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Background: The decision‐making of older adults and people with dementia is attracting more attention among healthcare professionals. While cognitive impairment has been examined as a factor related to decision‐making, it can also be assumed that involvement in decision‐making leads to the maintenance of cognitive function. This study examined the association of the decision‐making process with the onset of cognitive impairment. Methods: We analyzed data from a 2‐year longitudinal panel survey of community‐dwelling care recipients aged ≥65 years in Japan. The sample included 406 participants who responded to both baseline and follow‐up surveys, were cognitively intact at baseline, and had no missing cognitive impairment data regarding onset at follow‐up. The status of decision‐making involvement was assessed using a single item and classified into four categories: 'very involved,' 'less involved,' 'unclear about desired care,' and 'having no one to share the decision.' Results: Among the participants (women, 65.0%; ≥75 years old: 68.2%), the incidence of cognitive impairment during the follow‐up was 26.6%. Multivariable logistic regression showed that, compared with highly involved participants, those who lacked clarity about desired care were more likely to develop an onset of cognitive impairment (odds ratio: 5.49; 95% confidence interval: 1.63–18.54; P = 0.006). Conclusion: Even among cognitively intact care recipients, those who are not able to formulate their desired care may be at risk of cognitive decline. Therefore, support for the decision‐making process, not limited to the final decision, is essential to improving the prognosis of community‐dwelling care recipients. [ABSTRACT FROM AUTHOR]

Aim: To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA‐J), a multidimensional assessment scale for caregiver experiences. Methods: The internet survey involved 934 Japanese informal caregivers aged 20–79 years (mean age = 58.8 years; 50.2% women) who completed questionnaires, including the CRA‐J 18 items (CRA‐J‐18), consisting of five domains, such as impacts on schedule and finances and positive experiences of caregiving. A 10‐item short version of the CRA‐J (CRA‐J‐10; 0–50 points), which was prepared by selecting the two items with the highest factor loadings from each domain, was tested for model fit by confirmatory factor analysis (CFA) and was analyzed for correlations with the CRA‐J‐18, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Scale (PACS), Patient Health Questionnaire‐9 (PHQ‐9), and WHO‐Five Well‐Being Index (WHO‐5). The area under the curve (AUC) in the receiver operating characteristic was evaluated as discriminability for depressive symptoms (PHQ‐9 ≥ 10 points). Results: The CFA indicated a good model fit in the CRA‐J‐10. The CRA‐J‐10 correlated well with the CRA‐J‐18 and other variables (CRA‐J‐18, r = 0.970; ZBI, r = 0.747; PACS, r = −0.467; PHQ‐9, r = 0.582; WHO‐5, r = −0.588) and showed good discriminant performance for the presence of depressive symptoms (AUC = 0.793, 95% confidence interval = 0.762–0.823). Conclusions: The CRA‐J‐10 allows a simple assessment of caregiver experiences, helping support informal caregivers. Geriatr Gerontol Int 2024; 24: 290–296. [ABSTRACT FROM AUTHOR]

Aim: To identify facility‐level characteristics associated with hospitalization within 30 days after admission to a geriatric intermediate care facility (GICF) (30‐day hospitalization) in Japan. Methods: This retrospective cohort study used nationwide long‐term care insurance claims data and a national survey of long‐term geriatric care facilities. The study population was residents admitted to GICFs between October 2016 and February 2018. The outcome variable was 30‐day hospitalization. The independent variables were facility‐level characteristics such as level of healthcare professionals. Results: The final sample for analysis comprised 282 991 residents of mean age ± SD, 85.8 ± 7.2 years, of whom 12 814 (4.5%) experienced 30‐day hospitalization. In a multivariable logistic generalized estimating equation model adjusted for facility‐ and resident‐level characteristics, and clustering GICFs, the odds of 30‐day hospitalization were 0.906 times lower (95% confidence interval [CI] 0.857–0.958) among residents in a GICF with dental hygienist than in those in a facility without. Furthermore, the risk of 30‐day hospitalization was lower among residents who had been admitted to a GICF with higher staffing levels of pharmacists (adjusted odds ratio [aOR] 0.941, 95% CI 0.899–0.985), registered nurses (aOR 0.931, 95% CI 0.880–0.986), care workers (aOR 0.920, 95% CI 0.879–0.964) and speech‐language pathologists (aOR 0.926, 95% CI 0.874–0.982) than in those who had been admitted to a GICF with fewer of these healthcare professionals. Conclusions: Transitional care including dental hygienist or higher staffing levels of pharmacists, registered nurses, care workers and speech‐language pathologists may be a more effective way to prevent 30‐day hospitalization. Geriatr Gerontol Int 2021; 21: 1010–1017. [ABSTRACT FROM AUTHOR]

Aim: To determine the resident and facility characteristics associated with residents’ care‐need level deterioration in long‐term care welfare facilities in Japan. Methods: A nationally representative sample of 358 886 residents who lived in 3774 long‐term care welfare facilities for at least 1 year from October 2012 was obtained from long‐term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long‐term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow‐up to define the resident and facility characteristics associated with resident care‐need level deteriorations (lost to follow‐up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow‐up model). Results: Adjusting for the covariates, at the resident level, older age and lower care‐need level at baseline were more likely to show deterioration in the care‐need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed‐model facilities (partly private room settings) were less likely to experience care‐need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care‐need level deterioration only in the model including lost to follow‐up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care‐need level deterioration only in the model excluding lost to follow‐up. Conclusions: The present study could help identify residents who are at risk of care‐need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758–766. [ABSTRACT FROM AUTHOR]