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Tsuji T, Yamasaki K, Kondo K, Hongu N, Matsumoto Y, Fukuo K, Habu D. Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study. J Hum Nutr Diet 2024; 37:574-582. [PMID: 38229274 DOI: 10.1111/jhn.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS At-risk of malnutrition was associated with discontinuation of home medical care among older patients.
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Affiliation(s)
- Taeko Tsuji
- Department of Health and Nutrition, Faculty of Human Science, Osaka Aoyama University, Minoh, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Nishinomiya, Japan
| | - Kyoko Kondo
- Research Support Platform, Osaka Metropolitan University Graduate School of Medicine, Osaka-shi, Japan
| | - Nobuko Hongu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Daiki Habu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
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Miura H, Goto Y. Comparison of the Life-Sustaining Treatment, Cardiopulmonary Resuscitation, and Palliative Care Implementation Rates between Homebound Patients with Malignant and Nonmalignant Disease Who Died in an Acute Hospital Setting: A Single-Center Retrospective Study. Healthcare (Basel) 2024; 12:136. [PMID: 38255025 PMCID: PMC10815562 DOI: 10.3390/healthcare12020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study investigated and compared the implementation of life-support treatment (LST), cardiopulmonary resuscitation (CPR) implementation rates, and the influence of acute illnesses on the introduction of palliative care (PC) to homebound patients with malignant and nonmalignant disease, who subsequently died in an acute hospital setting. METHODS Among the homebound patients admitted to the ward in our hospital from 2011 to 2018, we investigated and compared the attributes, underlying diseases, causes of death, and rates of implementation of LST, CPR, and PC between patients with malignant and nonmalignant disease who died in the ward, using data obtained from hospitalization records. Furthermore, acute illnesses related to the introduction of PC were examined. RESULTS Of the 551 homebound patients admitted to the ward of an acute hospital, 119 died in the ward. Of the deceased patients, 60 had malignant disease and 59 had nonmalignant disease. Patients with nonmalignant disease had higher rates of LST implementation and CPR and a lower rate of PC. Patients with infectious disease, who required antimicrobial drugs, had significantly lower PC introduction rates. CONCLUSION Understanding the influence of the timing of PC introduction in acute care for homebound patients with advanced chronic illness are issues to be considered.
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Affiliation(s)
- Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu 474-8511, Aichi, Japan;
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Sya’diyah H, Efendi F, Mahmudah, Saidah QI, Poddar S. Impact of caregiver demands on growing family capabilities provide home care for dementia-affected seniors. J Public Health Res 2023; 12:22799036231197172. [PMID: 37667680 PMCID: PMC10475253 DOI: 10.1177/22799036231197172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Background The elderly with dementia occur cognitive decline and they are considered normal by the family, and then causing the need for care from elderly. This is not following the ability of home care by the family as an informal caregiver for the elderly with dementia. The purpose of this study was to analyze the effect of caregiver demands on the ability of families to do home care for elderly dementia. Design and methods An analytical observational study with a cross-sectional design. The sample size is 100 respondents with a cluster random sampling technique. Data were collected by questionnaire and analyzed using SEM-PLS. Results Caregiver demands have a direct effect on increasing the family's ability to do home care for elderly dementia with a p-value = 0.011 (p ≤ 0.05), t statistic value of 2.557 (≥1.96). Caregiver demands have four indicators, including care receiver impairment, caregiving activities, competency of caregivers, and caregiver/family relationship with elderly dementia. The condition of the elderly who experience various changes supports the increasing need for care to receive care and recovery as well as special attention from the family. Conclusion The higher the need for care, the higher the family's ability to do home care. This research implies that the family has a duty in the health sector to provide care for the elderly at home/home care, which strengthens the need for care, this supports caregiver empowerment and increases the independence of the elderly with dementia.
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Affiliation(s)
- Hidayatus Sya’diyah
- Faculty of Public Health, Universitas Airlangga, Kota SBY, Jawa Timur, Indonesia
- Sekolah Tinggi Ilmu Kesehatan Hang Tuah Surabaya, Kota SBY, Jawa Timur, Indonesia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Kota SBY, Jawa Timur, Indonesia
| | - Mahmudah
- Faculty of Public Health, Universitas Airlangga, Kota SBY, Jawa Timur, Indonesia
| | - Qori’ Ila Saidah
- Sekolah Tinggi Ilmu Kesehatan Hang Tuah Surabaya, Kota SBY, Jawa Timur, Indonesia
| | - Sandeep Poddar
- Lincoln University College, Wisma Lincoln, Petaling Jaya, Selangor, Malaysia
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Zimbroff RM, Ornstein KA, Sheehan OC. Home-based primary care: A systematic review of the literature, 2010-2020. J Am Geriatr Soc 2021; 69:2963-2972. [PMID: 34247383 DOI: 10.1111/jgs.17365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.
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Affiliation(s)
- Robert M Zimbroff
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Associations of blood pressure levels with clinical events in older patients receiving home medical care. Hypertens Res 2020; 44:197-205. [DOI: 10.1038/s41440-020-00538-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022]
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Huang CH, Umegaki H, Kamitani H, Asai A, Kanda S, Maeda K, Nomura H, Kuzuya M. Change in quality of life and potentially associated factors in patients receiving home-based primary care: a prospective cohort study. BMC Geriatr 2019; 19:21. [PMID: 30678632 PMCID: PMC6345012 DOI: 10.1186/s12877-019-1040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care. Methods Our prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients’ demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses. Results The participants’ mean age was 78.8 ± 10.8 years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (β = 1.74) had high baseline QOL scores (β = 0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a β-value of − 1.24 in the pre-bedridden group and − 1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (β = 0.50) and Mini-Nutritional Assessment–Short-Form scores (β = 0.37) were found to have positive associations with the QOL rating. Conclusions For the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.,Department of Family Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China.,School of Medicine for International Students, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, Republic of China
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hiroko Kamitani
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Atushi Asai
- Sanei Clinic, 3-560 Komaki, Komaki, Aichi, 485-0041, Japan
| | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, 1-5 Tenpaku, Minami, Nagoya, Aichi, 457-0803, Japan
| | - Keiko Maeda
- Mokuren Clinic, Department of Home Medical Care, 2-21-25 Izumi, Higashi-ku, Nagoya, Aichi, 461-001, Japan
| | - Hideki Nomura
- Aichi Clinic, 2-330 Fukuike, Tenpaku, Nagoya, Aichi, 468-0049, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Komiya H, Umegaki H, Asai A, Kanda S, Maeda K, Nomura H, Kuzuya M. Prevalence and risk factors of constipation and pollakisuria among older home-care patients. Geriatr Gerontol Int 2019; 19:277-281. [PMID: 30628140 DOI: 10.1111/ggi.13610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 01/28/2023]
Abstract
AIM The prevalence of constipation and prevalence of pollakisuria among older patients receiving home medical care have not been reported, and risk factors for these symptoms are not clear in this setting. The present study sought to determine the prevalence and risk factors of constipation and pollakisuria among older patients receiving home medical care in Japan. METHODS This study utilized data from patients in the Observational Study of Nagoya Elderly with Home Medical Care (n = 153). We carried out univariate and multivariate logistic regression analyses with the presence of constipation or pollakisuria as the dependent variable to evaluate the relationships between constipation or pollakisuria and several covariates. RESULTS The prevalence of constipation and pollakisuria were 56.9% and 15.7%, respectively. Multivariate logistic analysis showed that constipation was associated with Charlson Comorbidity Index score, polypharmacy and pollakisuria, and pollakisuria was associated with constipation and insomnia. Cardiovascular disease was inversely associated with constipation. CONCLUSIONS The prevalence of constipation among home-care patients was as high as that reported for nursing home residents and higher than that among community-dwelling individuals. Clinicians should be aware of increased constipation risk among home-care patients, particularly for those with a high Carlson Comorbidity Index score, polypharmacy and/or pollakisuria. Geriatr Gerontol Int 2019; 19: 277-281.
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Affiliation(s)
- Hitoshi Komiya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, Nagoya, Japan
| | - Keiko Maeda
- Mokuren Clinic, Department of Home Medical Care, Nagoya, Japan
| | | | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ryman FVM, Erisman JC, Darvey LM, Osborne J, Swartsenburg E, Syurina EV. Health Effects of the Relocation of Patients With Dementia: A Scoping Review to Inform Medical and Policy Decision-Making. THE GERONTOLOGIST 2018; 59:e674-e682. [DOI: 10.1093/geront/gny031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractBackground and ObjectivesResearch into the relocation (including international relocation) of people with dementia is increasingly important due to the aging population and latest developments in the international politics (including globalization and concerns over international migration). There is need for an overview of the health effects of relocation to facilitate and inform decision- and policy-making regarding these relocations. The aim of this literature review was to provide insight into the physical, psychological, and social consequences of varied types of relocations of older adults suffering from dementia.Research Design and MethodsA scoping literature review with a systematic search was performed in PubMed, Web of Science, PsychInfo, JSTOR, and ScienceDirect. The articles dealing with subject of relocation of older adults from 1994 to 2017 were included and analyzed. Methodological quality assessment was performed for all articles.ResultsFinal list included 13 articles. The effects of relocation were discussed in terms of mortality and morbidity. In most studies, the health effects of the relocation of older adults suffering from dementia were negative. A decline in physical, mental, behavioral, and functional well-being was reported. The most recurring effect was a higher level of stress, which is more problematic for patients with dementia. In general, unless it is carefully planned, it is best to avoid changing lives of people with dementia and it is recommended to actively work to reduce their exposure to stress.Discussion and ImplicationsThe outcomes of the study suggest definite evidence for the negative effects of relocation of the older adults. This research aims to be used as the support of the legal and medical decisions of relocation of patients with dementia.
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Affiliation(s)
- Frida V M Ryman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Jetske C Erisman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Lea M Darvey
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Jacob Osborne
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Ella Swartsenburg
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Elena V Syurina
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
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Kamitani H, Umegaki H, Okamoto K, Kanda S, Asai A, Shimojima T, Nomura H, Hattori A, Kimata T, Suzuki Y, Ohshima H, Kuzuya M. [Agreement in the responses to self-reported and proxy-reported versions of QOL-HC: a new quality-of-life scale for patients receiving home-based medical care]. Nihon Ronen Igakkai Zasshi 2018; 55:98-105. [PMID: 29503374 DOI: 10.3143/geriatrics.55.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM We developed quality-of-life (QOL) scales for patients receiving home medical care. The objective of this study was to examine the agreement between the scores of the scales answered by patients and those answered by their proxy, as cognitive decline may interfere with one's ability to understand complex topics, such as the QOL. METHODS Participants were pairs of patients receiving home medical care and their proxy. The patients were asked to complete self-reported QOL scales (QOL-HC), and their proxies were asked to complete proxy-reported versions of the QOL scales (QOL-HC for caregivers). We then statistically examined the extent of agreement between the self- and proxy-reported QOL-HC scores using contingency tables and Spearman's rank correlation coefficient. The SPSS software program, version 24, was used for all statistical analyses. RESULTS The concordance rate between patients and caregivers for questions 1 ( "Do you have peace of mind?" ), 2 ( "Do you feel satisfied with your life when you reflect on it?" ), 3 ( "Do you have someone that you spend time talking with?" ), and 4 ( "Are you satisfied with the home care service system?" ) were 52.3%, 52.3%, 79.5%, and 81.8%, respectively. The total scores for the patients and caregivers were significantly correlated (Spearman's ρ=0.364*). CONCLUSIONS We created the first QOL scale for patients receiving home-based medical care and for caregivers. The findings of this study suggest that the QOL-HC can be used in clinical practice for the assessment of patients receiving professional home care.
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Affiliation(s)
- Hiroko Kamitani
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
| | - Kazushi Okamoto
- Department of Public Health, Aichi Prefectural College of Nursing and Health
| | | | | | | | | | | | | | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultation
| | - Hiroko Ohshima
- National Center for Geriatrics and Gerontology, Section for Nursing and Care
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine
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Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, Kuzuya M. Factors associated with unexpected admissions and mortality among low-functioning older patients receiving home medical care. Geriatr Gerontol Int 2017; 17:1623-1627. [DOI: 10.1111/ggi.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/04/2016] [Accepted: 09/20/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital; Nagoya Aichi Japan
| | - Keiko Maeda
- Department of Home Medical Care; Mokuren Clinic; Nagoya Aichi Japan
| | | | | | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
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