Purpose: This study evaluated the effectiveness of home care management among older adults with dementia through a systematic review and meta-analysis.

Methods: An extensive literature search of English and Japanese databases was conducted in February, April, and June of 2019. The inclusion criteria for the literature review were as follows: i) the study was a randomized controlled trial; ii) the participants were older adults aged 65 years or more with dementia at home; and iii) the study examined the topic of effective care management, including assessment, care planning, and care coordination.

Results: Five studies were identified and included in the review. The findings indicated that there were no statistically significant differences in all outcomes between care management and usual care groups among the five studies at 9 or 12 months. However, in one study at 18 months, significant differences were found between the two groups in the improvement of quality of life and continuity of home-based care.

Conclusions: The results suggest that effective care management for older adults with dementia at home could improve their quality of life and the continuity of home-based care in the long term, but the evidence is limited.

Purpose: This systematic review assessed the effectiveness of rehabilitation visits by therapists in older adults with cerebrovascular disease living at home (June 13, 2019).

Methods: A systematic review and meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria were as follows: i) randomized controlled trials; ii) interventions for people with cerebrovascular disease aged ≥65 years and living at home; iii) interventions in which physiotherapists, occupational therapists, or speech-language-hearing therapists conducted home visits; iv) interventions, in which the outcomes included one- or lower-limb muscle strength, walking ability, and activities of daily living; and v) articles written in English or Japanese (including interventions in national and international settings). The quality of the studies was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis methods were used for quantitative integration, and extracted data were quantitatively integrated using forest plots.

Results: We extracted 22 studies that met the eligibility criteria. Only one study reported lower-limb muscle strength as an outcome. Meta-analysis indicated that seven studies on walking ability (I2 = 94%) and seven studies on activities of daily living (I2 = 91%) could not be integrated owing to their high heterogeneity. Therefore, we were unable to provide the integrated values. Subgroup analyses of intervention periods of 3 months (standardized mean difference = 0.32, 95% confidence interval = -0.03-0.68, I2 = 26%, p = 0.07) and in the range of 9 to 18 months (standardized mean difference = -0.05, 95% confidence interval = -0.20-0.11, I2 = 18%, p = 0.57) indicated that no improvement was observed.

Conclusions: The effectiveness of home-visit rehabilitation by therapists for older adults with cerebrovascular disease has not yet been established for lower-limb muscle strength, walking ability, and activities of daily living.

Abstract

In this study, floor-mark training was given to participants to examine its effectiveness in preventing falls, and fall prevention measures through which such training could be easily incorporated were implemented. This training was based on multi-target stepping (Yamada et al. 2013), a task in which participants must accurately choose and walk over multiple targets. For this study, targets in three different colors were placed along the participants’ usual route in their homes, which they then had to step on accurately and sequentially. The participants were 118 healthy older adult residents of Region A, who were not certified as needing nursing care (mean age 77.2 ± 6.45 years). Of these, 59 were allocated to the intervention group and underwent floor mark training. The remaining participants were allocated to the control group. Participants in the intervention group underwent floor-mark training for over 1 year, whereas those in the control group continued their lives normally. The following findings were observed in the intervention group: a significant improvement in Mini-Mental State Examination scores and a significant decrease in the time difference between single- and dual-task walking. In the floor-mark training, participants simultaneously worked on two tasks: a walking task (primary task) and an attention task (secondary task). The findings indicated that the training activated the participants’ attention, which may lead to improved cognitive function and thereby prevent falls. Moreover, this study found that engaging in floor-mark training as a secondary activity prevents falls. It was therefore considered that training can be incorporated into simple and easy-to-use fall prevention and health improvement methods.

The purpose of this study was to clarify the hypothesis that the experience of interpersonal volunteering at home hospice and the sense of belonging to the affiliated organization are related to the awareness of volunteer activities, and through this, the willingness to maintain activities is increased. A questionnaire was administered to 196 individuals from six home hospice volunteer organizations, and factor analysis was conducted using the complete data of 103 individuals. The findings suggested that the recognition of volunteer activities is composed of four factors: “delight in group activities,” “self-efficacy,” “social contribution through leisure time,” and “confidence in one’s self-ability.” Of these, only “delight in group activities,” in which the number of experienced interpersonal volunteers and the sense of belonging were significantly related, was significantly related to willingness to continue (standardized β0.52, p <0.001). In addition, low willingness to continue was associated with a lack of a reliable coordinator and sense of belonging. Therefore, satisfaction with the group organization was more of a motivation to continue volunteer activities than the individual factors.

The purpose of this study was to identify any challenges involved in the nursing practice being carried out by ward nurses in small and medium-sized hospitals in their discharge support work, in addition to clarifying the details of the work.

Semi-structured interviews were conducted with 13 nurses working at small or medium-sized hospitals. Thereafter the data was qualitatively analyzed using an inductive approach.

The content of the practice was: Working to improve motivation by leveraging the strengths of patients; Consideration for maintaining a good relationship between patients/family and the medical staff; Involvement that emphasizes the safety, maintenance, and feasibility of medical treatment behavior after discharge; Encourage patients/family to face reality and life after discharge; Finding compromises with patients/family regarding the life after discharge with functional deterioration; Coordinating points of agreement with patients/family while giving consideration to the circumstances of the hospital organization; Exercise leadership across multiple occupations by utilizing the expertise of nurses; and Team management to maintain and strengthen the support system for interdisciplinary approach.

The nurses provided support of patient/family decision making and team management for inter-professionals. To promote discharge support by nurses working autonomously, it is important that a nursing manager evaluate and approve the ward nurses’ discharge support practice.

Objective: The present study aimed to clarify the issues in the use of the Anticipatory Grief Scale in the provision of anticipatory grief support to the family by home-visiting nurses.

Methods: Six home-visiting nurses with more than 3 years of experience in Prefecture A were interviewed. The data were analyzed using a qualitative synthesis method (the KJ method).

Results: The findings were as follows: Some home-visiting nurses reported “hurdles to the realization of dying at home: acceptance status for home death and status of family care,” and as a result, “relied on the unspoken atmosphere due to a nurse’s underlying fear of grief reactions”. On the other hand, some home-visiting nurses “deeply understood the emotions and relationships and engaged with the family members by consciously recognizing anticipatory grief”. The “tensions of both the active and cautious groups” became clear as “nurses’ awareness of scale use” was identified as a problem. This was influenced by “time spent together with families who are engaged in end-of-life care” and “exploring how to spend the final days”

Conclusion: In order for home-visiting nurses to effectively provide anticipatory grief support to the family, the team should share the fear of the family’s grief reaction and lifelong education for grief should be provided.

The purpose of this research was to clarify the state of adaptation of elderly women at the daycare centers and to consider new ways of offering support to satisfy their needs.

Eight elderly women who visited the daycare center were studied. The modified grounded theory approach, M-GTA, was used in the analysis. Seven categories were extracted by comparing the 15 concepts and their relationships. The elderly women who attended the daycare center “accepted themselves as they were” “by questioning themselves.” Through the process of “creating new possibilities” and “discovering alternatives,” past worries were diverted. By becoming aware of “finiteness,” a new lifestyle was developed for secure and peaceful days.

The purpose of this study was to clarify visiting nursing practices to help older adults with a stoma and their families adjust to life in recovery. Semi-structured interviews were conducted with nine certified nurses visiting facilities, and these were analyzed qualitatively and descriptively.

Categories were arranged in chronological order. The beginning stages of life in recovery focused on “identifying the implementation status of stoma care and impeding factors,” “observing the status of stoma care and daily life support provided by family members,” “gauging the distance with family members and building relationships through repeated communication,” and “identifying the emotional relationship between older adults and their families.”

The following categories were derived during life in recovery: “recognizing difficulties in continuing stoma care and encouraging coping,” “provide 24-hour technical support for excrement leakage that occurs during the course of home visits,” “flexibly interpreting the emotional relationship of family members and encouraging change,” “motivating and encouraging the willingness of family members to engage in stoma care,” and “supporting stoma care while considering the emotional burden of families.”

It was suggested that visiting nurses should encourage coping with the difficulties associated with stoma care, improve the family’s ability to respond in consideration of psychological and financial burdens, and support adaptation to life.

The purpose of this study was to clarify the intentions and related factors regarding the hiring of new graduate nurses (hereinafter, new graduates) at home nursing stations (hereinafter, stations) through a questionnaire survey sent to station managers (hereinafter, managers). We mailed a questionnaire to 94 facilities in Prefecture A (47.8% response rate; 44 valid responses). The survey contents were related to past recruitment experiences, and intentions and reasons for hiring new graduates. The t-test and χ2 test were used in the analysis. Of all the respondents, 52.3% answered that they had “specific plans” to hire new graduates and were “proactively considering” it. With regard to factors related to hiring intention, the results indicated that the major factors were length of experience as a manager (p = .001), the shortness of time from establishment, and the number of users and visits per month (p <.05 each). In addition, the multiple regression analysis revealed that the number of years of experience as a visiting nurse was also a related factor. Managers who intend to hire new graduates have many years of experience, and their stations are in high demand in the community. In such cases, hiring new graduate nurses is considered a strategy for sustainable management.

Abstract

Objective: This study aimed to explore home hospice care through interviews with home hospice staff.

Methods: Semi-structured interviews were conducted with 13 home hospice staff members on their thoughts on the care of residents. The data from these interviews were used to analyze the care of home hospice in a qualitative and descriptive manner.

Results: We identified the need for staff to have a strong interest in end-of-life care, to “be enthusiastic about working in a home hospice,” to be able to provide independent care, and to be able to develop the foundation for an “environment in which care can be provided with peace of mind” (e.g., good relationships among staff members).

In addition, the staff was equipped with the perspective of a person living in the facility and worked to provide care that provided serenity to the residents through a “sincere attitude toward care,” such as adapting to the pace of residents’ lives and understanding their personalities.

Conclusions: We have enhanced the three outcomes of home hospice staff, who foster peace of mind in home hospice residents: “be enthusiastic about working in a home hospice,” “environment in which care can be provided with peace of mind,” and “sincere attitude toward care.”