五十嵐 歩

Aim This study examined the home care nurses' implementation of comprehensive assessment of their clients, their education and the association betwwen the two. Staff education in home care nursing agencies has the potential to improve nurses' comprehensive client assessment, contributing to the provision of high‐quality home care nursing services. Methods A cross‐sectional questionnaire survey was conducted to investigate educational approaches provided by agencies and comprehensive assessment by home care nurses. Multilevel regression analyses were performed to examine the association between education and comprehensive assessment. Results We analyzed data from 105 clients, based on 78 nurses' assessments, across 11 agencies with respect to their respective staff education systems. Various educational programs for novices and all staff were provided. In the multilevel regression analysis, having a designated individual in charge of staff education and regular case reviews for all staff were significantly associated with more comprehensive assessments. Conclusions Ensuring specific educational opportunities for all home care nurses, rather than solely for novices, might improve their comprehensive assessment in home care nursing agencies. Designating educators and introducing regular case reviews as part of agencies' educational systems may improve comprehensive assessment. Geriatr Gerontol Int 2025; ••: ••–••.

AIM: Standardized quality indicators for long-term care (QIs-LTC) were previously developed to ensure high-quality holistic nursing care for older adults. This research aimed to assess the feasibility and reliability of unfavorable health outcomes measured by the QIs-LTC and proposed strategies for improvement. METHODS: Thirty-nine pairs of home care nurses assessed 53 clients. We evaluated 20 of the 21 items of feasibility to calculate scores for the "I do not know" answer and test the interrater reliability using bias-adjusted and prevalence-adjusted kappa (PABAK). We then conducted interviews with 16 home care nurses to collect feedback on the implementation of QIs-LTC. Based on this feedback, we developed the QIs-LTC assessment manual and reassessed the QIs-LTC when used with the manual. RESULTS: The mean for the "I do not know" answer was 13.8%, and the mean PABAK was 0.75 (±0.28). Overall, the reliability was good for physical assessment but inadequate for social aspects. Using the assessment manual, the mean for the "I do not know" answers decreased to 10.4%. The mean PABAK was 0.77 (±0.32) and increased for 12 unfavorable health outcomes. CONCLUSIONS: The feasibility and reliability of most unfavorable health outcomes were ensured by using the newly developed assessment manual. Challenges in education and practice of social aspects were identified. QIs-LTC support individual and agency evaluations, nursing interventions and quality evaluations, which are a priority for long-term care in Japan. Geriatr Gerontol Int 2025; ••: ••-••.

Background Health care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools. Objective This study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students. Methods This single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes. Results Data collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal. Conclusions The gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia. Trial Registration ClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623 International Registered Report Identifier (IRRID) DERR1-10.2196/62654

Retail workers contribute to the daily wellbeing of customers, including those living with disabilities or diseases. The relational job design theory suggests that one’s perceived social impact (PSI) of their job contributes to improvements in job satisfaction, turnover intention, and persistence. Confirming such an association could encourage organization managers to commit more to community care for the purpose of improving the work outcomes of their employees. However, how convenience store workers perceive the social contributions of their work and the perception’s impact on their work outcomes remains unclear. Thus, the first objective of this study was to examine the association between retail workers’ PSI and work outcomes (job satisfaction, turnover intention, and hours worked). The second objective was to evaluate the effect of an intervention aimed at increasing the PSI on work outcomes. This study was part of a project to evaluate a dementia‐friendly program for convenience store workers. All participants completed a baseline survey after randomization. The intervention group was then required to complete a multicomponent e‐learning intervention program within one month. One month later, both groups completed a postintervention survey. The e‐learning program included lectures on dementia, virtual contact with people living with dementia, and information on the positive impact of retail store jobs on customers living with dementia. A total of 161 and 145 participants were analyzed in the baseline study and the postintervention survey, respectively. Cross‐sectional analysis of baseline data showed that the workers’ PSI was significantly correlated with job satisfaction (β = 0.203, p < 0.001) and turnover intentions (β = −0.305, p = 0.006). However, the e‐learning intervention did not change PSI and work outcomes. Interventions that highlight workers’ prosocial contributions more effectively and are successful in changing their PSI may improve their engagement and work outcomes. For retail workers, intervention based on a relational job design framework may be effective; however, designing such interventions remains challenging. This trial is registered with UMIN000043623.

Abstract Background and Objectives Raising dementia awareness is essential for building a dementia-friendly community. However, existing studies have underexplored the effects of virtual reality (VR) dementia educational programs for the general public on enhancing positive attitude toward dementia. This study aimed to examine the effectiveness of a VR dementia-friendly educational program called the Drive for Dementia Readiness Inside Virtual Reality (DRIVE) program to improve attitude toward dementia of the general public. Research Design and Methods A two-arm randomized controlled trial was conducted. Eligibility criteria for participants included being 16 years old and above in Japan and having no professional license in healthcare and social care. We randomized individuals to attend a multi-element VR dementia-friendly educational program (intervention), including simulation, VR films, short films, lectures, and discussions or a lecture-based program (control). Data were collected three times, including at baseline, post-intervention, and 3-month follow-up. The primary outcome was attitude toward dementia. The secondary outcomes were intention of helping behavior for people living with dementia and knowledge of dementia. Results We recruited 157 community residents, among whom 130 were included in the analysis. Although the mean changes in attitude score were not significantly different between the groups (Hedge’s g = .26), the intention of helping behavior score was significantly higher in the intervention group (g = .49). Discussion and Implication The DRIVE, a VR-based multi-element dementia-friendly educational intervention, was shown as a promising tool for significantly impacting the intention of helping behavior for people living with dementia to establish dementia-friendly communities.

Abstract Background This study developed a short version of a scale measuring attitudes toward people living with dementia, the Four‐Item Attitudes toward People Living with Dementia Scale (APDS4), that could be included in a large population survey. Methods We used three datasets from Japan: a web panel survey, a community‐based mail survey, and data from a randomised controlled trial on dementia education. The original scale used was the Attitudes toward People Living with Dementia Scale developed by Kim and Kuroda. Test–retest reliability and item response theory analyses were used to reduce the number of items. The reliability, internal consistency, validity, and responsiveness of the short version were evaluated. Results Six items with low test–retest reliability and four items with low discrimination parameters were removed from the 14‐item scale. The APDS4, consisting of four items, had test–retest reliability and internal consistency comparable to those of the original scale. Confirmatory factor analysis indicated that the APDS4 fit a unidimensional model. The validity of the APDS4 was confirmed by significant associations between the APDS4 scores and the original scale scores, knowledge of dementia, helping behaviour intentions toward people living with dementia, helping behaviour experience, attending the Dementia Supporter Training Course, and engagement in healthcare jobs. In a randomised controlled trial dataset, the APDS4 was more responsive to educational interventions than the original scale. Conclusion The shortened APDS4 was established as a reliable, validated, and responsive scale. This scale can be used efficiently in population surveys to evaluate dementia‐friendly initiatives at the community level.

Abstract Background Poor awareness of dementia care by healthcare professionals affects the quality of care for people living with dementia in acute care settings. Objectives This study examined the effectiveness of a virtual reality‐based educational programme for dementia for nurses working in acute care hospitals in Japan. Methods A dementia education programme for nurses was designed. The programme comprised short movies, virtual reality videos based on the short movies, a lecture, discussions and role‐playing based on the experimental learning model. Virtual reality video content was created to promote empathy for people living with dementia through a first‐person experience of dementia. The educational programme involved nurses working in an acute care hospital in the Tokyo Metropolitan area. Before and after the programme, we employed structured questionnaires using validated instruments to assess participants' attitudes towards people living with dementia, their intentions of helping behaviour and their confidence in providing dementia care. Results Seventy‐six nurses participated in and completed the pre‐ and post‐tests. The mean age was 34.9 ± 9.2 years, and 90.8% of the participants were female. A paired t‐test showed significant before‐after improvement in the participants’ attitudes towards people living with dementia (41.9 ± 5.1 vs. 44.5 ± 4.8), intentions of helping behaviour towards people living with dementia (10.8 ± 2.5 vs. 12.8 ± 2.1) and confidence in providing dementia care (25.9 ± 6.7 vs. 29.2 ± 6.0). Conclusion The programme effectively improved nurses’ attitudes towards people living with dementia and confidence in providing dementia care in acute care settings. Future research is important to explore the long‐term effects of this programme and its effects on actual dementia care. Implications for practice The dementia education programme may promote person‐centred care in acute hospitals. Future studies should consider the provision of more flexible programs so that nurses can more easily participate in them.

Abstract Objective This study aimed to investigate the feasibility and validity of measuring implicit attitudes towards dementia in adults and older adults and evaluate the impact of dementia‐friendly education using virtual reality (VR) on implicit attitudes. Methods This study was a secondary analysis of data from a randomised controlled trial. Community members in Tokyo aged 20–90 years participated in dementia‐friendly education with or without VR. At the end of the dementia‐friendly education programs, implicit attitudes towards dementia were measured using the Implicit Relational Assessment Procedure (IRAP). Results Of the 145 participants, 89 (61%) started the IRAP, and 21 (15%) completed it. Lower age was significantly associated with the start/completion of the IRAP, and the age thresholds at which 50% of participants would not start/complete it were estimated to be 72.3/44.8 years, respectively. Those who had experience interacting with people with dementia other than family members had lower IRAP scores than those who had no such experience. The intervention group participating in the VR program had lower IRAP scores than the control group (p = .09). Conclusions Although measuring implicit attitudes using IRAP is deemed not feasible for people in their 70s and older, the differences in interaction experience would be evidence supporting the validity of the measurements of implicit attitudes towards dementia. The results suggest that dementia‐friendly education, using VR, improves implicit attitudes towards dementia.

BACKGROUND: Early rehabilitation in intensive care units (ICUs) may be beneficial but is not routinely performed for adults with critical illness. In April 2018, the Japanese government introduced a health policy to provide financial incentives to hospitals that met the requirements of interdisciplinary collaboration and had teams specialized in ICU rehabilitation practices. OBJECTIVES: The present study aimed to investigate whether the health policy is associated with improved clinical practices of ICU rehabilitation. METHODS: Using a nationwide administrative inpatient database and hospital statistics data from Japan, we identified hospitals that admitted adult patients to the ICU within two days of hospital admission from April 2016 to March 2019. Using hospital-level propensity score matching, we created matched cohorts of 101,203 patients from 108 intervention hospitals that introduced the health policy, and 106,703 patients from 108 control hospitals that did not. We then conducted patient-level difference-in-differences analyses to examine changes in the percentage of patients from the intervention and control hospitals, who underwent early ICU rehabilitation within two days of ICU admission before and after the implementation of the health policy. RESULTS: In the intervention group, patients undergoing early ICU rehabilitation increased from 10% and 36% after the policy implementation. In the control group, it increased from 11% to 13%. The difference-in-difference in the percentage of patients who underwent early ICU rehabilitation between the two groups was 24% (95% confidence interval, 19%-29%). CONCLUSIONS: Early ICU rehabilitation can be facilitated by financial incentives for hospitals that engage in interdisciplinary collaboration with specialist teams. IMPLICATIONS FOR CLINICAL PRACTICE: Our Findings are relevant for hospital administrators, professional organizations, and policymakers in other nations considering strategies to support the additional deployment burdens of early ICU rehabilitation. Future studies need to explore the long-term effects and sustainability of the observed improvements in ICU rehabilitation practices.

Aim To clarify the association between constipation, diarrhea, and long‐term laxative use in Japanese nursing home residents. Methods Data from 306 residents with chronic constipation aged over 75 years for basic characteristics, medication use, activities of daily living, and concurrent illness were collected via two consecutive 6‐monthly surveys conducted using the Japanese interRAI assessment tool. We used bivariate and multivariate analyses to examine the associations between chronic constipation, diarrhea, and continuous laxative use. Results Chronic constipation persisted in 74.5% of residents despite their continuous use of laxatives. Additionally, 14.4% experienced chronic diarrhea while on laxatives. Residents using salt laxatives had significantly lower chronic constipation than those not using salt laxatives (adjusted odds ratio [AOR] 0.52), while residents using novel laxatives had significantly higher chronic diarrhea than those not using novel laxatives (AOR 4.28). Conclusions Our findings reveal that bowel movement‐related problems remain a concern and highlight the need for further research on the use of novel laxatives in nursing home residents. Geriatr Gerontol Int 2024; 24: 133–139.

Background Community members can play important roles in helping older adults in their community. This study aimed to clarify the actual situation of community members' helping behaviours towards older adults and examine the related factors. Methods This cross‐sectional study was conducted using an online survey system with a sample of 1000 community members in the Tokyo metropolitan area selected using quota sampling. Participants were asked about their experiences with helping an older adult, involvement with older adults with dementia, knowledge of dementia and care resources in the community, and perceptions regarding the community. Content analysis was used to classify participants' freely answered responses about helping behaviours, with logistic regression analysis subsequently used to examine the related factors. Results Community members provided older adults with various types of spontaneous help, including help with walking (20.0%), accident care (16.8%), giving directions to a destination (11.6%), accompanying them to a destination (12.9%), and support in daily life (10.4%). In the multinominal logistic regression analysis, advanced helping behaviours were associated with having a family member with dementia, experiences involving people living with dementia, knowledge of dementia and community support centres, and a stronger sense of community integration (P < 0.05). The reasons for not being able to help included being physically unable to (42.5%), not feeling responsible (19.3%), not knowing how to help (17.4%), and hesitating to help (14.4%). Conclusion The results suggest that providing learning opportunities for community members could further promote their helping behaviours for older adults. These could include interacting with older adults, especially those living with dementia; promoting a sense of community integration; or receiving training in helping actions. Such efforts could support the development of an effective community‐based care system for older adults.

Background High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients’ self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers. Objective The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP. Methods On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users’ self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system’s suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire. Results We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants. Conclusions DialBetes Step intervention might be a feasible and useful way of increasing workers’ step count for a short period and, consequently, improving their BP and BMI; self-efficacy–enhancing techniques of the system should be improved.

Abstract Aims To (i) assess the adherence of long‐term care (LTC) facilities to the COVID‐19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions. Design Cross‐sectional survey. Methods Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID‐19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines. Results The adherence was significantly higher among facilities with more pre‐pandemic in‐service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work–life imbalance. Conclusions Pre‐pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks. Impact This is the first study to comprehensively examine the adherence of LTC facilities to COVID‐19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre‐pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks. Patient or public contribution No Patient or Public Contribution.

Abstract Background Preventing peritoneal dialysis (PD)-associated peritonitis remains a major concern in continuing safe treatment and improving patient quality of life. This study aimed to determine the self-care education and quality care initiatives performed for patients undergoing PD and explored their association with patient self-care knowledge and behavior regarding peritonitis prevention. Methods A nationwide cross-sectional survey was conducted with PD patients and their nurses in Japanese hospitals as respondents. Nurses provided the regular practice of self-care education and quality care initiatives for PD patients within the hospital while patients answered questions on their self-care knowledge and behaviors. Multivariate logistic regression analyses were performed to explore the factors of patients’ self-care knowledge and behaviors. Results We analyzed data on 170 patients (mean age: 65.1 years old) matched with those of 58 nurses from 58 hospitals. Although most educational contents were taught, teaching methods varied; evaluating patients’ learning levels and re-educating during follow-up periods were less frequently performed. As for quality care initiatives, 60% of hospital nurses monitored peritonitis rates, 33% shared peritonitis-associated information with relevant departments, and 47% had performed home visits before PD patients' discharge in the past. The factors of patients’ self-care knowledge include nurses’ re-educating during follow-ups (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.01–1.22, p = 0.025), sharing information with relevant departments (OR = 1.66, 95% CI = 1.01–2.74, p = 0.047), and patients’ younger age (OR = 0.98, 95% CI = 0.96–1.00, p = 0.019). Hospitals performing home visits and patients’ perceived social support were associated with both self-care knowledge (OR = 1.16, 95% CI = 1.01–1.34, p = 0.038 and OR = 1.33, 95% CI = 1.10–1.61, p = 0.003, respectively) and behavior (OR = 1.29, 95% CI = 1.02–1.64, p = 0.031 and OR = 1.61, 95% CI = 1.14–2.28, p = 0.007, respectively). Conclusions Re-education during follow-up visits, sharing information, and home visits before discharge may benefit patients in promoting peritonitis preventive self-care.

This umbrella review followed the JBI methodology and synthesized systematic reviews of the effectiveness of long-term home visit nursing for older people (≥ 60 years) on improving mortality, hospitalization, institutionalization, patient satisfaction, and quality of life. Eight bibliographic databases were searched, and 10 reviews with 22 distinct relevant trials (n = 10,765 participants) were included. Mortality was the most frequently examined outcome and satisfaction was the least examined (n = nine and one reviews, respectively). Home visit nursing had a favorable effect on reducing the number of admissions to hospital (n = 1,152 participants in two trials vs. 788 participants in three trials) and no effect on other outcomes. The evidence of the effectiveness of long-term home visit nursing for older people is minimal. Future research needs to be based on a theoretical foundation that explains how interventions are expected to work.

Introduction Care quality in Japan's long‐term care (LTC) agencies, including home care, is the responsibility primarily of individual agencies, and the evaluation of service processes and outcomes is minimal. Objectives To describe the development of quality indicators for LTC (QIs‐LTC) in Japan. Methods QIs‐LTC were developed through literature review and expert panel discussions and then were piloted and used in a 2‐year longitudinal survey. The survey (launched in September 2019) targeted older people receiving home care (n = 1450), their family members (n = 880), their professional home care providers (n = 577), and managers of home care agencies (n = 122). Results Across eight domains (maintaining dignity, minimizing symptoms and disease deterioration, maintaining nutritional status, maintaining bladder/bowel control, encouraging physical activities, experiencing sound sleep, maintaining serenity and contentedness, and maintaining family's well‐being), 24 care quality objectives were set with 24 outcome QIs‐LTC and 144 process QIs‐LTC. In the survey, 84.8% of clients were using home care nursing, 26.3% were living alone, and 39.5% had dementia. In the month preceding the data collection, 13.9% of clients had a new disease or worsening of an existing disease, 8.8% were hospitalized at least once, and 47.9% did not participate in activities of interest. About 20% of clients' families were unable to spend time peacefully, and 52.8% were exhausted from the client's care. Conclusions The QIs‐LTC developed in the current study are generic and client‐ and family‐centered. They encompass objective and subjective information and would facilitate standardized monitoring if adopted and comparison between LTC settings, including home care. In addition, future research directives are outlined. Geriatr Gerontol Int 2023; 23: 383–394.

Family caregivers’ sense of security benefits older adults who receive home care. Advance care planning (ACP) is reported to affect family caregivers’ experience positively, but it might differ depending on family caregivers’ kin relationships with the older adults. This study aimed to investigate whether ACP for older adults in home care settings is associated with family caregivers’ sense of security and whether such an association depends on the family caregivers’ status as spouses or adult children. Clarifying this association may offer practical support for implementing ACP while maintaining family caregivers’ sense of security. This study was part of a prospective cohort study in Japan. The participants were older adults who used home-visit nursing services, their family caregivers, and the nurses who cared for them, recruited through the professional associations of home care nurses across Japan. Family caregivers answered a sense of security questionnaire, and the nurses were asked whether ACP was conducted. Data were collected three times from nurses and twice from family caregivers over a three-month period from August 2019 to June 2020. Multivariate logistic regression analyses were performed to examine the association between ACP implementation and positive changes in the sense of security scores after three months. Data from 169 cases were analyzed; 28.1% of the family caregivers were men and 55.6% were spouses. ACP was performed in 53.8% of the cases. The multivariate analysis showed an interactive effect between ACP implementation and family caregivers’ kin relationships. For spouses, ACP was significantly associated with a positive change in their sense of security. For adult children, such an association was not found. Thus, ACP might have a positive effect on caregiving spouses’ sense of security. Adult child caregivers, who often have multiple responsibilities and have difficulties facing their parents’ physical decline, may need support in addition to ACP.

Background: Convenience stores play an important role in supporting community-dwelling older adults’ lives. We started community-based participatory research (CBPR) in Nerima City, Tokyo Metropolitan area in Japan to develop a collaborative relationship to support older adults in the community-based integrated care system. Objectives: This study aimed to describe the CBPR process and evaluate building face-to-face relationships between health/social care professionals and the owners/employees of convenience stores. Methods: Using CBPR, health/social care professionals in community general support centers (CGSCs) directly approached convenience stores based on the public support agreement between the convenience store chain company and the municipality. To evaluate the face-to-face relationship building between convenience store owners/employees and CGSCs’ staff, we administered questionnaire surveys to convenience stores in Nerima City and two control cities from 2017 to 2019, and about 100 convenience stores com-pleted the survey each year. Results: Statistical analyses showed significant improve-ments in their knowledge for relationships with the CGSCs in Nerima City, including “knowledge of the CGSCs’ function” (P = 0.001), “knowing individual professionals in the CGSCs” (P = 0.023), and “knowledge of when to contact the CGSCs” (P = 0.002), compared with control cities. Helping behavior for older adults at convenience stores also increased significantly in Nerima City (P = 0.034). Conclusions: The CGSCs’ direct approach based on the public support agreement would effectively promote building relationships at convenience stores, leading to an age-friendly community.

Abstract Background and Objectives Dementia-friendly training should be incorporated in neighborhood stores for people living with dementia to maintain engagement in social activities. However, there is a lack of evidence of dementia-friendly training in these workplaces, and existing trainings have time constraints. We developed a mobile microlearning program based on stigma theory and the bystander intervention model. This study aimed to evaluate the microlearning program’s effectiveness. Research Design and Methods Convenience store workers in Tokyo were recruited for a randomized, waiting-list, and controlled trial. The intervention group completed a 50-min online course. The primary outcome was an attitude toward people living with dementia. The secondary outcomes were knowledge of dementia and helping behavior toward customers suspected of having dementia. Data were collected at baseline, after 1 month, and 4 months following the randomization. Results Process evaluations confirmed satisfaction and high completion rates of the program. In total, 150 participants were included in the analysis. The intervention group showed significantly greater improvements in attitude (Hedge’s g = 0.70) and knowledge (g = 0.59) after 1 month, compared to the control group. Helping behavior increased in the intervention group, although it did not differ significantly between the groups. All outcomes remained significantly improved after 4 months. Discussion and Implications The findings provide evidence that dementia-friendly training reduces the general public’s stigma and increases helping behavior in stores. Mitigation of time constraints through mobile microlearning is expected to contribute to the dissemination and help people living with dementia maintain their social participation in the communities. Clinical Trials Registration Number: UMIN000043623

看護系学会が学術集会で演題を募集する際,共同演者を会員のみとすることが多い.本研究の目的は,この会員要件を緩和することによる演題数,入会者数,収入への影響を定量化することである.実際に要件を緩和した一学術集会の筆頭演者を対象にWeb調査を行い,もし要件緩和が無かった場合の演題応募状況と,各演者の入会状況を尋ねた.64の有効回答があり(有効回答率86%),うち19演題(30%)の演者は要件緩和が無ければ応募していなかった.共同演者164名中20名は,要件緩和が無ければ入会していた.要件緩和により,入会者数は11名減少し,学術集会参加者数は40名増加し,学会の単年度収入は358,900円増加した.共同演者を非会員可とすることは,学術集会を盛会にすることと会計的な意味とで有用と考えられた.本論文は一学会の貴重な経験の記録であるとともに,根拠に基づく学会運営に向けた一方法を提案する.(著者抄録)

Abstract Aim To examine the response of long‐term care (LTC) residential facilities to the COVID‐19 pandemic worldwide, and the antecedents and outcomes of this response. Design A protocol of a cross‐sectional survey. Methods Two online questionnaires will be used to collect data from LTC residential facilities' managers and staff worldwide. Collected data include participants' socio‐demographic characteristics, facility‐related characteristics, facility response to the COVID‐19 pandemic, and possible influences of the pandemic on staff, residents, and residents' families. Data collection has started in April 2021. Data analyses will be conducted on the pooled sample and stratified by the type of facility, participants, or country if required. Multi‐level regression analysis will be considered to account for participants' data clustering in countries and facilities. Results The data collection is ongoing. The findings would guide policy‐makers and healthcare organizations to reform their protocols for the best interest of facilities, staff, residents, and residents' families.

Abstract Background and Objectives Dementia awareness initiatives aim to promote helping behaviors toward people living with dementia. We applied the bystander intervention process model in the context of the general public’s helping behaviors toward people living with dementia, and we sought to identify the mechanisms underlying the association between dementia knowledge and helping behaviors. Research Design and Methods In a survey featuring vignettes for the general public in Japan (N = 904), we presented four situations in which people could exhibit helping behaviors toward a person with dementia. Guttman scale analysis was used to test this sequential ordering of the bystander intervention process model: (a) interpreting the need to help, (b) perceiving personal responsibility, and (c) intention to provide help. Mediation analysis was used to examine whether the effects of knowledge on helping behaviors were mediated by attitude toward people living with dementia and the bystander intervention process. Results The results support the two-step model in which interpreting the situation as one where assistance is required is a prerequisite of helping behavior. Dementia knowledge had a significant total effect on intention to provide help (β = 0.136, p < .001). Interpretation (indirect effect: β = 0.092, p < .001), as well as attitude (indirect effect: β = 0.044, p < .001), was found to completely mediate the effect of dementia knowledge on intention to provide help. Discussion and Implications Dementia awareness initiatives designed to promote helping behaviors should focus on knowledge transfer, improving the general public’s attitudes toward people living with dementia, and their ability to interpret when such people need assistance.

目的:長期療養を要する高齢者の便秘ケアのあり方を検討するため、医療療養病棟の看護職による便秘ケアの課題と工夫を把握する。方法:全国1,180病院の医療療養病棟の看護職(看護管理者と看護スタッフ各1人)に質問紙調査を行った。病棟の便秘ケアの現状に対する認識を自由記載でたずね、回答を質的記述的に分析した。結果:看護職は、【下剤使用のベストプラクティスがよくわからない】【治療や患者状態により複雑化する便秘ケアに対応しきれない】【病棟で醸成される画一化された便秘ケアからなかなか抜け出せない】【便性状のコントロール不良に付随するトラブルが生じる】現状に直面していた。便秘ケアの工夫として【刻々と変わる排便状況に合わせて患者ごとに下剤を調整する】【画一化された便秘ケアにプラスアルファの工夫を組み込む】【便秘ケアに関する多職種間コミュニケーションの敷居を下げる】を実施していた。考察:医療療養病棟の看護職は下剤使用方法や、患者背景に応じた便秘ケアに困難を感じていた。一方、下剤の調整やコミュニケーションを図るなど、よりよい便秘ケアのための工夫も行われていた。おのおのの病棟で構築された便秘ケアの工夫を体系化し、医療療養病棟の入院患者に適した便秘ケア方法を確立する必要性が示唆された。(著者抄録)

BACKGROUND: Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses' burnout and selected objective quality metrics in long-term care wards in Japan. METHODS: This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards-the equivalent of skilled nursing homes in Western countries- completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses' burnout, and other confounders (e.g., ward size, participants' years of experience, and patients' conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators. RESULTS: Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = -.001, p-value = .019). CONCLUSIONS: Staff nurses' burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes-specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

目的:高齢COPD患者における呼吸リハビリテーション(以下呼吸リハ)の利用実態を明らかにする.方法:千葉県柏市の2012年4月から2013年3月までの医療・介護レセプトデータを用いた.同期間にCOPD(ICD10コードJ41-J44)の診断で外来受診が2月以上あり,COPD関連薬の処方が2月以上ある63歳以上の者を抽出し,入院・外来・在宅呼吸リハの利用実態を調査した.入院呼吸リハは,入院で呼吸器リハビリテーション料(I)(II)の算定が1回以上ある場合を,外来呼吸リハは外来で呼吸器リハビリテーション料(I)(II)の算定が1回以上ある場合を,在宅呼吸リハは医療保険・介護保険における訪問リハ・看護のいずれかの利用が1回以上ある場合を"利用あり"とした.結果:対象者2,682名の平均年齢は76.8歳だった.入院・外来・在宅呼吸リハ利用者はそれぞれ,61名(2.3%),25名(0.9%),101名(3.8%),年間利用月数の中央値は1ヵ月,2ヵ月,11ヵ月だった.対象者の平均年齢は,呼吸リハ非利用者と外来呼吸リハ利用者では76歳代だった一方,入院呼吸リハ利用者及び在宅呼吸リハ利用者では約80歳と高い傾向がみられた.要介護認定を有する者は,非利用者,外来呼吸リハ利用者で2〜3割程度だった一方,入院呼吸リハ利用者では約半数を占めた.在宅呼吸リハ利用者ではほぼ全数が要介護認定を有しており,要介護3〜5が半数以上を占めていた.結論:病院・在宅ともに呼吸リハ利用率は低いため,普及に向けた取り組みが必要である.各呼吸リハの利用期間や利用者の特徴が異なることから,呼吸リハ種別毎に介入内容や評価方法の検討が重要である.通院が可能なCOPD患者に対する外来呼吸リハの拡充や,呼吸リハ提供施設が不足している地域や定期的な通院が困難な患者に対する在宅呼吸リハの推進が必要と考えられる.(著者抄録)

BACKGROUND: There are no data on the provision of palliative nursing care in Egyptian adult intensive care units (ICUs). The Palliative and End-Of-Life (PEOL) Care Index is reliable and content valid; however, its construct and criterion validities have not been examined. AIMS AND OBJECTIVES: First, to assess palliative care education, practice, and perceived competence among adult ICU nurses in Egypt. Second, to explore factors related to palliative care nursing practice and perceived competence. Third, to assess the construct and criterion validities of the PEOL Care Index. DESIGN: A cross-sectional survey. METHODS: Nurse managers and staff nurses in 33 adult ICUs completed self-administered questionnaires. The questionnaires assessed nurses' palliative care practice and perceived competence. A multilevel regression analysis was used to determine the best predictors of palliative care practice and perceived competence. Theory evidence construct validity and predictive criterion validity of the PEOL Care Index were examined. RESULTS: Thirty-three nurse managers and 403 staff nurses participated in the study-response rate = 100% and 72.5%, respectively. On a 0-100 scale, the mean scores of undergraduate education, practice, and perceived competence were 54.0 ± 18.7, 49.7 ± 18.1, and 54.5 ± 17.0, respectively. Palliative care practice was significantly related to receiving in-service training on palliative care or end-of-life care (regression coefficients: 3.39), higher job satisfaction (0.97), and higher organizational support (1.85). Palliative care perceived competence was significantly related to older nurses' age (0.20), higher job satisfaction (0.97), and higher palliative care undergraduate education (0.63). CONCLUSIONS: Palliative care education, practice, and perceived competence among adult ICU nurses in Egypt are inadequate, especially in terms of spiritual and cultural care. The PEOL Care Index is construct and criterion valid. RELEVANCE TO CLINICAL PRACTICE: Palliative care education should begin in nursing schools and extend through clinical in-services. Guidelines should be developed to maximize staff collaboration and the utilization of chaplains in ICUs.

AIM: The dementia supporter training program is conducted by community general support centers (CGSCs) to raise dementia awareness. Convenience stores are widespread throughout Japan, and they play an important role in the daily lives of older adults. We examined whether participation of convenience stores in the program promotes cooperation between the stores and CGSCs. METHODS: Using data from a nationwide survey, we conducted a longitudinal observational study. Participation of stores in the program and cooperation with CGSC were measured. The proportion of cooperation with CGSCs in 2017 and 2018 were compared between stores that had already participated in the program in 2016 (participation group) and those that did not (non-participation group). RESULTS: Of the 14 884 stores, 542 stores participated in the program in 2016. In 2017 and 2018, 8.1% and 7.2% of the participation group cooperated with CGSCs, while 3.2% and 4.0% of the non-participation group did. CONCLUSIONS: Dementia supporter training programs could be an opportunity to promote cooperation between convenience stores and CGSCs to support older adults. Geriatr Gerontol Int 2020; 20: 956-960.

BACKGROUND: To date, a comprehensive, psychometrically robust instrument to assess palliative and end-of-life (PEOL) care education, practice, and perceived competence among intensive care unit (ICU) nurses does not exist. OBJECTIVE: To examine content validity and reliability of a proposed instrument to assess the PEOL care education-practice- competence triad among ICU nurses. METHODS: An international modified e-Delphi and a cross-sectional pilot questionnaire survey. The Delphi involved 23 panelists from 11 countries. The pilot study involved 40 staff nurses and 3 nurse managers from 3 adult ICUs in a randomly selected hospital in Egypt. An instrument was developed and judged for content validity by international panelists, and then pretested in a pilot study, where data were collected at 2 time points using self-administered questionnaires, followed by cognitive interviews. Test-retest reliability was examined using intraclass correlation (ICC), standard error of measurement (SEM), and repeatability coefficient (RC). RESULTS: The panelists confirmed content validity of the proposed instrument, and staff nurses confirmed its comprehensibility. At the level of the instrument's total scores, the lowest ICC was .9 (95% confidence interval: .8-.9); and the highest SEM and RC were 4.8 and 13.3, respectively. CONCLUSIONS: The PEOL Care Index is a comprehensive, comprehensible, content valid, and reliable instrument to assess the PEOL care education-practice-competence triad among ICU nurses. Construct and criterion validities need to be confirmed in future studies. Applicability of the PEOL Care Index in different settings and cultures needs to be examined.

BACKGROUND: The literature on the situation of palliative and end-of-life care in the Arab and Islamic world, including Egypt, is limited and does not present a clear picture of the cultural context. This report aims to portray the palliative and end-of-life care situation in Egypt, focusing on the nursing viewpoint. First, we describe health- and illness-related cultural, religious, and ethical issues. Second, we present an overview of the healthcare and nursing system in Egypt. Third, we discuss the situation of palliative and end-of-life care, highlighting the shortcomings of existing literature. Finally, we delineate country-specific recommendations to improve the palliative and end-of-life care situation at the level of policy, education, and research. Countries with similar healthcare, cultural, legal, religious, economic, or ethical contexts may benefit from the recommendations made in this study.

AIM: Despite the large and growing body of research on quality care evaluation and improvements in long-term care facilities, issues regarding the quality of care provided prevail worldwide. Further and more diverse research related to this topic is urgently required. To that end, this study examines the association between the subjective care process evaluations of nurses and selected patient outcomes in Japanese long-term care hospitals. METHOD: To conduct a cross-sectional survey, we approached 2,000 long-term care hospitals in Japan, of which 263 (13.2%) completed and returned the questionnaires. We recruited ward managers and all full/part-time nurses in one ward from each hospital. We questioned managers about six patient outcome indicators: prevalence of physical restraint, urinary tract infections, indwelling catheter use, monthly incidence of new pressure ulcers, falls and recreational activities. We examined the nurses' care process evaluations using nine questions pertaining to daily caregiving activities developed from previous qualitative research. We examined the association between the ward averages of the nurses' evaluations and selected patient outcomes using the generalised linear model with a negative binomial distribution, with the exception of recreational activities for which we used a Poisson distribution, controlling for ward size and patient case mix. RESULTS: We analysed the responses with complete data for outcome indicators from 199 (10.0%) managers and 2,508 nurses. Some patient outcome indicators were significantly associated with the nurses' care process evaluations, namely, urinary tract infections (B = -1.28, p < .001), indwelling catheter use (B = -0.57, p < .049), pressure ulcers (B = -1.20, p < .001) and recreational activities (B = 1.48, p < .001). These results suggest that better patient outcomes were associated with higher care process evaluations. CONCLUSION: The nurses' evaluations and certain patient outcome indicators were associated. When considering potential quality improvement programmes, focusing on these evaluations will be beneficial.

Abstract Objectives Dementia‐friendly communities promote community coherence and reduce the risk of ageism in the community. This study examined the effects of a Virtual Reality (VR) educational program on participants' attitudes towards dementia and their sense of community related to supporting community‐dwelling older adults. Methods We delivered an educational program using a virtual reality platform that provided a first‐person perspective of people with dementia in the courtyards of two convenience stores in the Tokyo Metropolitan Area, Japan. We investigated attitudes towards dementia and participants' sense of community before and after the educational program. Results There were 42 study participants (average age = 48 years). The total scores of attitudes towards dementia and sense of community changed positively from pre‐ to postintervention (P = .004 and &lt;.001, respectively). Conclusion This educational program for understanding dementia could enhance people's support of community members living with dementia.

【目的】高齢慢性閉塞性肺疾患(以下COPD)患者のセルフマネジメント(以下SM)行動の実態を明らかにすること。【方法】65歳以上のCOPD患者に対面式質問紙調査・診療録調査を行った。SM行動実施状況の記述統計量を算出し、息切れの程度別に各行動を比較した。【結果】81名(平均年齢78.2歳)のデータを分析した。在宅酸素療法、禁煙や内服に関するSM行動実施群(以下実施群)の割合は約8割以上であった一方、呼吸法、運動やコミュニケーションに関する項目では3〜6割であった。息切れ強群は息切れ弱群に比して、"急な動作を避ける""室内の環境整備""息苦しくなる動作を避ける""排痰""治療方針や療養場所に関する医療者との話し合い"の実施群の割合が有意に高く、"散歩"は実施群の割合が低かった。【結論】高齢COPD患者に対する、呼吸法や運動・コミュニケーションに関するSM支援が課題である。(著者抄録)

Abstract Aims and design Various healthcare services in Japan provide self‐management interventions for older people with chronic obstructive pulmonary disease (COPD). To examine the influence of healthcare service utilisation on self‐management activities, we conducted a cross‐sectional survey of older people with COPD who received care through outpatient clinics (OC), outpatient rehabilitation centres (OR) or home care (HC) services. Methods The survey consisted of 34 originally developed self‐report questions about three types of self‐management activities: (a) strategies to minimise dyspnoea, (b) appropriate activities to maintain physical and mental health status and (c) communication with healthcare professionals or family members. We compared self‐management activities in each setting (OC, OR and HC) using logistic regression analyses, controlling for dyspnoea level and age, which we chose as representative variables of disease severity. Results Among the total sample (n = 81; mean age: 78.2 years old), participants in the HC group (n = 25) had the most severe level of COPD, followed by those in the OR (n = 31) and OC (n = 12) groups. Compared with participants from the OC group, more participants from the OR and HC groups reported self‐management activities, such as “moving body corresponding to breathing” (OR: adjusted odds ratio [AOR], 6.71; HC: AOR, 6.98), “trying not to move quickly” (OR: AOR, 5.46), “avoiding suffocating movements” (HC: AOR, 7.37), “getting an influenza vaccination”(OR: AOR, 8.12; HC: AOR, 7.81), “stretching exercise” (OR: AOR, 6.42; HC: AOR, 16.76), “muscle training” (OR: AOR, 8.49; HC: AOR, 9.73) and “discussing lifestyle goals with healthcare professionals” (HC: AOR, 5.75) after controlling for dyspnoea level and age. Conclusions Some self‐management activities (such as breathing techniques and home exercise) were associated with the use of OR or HC services, an effect persisting after adjusting for degree of breathlessness and age. Implications for practice Findings suggest that we should provide additional services such as OR and HC besides OC to older people with COPD who are unable to practice self‐management activities. We need to consider strategies to provide effective self‐management intervention in each healthcare service setting according to the unique characteristics of each setting.

Dealing with an aging society is a global challenge, and more countries than ever before are now mobilizing their healthcare systems to provide high-quality long-term care (LTC) to older adults. This paper reviews the current situation pertaining to aging and the issues for measuring the LTC quality in Japan. It also introduces current efforts to develop quality indicators for measuring LTC quality. Assuring the quality of LTC and developing indicators to measure its quality is a challenge worldwide. Detailed systems for LTC quality measurement have been developed and managed, primarily in the US. In Japan, on the other hand, such systems do not exist; the public LTC system mostly depends on the evaluation of structural aspects, such as facility structure and staffing. Our research group has been developing quality indicators to measure LTC quality. In the future, we aim to evaluate care quality in various LTC settings using the proposed quality indicators, aiming to improve care quality across LTC settings in the community-based integrated care system.