Implementation of an Advance Care Planning Inventory and Its Possible Effect on Quality of Dying: A Nationwide Cross-Sectional Study in Group Homes for Persons with Dementia in Japan

This study aimed to develop an inventory for advance care planning implementation for persons with dementia in group homes and to examine the association between inventory implementation and residents’ quality of dying. A nationwide cross-sectional study was conducted via questionnaires mailed from 2000 group homes in Japan, selected through stratified random sampling. Participants were managers and care planners who had provided end-of-life care for recently deceased residents. The newly developed inventory was used to assess advance care planning implementation for persons with dementia, and the Quality of Dying in Long-term Care Scale was used to evaluate quality of dying. The valid response rate was 28.5% (n = 569). The factor structure of the newly developed Advance Care Planning Practice Inventory and the association between its implementation and quality of dying were verified using factor analysis and internal consistency, and logistic regression, respectively. The composite score and the factor score of the newly developed inventory were significantly associated with quality of dying (p < 0.05). The implementation of advance care planning improves the quality of dying. These findings can be used in development of educational programs, as well as research on advance care planning for care providers

Factors associated with deaths in ‘Elderly Housing with Care Services’ in Japan: a cross-sectional study

Abstract Background Although the Japanese government has expanded its ‘Elderly Housing with Care Services’ (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents’ deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths. Methods Our cross-sectional study involved all EHCS (N = 412) in Japan’s Tokyo, Kanagawa prefecture and used self-administered questionnaire data that the EHCS directors completed. In addition, we accessed the national statistics related to the municipal characteristics of the cities where the EHCS were located. These sources provided information about health care provision for the residents as well as facility/resident/regional characteristics that could potentially be associated with residents’ deaths in the EHCS. Based on this information, a sequential multiple logistic regression analysis was performed. First, we included in-facility health care provision (presence of nursing staff) and facility/residents/regional characteristics in Model 1. Next, visiting nurse agency’s care provision was included in Model 2. Finally, we included community hospitals or clinical care provision in Model 3. Results One hundred and fifty-four facilities answered the questionnaire (response rate: 37.4%). A total of 114 facilities were analysed. In-facility residents’ deaths occurred in more than half (54.4%) of the facilities. After adjusting for all variables (Model 3), end-of-life (EOL) care provision from community hospitals or clinics, the number of years since establishment and the number of residents were significantly associated with residents’ deaths. In Model 2, visiting nurse’s EOL care provision was significantly associated with residents’ death. Conclusion Our results suggest that in order to accommodate residents’ deaths, the government or the facility’s directors should promote the cooperation between EHCS facilities and community hospitals or clinics for in-residents’ EOL care. Furthermore, as the results suggest that community nurses contribute to the occurrences of death by collaborating with the physician, promoting cooperation with visiting nurse agencies may be also needed

Association between local-level resources for home care and home deaths: A nationwide spatial analysis in Japan.

AIM:Little is known about whether and how local-level resources regarding home care are associated with the prevalence of home deaths. We aimed to investigate whether geographic patterns of the resources for home care were associated with the prevalence of home deaths, taking spatial variation into consideration. METHODS:We conducted an ecological cross-sectional study in Japan using nationwide data in 2014. The areal unit was the municipality, the smallest administrative unit in Japan. We investigated the association between the percentage of home deaths and the resources of home care support clinics with available 24-hour-a-day functions, considering the geographic effect of neighboring municipalities by applying a geographically weighted regression model. RESULTS:The mean and standard deviation of the percentages of home deaths were 11.4% (5.0%), and those of the number of home care support clinics per 10,000 elderly population were 3.4 (3.7). The percentages of home deaths in neighboring municipalities tended to be significantly correlated (Moran's I 0.34, p<0.001). Adjusting for the number of hospital beds, total population, and the socio-economic status of municipality, the results of an ordinary least squares regression model showed a positive correlation between the percentage of home deaths and the local resources for home care support clinics per 10,000 elderly population (regression coefficient 0.15, 95% confidence interval 0.07, 0.22), while the existence of spatial autocorrelation of the residual was suggested (Moran's I of the residual 0.227, p<0.001). The geographically weighted regression model showed local regression coefficients varying across municipalities with a better model fit over the analogous ordinary least squares model (adjusted R2 0.414 vs. 0.131). CONCLUSION:Home deaths were more prevalent in municipalities with greater home care resources. This association was geographically varied and further strengthened in some areas