Special Nursing Home Research Articles

Determinants of the functionality of cost accounting systems in social welfare organizations: Exploratory study using cluster analysis

This paper presents a quantitative exploration of the functionality of cost accounting systems and their determinants in social welfare organizations. We conducted a questionnaire survey of managers of social welfare organizations running special nursing homes for the elderly and conducted a cluster analysis based on the data collected. The questionnaire was created based on the scales used in previous studies, with some new scales developed. For data analysis, the statistical analysis environment R was used. The clValid package of R was used to assess the validity of the cluster analysis. Based on the results of the analysis in this paper, it is expected that social welfare organizations that pursue cost leadership strategies and have a strong public interest orientation will benefit greatly by being able to utilize a highly functional cost accounting system. Such organizations will be able to improve their business efficiency by utilizing cost information, and their social contribution activities based on the resulting resources will truly be a contribution to public welfare. The findings from this study are of practical significance because they can be used by business managers of social welfare organizations to review the functionality of their cost accounting systems. We also focus on the degree to which nonprofit organizations focus on social contribution activities (in this paper, we call this public interest orientation). The public interest orientation of an organization is thought to affect the functionality of the cost accounting system in the same way as the organization’s strategy, but there has not been enough quantitative research on this point. By focusing on the public interest orientation of social welfare organizations, this study contributes to deepening our knowledge in this area.

Does the association between short-chain fatty acids and depressive symptoms vary with age? A large population-based study

IntroductionFat plays an important role in brain function; 60% of the brain’s dry weight is fat. Among fats, omega-3 fatty acids, which are long-chain fatty acids, have been reported to reduce depressive symptoms. On the other hand, there are few studies on short-chain fatty acids (SCFAs), and those that do exist are mostly animal studies, with only a few human studies (about 100 cases). This is the first study to examine the association between fecal short-chain fatty acids and depressive symptoms on a large scale in the general population.ObjectivesWe examined the association of fecal SCFAs with depressive symptoms. In addition, we analyzed the associations stratified by age and examined differences in the associations.MethodsThis study was conducted using data from the Dynamics of Lifestyle and Neighborhood Community on Health Study (DOSANCO Health Study). The target population was all residents of the city of Suttu, Hokkaido, Japan, excluding residents of special nursing homes (n=2638). 579 individuals (22% of the target population) aged 18 years and older who were able to measure fecal SCFA participated in this study with written informed consent. Approval was obtained from the Ethics Committee of Hokkaido University School of Medicine (15-002 and 15-045). Fecal SCFA was measured by high-performance liquid chromatography. We examined the association of fecal concentrations of SCFA subtypes (i.e., acetate, butyrate, and propionate) and total SCFA concentrations (mg/g wet weight as a continuous variable) with total Patient Health Questionnaire-9 (PHQ-9) scores using multiple regression analysis. We adjusted for age, sex, habitual exercise, total energy intake, and total dietary fiber intake. We performed additional multiple regression analyses with stratification by age group (18-59 years and 60 years or older). Two-tailed tests were used for all analyses with a significance level of P < 0.05.ResultsThe mean age (standard deviation) of the study participants (n=534) was 58.3 (16.0) years. Among them, 48% were 18-59 years old and 54% were female. Fecal propionate concentration was significantly associated with total PHQ-9 score (beta=0.62, p<0.01). Other SCFAs and total SCFA were not significantly associated with total PHQ-9 score. In addition, using stratification analyses by age group, the associations between fecal propionate concentration and total PHQ-9 score showed a different trend by age group (beta=0.18, p=0.62 for 18-59 years; beta=0.80, p<0.01 for 60 years or older).ConclusionsThe study showed an association between higher concentrations of fecal propionic acid and higher levels of depressive symptoms. The association was particularly pronounced in older people, those aged 60 years and older. The results suggest that improving dietary habits to reduce fecal propionic acid may be effective in preventing depression in the elderly.Disclosure of InterestR. Okubo Shareolder of: None, Grant / Research support from: A Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science (No. 22K17844), Consultant of: None, Employee of: None, Paid Instructor of: None, Speakers bureau of: Speakers bureau from Takeda Pharmaceutical Company Limited, R. Yamamura: None Declared, S. Ishikawa: None Declared, T. Kimura: None Declared, S. Ukawa: None Declared, K. Nakamura: None Declared, A. Tamakoshi: None Declared

Social Implementation and Measurement Accuracy Verification of Non-contact Biological Monitors

In this research, for the purpose of social implementation, we conducted a near-miss demonstration experiment using a car driving in the city and a drive-simulator. Next, we conducted a demonstration experiment to evaluate the reliability of biometric information measured on patients in a medical facility's recuperation ward and residents of a special nursing home. NBC-1100 emits radar waves from a distance of up to 3 meters from an object and uses the reflected waves to measure biological information such as pulse waves and breathing waves. The multi-element pyroelectric effect was used to measure body temperature by detecting infrared radiation emitted from distant objects. This device is unique in that it can measure biological information without being restrained while wearing clothes. In the demonstration test, simultaneous measurements were conducted on nine healthy men aged 45 to 65 using a pharmaceutically approved product (μBP-mp) and a prototype non-contact biological monitor (NBC-1100 manufactured by K&S Co., Ltd.). The demonstration experiments at medical institutions and nursing care facilities were conducted with the consent of residents and their families and were conducted on 30 men and women between the ages of 70 and 94 who were undergoing treatment or in need of care. The tests were conducted on residents with chronic diseases such as dilated gastrostomies, symptomatic epilepsy, hypertension, Alzheimer's disease, and progressive supranuclear palsy. The evaluation method was simultaneous measurement using a master meter (μBP-mp) and a test meter (NBC-1100).

Changepoint Detection in Heart Rate Variability Indices in Older Patients Without Cancer at End of Life Using Ballistocardiography Signals: Preliminary Retrospective Study.

In an aging society such as Japan, where the number of older people continues to increase, providing in-hospital end-of-life care for all deaths, and end-of-life care outside of hospitals, such as at home or in nursing homes, will be difficult. In end-of-life care, monitoring patients is important to understand their condition and predict survival time; this information gives family members and caregivers time to prepare for the end of life. However, with no clear indicators, health care providers must subjectively decide if an older patient is in the end-of-life stage, considering factors such as condition changes and decreased food intake. This complicates decisions for family members, especially during home-based care. The purpose of this preliminary retrospective study was to determine whether and how changes in heart rate variability (HRV) indices estimated from ballistocardiography (BCG) occur before the date of death in terminally ill older patients, and ultimately to predict the date of death from the changepoint. This retrospective pilot study assessed the medical records of 15 older patients admitted to a special nursing home between August 2019 and December 2021. Patient characteristics and time-domain HRV indices such as the average normal-to-normal (ANN) interval, SD of the normal-to-normal (SDNN) interval, and root mean square of successive differences (RMSSD) from at least 2 months before the date of death were collected. Overall trends of indices were examined by drawing a restricted cubic spline curve. A repeated measures ANOVA was performed to evaluate changes in the indices over the observation period. To explore more detailed changes in HRV, a piecewise regression analysis was conducted to estimate the changepoint of HRV indices. The 15 patients included 8 men and 7 women with a median age of 93 (IQR 91-96) years. The cubic spline curve showed a gradual decline of indices from approximately 30 days before the patients' deaths. The repeated measures ANOVA showed that when compared with 8 weeks before death, the ratio of the geometric mean of ANN (0.90, 95% CI 0.84-0.98; P=.005) and RMSSD (0.83, 95% CI 0.70-0.99; P=.03) began to decrease 3 weeks before death. The piecewise regression analysis estimated the changepoints for ANN, SDNN, and RMSSD at -34.5 (95% CI -42.5 to -26.5; P<.001), -33.0 (95% CI -40.9 to -25.1; P<.001), and -35.0 (95% CI -42.3 to -27.7; P<.001) days, respectively, before death. This preliminary study identified the changepoint of HRV indices before death in older patients at end of life. Although few data were examined, our findings indicated that HRV indices from BCG can be useful for monitoring and predicting survival time in older patients at end of life. The study and results suggest the potential for more objective and accurate prognostic tools in predicting end-of-life outcomes.

Surgical Treatment of Habitual Temporomandibular Joint Dislocation Caused by Aging

Temporomandibular joint dislocation occurs not only in the elderly but in all age groups. However, in recent years, the number of elderly people with various underlying diseases such as dementia, cerebral infarction, and Parkinson’s disease has increased, and the number of elderly people who suffer habitual dislocation of the temporomandibular joint has also increased. It is considered that there are potential patients in special nursing homes and health care facilities for the elderly, and thus a large-scale fact-finding survey is desired. There is a consensus that non-invasive therapy is the first choice for the treatment of habitual temporomandibular joint dislocation. Currently, non-invasive treatments as well as invasive treatments such as the mandibular condyle anterior motion inhibition method and the mandibular condyle reduction method are being performed at many facilities for treating habitual temporomandibular joint dislocation. It is our duty as surgeons to choose minimally invasive surgery as surgical therapy. Therefore, there is an urgent need to accumulate cases and determine trends through joint research with other institutions and to select minimally invasive surgery.

Relationship between Special Nursing Home Residents’ Level of Independence in Activities of Daily Living and Skeletal Muscle Mass Index

Relationship between Special Nursing Home Residents’ Level of Independence in Activities of Daily Living and Skeletal Muscle Mass Index

Experience of bereaved families in case of end-of-life care in special nursing homes

Experience of bereaved families in case of end-of-life care in special nursing homes

A study of an inter-professional team process model for terminal care in special nursing homes for the elderly

A study of an inter-professional team process model for terminal care in special nursing homes for the elderly

Factors influencing the choice of care for dying individuals in special nursing homes for the elderly

Factors influencing the choice of care for dying individuals in special nursing homes for the elderly

Outcomes of Pharmacists' Involvement with Residents of Special Nursing Homes for the Elderly

The current study aimed to examine the outcomes of pharmacists' involvement with elderly people in special nursing homes. We analyzed 58 cases involving regular visits by community pharmacists to 41 residents. The residents' mean age was 87.8±6.9 years, and 68.3% were prescribed 6 or more types of medication. Antipsychotic and insomnia medication was taken by 24.4% and 31.8% of residents, respectively. Pharmaceutical consultation following medication use accounted for 60.3% of pharmacists' involvement with residents. The outcomes of these consultations included improvements in prescription content; the identification and prevention of adverse drug events; improvement in activities of daily living; and improvement in test results, sleep, and urination/bowel control. The results also suggested that pharmacists' intervention reduced drug costs. Information that facilitated involvement was most frequently acquired via conversations (67.2%) and conferences (24.1%) in the facilities. The most common information sources were care workers (72.4%), followed by nurses (37.9%), physicians (6.9%), and functional training instructors (6.9%). Information was also acquired from patients (3.4%) and their family members (5.2%). The findings indicated that regular visits by pharmacists to facilities for elderly people and conversations between residents, their family members, and physicians, nurses and various other professionals improved various pharmacotherapy outcomes.

Evaluation of a high serum docosahexaenoic acid level as a predictor of longevity among elderly residents at a special nursing home

Evaluation of a high serum docosahexaenoic acid level as a predictor of longevity among elderly residents at a special nursing home

The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes.

Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

Risk factors of fecal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae in special nursing homes in Japan.

ObjectiveJapanese welfare facilities for the elderly are called as special nursing home (SNH), providing conventional‐type with group care or unit‐type with individual care. We investigated the risk factors of fecal colonization with extended‐spectrum β‐lactamase‐producing Enterobacteriaceae (ESBL‐E) of elderly who required care at SNH in Japan.MethodsThe feces discharged on diaper were obtained from the total of 100 residents with fecal incontinence in 9 SNHs located in Tokyo, Japan. The samples were cultured on ESBL selection agar, and ESBL‐E were determined by the antimicrobial susceptibility test and genetic analysis. The status of the residents and the characteristics of facilities, especially about the incontinence care, were obtained by questionnaire methods. Statistical analysis was performed to determine the factors related to carriage of ESBL‐E.ResultsExtended‐spectrum β‐lactamase‐producing Enterobacteriaceae was isolated from 53 of 100 SNH residents. Risk factors of colonization among the individual residents were not found. The prevalence of ESBL‐E carriage was significantly higher in the 6 conventional‐type facilities than in the 3 unit‐type facilities (P = .015). The cart for diaper exchange was used in 5 of 6 conventional‐type facilities in 9 SNHs, and their residents tended to show high of ESBL‐E colonization rate. The residents living in unit‐type facilities which do not use gloves for changing diaper tended to show high ESBL‐E colonization rate than other 2 facilities using gloves.ConclusionsIt is suggested that using the cart for changing diaper has relation to carry ESBL‐E. In the facilities using cart, revision of their methods of excretion care will be needed.

Lifetime Expectancy in Dementia with Lewy Bodies: Effects of Donepezil Administration and Special Nursing Home Replacement. A Retrospective Analysis in the Tajiri Project

Objective: Cholinesterase inhibitors (ChEIs) can delay the progression of Alzheimer disease (AD). We previously demonstrated a positive effect of donepezil (DNP) administration and a Special Nursing Home (SNH) replacement on lifetime expectancy after the onset of AD. Recently DNP has been indicated for use in the treatment of dementia with Lewy Bodies (DLB); however, the effect on lifetime expectancy remains unclear. Herein, we analyzed the effects of DNP on DLB. Methods: All outpatients at the Tajiri Clinic with available medical records and death certificates from 1999- 2012 were included in this retrospective analysis. The entry criteria were a diagnosis of dementia based on DSM-IV criteria and diagnosis of DLB using the international consensus criteria; medical treatment for more than 3 months and follow up to less than 1 year before death. Results: We identified 510 subjects based upon medical records and death certificates, of which 360 had a diagnosis of dementia that met the entry criteria. Of 51 patients diagnosed with DLB, 23 had taken DNP and 28 patients had not undergone drug treatment due to treatment prior to the introduction of DNP in 1999 in Japan. The lifetime expectancies after onset were 6.4 years in the DNP group and 3.6 years in the non-DNP group; with a significant drug effect. However, in contrast with the previous AD data, no significant effect of SNH residency was noted. Conclusion: Although this report has the limitation that all analyses were retrospective and lacked randomization, we found a positive effect of DNP on lifetime expectancy after the onset of DLB. The lower life expectancy compared with that of AD and the lack of an effect of SNH residency suggest the cholinergic deficiency in DLB is greater than that in AD.

Evaluation of Factors Associated with Tongue Coating Status in Elderly with Care Needs.

The tongue surface in older people requiring nursing care is often coated with a layer believed to comprise, keratinized products of degeneration, food residue, bacteria, and leukocytes attached to the tongue papillae. Which factors affect the status of this tongue coating remain to be elucidated, however. The purpose of this study was to evaluate factors related to tongue coating status in older people requiring nursing care. The study participants comprised 41 individuals admitted to special nursing homes for the elderly. After undergoing tooth brushing and tongue cleaning by the facility staff, the participants were required to refrain from oral cleaning until evaluation of tongue coating status, which was performed just after lunch. The moisture level of the tongue surface was measured and total number of oral microbes determined. Food type, care level, and sex were determined by a questionnaire given by the attending nurses. Correlations between the tongue coating status and various factors were analyzed using Spearman's rank correlation coefficient. The participants were divided into 2 groups according to the median value of the tongue coating status. Factors related to tongue coating were analyzed using binomial logistic regression analysis (α=0.05). Tongue coating status showed a significant correlation with the total number of oral microbes on the tongue surface (rS=0.449, p=0.003), type of food (rS=0.388, p=0.012), and care level (rS=-0.308, p=0.050). Logistic regression analysis revealed that the food type of the side dish significantly affected tongue coating status. These results showed a correlation between tongue coating status and type of food of the side dish in older people requiring nursing care.

The relationship between participation in occupational therapy activities and stress in elderly in a special nursing home for the elderly

The relationship between participation in occupational therapy activities and stress in elderly in a special nursing home for the elderly

Effect of physical and cognitive function by 6 months exercise intervention for demented residents of special nursing home

Background: It is widely known effects of exercise intervention for patients with dementia.

Stress response of dogs repeatedly participated in animal-assisted activities at special nursing homes for elderly people

Stress response of dogs repeatedly participated in animal-assisted activities at special nursing homes for elderly people

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

The Influence of Living Environment on Independence Level of Special Nursing Home Residents

The Influence of Living Environment on Independence Level of Special Nursing Home Residents