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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. [ABSTRACT FROM AUTHOR]

Aim: In Japan's public health system, dentists can assess and intervene in oral hypofunction cases. However, the associations between oral hypofunction and health outcomes and costs remain unclear. This study aimed to identify these associations. Methods: This retrospective cohort study using a Japanese health insurance claims database included 45 916 individuals aged ≥65 years who underwent dental examinations for oral hypofunction. The primary outcomes were incidence rates of aspiration pneumonia, femoral or vertebral fractures and all‐cause mortality. Secondary outcomes were annual medical and dental costs. We used competing risk regression and Cox models to estimate primary outcomes, and gamma regression models for secondary outcomes. Results: The adjusted hazard ratios were 0.84 (95% CI 0.74–0.96) for the incidence of aspiration pneumonia, 1.11 (1.02–1.21) for the incidence of femoral or vertebral fractures and 1.27 (1.07–1.50) for all‐cause mortality in individuals with oral hypofunction compared with those without. The adjusted relative risk was 1.05 (1.01–1.10) for annual medical costs and 0.94 (0.81–1.09) for annual dental costs in individuals with oral hypofunction compared with those without. Conclusions: Individuals with oral hypofunction were at increased risk of femoral or vertebral fractures and all‐cause mortality, and they incurred significantly higher annual medical costs, compared with those without this condition. Notably, they showed a lower risk of aspiration pneumonia, suggesting potential benefits of dental intervention. Integrating dental care into medical strategies might be necessary to improve health outcomes and reduce healthcare costs for those with oral hypofunction. Geriatr Gerontol Int 2024; 24: 1053–1059. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to examine the association between physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care hospitals. Background: Physical restraints are frequently used in the management of patients, especially amongst patients with dementia. No previous study investigated the potential undesirable effects of physical restraints in patients with dementia. Methods: This was a cohort study using a nationwide discharge abstract database in Japan. Patients aged ≥65 years with dementia hospitalised for pneumonia or aspiration pneumonia between April 1, 2016 and March 31, 2019 were identified. The exposure was physical restraint. The primary outcome was hospital discharge to the community. Secondary outcomes included hospitalisation costs, functional decline, in‐hospital mortality, and institutionalisation for long‐term care. Results: A total of 18,255 inpatients with pneumonia and dementia in 307 hospitals were included in this study. Of them, 21.5% and 23.7% had physical restraint during full and partial days of hospital stays, respectively. Discharge to the community incidence rates was lower in the full‐restraint vs. the no‐restraint group (27 vs. 29 per 1000 person‐days; HR, 1.05 [95% CI, 1.01–1.10]) and the partial‐restraint vs. the no‐restraint group (17 vs. 29 per 1000 person‐days; HR, 1.79 [95% CI, 1.71–1.87]). The risks of functional decline were higher in the full‐restraint vs. the no‐restraint group (27.8% vs. 20.8%; RR, 1.33 [95% CI, 1.22, 1.46]) and the partial‐restraint vs. the no‐restraint group (29.2% vs. 20.8%; RR, 1.40 [95% CI, 1.29, 1.53]). Conclusions: The use of physical restraints was associated with a lower incidence rate of discharge to the community and an increased risk of functional decline at discharge. Further research is needed to judge the benefit–risk balance of physical restraints in acute care settings. Relevance to Clinical Practice: Understanding the risk of physical restraints allows medical staff to improve the process of decision making in everyday practice. No Patient or Public Contribution. Reporting Methods: The reporting of this article conforms to the STROBE statement. [ABSTRACT FROM AUTHOR]

Background: To meet the increasing demand for home healthcare in Japan, as part of the national healthcare system, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012 respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24‐h home care services through the end of life. Methods: A retrospective cohort study was conducted using the national database in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, or enhanced HCSCs. Each patient was followed up for 6 months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end‐of‐life care defined as in‐home death. Multivariable logistic regression analyses were performed for statistical analysis. Results: The analysis included 160,674 patients, including 13,477, 64,616, and 82,581 patients receiving regular home visits by general clinics, conventional HCSCs, and enhanced HCSCs respectively. Compared to general clinics, the use of conventional and enhanced HCSCs was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56–1.69] and 1.86 [1.79–1.93], respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82–0.90] and 0.88 [0.84–0.92] respectively). Among 39,082 patients who died during the follow‐up period, conventional and enhanced HCSCs had more in‐home deaths (aOR [95% CIs] of 1.46 [1.33–1.59] and 1.60 [1.46–1.74], respectively) compared to general clinics. Conclusions: HCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting that further promotion of HCSCs (especially enhanced HSCSs) would be advantageous. [ABSTRACT FROM AUTHOR]

Background: Inadequate postoperative analgesia has been noted in patients with dementia, but this topic has only been studied in hip fractures. This study aimed to examine whether the duration of postoperative analgesia associated with three surgical procedures was shorter in patients with dementia than in those without dementia. Methods: This retrospective observational study was based on a nationwide discharge database of acute care hospitals in Japan and included patients aged ≥ 65 years diagnosed with lung cancer, rectal cancer, or hip fracture, who underwent surgery in 366 hospitals between April 2013 and September 2018. The primary outcome was the incidence of injectable analgesic use during the postoperative hospital stay. The number of person-days of opioid, non-steroidal anti-inflammatory drug, or acetaminophen use was calculated for patients with and without dementia after each surgery using generalized estimating equations to obtain the age-adjusted incidence per 100 person-days. Results: Among the 32,379 patients included, 4828 (14.9%) had dementia. The duration of opioid administration per 100 person-days was 14% shorter in patients with dementia than in those without dementia after open rectal cancer surgery (incidence rate ratio [IRR] 0.86; 95% confidence interval [CI] 0.74–1.00) and 20% shorter in patients with dementia after open lung cancer surgery (IRR 0.80; 95% CI 0.70–0.91). In patients who underwent thoracoscopic lung cancer surgery, laparoscopic rectal cancer surgery, or hip replacement surgery, the duration of opioid administration was shorter in patients with dementia than in those without dementia, but the difference was not statistically significant. Conclusions: The length of postoperative opioid administration after lung and rectal cancer surgery was reduced in patients with dementia, suggesting that the duration of postoperative analgesia in patients with dementia may be insufficient. More careful pain assessment and management of postoperative analgesia in these patients may be necessary. [ABSTRACT FROM AUTHOR]

Aim: Obesity is reported to be a risk factor for Clostridioides difficile infection. However, obesity rarely occurs in older Asian patients, and the effects of obesity on health and disease are different in Asian and Western countries. This study aimed to assess the association between body mass index and C. difficile infection risk among older patients with pneumonia in Japan. Methods: This retrospective observational cohort study used data from the nationwide database of acute hospital inpatients' data in Japan between July 2014 and March 2016. All patients aged ≥65 years admitted with a primary diagnosis of pneumonia were enrolled. Risk factors for C. difficile infection were determined by logistic regression analysis, including known risks as covariates. Results: Among 221 242 pneumonia patients, 611 developed C. difficile infection. Underweight patients (body mass index <18.5 kg/m2) showed higher odds for C. difficile infection (odds ratio 1.38, 95% confidence interval 1.17–1.62, P < 0.001) than normal weight patients (body mass index 18.5–24.9 kg/m2), whereas overweight patients (body mass index ≥25 kg/m2) showed lower odds (odds ratio 0.63, 95% confidence interval 0.45–0.89, P < 0.01). Conclusions: Body mass index was associated with C. difficile infection in older pneumonia patients in Japan. Underweight was a risk factor, whereas overweight was a protective factor for C. difficile infection. Geriatr Gerontol Int 2022; 22: 63–67. [ABSTRACT FROM AUTHOR]

Aim: Family caregivers can experience psychological distress, resulting in physical and mental health problems, and discontinuation of caregiving. This study's objective was to examine factors associated with caregiver psychological distress. Methods: We analyzed data from the Comprehensive Survey of Living Conditions in 2007, 2010, 2013 and 2016, which included 12 504 pairs of caregivers and care recipients sharing a household in Japan. Kessler's Psychological Distress Scale (K6) was used to measure caregiver psychological distress. Multivariable logistic regression analyses identified factors associated with caregiver psychological distress (K6 score ≥5). Results: Caregivers' median K6 score was 3 (interquartile range 0–7), and 38.6% had a K6 score ≥5. K6 scores ≥5 were positively associated with female sex (adjusted odds ratio 1.35, 95% CI 1.21–1.51), poor caregiver health status (compared with "very good," 9.48, 95% CI 7.91–11.37 for "not very good/poor"), longer care time (compared with "help only when needed," 1.40, 95% CI 1.25–1.58 for "almost all day") and dementia (1.16, 95% CI 1.05–1.28), lower respiratory tract disease (1.25, 95% CI 1.06–1.49) and diabetes (1.16, 95% CI 1.00–1.33) in care recipients. K6 scores ≥5 were negatively associated with older caregiver age (compared with 20–54 years, 0.65, 95%CI 0.58–0.74 for 55–64 years, 0.54, 95%CI 0.46–0.63 for 65–74 years and 0.50, 95% CI 0.40–0.62 for ≥75 years), employment (0.88, 95% CI 0.80–0.97) and being a care recipient's child‐in‐law (compared with spouse 0.75, 95% CI 0.61–0.92). Conclusions: The findings identified several factors associated with caregiver psychological distress, showing that particular attention might need to be paid to caregivers with these risk factors. Geriatr Gerontol Int 2021; 21: 855–864. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between dementia and risk of hospital readmission and to evaluate whether the effect of dementia on hospital readmission varies according to primary diagnosis. Design: Retrospective cohort study. Setting: Nationwide discharge database of acute care hospitals in Japan. Participants: Individuals aged 65 and older diagnosed with one of the 30 most common diagnoses and discharged from 987 hospitals between April 2014 and September 2015 (N = 1,834,378). Measurements: The primary outcome was unplanned hospital readmission within 30 days. Poisson generalized estimating equation models were fitted to assess the risks of readmission for individuals with and without dementia, using primary diagnosis as a possible effect modifier and clinical factors as potential confounders. Results: The overall prevalence of dementia was 14.7% and varied according to primary diagnosis, ranging from 3.0% in individuals with prostate cancer to 69.4% in those with aspiration pneumonia. Overall, individuals with dementia had a higher risk of hospital readmission (8.3%) than those without (4.1%) (adjusted risk ratio (aRR])=1.46, 95% confidence interval (CI)=1.44–1.49), although diagnostic category substantially modified the relationship between dementia and hospital readmission. For hip fracture, dementia was associated with greater risk of hospital readmission (adjusted risk 11.5% vs 7.9%; aRR=1.46; 95% CI=1.28–1.68); this risk was attenuated for cholecystitis (adjusted risk 12.8% vs 12.4%; aRR=1.03; 95% CI=0.90–1.18). Conclusion: Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission. [ABSTRACT FROM AUTHOR]