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Aim: As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors., Methods: We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long-term-care (LTC) resources, adjusted for the older adult population; proportion of single-person households; and regional factors. We performed a multivariate negative binomial distribution analysis., Results: A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home-visit rates. Beds in LTC welfare facilities (coefficient, -0.10 [95% CI, -0.19 to -0.01]) and beds in LTC health facilities (coefficient, -0.09 [95% CI, -0.17 to 0.00]) were negatively associated., Conclusions: Policies to promote home health care have led to high home-visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; 24: 1350-1361., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Purpose Over the past few years, community midwives have increasingly been expected to remedy the problems of the declining birthrate, midwives' preference to work in medical facilities, and the underutilization of midwives in those facilities. The aim of this study was to ascertain the actual activities and identity of community midwives by surveying all members of the Niigata Midwives Association. Methods With the approval of the President of the Niigata Midwives Association, a questionnaire was sent to all 223 members and returned by mail. Descriptive statistics were calculated, and responses were subjected to a χ² test by 5 groups of years of experience in the community. Open-ended responses were qualitatively and descriptively analyzed. Results Of the 127 responses received (response rate: 56.9%), 94 from midwives who worked in the community were analyzed. The distribution was thirty percent of respondents in each of the 40s, 50s, and 60s age groups. Eighty respondents (85.1%) provided "home visits" and 64 (68.1%) provided "breastfeeding and breast massage care." Respondents found "home visits" rewarding mainly. Of the 68 respondents who were "not birth attendance," 48 (70.6%) did "not plan to attend births in the future." Despite years of experience, respondents had honed their skills by attending workshops and seminars. There were 126 responses to open-ended questions from 40 respondents which were grouped into 8 categories: "lifelong care and support for women from close relationships", "rewarding satisfaction and aspiration through own activities", "continuous honing of skills to provide professional care", "collaboration with community and other midwives", "wonderful role of midwives", "living as a community midwife for a lifetime", "limited income", and "need to raise awareness, social status and recognition of midwives". Conclusion Community midwives were most rewarded by home visits and spending time, but they were also involved in various other activities, such as "breastfeeding and breast massage care." They had continued to hone their skills, did not adhere to "birth attendance," and planned to continue being community midwives for women from close relationships. However, low income, low public awareness and low social status were pointed out as problems. [ABSTRACT FROM AUTHOR]

This article describes the evaluation of an innovative nursing education curriculum project, preventive home visiting practice, which began full implementation in 2015, in terms of students' learning outcomes. For the purpose of learning how elder persons live in community, all the 327 undergraduate nursing students, from freshmen to seniors, provided monthly or bi‐monthly visits to home‐dwelling elderly persons aged 75 or above in their home over 1 year period, in order to provide support for their independent living and to learn from them. The students' reports submitted at the end of the first academic year were qualitatively analyzed to evaluate what they learned. They acquired multiple perspectives for understanding elder persons, including a variety of individual and environmental aspects of wellness, prevention, and community life. They also acknowledged the importance of team practice through working and collaborating with different grade levels and generations. Overall, the observed learning contents were useful for future nursing education with elder persons and facilitating critical changes in nursing education systems to address the problems of aged society. [ABSTRACT FROM AUTHOR]

Background: Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan.Methods: A cross-sectional study was performed to compare the total medical costs during patients' final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan.Results: Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p = 0.055).Conclusions: Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time. [ABSTRACT FROM AUTHOR]

Aim Associations between markedly low activities of daily living ( ADL) at the start of home visit care and patient home death were analyzed using data from a home care support clinic in Japan that has a low rate of home deaths. Methods The study was a historical cohort study. It involved patients who began to receive home visit care from a home visit care support clinic between 1 April 2006 and 31 March 2011. Using home death as a dependent variable and presence/absence of markedly low ADL and other parameters (cancer, the patient's desire for home death, etc.) as independent variables, the adjusted hazard ratio and 95% confidence interval ( CI) were calculated using the Cox proportional hazards model. Results Markedly low ADL were associated with home death even after adjustment for factors that influence home death (adjusted hazard ratio 4.40; 95% CI 2.37-8.16). Cancer and the patient's desire for home death were statistically significant factors involved in home death. In a subgroup analysis according to the presence/absence of cancer, the association between markedly low ADL and home death was stronger in the cancer-free group (adjusted hazard ratio 10.78; 95% CI 2.89-40.26) than in the cancer group (adjusted hazard ratio 5.58; 95% CI2.39-13.05). Conclusion Patients' desire for home death could be fulfilled if home care support clinics provide home visit services to not only terminal-stage cancer patients, but also bedridden cancer-free patients. We must establish systems for older adults to remain at home during the terminal period of their lives. Geriatr Gerontol Int 2012; 13: 874-880. [ABSTRACT FROM AUTHOR]

Abstract: Home confinement is, at first, a limitation to the family home and then almost exclusively within the bedroom, with social withdrawal, and more or less marked retreat of family relationships; so the rhythm of sleep and meals is not anymore in adequation with the usual domestic cycle. Nowadays, an immoderate use of computers and Internet is almost always associated to this confinement. We use the terms of confinement, social withdrawal, Housebound syndrome, Hikikomori, for former or current descriptions, in various countries, and not only in Japan. On the nosographic level, the associated use of the Internet cannot clearly be called addiction, but these events are sometimes considered as part of various diseases taking into account the particularities of culture, sometimes as a distinct syndrome for future DSM. Regarding 21 cases of these young people that we have met at home, after one, or more, visits of their families, who came by their own to ask for help in an emergency department, we observed that such conduct and confinement tend to recur. It is why, making contact with these young people, and the question of hospitalization can be usefully discussed. [Copyright &y& Elsevier]

Aim: This study aimed to determine the effect of a home visit program using a Functioning Improvement Tool (FIT) compared with a home visit using conversation alone. Methods: Twenty-eight participants (mean age, 78.6 ± 7.5 years) were randomly assigned to an intervention (n = 13) or control (n = 15) group for 3 months. The intervention group received a 60-minute FIT home visit program; the control group received a 30-minute home visit using common conversational techniques. Measures were Mini-Mental State Examination, Frontal Assessment Battery (FAB) and Geriatric Depression Scale. Results: The FAB score was significantly improved in the intervention group compared with the control group (2.5 vs −0.5, P = 0.02). Conclusions: Our FIT home visit program improved cognitive function. Further studies with larger samples and longer follow-up periods are needed to assess the long-term effectiveness of a FIT home visit program on cognition. [ABSTRACT FROM AUTHOR]

A video that simulates the anatomical mechanism of shaking the infant head, which may have a stronger impact on the viewer, and a tool to prevent self-reported smothering in response to crying, has never been investigated. To investigate whether watching an educational video at home visit at 2 months postpartum on infant crying and the dangers of shaking and smothering reduces self-reported shaking and smothering behaviors at 4 months postpartum. In a quasi-experimental study in A city in Japan, the video intervention was implemented at home visits by a midwife, public health nurse or trained volunteers when babies were 2 months old. At the 4-month health checkup, participants received a questionnaire about the video, self-reported shaking and smothering behaviors and other covariates. The impacts of watching the video and self-reported shaking or smothering were analyzed using multiple logistic regression. In total, 5961 caregivers provided valid response for this study (valid response rate: 73.8 %). In the adjusted model, those who watched the video were 74 % less likely to shake their infants (odds ratio (OR): 0.36, 95 % confidence interval (CI): 0.21–0.64), 43 % were less likely to smother their infants (OR: 0.57, 95 % CI: 0.37–0.89), 52 % were less likely to shake or smother (OR: 0.48, 95 % CI: 0.33–0.69) their infants. The educational video on infant crying and the dangers of shaking and smothering, with anatomical mechanism of shaking, may halve the risk of self-reported shaking and smothering at 4 months of age. [ABSTRACT FROM AUTHOR]

Abstract: Aim: HCSCs were introduced in Japan in April 2006 with the aim of playing a central role in providing end-of-life care at home. However, it is unclear how the HCSCs are operated because statistical data regarding their activities have not been disclosed to the Japanese public. The purpose of this study was to describe the trends associated with the HCSC activity in Tokyo, Japan. Methods: We submitted an application to the relevant government ministry to disclose the annual activity reports from 2008 to 2010 of the HCSCs located in Tokyo. Reports from each HCSC contained information on the number of patients, the number of deceased patients, their place of death and the number of home visits by physicians and nurses. Results: The number of HCSC activity reports for each year was 1166 (2008), 1209 (2009) and 1246 (2010), while the total number of patients for each year was 67,765 (2008), 67,094 (2009) and 83,486 (2010). Patients who died at home each year under the care of HCSCs was 4431 (2008), 4786 (2009) and 5234 (2010). It is of note that in 2010 about 87% of patients were cared by HCSCs that cared for >50 patients a year and as many as 26.9% of patients who died at home utilized clinics that cared for >50 deceased patients a year. Conclusion: The advent of HCSCs caring yearly for >50 patients and deceased patients has led to a shift in the location in which patients receive end-of-life care. [Copyright &y& Elsevier]

Aim: This research identified and analyzed relationships of grief care by visiting nurses using antecedent factors and grief care outcomes., Methods: A mailed, original, researcher-developed, self-administered questionnaire for visiting nurses employed at home-visit nursing care stations throughout Japan provided data which was then analyzed using multiple regression analyses. Grief care provided by nurses is divided into three scales: (i) grief care from beginning of home care to the terminal period (GCBT); (ii) grief care at deathbed (GCDB); and (iii) grief care after the patient's death (GCAD)., Results: Valid responses were provided by 332 (90.7%) administrators and 1442 (76.1%) staff nurses. The data revealed that it was "years of experience as a visiting nurse" and "experience of learning grief care after the patient's death" that were significant to GCBT. Also, nurses' outcomes "learning opportunity" and "confidence in visiting nursing" were significant to GCBT and GCAD., Conclusion: Simply being told how to provide care to the patient during the terminal phase is inadequate. The care during this period seemed to require years of experience as a visiting nurse. Nurses should consider more effective educational methods to nurture this skill rather than wait for it to be acquired through experience. Implementation of grief care is an opportunity for receiving feedback on the care nurses provided. Grief care provides motivation for nursing and maintains mental health., (© 2012 The Author. Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science.)