Geriatric Intermediate Care Facilities Research Articles

Antibody responses after BNT162b2 vaccination in Japanese geriatric intermediate care facilities

BackgroundTo evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2] vaccines in the staff and residents of Japanese geriatric intermediate care facilities. MethodsAll subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 [anti-RBD] IgG was measured using two immunoassays. ResultsAfter the second dose, geometric mean titers [GMT] of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios [ORs] for older age (adjusted OR per 10 year increase [aOR] = 0.62, 95 % confidence interval [95 %CI]; 0.38–1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01–0.60) and regular nonsteroidal anti-inflammatory drugs [NSAIDs] usage (aOR = 0.16, 95 %CI; 0.03–0.88). ConclusionsElderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.

Incidence and risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities: A prospective cohort study.

The risk of developing infectious diarrhea among elderly residents at Japanese geriatric intermediate care facilities is unclear. We investigated the incidence rate and risk factors of norovirus-related diarrhea at such facilities. This prospective cohort study followed 1727 residents from November 2018 to April 2020 at 10 geriatric intermediate care facilities in Osaka, Japan regarding the occurrence of diarrhea. Resident data were collected from their medical records using structured forms at two to three of the following three time points: at recruitment, if they developed diarrhea, and when they left the facility. Residents who developed diarrhea were tested using rapid diagnostic tests for norovirus. Cox proportional hazard model was employed to hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate the risk factors for norovirus-related diarrhea. During the study period, 74 residents developed diarrhea, 13 of whom were norovirus positive. The incidence rate of norovirus-related diarrhea was 10.11 per 1000 person-years (95% CI: 4.61-15.61). In terms of risk factors, people with care-needs level 3 were at a higher risk for developing norovirus-related diarrhea (adjusted HR [aHR]=7.35, 95% CI: 1.45-37.30). Residents with hypertension (aHR=3.41, 95% CI: 1.05-11.04) or stroke (aHR=8.84, 95% CI: 2.46-31.83), and those who walked with canes (aHR=16.68, 95% CI: 1.35-206.52) also had a significantly higher risk for norovirus-related diarrhea. Throughout the study period, the incidence of development of diarrhea was low. Care-needs level 3, stroke, hypertension and use of a cane were identified as risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities. Geriatr Gerontol Int 2023; 23: 179-187.

674The incidence and risk factors of acute infectious diarrhea at Japanese geriatric intermediate care facilities

Abstract Background Norovirus infection and Clostridioides difficile infection (CDI) are major causes of acute infectious diarrhea at medical facilities. “Geriatric intermediate care facilities” are a type of medical facility that tend to the daily life needs of elderly Japanese people. However, there is no research about norovirus- or CDI-related diarrhea at Japanese geriatric intermediate care facilities. Methods This prospective cohort study included 1445 residents at 10 geriatric intermediate care facilities in Osaka between November 2018 and October 2019. The study subjects were followed regarding the occurrence of acute infectious diarrhea and the results of rapid diagnostic tests for norovirus and CDI. We calculated incidence rates and hazard ratios (HR) with 95% confidential intervals (CI) to identify the risk factors of infectious diarrhea. Results Thirty-seven residents developed diarrhea during the observation period, although none of them was positive for norovirus or CDI. The total incidence rate was 1.21/10,000 person-days (95%CI: 0.82-1.60). Compared with residents aged 87-91 years, those aged ≤ 80 years had a significantly higher risk of diarrhea (HR = 3.85, 95%CI: 1.27-11.66). Moreover, residents with thyroid diseases had a significantly higher risk of diarrhea than those without thyroid disease (HR = 5.33, 95%CI: 2.32-12.25). Conclusions The incidence of acute infectious diarrhea is relatively low. However, residents who are < 80 years old and those with thyroid diseases are more likely to develop diarrhea. Key messages We describe the situation of acute infectious diarrhea at Japanese geriatric intermediate care facilities

介護老人保健施設に入所した高齢者の「満足」「不満」ならびに「不満への対処」の分析

介護老人保健施設に入所した高齢者の「満足」「不満」ならびに「不満への対処」の分析

Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities.

Professionalism of Nurses Working In Geriatric Intermediate Care Facilities: An Analysis Using Semi-Structured Interviews

Background: Japan is getting older and older. More than 26% of the population is 65 years or over. Therefore, the needs and quality of geriatric nursing should be improved. At the same time, the standards and requirements in geriatric intermediate care facilities (GIFs) are also changing. However, the quality of geriatric care in Japan is not in a satisfied level. In order to improve the quality of geriatric nursing, reconsidering professionalism in nurses is crucial. Moreover, it is important to address appropriate working environment of nurses to develop, maintain and enhance their professionalism. Objectives: The aim of this study was to obtain insights to the professionalism of nurses in geriatric intermediate care facilities from the perspectives and experiences of geriatric care. Methodology: A qualitative exploratory descriptive research design was used in this study. The study participants were three clinical nurse specialists of geriatric nursing and five nurse managers from geriatric care facilities. A purposive sampling was used. Results: Five descriptive themes related to the professionalism of nurses in geriatric care facilities were identified: autonomy, comprehensive care, patient advocacy, educational activities, and work with other specialists. Conclusions: Professionalism identified in this study is similar to that of clinical nurses that was reported previous studies. However, some sub-categories indicate the characteristics of geriatric care facilities, such as decision making when a physician is absent, which is included in autonomy, and the life model, which is included comprehensive care.

Discharge Destination of Dementia Patients Who Undergo Intermediate Care at a Facility

ObjectivesIntermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan. DesignThis study was conducted using a retrospective study design for data from 2007, 2010, and 2013. SettingWe used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September. ParticipantsThere were 9992 discharged patients included in the analysis. MeasurementsDischarge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group. ResultsOf the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25–1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64–2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13–1.89; P = .004) than discharged to home. ConclusionIntermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.

Health Care and Personal Care Needs Among Residents in Nursing Homes, Group Homes, and Congregate Housing in Japan: Why Does Transition Occur, and Where Can the Frail Elderly Establish a Permanent Residence?

Japan has had high rates of transition to nursing homes from other long term care facilities. It has been hypothesized that care transitions occur because a resident's condition deteriorates. The aim of the present study was to compare the health care and personal care needs of residents in nursing homes, group homes, and congregate housing in Japan. The present study was conducted using a cross-sectional study design. The present study included 70,519 elderly individuals from 5 types of residential facilities: care medical facilities (heavy medical care; n = 17,358), geriatric intermediate care facilities (rehabilitation aimed toward a discharge to home; n = 26,136), special nursing homes (permanent residence; n = 20,564), group homes (group living, n = 1454), and fee-based homes for the elderly (congregate housing; n = 5007). The managing director at each facility provided information on the residents' health care and personal care needs, including activities of daily living (ADLs), level of required care, level of cognitive impairment, current disease treatment, and medical procedures. A multinomial logistic regression analysis demonstrated a significantly lower rate of medical procedures among the residents in special nursing homes compared with those in care medical facilities, geriatric intermediate care facilities, group homes, and fee-based homes for the elderly. The residents of special nursing homes also indicated a significantly lower level of required care than those in care medical facilities. The results of our study suggest that care transitions occur because of unavailable permanent residence option for people who suffer with medical deterioration. The national government should modify residential facilities by reorganizing several types of residential facilities into nursing homes that provide a place of permanent residence.

P.5.008 Prevalence of dementia in St. Petersburg and Leningrad Region (Russian Federation), 2000–2004

Intermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan.This study was conducted using a retrospective study design for data from 2007, 2010, and 2013.We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September.There were 9992 discharged patients included in the analysis.Discharge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group.Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25–1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64–2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13–1.89; P = .004) than discharged to home.Intermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.

Factors influencing continuation of home life after returning home from geriatric intermediate care facilities in a metropolitan suburb

A follow-up study was conducted to elucidate the factors influencing continuation of home life after returning home from geriatric intermediate care facilities (GICFs). The subjects were 237 elderly persons (56 men, 181 women, average age of 84 years) who were admitted to three GICFs located in the suburbs of Osaka, and their family caregivers. A follow-up study was performed from 1997 to 1998. Seventy percent of the elderly were bedridden persons with grade B or C of activities of daily living (ADL) according to the criteria of disabled elderly of the Japanese government. Dementia was observed in 82.3% of them. Family caregivers were sons (30.7%), daughters (27.4%), daughters-in-law (27.8%) and spouses (9.7%). The percentage of families spending all day long with the elderly person was 57.5%. Although the rate of having their own detached house was high, that of a private room for the elderly individuals was only about 60%. Most of the families cared for the elderly before admission to the GICFs. The families desired them to stay in the GICFs for as long as possible. Therefore, the families did not want to take the elderly into their home after discharge and only 45% of the families desired home care after the discharge. Concerning the flow of the 237 elderly subjects, the rate of admission from hospitals was high (60.8%), and that of discharge to hospitals was also high (44.3%). The place of residence at the end of follow-up was the GICF (35.4%), the elderly subject's home (19.0%), and hospital (16.0%). Of the 96 elderly who had returned home from GICFs, 40.6% were re-admitted to GICFs. According to multiple logistic analysis, the factors related to continuation of home life were "the elderly with family caregivers who can always supervise him/her", and "the elderly without problem behavior". From the results obtained, it is important that in order for disabled elderly individuals to continue their home life, the GICFs must be the function as the center of a comprehensive service system in the community.

Factors influencing clients' return home on discharge from geriatric intermediate care facilities in a metropolitan suburb

The present study investigated factors influencing the destination following discharge from geriatric intermediate care facilities (GICF) located in a suburb of a metropolis. A set of questionnaires was prepared, and a survey was conducted involving 204 subjects (46 men, 158 women, average age 84 years) of three GICFs and their families. Seventy-two percent of clients were termed bedridden and 84% as having dementia. Furthermore, 63% of them were admitted to GICFs from hospitals, and about half used the GICFs more than twice. Most families cared for the subjects before admission into the GICFs, and were feeling the burden of daily care. The families desired them to stay in the GICFs for as long as possible. Forty-five percent of the families wanted the subject to go back home after discharge. About 30% of subjects returned home, 31% were admitted to a hospital and 40% were placed in GICFs. The following factors were related to discharge and return home: the family wanted the subject to return home, subjects admitted to GICFs from home could return home, good ability to walk, families consulted subjects about the destination following discharge, the cost of staying at the GICF was covered by the subjects' pension, and confirmed administration of drugs was not necessary. These findings suggest that in order for clients at GICFs to successfully return home, the facilities should consider where the family wants the clients to go.

The role of geriatric intermediate care facilities in long-term care for the elderly in Japan

Geriatric intermediate care facilities (GICFs) were first established in 1987 to help the hospitalized elderly return home within 3 months. Users of the GICFs are the elders who do not require hospitalization, but are mentally or physically impaired. Rather than providing unnecessary medical services, GICFs emphasize nursing care and rehabilitation so that users can carry out their daily tasks independently. Due to the limited supply of institutional and in-home services for the elderly in long-term care systems in Japan, only half of the discharged users were able to return home and a quarter stayed at GICFs for over 1 year, contrary to the initial purpose. This suggests that in addition to serving as an intermediate facility between institutions and private homes, GICFs should enlarge their role of home care supporting facilities in ways that would enable them to provide frail elderly patients at home with respite care and daycare services.

Factors influencing users' destination upon discharge from a geriatric intermediate care facility in an urban area

Geriatric Intermediate Care Facilities (GICF) have been established to help the hospitalized elderly return home. Users of the GICF are elderly persons who do not need hospitalization, but are mentally or physically impaired. To determine what factors influence users' destinations upon discharge from GICF, we analyzed various characteristics such as age, sex, place of residence before admission, length of stay, intellectual impairment, ability to perform activities of daily living (ADL) among users (N = 389) in a GICF in Chiba City. Multiple logistic regression analyses revealed that, compared with the users who were hospitalized, users who were male, admitted for home, stayed for long periods, and had a high ability to perform ADL were more likely to return home. The analyses also revealed that, compared with the users who were institutionalized, users who came from home, stayed for short periods, and had a high ability to perform ADL were more likely to return home. Evaluating a user's physical, mental, and socioeconomical conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended period.

Follow-up study of the elderly users of a geriatric intermediate care facility after discharge

Geriatric intermediate care facilities (GICF) were started by subsidies from the Ministry of Health and Welfare in 1987 to promote the return of elderly from hospitals to their homes or nursing homes and to give support to the cared elderly and their families. This paper describes about the function of a GICF established in a rural community in Oita, Kyushu. One hundred seventy four elderly users (66 males, 108 females: mean age; 81 years old) who were discharged from the GIFC between July 1990 and June 1991 were studied. The main results were as follows: 1. The reason for admission to the GIFC of 174 elderly users were cerebrovascular disease in 50 cases, bone and/or joint diseases in 63, senile dementia in 25 and other diseases in 36.2. Eighty three persons (48%) needed continuous care. 3. The activities of daily living of approximately 37% of those who needed continuous care improved to some degree. 4. Ninety six users were discharged and went home, 43 were readmitted to a hospital, 32 were admitted to a nursing home, and 3 died at the GIFC. 5. The situation as of September 1991 was 70 persons (40%) at home, 12 persons in hospital, 33 persons in the GICF, 35 persons in nursing homes and 24 deaths. 6. Fifty two persons (37%) used the GICF more than twice. These findings suggested that the GICF enabled care for weak elderly persons at home.