Introduction : The aim of this study was to identify prognostic predictors in critically ill non-cancer patients without severe organ failure in a medical long-term care ward.
Method : We retrospectively studied 36 non-cancer patients who died in our ward between October 2011 and March 2014. All patients were bedridden with mild impairment of consciousness, were unable to consume food or water, but had no severe organ failure. We attempted to identify the factors that significantly affected their prognosis.
Result : Mean age was 85 years and the male to female ratio was 19 : 17. Diagnoses were dementia (21cases), senility (8 cases), Parkinson's disease (4cases) and multiple cerebral infarctions (3 cases). Median survival time after subcutaneous drip infusion was 31days. No significant prognostic factors were identified by correlation and multivariate regression. Prognosis for patients who had serum albumin levels under 3mg/dl, however, was worse than in patients with levels above 3mg/dl (27 days vs 61 days , p=0.001).
Conclusion : We were unable to identify clear prognostic predictors in this study. Serum albumin levels, however, may influence prognosis in critically ill non-cancer patients without severe organ failure.

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Objective : Although current preventative care policies consider the issue of the homebound elderly to be important, effective means of intervention have not been established. Therefore, it is necessary to elucidate the relevant causes of the poorly understood “homebound” problem. As little expertise exists on the social and psychological factors of those who are homebound, this study focuses on the sense of coherence (SOC) —a new estimate of the psychosocial factors involved in being homebound—and examines the connection between being homebound and SOC.
Methods : A mail survey was conducted among 1,895 elderly adults, none of whom had been issued a Certification of Long-Term Care Need. Survey items included basic attributes, physical characteristics, psychological and socioenvironmental characteristics, and the condition of being homebound. Furthermore, SOC was investigated as part of the psychosocial and environmental evaluation. The 853 respondents chosen for the analysis were divided into three groups depending on their level of homeboundedness, and an ordered logistic regression analysis was conducted using homeboundedness as the dependent variable.
Results : The following items were found to have a significant association with homeboundedness : age, sex, low motor function, depressive tendencies, low SOC, and the low TMIG Index of Competence.
Discussion : This study identified a relation between being homebound and SOC, suggesting that in addition to interventions for depression and motor function, new SOC focused aid must be considered in the prevention of homeboundedness.

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Purpose : The purpose of this study was to determine how frequently cancer patients would be missed if primary care clinics do not participate in the Japanese National Cancer Survey, and to describe the characteristics of those cancer patients who would be missed.
Methods : This research is a case series study. We collected cancer patients who were identified in Ryuocho-Kokuminkenkouhoken Clinic and Yuge medical clinic for 26 years and were registered in the Shiga Cancer survey. We then extracted the records of those cancer patients who would be potentially missed from the national cancer registry and investigated the background.
Results : The total number of cancer patients registered was 441. Of these, 28 (6.3%) patients who did not admit to the hospitals may be missed from the national cancer registry ; ten patients had their cancer diagnosed at an advanced stage and died at home without hospital admission. Two further cases had treatment for cancer (endoscopic resection) completed in the primary care clinic without hospital admission. Twelve patients only attend the hospital outpatient clinic for investigation and died at home without admission. And four patients received only CT scan examination and didn't attend the hospital outpatient clinic and died at home without admission.
Conclusion : Primary care clinics that deal with the cancer patients treated completely in the clinics or home terminal care should participate in the Japanese National Cancer survey.

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Objective : The present study was conducted to examine the efforts of the managers of magnet home-visit nursing station to improve their organizations and prevent the turnover of nurses, focusing on their ideas and approaches.
Methods : A total of 6 magnet home-visit nursing station managers were interviewed and the obtained data were subjected to qualitative and inductive analyses.
Results : The managers exerted efforts to [provide advice on the missions of home-visit nursing], which were classified into the following three categories : “sharing experience and knowledge obtained from nursing practice to increase the level of home-visit nursing care services”, “meet the expectation of patients and their families”, and “working in collaboration with a variety of health care professionals”. The managers also improved their work environments to train staff members while valuing their personalities, and the efforts were classified into the following three categories : “enhancing the strengths of nursing staff”, “encouraging the independence of nursing staff”, and “helping staff members maintain their work-life balance”.
Conclusion : The managers of home-visit nursing stations attempted to reduce the staff turnover rate by improving home-visit nursing care services and work environments.

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Introduction : This study aimed to clarify the relationship between the presence of someone to care for and the subjective QOL (quality of life) of local elderly people.
Methods : Data for 7,728 residents aged 65 and above was obtained from the everyday life sphere needs survey implemented by the government of Nanto City, Toyama Prefecture, between May to July, 2014. Multiple logistic regression analysis was conducted to evaluate the relationship between two sets of variables : first, the presence (or absence) of “something to live for”, “sense of fulfillment”, and “self-esteem” as indicators of the respondents'subjective QOL ; and second, a set of explanatory variables (common to all models) including the presence of someone to care for, indicators of the personal attributes, health, and life style of the respondents.
Results : The presence of someone to care for was positively related to the presence of “something to live for,” “sense of fulfillment,” and “self-esteem,” which were indicators of subjective QOL, even after several indicators of personal attributes, health, and life style were accounted for.
Conclusion : Promoting mutual help in local areas has a positive significance for those elderly who take care of others, as well as for those who accept care. The results also suggest the social importance of being the recipient of care in the elderly.

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[in Japanese]

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[in Japanese]

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