Who Is Responsible? A Man With Dementia Wanders From Home,Is Hit by a Train,and Dies

The impact of dementia and Alzheimer's disease extends far beyond the healthcare needs of the person with dementia. As the disease progresses, individuals with dementia often require ongoing formal or informal care for their basic daily routine because of behavior changes and continuing loss of cognitive function. Most of the care for people with dementia takes place at home, and the unpaid, informal caregivers are often spouses or other relatives. Providing long-term informal care at home for someone with dementia is psychologically, physically, and financially draining. The tragedy described in this case elucidates the far-reaching societal impact of dementia care and the implicit health policy considerations.In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when he wandered from home, was hit by a train, and died, immediately affecting the Central Japan Railway Company operations and, subsequently, legal practice as well as Japanese elder care policy. The railway sued the man's wife and son for negligence and lost revenue, winning both trials at the local and district courts. This ruling shocked families and caregivers in Japan, where care for elderly parents traditionally falls on the oldest son, and brought attention to the complex issues related to dementia care. A decade later, we revisit this case to provoke a renewed dialogue about the matrix of responsibilities and liabilities associated with caregiving; to illuminate the unmet needs of the person with dementia, as well as his or her informal caregivers; and the financial implications related to long-term care policy. We close with 2 practical suggestions which preserve the dignity of the individual and provide reassurance for caregivers.     

Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting

The prevalence of childhood obesity is increasing worldwide with long‐term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty‐eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e‐health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z‐score and body fat percentage, 12 of which included both parental/family‐based interventions in conjunction with modifying the child''s diet and physical activity behaviours. Home‐based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child''s weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.     

2015年重庆市住院儿童疾病谱分析

目的 探讨儿童住院疾病谱特点.方法 对2015年重庆市二级及以上医院0～14岁儿童住院病案首页数据中的主要诊断、性别、年龄等项目进行疾病谱顺位及构成比分析,深入挖掘疾病谱变化趋势与年龄、性别的关系.结果 影响儿童健康的前5位系统疾病分别是呼吸系统疾病(男43.84％,女45.74％)、起源于围生期的某些情况(男12.01％,女13.87％)、传染病和寄生虫病(男9.48％,女9.88％)、消化系统疾病(男9.09％,女6.95％)、损伤中毒和外因的某些其他后果(男6.86％,女5.27％),呼吸系统疾病始终排在第1位,各系统疾病性别差异不明显,随着年龄的增长,损伤、中毒和外因的某些其他后果构成及顺位上升;呼吸系统疾病排名中,肺炎(38.73％)、急性支气管炎(17.29％)、急性扁桃体炎(13.83％)是影响儿童健康的前3位类目疾病.结论 呼吸系统疾病是儿童健康促进关注的重点,卫生防疫部门应针对儿童提供预防呼吸系统疾病的有效方法和措施,并对于儿童不同年龄组疾病顺位的差异,提出有针对性的防治措施.     

家庭支持与鼻咽癌放疗患者生活质量的相关性研究

目的探讨家庭支持对鼻咽癌放疗患者生活质量的影响因素。方法采用问卷调查的方法,对150例行放疗的鼻咽癌患者家庭支持和生活质量情况进行评估,并分析两者之间的关系。结果鼻咽癌患者家庭支持度高低对其生活自理度、情绪稳定度、社会参与度存在不同程度的影响(P<0.05),而对其躯体舒适度的影响尚不能证明(P>0.05)。结论家庭支持高低直接影响鼻咽癌放疗患者生活质量,护理人员应积极构建家庭支持干预方案,以提高患者生活质量。     

Introduction to Section IV

Abstract

The concept of Mental Homelessness is presented and developed. This paper will provide a historical review of the connection between mental illness and housing and the changing approaches toward institutionalization and de-institutionalization over several centuries. Case illustrations from practice in Israel will be presented to highlight the theme of home, or rather the theme of lacking a home as an element which may be inherent to a mental illness.

More specifically, the paper argues that homelessness is a state of mind of which the actual, physical homelessness may be a manifested reflection of. If so, even if a mental patient does initially own a home, he or she is at high risk to lose it somehow.     

A Multivariate Analysis of the Predictors of Long-Term Care Placement

In this paper the authors investigate the predictors of long-term care placement. Regression analysis is used to estimate a multivariate placement model. Variables found to be significantly related to placement are sex, marital status, help from relatives, client and family preferences, index of ADL, number of medical conditions, ability to take medications, ability to make decisions, and income. The estimated function explained 68 percent of the variance. Discriminant analysis and logistic regressions were used to evaluate the performance of the estimated placement function. The authors stress the importance of learning more about the placement process before making causal inferences about the cost-effectiveness of alternative long term care settings.     

Health Services Utilization and Costs of Care in Terminal Cancer:

This study examines utilization of health services and costs of care for cancer patients during the last 6 months of life broken down into 3 time periods, and the relationship with costs of patient characteristics and home-carelhome-hospice use. The data werc derived from a retrospective study of a random samplc of 133 adult cancer deaths in Monroe County. Data sources included revicw of medical records, including hospital billing records, and interviews with physicians and surviving relatives. Sixty-five patients (49%) used home care services; their total costs of care were somewhat higher than those of non-users even after controlling for age, marital status and length of the terminal care period. The implications of the upcoming hospice legislation arc discussed in the light of these results.     

Differences in the Scalability of Formal and Informal In-Home Care of Urban Elderly

Differences in the scalability of formal and informal in-home care to elderly are examined. A Guttman scale showed that exclusive use of informal in-home care was hierarchically scalable, but not when services were provided by any formal sources. There was some clustering of formal services, for example, a large number of those who received meals also used homemaker services. However, a large number of those who received nursing did not receive personal care. There was no overall pattern to the use of formal services. Implications of these findings as related to service planning and delivery are discussed.     

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

SUMMARY

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g., Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.