Factors promoting resident deaths at aged care facilities in Japan: a review

Patterns of visiting nurse services for older adults in Japanese residential facilities: A latent class analysis

AIM

To examine the patterns of the visiting nurse services provided to older adults in a type of residential facility in Japan and to identify associated factors.

METHODS

This secondary analysis used past survey data from visiting nurse service agencies providing services to older adults in residential facilities with few nurses, known as non-specified facilities in Japan. Approximately 515 cases were used to determine the patterns of visiting nurse services using latent class analysis. Multinomial logistic regression analysis examined the relationships between identified classes, residents' characteristics, facilities, and services provided by visiting nurses.

RESULTS

Three service patterns were identified as follows: Class 1, observational and follow-up care (37.1%); Class 2, chronic disease care (35.7%); and Class 3, end-of-life care (27.2%). Class 1 comprised fewer nursing services than the other classes and primarily involved the observation of medical conditions, whereas Classes 2 and 3 involved higher care-need levels and provided diverse nursing care support. Specifically, Class 3 was associated with the inclusion of family (odds ratio: 2.42) and a visiting nurse at the attached facility (odds ratio: 4.88).

CONCLUSIONS

The three identified classes describe the older residents' healthcare needs. Additionally, the factors associated with the end-of-life care class suggest that older residents with these factors may have difficulty accessing end-of-life care by visiting nurses. Geriatr Gerontol Int 2023; ••: ••-••.

National trends in the proportion of in-hospital deaths by cause of death among older adults with long-term care: a nationwide observational study in Japan from 2007 to 2017

Background

Japan has promoted end-of-life care at home and in long-term care facilities, and the total proportion of in-hospital deaths has decreased recently. However, the difference in trends of in-hospital deaths by the cause of death remains unclear. We investigated the variation in trends of in-hospital deaths among older adults with long-term care from 2007 to 2017, by cause of death and place of care.

Methods

Using the national long-term care insurance registry, long-term care claims data, and national death records, we identified people aged 65 years or older who died between 2007 and 2017 and used long-term care services in the month before death. Using a joinpoint regression model, we evaluated time trends of the proportion of in-hospital deaths by cause of death (cancer, heart diseases, cerebrovascular diseases, pneumonia, and senility) and place of care (home, long-term care health facility, or long-term care welfare facility).

Results

Of the 3,261,839 participants, the mean age was 87.0 ± 8.0 years, and 59.2% were female. Overall, the proportion of in-hospital deaths decreased from 66.2% in 2007 to 55.3% in 2017. By cause of death, the proportion of in-hospital deaths remained the highest for pneumonia (81.6% in 2007 and 77.2% in 2017) and lowest for senility (25.5% in 2007 and 20.0% in 2017) in all types of places of care. The joinpoint regression analysis showed the steepest decline among those who died of senility, especially among long-term care health facility residents.

Conclusions

The findings of this nationwide study suggest that there was a decreasing trend of in-hospital deaths among older adults, although the speed of decline and absolute values varied widely depending on the cause of death and place of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02700-1.

Provision and related factors of end-of-life care in elderly housing with care services in collaboration with home-visiting nurse agencies: a nationwide survey

Background

Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase “Elderly Housing with Care Services (EHCS)”, which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS.

Methods

A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing.

Results

Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident’s physician.

Conclusions

This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00847-7.

Factors associated with the accomplishment of home death among patients receiving physician-led home healthcare

AIM

To evaluate unique factors associated with home death in older Asian individuals who received physician-led home healthcare.

METHODS

We carried out a case-control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician-led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death.

RESULTS

A total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52-27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15-25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13-26.19).

CONCLUSIONS

Older age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525-531.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Impact of a Japanese Incentivization Program to Increase End-of-Life Care Outside of Hospitals

OBJECTIVES

To analyze the association of an incentivization program to promote death outside of hospitals with changes in place of death.

DESIGN

A longitudinal observational study using national databases.

SETTING AND PARTICIPANTS

Participants comprised Japanese decedents (≥65 years) who had used long-term care insurance services and died between April 2007 and March 2014.

METHODS

Using a database of Japanese long-term care insurance service claims, subjects were divided into community-dwelling and residential aged care (RAC) facility groups. Based on national death records, change in place of death after the Japanese government initiated incentivization program was observed using logistic regression.

RESULTS

Hospital deaths decreased by 8.7% over time, mainly due to an increase in RAC facility deaths. The incentivization program was more associated with decreased in-hospital deaths for older adults in RAC facilities than community-dwelling older adults.

CONCLUSIONS AND IMPLICATIONS

In Japan, the proportion of in-hospital deaths of frail older adults decreased since the health services system introduced the incentivization program for end-of-life care outside of hospitals. The shift of place of death from hospitals to different locations was more prominent among residents of RAC facilities, where informal care from laymen was required less, than among community residents.

Factors associated with deaths in 'Elderly Housing with Care Services' in Japan: a cross-sectional study

BACKGROUND

Although the Japanese government has expanded its 'Elderly Housing with Care Services' (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents' deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths.

METHODS

Our cross-sectional study involved all EHCS (N = 412) in Japan's Tokyo, Kanagawa prefecture and used self-administered questionnaire data that the EHCS directors completed. In addition, we accessed the national statistics related to the municipal characteristics of the cities where the EHCS were located. These sources provided information about health care provision for the residents as well as facility/resident/regional characteristics that could potentially be associated with residents' deaths in the EHCS. Based on this information, a sequential multiple logistic regression analysis was performed. First, we included in-facility health care provision (presence of nursing staff) and facility/residents/regional characteristics in Model 1. Next, visiting nurse agency's care provision was included in Model 2. Finally, we included community hospitals or clinical care provision in Model 3.

RESULTS

One hundred and fifty-four facilities answered the questionnaire (response rate: 37.4%). A total of 114 facilities were analysed. In-facility residents' deaths occurred in more than half (54.4%) of the facilities. After adjusting for all variables (Model 3), end-of-life (EOL) care provision from community hospitals or clinics, the number of years since establishment and the number of residents were significantly associated with residents' deaths. In Model 2, visiting nurse's EOL care provision was significantly associated with residents' death.

CONCLUSION

Our results suggest that in order to accommodate residents' deaths, the government or the facility's directors should promote the cooperation between EHCS facilities and community hospitals or clinics for in-residents' EOL care. Furthermore, as the results suggest that community nurses contribute to the occurrences of death by collaborating with the physician, promoting cooperation with visiting nurse agencies may be also needed.