaire , mini nutritional assessment (MNA) and anthropometric measurement took place .Then introduction of geriatric services unit in the FHC .It was shown that 59% had moderate depression, 62% were malnourished and 75.8% had VIT D deficiency.Nutritional status significantly associated with depression (P<0.01).The GDS-15 score significantly correlated with both MNA-15 and VIT D (p < 0.01) Elderly individuals suffer from depressive symptoms and malnutrition with high prevalence. Depression is correlated with malnutrition and VIT D status. There is a need for enhancement of geriatric health services.

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.

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

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.

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

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

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 &amp;ldquo;community&amp;rdquo; in both hospitals and facilities. Hospitals had a significantly higher rate of 60.7% (P&amp;lt; 0.05) of including &amp;ldquo;trust&amp;rdquo; or &amp;ldquo;feeling of relief&amp;rdquo; in their management philosophies. Facilities had higher rates of including any of the terms &amp;ldquo;return&amp;rdquo; or &amp;ldquo;independence&amp;rdquo; or &amp;ldquo;home&amp;rdquo; (32.1%, P= 0.051), and also of including either &amp;ldquo;service&amp;rdquo; or &amp;ldquo;care&amp;rdquo; (46.1%, P&amp;lt; 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.

Lay-delivered behavioral activation for depressed senior center clients: Pilot RCT.

We describe the development of a lay-delivered behavioral intervention ("Do More, Feel Better") for depressed senior center clients, and we present preliminary data from a pilot randomized controlled trial (RCT) on (a) the feasibility of training lay volunteers to fidelity and (b) the acceptability, impact, and safety of the intervention. We trained 11 volunteers at two aging service settings in "Do More, Feel Better" and randomized 18 depressed clients to receive the intervention or referral to mental health services. Pilot data indicated that we can successfully train and certify 64% of older volunteers and that depressed clients receiving the intervention reported high levels of session attendance and satisfaction. While there were no significant differences in 12-week reduction in Hamilton Depression Rating Scale scores between groups, intervention clients showed an 8-point reduction in comparison with a 0-point reduction among referral clients. "Do More, Feel Better" has the potential of transferring evidence-based behavioral interventions to the hands of supervised lay volunteers and can address the insufficient workforce providing geriatric mental health services.

Geriatric oncology health services research: Cancer and Aging Research Group infrastructure core

Geriatric oncology health services research: Cancer and Aging Research Group infrastructure core

KNOWLEDGE AND ACTIVITY OF COMMUNITY HEALTH WORKERS REGARDING HYPERTENSION AND ITS MANAGEMENT IN MALANG

Community health workers have had an increasing role in CVD prevention and control. Their knowledge and activity contributed to hypertension management in community. Hence, this study aimed to assess the knowledge of community health workers in community. This cross sectional study was conducted in 94 community health workers. All of the participants worked in primary geriatric community health service (posyandu lansia). Hypertension knowledge and management activity in the community was assessed by questionnaire. Most of the community health workers (57%) had high knowledge level. Participants with high knowledge had significant awareness of hypertension and higher knowledge on hypertension therapy, medication adherence, life style, diet, and hypertension complication compared to those of low knowledge level. Moreover, both groups had similar activities in community regarding hypertension management, such as blood pressure measurement, health education, and body mass index measurement. This study suggested that all health care workers shared similar activity in community hypertension management regardless their knowledge level.

SURVIVE, THRIVE OR DIE OUT: MEDICARE AND THE PRACTICE OF GERIATRIC PSYCHIATRY: Session 405

Our fragile geriatric psychiatric population is at risk due to lack of outpatient clinicians available to take Medicare. PCPs and geriatric internists may be hesitant to accept elderly patients with behavioral problems or history of mental illness without the back up of a geriatric psychiatrist, but patients and families often struggle to find an psychiatrist who takes Medicare. For clinicians, discouraging elements of Medicare include poor reimbursement and the strenuous regulatory requirements of MACRA/MIPS. Geriatric psychiatrists practicing in nursing homes face additional daunting regulatory burdens and hostility towards psychiatric diagnoses and psychotropic medications, particularly antipsychotics. In this session, members of the AAGP Clinical Practice Committee (CPC) will discuss major challenges in Medicare faced by geriatric psychiatrists. CPC Committee Chair Dr. Marie Dewitt will introduce the topic and the speakers. Dr. Maureen Nash will review challenges related to the use of antipsychotics in nursing homes and the Partnership to Improve Dementia Care (the challenges of appropriate prescribing of psychotropic medications like antipsychotics to decrease suffering in those who live in a nursing home). Dr. Chanida Siripraparat will further discuss the use of antipsychotics in nursing homes, with a focus on what AAGP needs to do as an organization to tackle this major problem. Dr. Elliott Stein will provide a brief review of challenges related to in Medicare billing, documentation and coding, including the Medicare Physician Fee Schedule Proposed Rule for 2019 (#MPFS2019) and its proposed Evaluation and Management (E/M) Changes. Dr. Karen Reimers will discuss forensic aspects of Medicare litigation in geriatric psychiatry and summarize curent Medicare advocacy efforts. Dr. Tatyana Shteinlukht will serve as discussant. All speakers will highlight key directions for future advocacy efforts to improve Medicare and promote quality geriatric mental health services in the future. Robust discussion and audience participation will be encouraged.

ADVOCACY, LIFE AND DEATH: GERIATRIC SUICIDE AND PHYSICIAN ASSISTED SUICIDE: Session 304

Geriatric suicide and physician assisted suicide are important problems facing geriatric psychiatrists. Suicide in elderly populations is a major and growing concern, with those 85 and older having the highest rate of suicide among adults. As geriatric psychiatrists, we endeavor to understand why this is happening and provide essential services for prevention and treatment. Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act. There is growing public support for physician-assisted suicide, which is legal and increasingly common in other countries including the Netherlands, Belgium and Canada. However, most professional organizations in the USA maintain that allowing physicians to engage in assisted suicide would cause more harm than good, being incompatible with the physician's role as healer, and difficult or impossible to control. This session will highlight current issues related to geriatric suicide and physician assisted suicide. Dr. Karen Reimers will introduce the topic and speakers. Dr. Michael Redinger will provide an ethical and moral framework for these questions. Dr. Sherif Soliman will review the suicide of an older individual, Martin Manley, and discuss psychological changes of aging and coping with illness. Dr. Mark Komrad will discuss physician-assisted suicide, including special considerations for geriatric psychiatry and the slippery slope of extending it to those with non-terminal conditions. Dr. Maria Lapid will give an overview of the basics of hospice and palliative care, to put "end of life' into context, and to clearly distinguish it from any medically-assisted suicide. Dr. Melanie Gentry will serve as discussant. All speakers will highlight key directions for future advocacy efforts in prevention of geriatric suicide and physician assisted suicide, and what AAGP and other professional organizations can do to and promote quality geriatric mental health services in the future. Robust discussion and audience participation will be encouraged.

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〜

Vulnerability of the elderly: a conceptual analysis.

To analyze the concept of vulnerability of the elderly. A concept analysis, according to the method proposed by Walker and Avant, operationalized through integrative review through search in scientific data portals using the. Health vulnerability, aged, health services for the aged, health of the elderly, vulnerable populations and geriatric health services. To compose the literary corpus, 36 studies were selected. Concept antecedents, as well as its attributes, were identified in individual, social and programmatic characteristics, which make up the characteristics of "vulnerability of the elderly", besides consequences of the phenomenon. These characteristics were analyzed with emphasis on aspects that contribute to the process of vulnerability of the elderly. The study demonstrated the multidimensionality of the phenomena studied, highlighting the peculiarities of vulnerability during aging. However, there is a need for further studies on the construct.

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