Home In Japan Research Articles

Analysis of Price- and Services-Related Preferences for Nursing Homes in Japan Using a Nested Logit Model in Choice-Based Conjoint Analysis

Analysis of Price- and Services-Related Preferences for Nursing Homes in Japan Using a Nested Logit Model in Choice-Based Conjoint Analysis

Elucidations of Present Situation of Preparedness for Natural Disasters at Home in Japan and its Effective Factors

This study elaborates on the measures to improve preparedness for natural disasters by elucidating the present situation of preparedness for natural disasters at home in Japan as well as the effective factors to promote such preparedness. An Internet monitoring survey was conducted throughout Japan, and valid responses (n=1,599) were obtained. To measure preparedness for natural disasters at home, we used 31 items, including the ones in the “public opinion poll on disaster management” conducted by the Cabinet Office, Government of Japan. The Internet monitoring survey revealed that approximately 30% of the respondents arranged for articles they may require in the event of a disaster and had contemplated their evacuation actions immediately after a disaster. The Internet monitoring survey results were compared with the results of the Cabinet Office, Government of Japan’s public opinion poll. It revealed that the internet monitoring survey results better represent the tendency of the Japanese people as a whole. A multiple regression analysis was conducted to determine six independent variables—age, marital status, prior disaster experience, awareness of hazard maps, disaster imminence, and communal exchanges—statistically significant as effective factors to improve preparedness for natural disasters at home. Particularly, considering a large standardizing coefficient (β) for awareness of hazard maps, it is proposed that the most effective measure to improve preparedness for natural disasters at home to comprehend the risks posed to one’s community and own house is by using the opportunities of disaster prevention education and drill rather than simply viewing the hazard maps aimlessly.

Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries

PurposeThere is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. MethodsSecondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics. ResultsOverall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). ConclusionsOne in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.

Factors related to evacuation intention when a Level 4 evacuation order was issued among people with mental health illnesses using group homes in Japan: A cross-sectional study.

This study aimed to identify factors related to the intention to evacuate in a disaster following a Level 4 evacuation order among people with mental health illnesses living in group homes in Japan. The participants were people with mental health conditions living in group homes in Ishikawa Prefecture, Japan. We created an original self-administered questionnaire and conducted a survey among this group. Of the 625 people with mental health conditions using group homes, 152 (24.3%) responded. Of these, 110 (5.9%) who provided valid data were included in the analysis. A total of 85 (77.3%) people said that they intended to evacuate in the event of a Level 4 evacuation order. We controlled for gender, age group, type of disability, experience of participating in disaster training, fear of contracting COVID-19 during evacuation, and earthquake and flood disaster experience as confounders. After controlling for these variables, the factors associated with intention to evacuate under a Level 4 evacuation order included not having emergency food prepared (odds ratio [OR] 3.81, 95% confidence interval [CI]: 1.03-14.08); believing that group home users would help them during disasters (OR 3.08, 95% CI: 1.04-9.12); and planning to ask the local government for help (OR 2.84, 95% CI: 1.01-8.01). Group home managers should be aware that people who do not believe that other group home residents would help them, and those not wishing to seek help from local government, may decide not to evacuate. Longitudinal studies across diverse regions are needed to identify factors that affect evacuation intention.

Exploring the Landscape of Home-Based Teleradiology in Japan: A Qualitative Analysis of Radiologists’ and Neurosurgeons’ Experiences to Elucidate Advantages, Challenges, and Future Directions

This study aimed to investigate the advantages, disadvantages, working methods, and support needs of physicians practicing teleradiology from home in Japan, as well as to explore challenges related to the COVID-19 pandemic. We conducted semi-structured interviews with 15 physicians (12 radiologists and 3 neurosurgeons) engaged in teleradiology services. Participants were recruited through purposive sampling to ensure diversity in age, gender, and experience. Data were analyzed using inductive thematic analysis following Braun and Clarke’s six-step approach. Five main themes were generated: (1) the ability to work from home according to one’s lifestyle, allowing for better work-life balance; (2) reduced quality and efficiency of reading work, due to limited patient information and lack of immediate consultation; (3) self-management and reliance on available resources, including literature searches and networking with colleagues; (4) need for comfortable infrastructure facilities, such as high-quality monitors and stable internet connections; and (5) provision of resources to resolve questions and concerns, including platforms for peer discussions. Interestingly, no specific themes related to the COVID-19 pandemic were identified, suggesting that the challenges of teleradiology were not uniquely affected by the pandemic. While home-based teleradiology offers lifestyle flexibility, it presents challenges in maintaining work quality and efficiency. Physicians employ self-management strategies and rely on available resources to mitigate these challenges. The findings highlight the need for improved infrastructure and support systems to enhance the practice of home-based teleradiology in Japan. This study contributes to the growing body of literature on remote healthcare delivery and may inform policy decisions and best practices in diagnostic radiology both in Japan and internationally.

Impact of the COVID-19 Pandemic on Cancer Death Locations in Japan: An Analysis of Excess Mortality Through February 2023.

The novel coronavirus disease 2019 (COVID-19) pandemic has significantly impacted end-of-life decisions for cancer patients in Japan, with disparities existing between preferred and actual care settings. Our study investigates the potential shifts in cancer death locations during the pandemic and if there were excess cancer deaths. Utilizing national mortality data from the Ministry of Health, Labour and Welfare from January 2012 to February 2023, we identified cancer deaths using International Classification of Disease, 10th revision codes. We assessed death locations, including medical institutions, nursing facilities, and homes. The Farrington algorithm was employed to estimate expected death counts, and the differences between observed and expected counts were denoted as excess deaths. From January 2018 to February 2023, there was consistently increase in the weekly observed cancer deaths. The presence of a definitive excess during the pandemic period remains uncertain. The percentage of deaths in medical institutions declined from 83.3% to 70.1%, while home deaths increased from 12.1% to 22.9%. Between April 2020 and February 2023, deaths in medical institutions frequently fell below the 95% prediction lower limit. Home deaths consistently exceeded the 95% prediction upper limit, with significant excess deaths reported annually. Our study found a shift in cancer death locations from medical institutions to homes in Japan during the COVID-19 pandemic. Our study did not confirm an overall increase in cancer deaths during this period. As with global trends, the profound shift from hospitals to homes in Japan calls for a comprehensive exploration to grasp the pandemic's multifaceted impact on end-of-life cancer care decisions.

Matter and ECHONET Lite: Similarities, differences, and a bridge solution for interoperability

With the increasing number of connected devices in smart homes, ensuring compatibility and interoperability is becoming increasingly more important. Matter and ECHONET Lite have been introduced to tackle this issue. While Matter is gaining significant attention globally as the future protocol for smart homes, ECHONET Lite has a long history of development and adoption in the smart home in Japan. Therefore, it is essential that both Matter and ECHONET Lite devices are interoperable to provide maximum benefits to users.In this paper, we provide an in-depth analysis that compares the architecture and features of Matter and ECHONET Lite, highlighting both their commonalities and differences. On top of that, we introduce a solution to bridge ECHONET Lite devices into the Matter ecosystem, enabling them to collaborate seamlessly with other Matter devices. This bridge solution is developed, implemented, and tested within a real smart home testbed installed with commercial and experimental ECHONET Lite devices. Our results show that the proposed solution effectively enables the smooth integration of ECHONET Lite devices into the Matter ecosystem, making it suitable for everyday use in smart home environments.

Factors Related to the Willingness of People with Mental Health Illnesses Living in Group Homes to Disclose Their Illness to Supporters during Disaster Evacuation: A Cross-Sectional Study.

Severe heavy rains caused by linear precipitation systems are occurring more frequently in Japan owing to climate change, and residents are being asked to evacuate more often. The purpose of this study was to identify factors associated with the willingness of people with mental health illness (PMHI) in group homes to disclose their illness when being evacuated. Participants were PMHI living in group homes in Japan. We conducted an original anonymous self-administered questionnaire based on previous research. Valid data from 119 people were analyzed. Factors associated with the willingness to disclose illness to supporters upon evacuation were "I can imagine living in a public shelter" (Odds Ratio [OR] 4.50, 95% Confidence Interval [CI]: 1.78-11.43), and "I socialize with neighbors" (OR 5.63, 95% CI: 1.74-18.22). Managers of group homes should encourage PMHI to imagine life in an evacuation zone by increasing opportunities for disaster training and for interaction with local residents. People who are less likely to socialize with neighbors should be especially careful, as they may not be able to disclose their illness, and those who support evacuees should pay special attention to these people.

Homebound elderly with dementia and their family caregivers: Examining the situation in Hong Kong, Singapore, and Japan before COVID-19

This study aimed to clarify the status of problematic behaviors among elderly patients with dementia at home and the associated burden on their family caregivers in Japan, Hong Kong, and Singapore immediately before the COVID-19 pandemic. The study included 563 family caregivers of elderly patients with dementia living at home in these three regions. Information regarding their demographic characteristics, such as age, gender, education level, income, marital status, and family status, was obtained. The Revised Memory and Behavior Problems Checklist, a 24-item scale for assessing problem behaviors, and the Zarit Burden Interview, a 22-item scale for measuring caregiver burden, were used alongside other relevant scales. The findings indicated that the majority of family caregivers were female and in their 60s across all three regions, while elderly patients with dementia were mostly female and living alone in their 80s. In addition, a significant proportion of these patients had comorbidities such as diabetes and other health conditions. In Japan, although the patients exhibited relatively intact physical function and a low degree of dementia, the caregivers experienced high-stress levels. The demographic profiles of family caregivers of elderly patients with dementia at home in Hong Kong, Singapore, and Japan were remarkably similar, particularly in terms of age and gender distribution. Furthermore, marital and employment statuses were comparable between Hong Kong and Singapore. While the previous studies have taken a broad view of Asia, focusing on Hong Kong, Singapore, and Japan in particular has facilitated the identification of clues for developing targeted countermeasures.

Deprescribing Opportunities for Frail Residents of Nursing Homes: A Multicenter Study in Australia, China, Japan, and Spain

ObjectiveDeprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain. DesignSecondary cross-sectional analyses of data from 4 cohort studies. Setting and ParticipantsA total of 1142 residents in 31 nursing homes. MethodsMedication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0–2; frail 3–6; most-frail 7–14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts. ResultsIn total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06–1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45–2.18), aspirin (PR, 1.31; 95% CI, 1.04–1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00–1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan. Conclusions and ImplicationsThere were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing.

Mortality from decreased food intake in older adults in nursing homes: A retrospective cohort study using electronic care record data

AimTo our knowledge, no studies have examined the risk of mortality in nursing homes using the routinely collected electronic care record information. We aimed to assess the risk of mortality using food intake data documented in electronic care records from Japanese nursing homes. MethodsThis academic–industry collaborative research included 814 older adults from five nursing homes in Japan. The study period was from January 1, 2016 to June 23, 2020. We used the rate of food intake data recorded by care workers in the electronic care records of the residents. We defined decreased food intake as the percentage decrease between admission and 90 days after admission into the nursing home, with cutoffs of 10%, 20%, and 30%. ResultsThe number of older adults whose food intake decreased between admission and 90 days after admission was 114 (14.0%) at a 10% rate, 58 (7.1%) at a 20% rate, and 35 (4.3%) at a 30% rate. All three rates were significantly associated with mortality (10%: hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.30–3.15; 20%: HR 3.03, 95% CI 1.68–5.47; and 30%: HR 4.50, 95% CI 2.15–9.44). ConclusionsWe found that the risk of mortality could conveniently be assessed from the food intake data collected routinely and comprehensively and documented in electronic care records in nursing homes. Our findings can be utilized in nursing homes, where medical staff are limited, to assess high-risk residents and to encourage a discussion regarding the management of end-of-life care.

Social support needs of caregivers rearing children with severe motor and intellectual disabilities at home in Japan.

In Japan, recently, the number of children with severe motor and intellectual disabilities (SMID) is steadily increasing. Caregivers such as parents and family members are struggling with how to live with their children at home and in the community after discharge. The current study aimed to explore the social support needs faced by caregivers while rearing children with SMID in order to identify effective means of social support in Japan. We conducted a cross-sectional survey of the primary caregivers of children with SMID at home through special-needs elementary, junior high, and senior high schools nationwide, using a self-administered, anonymous questionnaire to investigate the actual social support needs of the caregivers. All statements of social support need were coded using Krippendorff content analysis. Questionnaire returns were obtained from 1,176 families, and the descriptions of 1,173 families were included in the analysis. The results of the analysis showed that the needs of the caregivers consisted of seven categories. The social support needs expressed by the caregivers are necessary findings for Japan today, both for the soft side, such as the development of local systems and regulations to support these families, and for the hard side, such as the increase and improvement of facilities and equipment.

Theorizing the Real in Social Robot Care Technologies in Japan

Japanese care centers have seen an increasing reliance on robotic assistance in service and social-care tasks, which poses questions about ethics, governance, and caregiving practices. This article addresses the concept of robotics as a media technology, and the role of human agency in shaping imagination as an interpretive framework as it reflects on two specific points of debate; (1) whether the humanoid robot Pepper, deployed in an elder-care nursing home in Japan, has some form of agency in its interaction with a nursing home resident; and (2) whether appropriate anthropological debates about being (properly reframed with regard to difference) provide insight into the reality of robot care. Adapting an approach by anthropologist Boellstorff (2016), whose work focuses on the reality of virtual worlds, this article analyzes whether questions regarding the real of robot care are questions of being, i.e. of ontology. Conflating the interhuman with the real and the robotic with the unreal—or, in this case, conflating human care with the real (authentic) and robot care with the unreal (artificial)—can negatively affect our ability to discuss the reality of the robotic. The ontological turn can yield important insights, but its potential is lost if what is real is preassigned to the physical.

A scoping review of studies for senior nursing home planning in Japan—Trajectory of introducing private rooms and unit care system in nursing home

AbstractIn aging and aged countries, one of the main issues is to establish sufficient nursing homes for seniors. Japan, as one of the most rapidly aged countries, has been reforming nursing homes for the elderly since the 1990s and established a long‐term care insurance system. The purpose of this scoping review is to systematically map the evolution of researches for nursing homes in Japan since the 1990s, particularly with the post‐occupancy evaluation of the introduction of private rooms and small units. Forty‐three articles concerning privatization of rooms, shared spaces, and small unitization in nursing homes were extracted and analyzed. They were published between 1994 and 2021 in Journal of Architecture and Planning, AIJ Journal of Technology, JAABE, and JAR. The results revealed an evaluation of the privatized rooms mainly from the perspectives of residents' lives and care staffing, the effects and issues of the shared spaces introduced at the same time as private rooms, and the evaluation and issues on subsequent unit‐type floor plans. This study offers significant implications to Asian countries that will have aging and aged populations in the near future by summarizing Japan's experience in dealing with realistic and practical problems over the past 20 years.

Support Issues for People with Mental Disorders in Group Homes in Japan

Support Issues for People with Mental Disorders in Group Homes in Japan

Physical function decline predictors in nursing home residents using new national quality indicators.

To determine the predictors of physical function (PF) decline among nursing home residents using items from the Long-term care Information system For Evidence (LIFE), a system launched in 2021 to ensure the quality of long-term care. The LIFE data of 1648 residents from 45 nursing homes in Japan were retrospectively collected in July 2021 (T0) and January 2022 (T1), including demographics, PF assessed by the Barthel index (BI), nutrition and oral health, and cognitive function. The Dementia Behavior Disturbance scale was used to assess the frequency of certain behaviors, such as "waking at midnight." The predictors of PF decline, defined as a decrease ≥5 in the BI score at T1 compared with that at T0, were determined using mixed-effects logistic regression analyses. PF at T0 was classified into high (>60 BI) and low (≤60 BI) groups. The participants' mean age was 87.2 ± 7.1 years, and 45.3% experienced PF decline. The significant predictors of PF decline were age ≥ 90 years, body mass index <18.5 kg/m2 , dementia diagnosis, moderate and severe cognitive impairments, not vocalizing reciprocal exchanges at will, always "waking at midnight," and high PF at T0. The LIFE items predicted PF decline among nursing home residents, suggesting that LIFE data can be used to ensure the quality of long-term care. Geriatr Gerontol Int 2024; 24: 123-132.

Nurse Practitioner Placement in A Nursing Home in Japan

This study aimed to clarify the role of nurse practitioners (NPs) in a specialized nursing home for older adults in Japan. A retrospective medical chart investigation was conducted to compare the period before and after NP placement. Multilevel logistic regression analysis showed an increase in residents requiring care level 4 or higher (log odds ratio = 0.72; 95% confidence interval [CI], 0.12-1.31), a decrease in emergency outpatient visits (log odds ratio = −0.74; 95% CI, −1.13 to −0.34), and a significant interaction term between emergency visits and hospitalizations after NP placement (log odds ratio = 1.04; 95% CI, 0.27-1.81). Our findings suggest that the placement of NPs contributed to the appropriate utilization of health care resources.

Relationship Between Changes in Daily Living and Quality of Life During the Coronavirus Disease 2019 Pandemic Among the Older Population of Japan

Aim: This study aimed to examine changes in daily living and quality of life (QOL) among older adults living at home in Japan during the coronavirus disease 2019 (COVID-19) pandemic and to determine the relationship between the two. Methods: The participants in this study were Japanese adults aged ≥65 years who agreed to participate. This study was conducted using a questionnaire survey from 2021 to 2022 during the COVID-19 pandemic. Survey items included participants' age, sex, need for care, changes in daily living, and QOL. To assess changes in daily living, the participants were asked about changes in time spent standing, exercising, going out, talking, laughing, sleeping, and alone. QOL was assessed using the SF-8. The relationship between QOL and changes in daily living was analyzed using multiple regression analysis. Results: Of the 485 participants included, 198 (40.8%), 196 (40.4%), 284 (58.6%), 163 (33.6%), 149 (30.7%), and 43 (8.9%) reported a decrease in time spent standing, exercising, outside, talking, laughing, and sleeping, respectively. Additionally, 131 (27.0%) participants reported an increase in time spent alone. Multiple regression analyses indicated that physical QOL was associated with time spent outside, sleeping, and standing, and mental QOL with time spent standing, laughing, and alone. Conclusions: Physical and mental QOL were significantly associated with changes in daily living. Since time spent standing is associated with both physical and mental QOL, guidelines for maintaining time spent standing are particularly important.

Anticipated deaths with physician care (mitori) at home in one town in Japan: A preliminary report.

There are few reports on the numbers of anticipated deaths (mitori [り]) at home in Japan. We used the Japanese death certificate system (shiboukohyou []) for Toyono town citizens who died between 2020 and 2022 and judged a death to constitute mitori when the certificate was not written by a doctor referred from the police. Among 756 deaths, 109 (14.4%) were mitori at home. Deaths at home were 144 and mitori at home accounted for 75.7%. Shiboukohyou appear to provide numbers of mitori at home. Death certificate should include a space which shows mitori or not.

6 Exploring professional-robot interactions in care settings: a case of adopting an Irish air-disinfection device in a nursing home in Japan

Abstract Background Digital welfare technologies are increasingly expected to perform a broader set of functions and roles. The worldwide COVID-19 pandemic further underscored use of technology, as it heightened the need for security and safety in care settings, with cleanliness and infection control becoming an even more important aspect of care delivery. While there are great expectations for digitalization and automation of care work, bringing new technologies such as robots into a workplace remains a challenge in terms of acceptance and usability, as well as a reflection of user preferences and needs. Methods An original air-disinfection ‘robot’ was developed for a cross-cultural research project, and was introduced to a residential nursing home in Japan. Prior to its instalment, seven main users (physiotherapists, nurses and social care professionals) were trained by the developer. Semi-structured interviews and focus groups were conducted before, during and after the trial in order to understand care professionals’ needs regarding and impressions of the device. The System Usability Scale (SUS) was also used to test professionals’ experience with the device. Results Overall, the users had a positive experience of using the robot (SUS score of 74.3/100). During the trial, the team of users changed the inorganic appearance of the robot by adding a face, hair, hands and music to it. The qualitative data reveal how additional efforts were made to transform a piece of air-disinfection equipment into an interactive and accessible robot for older adults. The appropriate size and the level of automation were also raised as essential points for design consideration. Conclusion There is great potential for a variety of care robots to be deployed and evaluated beyond cultural boundaries, but local knowledge and professional expertise are crucial to smooth implementation. The study ‘Harmonisation towards the establishment of Person-centred, Robotics-aided Care System’ was supported by the Toyota Foundation (D18-ST-0005, 2019–2022).