Objective: This study aimed to review research on individuals with multiple caregiving roles and caregivers providing double care to family members.

Methods: We searched PubMed, CINAHL, MEDLINE, and Ichushi Ver. 5 for Japanese and English articles using various relevant keywords regarding “multiple caregiving” and similar conditions published up to December 2020. Articles found in this search were classified according to care target, and their contents were scrutinized in detail.

Results: The articles on caregiving for multiple family members were divided into “multiple caregiving,” which implies care for multiple elderly persons, and “double care,” which implies an individual caring for both their children and parents. There were no scientific articles in Japan, and the English literature has pointed out the physical and psychological burden of conflict between caregiving and other daily activities. However, details of the content of caregivers and caregiving roles were not addressed.

Conclusion: Although the burden of multiple caregiving roles seems to be more critical than that of a single caregiving role, the actual situation has not yet been completely ascertained. Further empirical research is required to clarify the problems related to multiple types of caregiving and to establish a support system and strategy.

Purpose: This systematic review aimed to assess the effectiveness of at home rehabilitation visits by therapists in older adults with dementia.

Method: A systematic review and meta-analysis were conducted based on the PRISMA Statement. The eligibility criteria were: i) randomized controlled trials; ii) interventions for people with dementia aged ≥65 years living at home or with a primary caregiver; iii) interventions in which physiotherapists, occupational therapists, or speech therapists visit individuals at home; and iv) interventions whose outcomes include one or more activities of daily living (ADL), depression, behavioral and psychological symptoms of dementia (BPSD), quality of life, caregiver depression, and caregiver burden.

Results: Ten studies met the eligibility criteria. Meta-analysis indicated that depression improved in older adults with dementia in the intervention group (standardized mean difference [SMD]= – 0.39, 95% confidence interval= – 0.64 to – 0.13; p=0.003), while no improvements in ADL, BPSD, QOL, caregiver depression, and caregiver burden scores were observed.

Conclusion: Home-visit rehabilitation by therapists for older adults with dementia could improve their depression; however, the available evidence is limited. The results of this review provide insufficient evidence to support other health outcomes.

【Purpose】Through a systematic review and meta-analysis, we aimed to review the effectiveness of telemonitoring support by healthcare providers on health outcomes in home-care patients with heart failure.

【Methods】A systematic literature review was conducted using the following inclusion criteria for literature selection: (1) randomized controlled trials, (2) targeted adults and older adults with heart failure, (3) telemonitoring performed by healthcare providers, and (4) telemonitoring was not provided in the control group. This review was conducted as part of the Guideline Development Committee for the Japan Academy of Home Care.

【Results】Thirty-four studies were selected. Blinded trials in these studies identified a risk of bias. Support included tele-counselling for symptom management and patient education by nurses. The intervention group had a significantly lower cardiac function classification (p= .0002). There were no significant differences in adherence, emergency department visits, number of hospital bed days, number of hospitalizations, quality of life, or cost.

【Conclusion】Professional telemonitoring was suggested to be effective in improving health outcomes, such as the number of emergency visits, in home-care patients with heart failure. However, the conclusive evidence is limited.

【Purpose】Through a systematic review and meta-analysis, we aimed to evaluate the effectiveness of telemonitoring support by healthcare providers on improving anxiety, depression, and quality of life (QOL) in home-care patients with chronic obstructive pulmonary disease (COPD).

【Methods】A systematic review was conducted using the following inclusion criteria for literature selection: (1) randomized controlled trials, (2) more than 40% of patients had COPD, (3) telemonitoring was performed by professionals, and (4) telemonitoring was not performed in the control group. Moreover, subgroup analyses based on intervention period were performed. This review was conducted as part of the Guideline Development Committee for the Japan Academy of Home Care.

【Results】Twelve studies were selected. Randomized trials in these studies identified a risk of bias. Support included tele-education and support from professionals, such as nurses. The intervention group had significantly lower anxiety (HADS-Anxiety scale) within six months of the intervention (p= .02).

【Conclusion】Telemonitoring support from healthcare providers was suggested to be effective in improving anxiety in home-care patients with COPD. However, confidence in the evidence is limited.

Purpose: Although optimizing pharmacotherapy for community-dwelling older adults is important, it is unclear whether interventions by interdisciplinary teams improve polypharmacy, frailty, or other health outcomes when reviewing patient prescriptions.

Methods: We conducted a systematic review to evaluate the efficacy of interdisciplinary team interventions in community-dwelling older adults. PubMed, CINAHL with Full Text, CENTRAL, Embase, and gray literature were systematically searched to identify articles. The selection criteria included the following: 1) age ≥65 years, 2) intervention by interdisciplinary teams (physicians, nurses, and pharmacists), and 3) randomized controlled trials.

Results: A total of 579 articles were identified, and five articles met the inclusion criteria. Meta-analysis was not conducted because of the different outcome measures of the studies. The studies showed that polypharmacy is prevalent among community-dwelling older adults. Additionally, while intervention by interdisciplinary teams reduced the number of drugs administered, it did not improve frailty, ADL, QOL, or other health outcomes. No study has evaluated the complexity of medication regimens (e.g., one-dose packaging).

Conclusions: This systematic review revealed that studies of pharmacotherapy in community-dwelling older adults have not been adequately conducted. Appropriate pharmacotherapy is important; therefore, further studies are needed in the future.

Objective: To assess whether the combined interventions of resistance training and high-protein nutritional therapy in older adults with reduced physical function at home are more effective than single or no interventions.

Methods: This systematic review and meta-analysis were performed by using the method in the Cochrane handbook. The eligibility criteria were (1) older adults aged ≧ 65 who have physical function decline, (2) combined interventions in resistance training and high-protein nutritional therapy, (3) controls excluding these multiple interventions, and (4) randomized controlled trials.

Results: Thirteen original studies were included in the review. As a result of the meta-analysis, significant improvements were observed in the results of the 5-Times-Sit-to-Stand Test after 10 and 12 weeks compared to those in the group that did not undergo both interventions (mean difference=-2.15; 95% confidence interval = -3.00, -1.30; I2 = 0%).

Conclusion: Resistance training and high-protein nutritional therapy for older adults who have physical function decline at home are effective in improving lower limb and balance functions; however, the evidence is limited.

【Methods】Rodgers’ concept analysis was used to clarify the concept of interprofessional work as part of at-home care. “Interprofessional work” as dealt with in this study refers to coordination of multiple professions, including medical personnel and care workers, as part of at-home care. Literature from the academic article databases Ichushi Web, CiNii, PubMed, and CINAHL was narrowed down to 46 articles, which were analyzed.

【Results】Results revealed 3 attributes of interprofessional work: “Sharing Information among Facilities and Professions”, “Use of Resources to Facilitate Communication”, and “Apportioning Roles and Functions among Professions and Facilities”. Results also revealed 4 prerequisites for interprofessional work: “A Need for Interprofessional Care”, “Understanding from Medical Professionals and Care Workers”, “A Care Recipient-centered Attitude”, and “The Relationship between Different Professions in Different Facilities”. Results further revealed 4 outcomes of interprofessional work:“Improved Quality of At-home Care”, “Improved Teamwork among Different Professions at Different Facilities”, “Fewer Constraints on Roles”, and “Job Satisfaction”.

【Conclusion】Interprofessional work is defined as medical professionals and care workers “Apportioning Roles and Functions among Professions and Facilities”. This is achieved by “Sharing Information among Facilities and Professions” through the Use of “Resources to Facilitate Communication”. In interprofessional work, these 3 elements are continually iterated instead of being imposed unilaterally. Interprofessional work begins with a recipient of at-home care with “various Needs for Interprofessional Care”. Care is also affected by other elements, i.e. “Understanding from Medical Professionals and Care Workers”, “A Care Recipient-centered Attitude”, and “The Relationship between Different Professions in Different Facilities”. When interprofessional work goes smoothly, it leads to “Improved Quality of At-home Care” along with “Improved Teamwork among Different Professions at Different Facilities”, “Fewer Constraints on Roles”, and “Job Satisfaction”.

This study aimed to clarify the actual situation and factors related to information comprehension among care managers with varying basic qualifications who support elderly persons requiring insulin therapy and long-term home care. A survey was administered to 186 care managers.

Results show that depending on their qualifications, care managers’ ability to understand safety-related information in insulin therapy management, such as response during “sick day,” differed. Other factors included whether they provided home-visit nursing care (p = 0.006) and had a means of contact with the medical staff (p < 0.001).

Measuring the degree of information comprehension of care managers, regardless of their basic qualifications, requires standardization. For this, interventions should promote a better understanding of information by introducing home-visit nursing and establishing proper contact with medical staff.

Objectives: This study clarifies the factors affecting medical social workers’ (MSWs) and discharge coordination nurses’ practical ability to provide discharge support in acute-care hospitals. We also reveal the differences in their practical ability to explore the strengths of professional skills in each job type.

Methods: A questionnaire survey concerning the practical ability to provide discharge support was conducted at 251 acute-care hospitals in all 47 Japanese prefectures. Data collected from 326 participants comprising 154 MSWs and 172 discharge coordination nurses were included in the exploratory factor analysis. Additionally, we calculated the means of the factor scores by job type and performed independent samples t-tests.

Results: This study showed that MSWs’ and discharge coordination nurses’ practical ability to provide discharge support in acute-care hospitals was composed of the following three factors: “the ability to support decision making systematically,” “the ability to integrate medical care into the lives of patients and their families,” and “the ability to coordinate health, medical, and welfare services.” The means of the factor scores of the discharge coordination nurses were higher than those of the MSWs for “the ability to support decision making systematically” and “the ability to integrate medical care into the lives of patients and their families.” In contrast, the mean of the factor scores of the MSWs was higher than that of the discharge coordination nurses for “the ability to coordinate health, medical, and welfare services.” A statistically significant difference was recognized between MSWs and discharge coordination nurses for each of the three factors.

Conclusions: The results suggest that cooperation between MSWs and discharge coordination nurses, such that they utilize the strengths of each type of job, is useful.

The purpose of this study was to clarify the course of treatment for patients with chronic obstructive pulmonary disease COPD in the terminal stage and examine the support provided by visiting nurses. The participants were eight visiting nurses who had experience caring for patients with end-stage COPD. The mean length of experience as a visiting nurse was 13.8 years (SD±4.8). The collected data were analyzed both qualitatively and descriptively. The results indicated that the support provided by visiting nurses could be categorized into “support that has been continuously provided from the stable period” and “support that is provided in anticipation of progression to the end stage.” From the former, the following four categories were extracted: repeatedly communicating preventive measures for acute exacerbation as well as signs thereof, incorporating the correct methods of using home-based oxygen therapy in the patient’s everyday life, maintaining respiratory function by continuing pulmonary rehabilitation, and providing the patient with support for self-care in maintaining their everyday life. Regarding the latter aspect, the following four categories were extracted: preventing exacerbation of respiratory distress by increasing the number of home visits, collaborating with the visiting nursing team and physicians to help the patient maintain their emotional stability, maintaining the patient’s hope through to the end of their life, and achieving the provision of end-of-life care as requested by the patient.

This study aimed to clarify the values that people over the age of 75 hold when taking medication. Semi-structured interviews were conducted with 31 people over the age of 75 attending three internal medicine clinics. The subjects were 82.0 ± 5.2 years old on average, 14 were males (45.1%), 8 lived alone (25.5%), and 22 had been taking the drug for 10 years or more (71.0%). Additionally, subjects took an average of 2.9 ± 1.9 different drugs. The subjects also included a group that never forgot to take the drug. As a result of the qualitative analysis, four core categories were extracted: I trust my doctor, I do not get worse than I am now, I take medicine and stay healthy, and I do not bother my family. While respecting these values, it is necessary to share information between teams based on a trusting relationship with doctors, and to assist these individuals so that they can continue taking medication with the support of their families.

A series of semi-structured interviews was conducted with ten visiting nurses in charge of home-bound patients with intractable neurological diseases. These patients received care from two visiting nursing stations in the Prefecture. The cooperation structure among nurses at multiple stations was qualitatively and descriptively analyzed. Four core categories were extracted: medical care and aggravation of daily life, understanding others and building trust, various means of cooperation and coordination, and complementation among supporters. Visiting nurses understood the characteristics of patients with intractable neurological diseases. Based on disease progression and patient condition, they responded flexibly and provided diverse types of support. Their attitudes were cooperative in collaboration, and they attempted to form a support team while recognizing the function and role of the visiting nursing stations. The nurses worked to improve nursing quality while complementing each other, as well as maintaining and improving the quality of life of patients and families. This study suggests that home-visit nursing by multiple home-visit nursing stations would help promote the nursing cooperation required for a comprehensive community care system.

Objectives: This study aimed to clarify the importance and implementation of observations and practices by outpatient nurses for recognizing outpatient home care needs.

Methods: A cross-sectional survey using a self-administered questionnaire was conducted among staff who had worked for more than three years as hospital outpatient nurses. This survey was administered in 436 hospitals across Japan.

Results: Data from 1,015 participants were analyzed. Thirty-nine out of 41 items were perceived as important to recognizing outpatient home care needs by over 75% of the participants. “Mention of subjective symptoms by the patient (e.g., condition aggravation, malaise, pain)” showed the highest percentage in both importance and implementation. However, nurses were less likely to implement major categories of observational points, such as the recognition and application status of patients and caregivers to home care services.

Conclusion: Thirty-nine out of 41 items commanded consensus as important observational points and practices. However, the rate of implementation of the item in the major observational points category, recognition and application status of patients and caregivers to home care service, was low compared to its rate of importance, suggesting the need to enhance education on implementation.

[Purpose] This study investigated the relationship between the scores of the Japanese version of the Frommelt Attitude toward Care of the Dying Scale (FATCOD-B-J) and the demographics of nursing care staff, nursing staff, social workers, rehabilitation staff, and clerical staff in long-term care facilities. [Methods] An anonymous self-rated questionnaire survey was conducted with 410 employees in long-term care facilities. [Results] A total of 356 valid responses (86.8 %) were obtained. Attitudes toward caring for end-of-life individuals, as measured by the FATCOD-B-J, were related to attendance of terminal care training, occupation, and gender. By attending terminal care training more than once, a more positive attitude toward nursing care can be formed. Among the multiple occupations, social workers’ caregiving attitudes were positive. [Conclusion] It is important for multiple occupations to continue learning about caring for people at the end of their lives and to improve the caring attitude of the entire facility.

Study objective: To clarify the psychology of visiting nurses who provided grief care to families of patients who died at home.

Study methods: A qualitative descriptive study was performed with 10 visiting nurses as study participants. For analysis, the transcript data were first categorized into three stages: terminal care, impending death care and bereavement care, and then the psychology of the nurses at each stage was extracted.

Results: “Anguish over forming relationships with family,” “hesitation and conflict in conveying the patient’s final hour,” and “relief arising from the presence of family and staff members who they can connect with” were generated as categories in the terminal care stage. During the end-of-life stage, “relief and healing through after-death care with the family,” “self-condemnation towards the moment of death they made the family face without providing enough support,” and “calm feelings affected by death in everyday life ” were extracted. During the bereavement care stage, “loss and emptiness,” “feeling overwhelmed by family sentiment,” “feeling guilty with the family,” and “relief and joy attained from the family” were extracted.

Conclusion:The psychology of visiting nurses who provide grief care to families has both negative and positive aspects, which may be influenced by the relationship with the family, the feeling of family support, and the reaction of the bereaved family.

This study aimed to clarify the characteristics of the learning of nurses who participated in the Continuing Nursing Management (CNM) education program (basic version), and to obtain suggestions for the significance of the education program and its future use. After their training, 252 participants in the CNM program completed a self-administered questionnaire survey. A total of 188 valid responses (74.6%) were analyzed. The survey consisted of 19 evaluation items for the CNM training and free descriptions of “new learning” and “application in practice.” The training participants included ward nurses, discharge support nurses, outpatient nurses, visiting nurses, and educators. The results showed that visiting nurses had significantly higher scores than ward nurses on five out of the 19 evaluation items. Ward nurses learned CNM as a new concept of practice, whereas visiting nurses reflected on their own practice and connected CNM to it. CNM training provides an opportunity for nurses working in diverse settings to learn to understand patients as consumers and to be goal-oriented by viewing patients from a time-based perspective. In addition, it encourages them to understand each other according to recognized characteristics and their roles.

This study aimed to review the obstructive factors that challenge people with dementia who continue to live alone at home. Literature sources included the Japan Medical Abstracts Society and CiNii Articles. The search terms were “dementia,” “elderly,” and “live alone,” or “living alone.” Twelve research papers were selected for this review. The major findings were classified as follows: 1) risks regarding safety, 2) disease and decline of physical function, that affects daily life, 3) decline of self-management, 4) difficulties using services, 5) economic abuse, and 6) difficulties in their relationships with neighbors. It is not just a single obstructive factor that makes it difficult to continue living alone at home, but rather a combination of factors. It is important that people with dementia and their support system engage in dialogue about these factors to ensure that the mere presence of these factors does not jeopardize the ability of elderly people with dementia to continue to live alone.