Bowel incontinence is related to improvement in basic activities of daily living in residents of long-term health care facilities for the elderly in Japan

Background:   The purpose of the present study is to clarify the target criteria for care in long-term health care facilities for the elderly in Japan and to investigate the relationship between changes in basic activities of daily living (BADL) over 1 year and the comprehensive geriatric assessment (CGA) scale.
Methods:   An observational study was conducted in a facility in Nagoya, Japan. The participants consisted of 54 residents. The following four scales of comprehensive geriatric assessment were administered to the residents in both 2000 and 2001: Barthel index (BI), Lawton scale, mini-mental state examination and geriatric depression scale 15.
Results:   The Barthel index was significantly improved in 2001 compared with 2000 ( P = 0.007). The Lawton scale was significantly lower in 2001 ( P = 0.029). Neither the mini-mental state examination nor geriatric depression scale 15 scores changed significantly. To determine the factors that influenced the change in BADL, logistic regression analyses were performed using the above four scales as independent variables and the BI change as a dependent variable. In multivariate analysis, a BI score of less than 75 approached significance for improvement in BADL ( P  = 0.094, odds ratio = 2.79). Other logistic regression analyses were also performed using each ADL task in BI as an independent variable and the change in BI as a dependent variable. In multivariate analysis, bowel incontinence was a significant independent variable ( P  = 0.006, odds ratio = 10.9).
Conclusion:   As bridging facilities between acute-care hospitals and home, long-term health care facilities are a reasonable choice for the elderly with bowel incontinence.     

Factors that influence home return from health care facilities for the elderly--related to the attitude of family caregivers

AIM: The number of users of long-term care insurance has been increasing rapidly since it started in 2000. The number of those who want to enter the long-term care insurance facilities has increased. Although the basic philosophy of long-term care insurance is independence support and self-decision, to enter a facility or home return from facilities is likely to be decided by family caregivers, not by the elderly themselves. Moreover, the number of elderly who return home from welfare facilities is decreasing. We investigated the intension of caregivers who are willing to accept the institutionalized elderly at home and analyzed the factors affecting the acceptance of caregivers. METHODS: Subjects were elderly who were in long-term care insurance facility in June 2004, and their caregivers. The study was conducted between June 2004 and September 2004 in Ibaraki Prefecture in Japan. A face-to-face interview based on a questionnaire was conducted for the institutionalized elderly and by the mail for the caregivers. RESULTS: The caregivers of 34.6% of the elderly who hoped to return home intended to accept them home. There were differences between the plans of the elderly and caregivers. The risk factors (OR, 95% CI) to make the intention of the caregivers to accept the institutionalized elderly home difficult were level of cooperation with other family members to take care of elderly (OR 15.37, 2.05-115.24), dementia behavior disturbance category with more than one (OR 8.34, 1.02-68.05), time spending in bed of a day (OR 1.31, 1.01-1.71), few knowledge of long-term care insurance system of caregivers (OR 3.65,0.81-16.38). CONCLUSION: It has been suggested that more physical activities in the facility, establishment of a care-system for the demented elderly living in the community and an educational campaign by the long-term care insurance system are necessary to increase the willingness of caregivers to accept home return of institutionalized elderly.     

Non-medical palliative care and education to improve end-of-life care at geriatric health services facilities: A nationwide questionnaire survey of chief nurses

Background:   Geriatric health services facilities (GHSF) are expected to assume a growing role in caring for the dying elderly. However, research in this area has so far been scant. The purpose of the present study is to reveal the status of non-medical palliative care and staff education aiming at improving and enhancing end-of-life care at GHSF.
Methods:   The subjects were 2876 chief nurses of GHSF. Data was collected through a mailed questionnaire in 2003. The questionnaire covered the following: (i) staff perception of end-of-life care policies; (ii) staff education; and (iii) available non-medical care. To evaluate the factors correlated with end-of-life care policies at GHSF, we divided the facilities into two groups.
Results:   We analyzed the answers collected from 313 facilities with a progressive policy toward end-of-life care (PP group) and 818 with a regressive policy toward it (RP group). It was found that staff training was conducted more frequently among PP facilities. Generally, nurses in the PP facilities were more confident that they could provide comprehensive on-site end-of-life care and grieving support, but did not feel so sure about their ability to provide better end-of-life environments for dying residents and family by organizing outside support from voluntary and/or governmental organizations and religious organization for healing and to pursue appropriately a written follow-up communication with the bereaved family.
Conclusions:   Our results suggest that providing GHSF staff with education about end-of-life issues or setting up collaboration with the outside is an important factor to enhance overall end-of-life care at these facilities.     

Transfer of elderly patients from health care facilities to emergency departments: Prospective observational study of the emergency department in Japan

Background:   The purpose of the present paper is to describe the current status of emergency departments (ED) that are used by health care facilities for elderly (HCFFE) residents in Japan.
Methods:   The present paper is based on a prospective, observational study that was undertaken at a teaching hospital in Nagoya city over a 12-month period. All patients transferred to the hospital ED from a regional HCFFE were analyzed. Demographic data, timing of the visit, the primary reason for transfer, diagnosis and disposition were recorded. The need for ambulance use was graded prospectively using three categories of urgency.
Results:   A total of 102 HCFFE residents made 116 ED visits. Their mean age was 83.3 years (range 58–101), 68% were female. The majority of patients (93%) were transferred by ambulance. Ambulance transfer was classified as emergency (20% of patients), urgent (51%) and routine (29%). The main reasons for patients to be transferred were fever (15.5%), fall (11.2%), altered mental status (10.3%), focal neurological deficits (10.3%), and weakness (9.5%). A total of 88% of the ED visits led to admission to the hospital. After admissions, the mean length of stay was 21.4 days and the mortality rate was 13%.
Conclusion:   Elderly patients staying in HCFFE are frequently transferred to an ED, and their visits are likely to lead to admission to the hospital, which is associated with prolonged lengths of stay as well as high mortality rates.     

Usefulness of the Mini-Nutritional Assessment (MNA) to evaluate the nutritional status of Japanese frail elderly under home care

Background:   The Mini-Nutritional Assessment (MNA) has proved useful in Western countries to predict long-term mortality of institutionalized elderly patients, as well as the elderly living at home. However, there are few reports on the usefulness of this evaluation in the elderly in Japan. Our objective was to examine the usefulness of the MNA to screen and diagnose malnutrition in the elderly in Japan and investigate the effect of nutritional status on their activities of daily living (ADL) and mortality.
Methods:   We recruited 181 frail elderly (62 men and 119 women) under home care whose age was 79.8 ± 8.8 years old. We assessed their nutritional status (anthropometric measurements, serum albumin, MNA) and ADL; then we followed up these patients for more than 2 years to see whether the MNA reflected their prognosis.
Results:   The MNA score correlated with anthropometric measurements, serum albumin and ADL ( P  < 0.01). The hazard ratio of mortality by all causes was significantly higher in the elderly with protein energy malnutrition (PEM) and risk for PEM, compared with well-nourished elderly patients.
Conclusion:   The MNA was useful to screen the elderly for nutritional status because it reflected the ADL and the prognosis, as well as conventional nutritional indexes such as anthropometric values and serum albumin.     

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire

Objective  To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services.
Methods  Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002–2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations ( n  = 606 before; n  = 591 after) and deliveries ( n  = 229 before; n  = 231 after) and exit interviews of women; and interviews of health facility staff.
Results  HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% ( P  < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme.
Conclusions  Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.     

Predicting 3-year mortality and admission to acute-care hospitals,skilled nursing facilities,and long-term care facilities in Medicare beneficiaries

PurposeThe ability to predict mortality and admission to acute care hospitals, skilled nursing facilities (SNFs), and long-term care (LTC) facilities in the elderly and how it varies by activity of daily living (ADL) and instrumental ADL (IADL) status could be useful in measuring the success or failure of economic, social, or health policies aimed at disability prevention and management. We sought to derive and assess the predictive performance of rules to predict 3-year mortality and admission to acute care hospitals, SNFs, and LTC facilities among Medicare beneficiaries with differing ADL and IADL functioning levels.MethodsProspective cohort using Medicare Current Beneficiary Survey data from the 2001 to 2007 entry panels. In all, 23,407 community-dwelling Medicare beneficiaries were included. Multivariable logistic models created predicted probabilities for all-cause mortality and admission to acute care hospitals, SNFs, and LTC facilities, adjusting for sociodemographics, health conditions, impairments, behavior, and function.ResultsSixteen, 22, 14, and 14 predictors remained in the final parsimonious model predicting 3-year all-cause mortality, inpatient admission, SNF admission, and LTC facility admission, respectively. The C-statistic for predicting 3-year all-cause mortality, inpatient admission, SNF admission, and LTC facility admission was 0.779, 0.672, 0.753, and 0.826 in the ADL activity limitation stage development cohorts, respectively, and 0.788, 0.669, 0.748, and 0.799 in the ADL activity limitation stage validation cohorts, respectively.ConclusionsParsimonious models can identify elderly Medicare beneficiaries at risk of poor outcomes and can aid policymakers, clinicians, and family members in improving care for older adults and supporting successful aging in the community.     

Comparison of public and private care management agencies under public long-term care insurance in Japan: A cross-sectional study

Aim:   Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies.
Methods:   The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55 000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined.
Results:   Public care management agencies favored younger subjects ( P  = 0.003), male subjects ( P  = 0.006) and people with a higher need for care ( P  = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies ( P  = 0.02).
Conclusion:   Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.     

Emergency department use by nonagenarian patients

Background:   In accord with the rapid growth of the nonagenarian population, their emergency departments (ED) visits are increasing. The aim of our study was to examine ED use by nonagenarian patients and their dispositions.
Method:   We analyzed 275 consecutive ED visits of nonagenarian patients in Japan during 1 year. Demographic data, chief complaint, diagnosis, categories of urgency, and disposition following the ED visit were recorded. A 1-year follow up was conducted on all discharged nonagenarian patients.
Results:   A total of 199 patients made 275 visits. Of these patients, 56.4% were transferred by ambulance, 15.6% were classified as emergency, and 65.1% led to hospitalization. Fever, fall, altered mental status, anorexia, focal neurological deficits and general fatigue accounted for 72% of the reasons for ED visits, and 43% of their ED visits resulted in a diagnosis of pneumonia, stroke, head trauma or hip fracture. In hospitalized patients, the mean length of stay was 23.4 days. Most of the patients had geriatric problems such as disability (78%), comorbidity (86%) and polypharmacy (82%). The in-hospital mortality of the 179 hospitalized patients was 19.6% (35/179). Eighty-six percent of alive patients were discharged to long-term care facilities (124/144). The total 1-year mortality of the 199 patients who visited the ED accounted for 49.2% (98/199).
Conclusion:   Nonagenarians' ED visits were associated with prolonged admissions, postdischarge institutionalizations, and high risk of in-hospital and postdischarge death. Their ED visits seemed to be a major transition in their own life.     

Gerontology in the developing Brazil: Achievements and challenges in public policies

Aim:   In the last three decades, the segment of population aged 60 years and older has more than doubled in Brazil. People aged 80 years and older are expected to be the fastest-growing segment in the near future. This aim of this study was to analyze the legal structures currently in place in Brazil and to provide a framework for care policies and practices towards older-adults.
Methods:   This article focuses on past and present major socioeconomic burdens on this segment of the Brazilian population as well as on public achievements to overcome inequities.
Results:   Both the public health and the social security systems have been directed to provide preferential assistance to the aged. Nonetheless, the elderly remain the most impoverished segment of Brazil and carry the burden of an overall lack of specialized services. Moreover, socioeconomic inequalities and population diversity in Brazil affects elderly care, adding complexity to this unique scenario.
Conclusion:   Brazil has adopted legal hallmarks that substantially shifted public practices towards the elderly segment from a philanthropic status to a legitimate right for care and assistance. The demographic transition that took place provides an opportunity for innovative solutions in public policies for older adults in a developing economic environment.     

Oral condition and health status of people aged 80–85 years

Objectives:   To clarify the relationship between oral condition and health status, particularly bone mineral density (BMD), in the elderly aged 80 years or more.
Methods:   We examined the oral conditions and health status of two groups. One was elderly who lived at home and had at least 20 teeth at the age of 80 (8020 elderly). The other group consisted of elderly people residing in long-term care facilities (institutionalized elderly). The oral conditions we examined were the number of teeth, masticatory ability, occlusal force, stimulated salivary flow rate, saliva buffer ability, community periodontal index (CPI) and salivary occult blood test. The health status indicators we examined were BMD, grip strength, height, weight and body mass index (BMI).
Results:   The number of teeth, stimulated salivary flow rate, masticatory ability, and occlusal force in the 8020 elderly were significantly higher than in the institutionalized elderly. BMD, grip strength, height, weight and BMI in these 8020 elderly were also significantly higher than in the institutionalized elderly. Masticatory ability and occlusal force in the institutionalized elderly with high BMD (high BMD group) were significantly higher than in the institutionalized elderly with low BMD (low BMD group). Grip strength, height and weight in the high BMD group were higher than in the low BMD group.
Conclusions:   The 8020 elderly had good oral condition and health status compared to the institutionalized elderly. There may be a relationship between number of teeth and BMD in elderly aged 80–84.     

Families' acceptance of near death: A qualitative study of the process for introducing end-of-life care

Aim:   Providing effective end-of-life (EOL) care for the elderly with severe brain damage is difficult because patients' families find it hard to accept the condition of their loved ones as "near death". In Japan, this has become an urgent social problem. Although health-care teams sometimes expect that the elderly with severe brain damage should be treated as terminal, many find that patients' families cannot accept the condition as near death. As a result, they are not able to appropriately introduce any EOL services. It was the aim of the present study to develop a comprehensive understanding of the process by which families accept the elderly with severe brain damage as near death.
Methods:   Qualitative methodology with focus groups and semi-structured interviews were used. Twenty-three participants in two sets of male and female focus groups were interviewed in a semi-structured format. Ten participants (five men and five women) who made important medical decisions were then interviewed separately.
Results:   Eleven categories emerged: (i) family affection with wishes for continued survival; (ii) vacillation of desire for death with dignity; (iii) family members' hierarchy; (iv) awareness that others may make different decisions; (v) family members' discussion overcoming discordance; (vi) satisfaction with physicians' explanations; (vii) impressions of life-sustaining measures; (viii) entrusting important decisions to hospital physicians; (ix) significance of family members' previous experiences; (x) patient's age; and (xi) duration of medical treatment.
Conclusion:   We developed a conceptual model that is useful for evaluating which stage of the process families are currently experiencing as well as introducing EOL care in a timely manner.     

The impact of primary health care on malaria morbidity – defining access by disease burden

Objectives  Primary care facilities are increasingly becoming the focal point for distribution of malaria intervention strategies, but physical access to these facilities may limit the extent to which communities can be reached. To investigate the impact of travel time to primary care on the incidence of hospitalized malaria episodes in a rural district in Kenya.
Methods  The incidence of hospitalized malaria in a population under continuous demographic surveillance was recorded over 3 years. The time to travel to the nearest primary health care facility was calculated for every child between birth and 5 years of age and trends in incidence of hospitalized malaria as a function of travel time were evaluated.
Results  The incidence of hospitalized malaria more than doubled as travel time to the nearest primary care facility increased from 10 min to 2 h. Good access to primary health facilities may reduce the burden of disease by as much as 66%.
Conclusions  Our results highlight both the potential of the primary health care system in reaching those most at risk and reducing the disease burden. Insufficient access is an important risk factor, one that may be inequitably distributed to the poorest households.     

Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: IV. Savannakhet in Laos

Background:   The objective of the present study is to compare the findings of comprehensive geriatric assessments (CGA) of community-dwelling elderly people living in Lao People's Democratic Republic (Laos) with those in Japan.
Methods:   A cross-sectional, interview- and examination-based study was undertaken. The subjects consisted of community-dwelling elderly people in Songkhon, a rural district in Laos and in Sonobe, a rural town in Kyoto, Japan. Two hundred and ninety-four people aged 60 years and over in Laos and 411 aged 65 years and over in Japan were examined using a common CGA tool. Interviews pertaining to activities of daily living (ADL), medical and social history, quality of life (QOL) and Geriatric Depression Scale as well as anthropometric, and blood chemical examinations were included in the assessment.
Results:   All scores for basic and instrumental ADL, intellectual activity and social roles, body mass index, prevalence of hypertension, mean total and HDL cholesterol levels were lower in Laos than in Japan, while prevalence of depression, impaired glucose tolerance and anemia were higher in Laos than in Japan.
Conclusion:   Differences in lifestyle and medical status were found between economically developing Laos and highly developed Japan. Almost all comprehensive geriatric functions such as ADL, QOL, mood and nutritional condition in blood chemistry were lower in the elderly in Songkhon than in Kyoto. Of particular note were the higher prevalence of diabetes mellitus and anemia and lower prevalence of hypertension in the elderly population in Songkhon district, which should be examined in future studies.     

The rural elderly support in China and Thailand

Aims:   This paper aims to investigate support mechanisms for the elderly in rural China and rural Thailand, and to take lessons from each other on its rural elderly support and the policy interventions.
Methods:   Using data from secondary sources, the situation of the rural elderly was investigated from different aspects. Policies and programs designed for the rural elderly were then summarized in the following section.
Results:   China and Thailand are both under tremendous social changes and economic development processes, with Thailand more economically developed. Family remains the main source of support for the rural elderly in both countries, however, it has been suffering increasing difficulties and problems such as industrialization, modernization, and rural-to-urban migration have been taking place. This calls for attention and the development of social security services to support the elderly in rural areas.
Both countries have set up a number of policies, plans, and programs toward supporting the elderly, the coverage, however, is relatively low.
Conclusions:   Governments should introduce policies for integrating the rural elderly into national development strategies. Family should be empowered to become strong sociocultural units, as well as an economic resource and a focal point for the preservation of social and moral values in providing support for the elderly. Health care should be given freely to the rural elderly. Programs providing support to the rural elderly should be gender-specific with more focus on female elderly.     

Are Elderly Hospitalized Patients Getting Enough Protein?

OBJECTIVES: To determine the protein requirements of elderly hospitalized patients.
DESIGN: Cross-sectional evaluation of nitrogen balance.
SETTING: Short-stay geriatric ward or rehabilitation care unit.
PARTICIPANTS: Thirty-six elderly hospitalized patients (aged 65–99) admitted to short-stay and rehabilitation care units.
MEASUREMENTS: Resting energy expenditure and nitrogen balance were determined under usual and spontaneous energy and protein intake after subjects were clinically stable (3–5 days after admission). All items consumed over a 3-day period were weighed to determine energy and protein intake.
RESULTS: Energy (23.5±6.3 kcal/kg per day) and protein (0.99±0.24 g/kg per day) intake were similar in men and women, and nitrogen balance was neutral (0.37±2.6 g/day; P =.41 vs a neutral nitrogen balance, i.e., 0 g/d). Half of the patients had a positive nitrogen balance. Plasma C-reactive protein, renal function, nutritional status, and initial diagnosis had no influence on nitrogen balance. In contrast, energy and protein intakes correlated positively with nitrogen balance. Linear regression analysis suggested that an elderly hospitalized patient with an energy intake of 1.31 times resting energy expenditure or greater appears to require a minimum protein intake of 1.06±0.28 g/kg per day.
CONCLUSION: Mean protein intake to reach a neutral nitrogen balance in elderly hospitalized patients is 1.06±0.28 g/kg per day, which is higher than current recommendations for healthy elderly people. Safe protein intake (that would be adequate to ensure that 95% of patients remain in positive nitrogen balance) is difficult to establish.     

Road traffic accidents and the elderly

Aim:   To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly.
Methods:   Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination.
Results:   The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims.
Conclusion:   The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented.     

Influence of diabetes mellitus on caregiver burden in home care: A report based on the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE)

Background:   Because little attention has so far been paid to the impact of diabetes mellitus (DM) on caregiver burden in community settings, we sought to confirm the influence of DM on perceived caregiver burden among caregivers providing care to a home elderly person using data from the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE).
Methods:   The NLS-FE is a large prospective study of 1875 community-dwelling elderly. A total of 1592 pairs of dependents and caregivers were included in the analysis. The data we used in this study included the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), characteristics of caregivers and dependents, and caregiving situation. The pairs were sorted into one control and three DM groups: (i) no DM; (ii) DM taking no medications; (iii) DM taking oral medication only; and (iv) DM taking insulin. The differences in dependent and caregiver characteristics among the groups were assessed.
Results:   Two hundred and twenty-eight dependents from the NLS-FE study had DM. Of these, 25% took no medication to treat it, 55% took oral medications only, and 20% used insulin. No statistical differences were found in age, gender or kinship among caregivers. No differences were found among the DM categories in levels of caregiver burden according to the J-ZBI, before and after adjusting for these baseline variables.
Conclusions:   Among the community-dwelling frail elderly, DM is not an independent predictor of caregiver burden.     

Policies to increase influenza and pneumococcal immunizations in chronically ill and institutionalized settings

BACKGROUND: The objective of this study was to understand better the status of and ways to improve dissemination of influenza and pneumococcal standing-order vaccination policies to at-risk adults in health care institutions. METHODS: A statewide sample of 5 different types of institutions serving at-risk elderly persons in North Carolina was surveyed. A 45-question telephone survey was administered to infection control nurses or facility directors at 267 (86% response rate) health care facilities involved in direct patient care. RESULTS: A majority of respondents reported that influenza (81%) and pneumococcal (59%) diseases were important to their facility, and 63% stated that the influenza vaccine was very effective versus 47% for pneumococcal. Except nursing homes, few facilities reported adoption of standing-order policies to vaccinate routinely the at-risk adults. Over 70% of respondents stated that their facilities might consider adopting standing-order policies for influenza and pneumococcal disease. A majority of respondents also supported a state law that requires such vaccines for high-risk patients unless contraindicated or the patient refuses. CONCLUSIONS: Respondents across diverse health care institutions appear interested in adopting standing-order policies to increase influenza and pneumococcal vaccination rates and are more likely to do so if provided with appropriate administrative and/or financial support for implementation.     

What determines the life satisfaction of the elderly? Comparative study of residential care home and community in Japan

Background:   Increasing lifespan has forced elderly persons and researchers alike to look at life and aging in a new way: at adding life to years rather than years to life. With increasing lifestyle choices for the elderly, the present study was undertaken to determine and compare the factors associated with life satisfaction in elderly living in a residential care home and in the community in Japan.
Methods:   This was a cross-sectional, self-reported, questionnaire-based study. Elderly persons from the residential care home in Kyoto City ( n  = 261, mean age ± SD = 79.6 ± 6.6 years, male : female = 1 : 3.1) and from the town of Urausu, Hokkaido ( n  = 733, mean age ± SD = 74.8 ± 6.8 years, male : female = 1 : 1.3), participated in the study. This represented 95.3% and 89.5% of all eligible elderly ≥ 65 years in the home and town, respectively. Activities of daily living, higher functions, medical and social history, geriatric depression scale and quality of life were studied. Using multiple logistic regression models, factors associated with high satisfaction of life were identified.
Results:   In community-dwelling elderly, relationship with friends, as opposed to relationship with family for elderly in residential care home, were factors related to life satisfaction.
Conclusions:   This study demonstrates the relative importance of social factors versus medical and functional factors as determinants of life of elderly. We have also shown how these factors differ for elderly living in different environments. Understanding these different as well as common determinants of life satisfaction from a whole array of diverse ones allows us to make effective strategy to improve the quality of life of elderly living in different conditions.