Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey

Changes in the place of death before and during the COVID-19 pandemic in Japan

BACKGROUND

In the global aging, the coronavirus disease 2019 (COVID-19) pandemic may have affected the place of death (PoD) in Japan, where hospital deaths have dominated for decades. We analyzed the PoD trends before and during the COVID-19 pandemic in Japan.

METHODS

This nationwide observational study used vital statistics based on death certificates from Japan between 1951 and 2021. The proportion of PoD; deaths at home, hospitals, and nursing homes; and annual percentage change (APC) were estimated using joinpoint regression analysis. Analyses were stratified by age groups and causes of death.

RESULTS

After 2019, home deaths exhibited upward trends, while hospital death turned into downward trends. By age, no significant trend change was seen in the 0-19 age group, while hospital deaths decreased in the 20-64 age group in 2019. The trend change in home death in the ≥65 age group significantly increased since 2019 with an APC of 12.3% (95% confidence interval [CI]: 9.0 to 15.7), while their hospital death trends decreased by -4.0% (95% CI: -4.9 to -3.1) in 2019-2021. By cause of death, home death due to cancer and the old age increased since 2019 with an APC of 29.3% (95% CI: 25.4 to 33.2) and 8.8% (95% CI: 5.5 to 12.2), respectively.

CONCLUSION

PoD has shifted from hospital to home during the COVID-19 pandemic in Japan. The majority of whom were older population with cancer or old age.

The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka, Japan

This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31-17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86-17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47-13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42-2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92-5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.

Integrated Quantitative Evaluation of Spatial Cognition and Motor Function with HoloLens Mixed Reality

The steady increase in the aging population worldwide is expected to cause a shortage of doctors and therapists for older people. This demographic shift requires more efficient and automated systems for rehabilitation and physical ability evaluations. Rehabilitation using mixed reality (MR) technology has attracted much attention in recent years. MR displays virtual objects on a head-mounted see-through display that overlies the user's field of vision and allows users to manipulate them as if they exist in reality. However, tasks in previous studies applying MR to rehabilitation have been limited to tasks in which the virtual objects are static and do not interact dynamically with the surrounding environment. Therefore, in this study, we developed an application to evaluate cognitive and motor functions with the aim of realizing a rehabilitation system that is dynamic and has interaction with the surrounding environment using MR technology. The developed application enabled effective evaluation of the user's spatial cognitive ability, task skillfulness, motor function, and decision-making ability. The results indicate the usefulness and feasibility of MR technology to quantify motor function and spatial cognition both for static and dynamic tasks in rehabilitation.