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Kimura T, Chiba H, Nomura K, Mizukami J, Saka S, Kakei K, Ishikawa J, Yamadera S, Sakato K, Fujitani N, Takagi H, Ishikawa H. Communication between physicians, patients, their companions and other healthcare professionals in home medical care in Japan. Patient Educ Couns 2024; 123:108239. [PMID: 38484599 DOI: 10.1016/j.pec.2024.108239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To examine communication in home medical care. METHODS Conversations that happened during home medical care involving physicians at nine clinics were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Additional categories were developed to code aspects of home medical care. RESULTS Overall, 55 conversations were analyzed. The mean age of the patients was 82.9 ± 10.1 years old. The most common triad was physician, patient, and patient's companion. Information about home medical care professionals who were not present during the conversation was provided by the physician in 21 cases (38.2%), the patient in nine cases (16.4%), and companions in 21 (39.6%) cases. CONCLUSION In home medical care, the participants mentioned home medical care professions who were not present at the time, suggesting that these conversations may have facilitated interprofessional collaboration. PRACTICE IMPLICATIONS Physicians should be aware that during home medical care, the presence of multiple attendants and other medical professionals contributing to communicate with the patient.
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Affiliation(s)
- Takuma Kimura
- Home Medical Care Communication Research Group, Japan; Department of R&D Innovation for Home Care Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan.
| | - Hiroki Chiba
- Home Medical Care Communication Research Group, Japan; Department of Medical Education, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kyoko Nomura
- Home Medical Care Communication Research Group, Japan; Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | | | - Shohei Saka
- Home Medical Care Communication Research Group, Japan
| | - Kotaro Kakei
- Home Medical Care Communication Research Group, Japan
| | | | | | | | | | | | - Hirono Ishikawa
- Home Medical Care Communication Research Group, Japan; Teikyo University Graduate School of Public Health, Tokyo, Japan
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Tarasawa K, Fujimori K, Ogata T, Chiba H. Associations Between Death at Home with Medical Resources and Medical Activities in Cancer Patients: A Nationwide Study Using Japanese National Database. Ann Geriatr Med Res 2023:agmr.23.0048. [PMID: 37305898 DOI: 10.4235/agmr.23.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Background Over half of the Japanese population hope to spend their last days at home; however, 73.0% die in hospitals. The proportion of deaths due to cancer in hospitals is even higher, at 82.4%, and is also high globally. Therefore, there is an urgent need to establish conditions that fulfill the hopes of patients, especially those with cancer, who hope to spend their last days at home. This study aimed to clarify medical resources and activities that are related to proportion of death at home among cancer patients. Methods We used data from the Japanese National Database and public data. Japan's Ministry of Health, Labor, and Welfare provides national data on medical services to applicants for research purposes. Using the data, we calculated the proportion of deaths at home in each prefecture. We also collected information on medical resources and activities from public data and conducted multiple regression analyses to investigate factors associated with the proportion of death at home. Results In total, 51,874 eligible patients were identified. The maximum and minimum proportions of death at home based on prefectures differed by approximately three-fold (14.8%-41.6%). We also identified scheduled home-visit medical care (coefficient 0.580) and acute and long-term care beds (coefficients -0.317 and -0.245) as factors that increased and decreased the proportion of death at home, respectively. Conclusion To fulfill the hopes of cancer patients to spend their last days at home, we recommend that the government develop policies to increase home visits by physicians and optimize hospital acute and long-term care beds.
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Affiliation(s)
- Kunio Tarasawa
- Department of Health Administration and Policy, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tomoaki Ogata
- Division of Health Policy and Management, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Hiroki Chiba
- Department of Medical Education, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
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Mitsunaga T, Ohtaki Y, Yajima W, Sugiura K, Seki Y, Mashiko K, Uzura M, Takeda S. Ability of combined soluble urokinase plasminogen activator receptor to predict preventable emergency attendance in older patients in Japan: a prospective pilot study. PeerJ 2022; 10:e14322. [PMID: 36353607 PMCID: PMC9639425 DOI: 10.7717/peerj.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Soluble urokinase plasminogen activator receptor (suPAR) is a strong and nonspecific inflammatory biomarker that reflects various immunologic reactions, organ damage, and risk of mortality in the general population. Although prior research in acute medical patients showed that an elevation in suPAR is related to intensive care unit admission and risk of readmission and mortality, no studies have focused on the predictive value of suPAR for preventable emergency attendance (PEA). This study aims to evaluate the predictive value of suPAR, which consists of a combination of white blood cell count (WBC), C-reactive protein (CRP), and the National Early Warning Score (NEWS), for PEA in older patients (>65 years) without trauma who presented to the emergency department (ED). This single-center prospective pilot study was conducted in the ED of the Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, in Hachiouji City, Tokyo, Japan, from September 16, 2020, to June 21, 2022. The study included all patients without trauma aged 65 years or older who were living in their home or a facility and presented to the ED when medical professionals decided an emergency consultation was required. Discrimination was assessed by plotting the receiver-operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). During the study period, 49 eligible older patients were included, and thirteen (26.5%) PEA cases were detected. The median suPAR was significantly lower in the PEA group than in the non-PEA group (p < 0.05). For suPAR, the AUC for the prediction of PEA was 0.678 (95% CI 0.499-0.842, p < 0.05), and there was no significant difference from other variables as follows: 0.801 (95% CI 0.673-0.906, p < 0.001) for WBC, 0.833 (95% CI 0.717-0.934, p < 0.001) for CRP, and 0.693 (95% CI 0.495-0.862, p < 0.05) for NEWS. Furthermore, the AUC for predicting PEA was 0.867 (95% CI 0.741-0.959, p < 0.001) for suPAR + WBC + CRP + NEWS, which was significantly higher than that of the original suPAR (p < 0.01). The cutoff values, sensitivity, specificity, and odds ratio of suPAR and suPAR + WBC + CRP + NEWS were 7.5 and 22.88, 80.6% and 83.3%, 53.8% and 76.9%, and 4.83 and 16.67, respectively. This study has several limitations. First, this was pilot study, and we included a small number of older patients. Second, the COVID-19 pandemic occurred during the study period, so that there may be selection bias in the study population. Third, our hospital is a secondary emergency medical institution, and as such, we did not treat very fatal cases, which could be another cause of selection bias. Our single-center study has demonstrated the moderate utility of the combined suPAR as a triage tool for predicting PEA in older patients without trauma receiving home medical care. Before introducing suPAR to the prehospital setting, evidence from multicenter studies is needed.
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Affiliation(s)
- Toshiya Mitsunaga
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan,Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Yuhei Ohtaki
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Yajima
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kei Sugiura
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Seki
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Kunihiro Mashiko
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Masahiko Uzura
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Takeda
- Department of Emergency Medicine, Jikei University School of Medicine, Tokyo, Japan
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Suzuki S, Kamibeppu K. Impact of respite care on health-related quality of life in children with medical complexity: A parent proxy evaluation. J Pediatr Nurs 2022; 67:e215-23. [PMID: 35902354 DOI: 10.1016/j.pedn.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/16/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study examined the impact of respite care received by children with medical complexity (CMC) on their health-related quality of life (HRQOL). We hypothesized that out-of-home respite care would increase both opportunities to engage in activities and participation with non-family members and help with acquiring autonomy and social skills. DESIGN AND METHODS This cross-sectional study of CMC aged between 8 and 18 years living at home used a web-based questionnaire survey that parents living with the target CMC answered for proxy evaluation of CMC's HRQOL (KIDSCREEN-27). We asked 3142 parents to participate in the study through 237 special-needs schools throughout Japan. Path analysis was used to estimate the variation in each aspect of HRQOL with respite care time of in-home care services, day care services, short-stay services, and school time. RESULTS We analyzed the responses from 618 parents of CMC. The results showed that respite care by day care services and special-needs schools increased "physical well-being," "psychological well-being," and "peers and social support," which are components of the HRQOL. Furthermore, respite care at schools had an impact on "school environment." CONCLUSIONS Respite care provided by special-needs schools and day care services has implications not only in terms of relief for caregivers but also in improving the HRQOL of CMC. PRACTICE IMPLICATIONS Nurses can provide respite care that does not require parental accompaniment at school or day care facilities, which can lead to CMC's involvement in fostering autonomy and social skills. (249/250 words).
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Koujiya E, Kabayama M, Yamamoto M, Higami Y, Kodama K, Mukai S, Yano T, Nako Y, Nakamura T, Hirotani A, Fukuda T, Tamatani M, Okuda Y, Ikushima M, Baba Y, Nagano M, Rakugi H, Kamide K. [Seasonal changes in blood pressure and related factors among older patients receiving home medical care]. Nihon Ronen Igakkai Zasshi 2021; 58:602-609. [PMID: 34880179 DOI: 10.3143/geriatrics.58.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM We investigated seasonal variations in blood pressure (BP) and factors related to these variations among older patients receiving home medical care. METHOD A total 57 patients ≥ 65 years old receiving home medical care who participated in the Osaka Home Care REgistry study (OHCARE), a prospective cohort study, were included. We investigated the seasonal patient characteristics and variations in the BP. In addition, to determine the influence of seasonal variations in the systolic blood pressure (SBP) on the occurrence of clinical events (hospitalization, falls and death), we classified patients into larger- and smaller- change groups based on the median seasonal variations in SBP. RESULT About 60% of subjects were very frail or bedridden. The mean BP was higher in winter than in summer (124.7±11/69.5±7 vs.120.5±12/66.9±8 mmHg) (P< 0.01). On comparing the characteristics of the two groups with larger and smaller changes in the SBP, the group with large BP changes had a significantly lower BP in summer than the group with small BP changes. In addition, the incidence of "hospitalization" was significantly higher in the group with large BP changes than in the group with small BP changes (P = 0.03). CONCLUSION The present study revealed that there were seasonal changes in the BP in older patients receiving home medical care. It was also suggested that seasonal changes in the BP might be associated with the risk of hospitalization events. Given these BP variations, doctors and visiting nurses should be alert for systemic abnormalities, especially in frail patients receinving home medical care.
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Affiliation(s)
- Eriko Koujiya
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | | | | | - Kana Kodama
- Division of Medicine, Osaka University Graduate School of Medicine
| | - Sakino Mukai
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Tomoko Yano
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Yumiko Nako
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine
| | - Kei Kamide
- Division of Health Sciences, Osaka University Graduate School of Medicine.,Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine
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Ikeda T, Tsuboya T. Place of Death and Density of Homecare Resources: A Nationwide Study in Japan. Ann Geriatr Med Res 2021; 25:25-32. [PMID: 33794586 PMCID: PMC8024167 DOI: 10.4235/agmr.21.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
Background Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan. Methods We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home. Results Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities. Conclusion Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.
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Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Department of Community Health, Public Health Institute, Shiwa, Japan
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Iida C, Muneuchi J, Yamamoto J, Yokota C, Ohmura J, Kamimura T, Ochiai Y, Matsumoto N, Araki S, Shimizu D, Yamaguchi K, Sakemi Y, Watanabe M, Sugitani Y, Takahashi Y. Impacts of surgical interventions on the long-term outcomes in individuals with trisomy 18. J Pediatr Surg 2020; 55:2466-2470. [PMID: 31954556 DOI: 10.1016/j.jpedsurg.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aim to clarify whether surgical interventions can contribute to improve the long-term outcomes among individuals with trisomy 18. METHODS We retrospectively studied 69 individuals with trisomy 18 admitted to 4 tertiary neonatal centers between 2003 and 2017. A cohort was divided into two groups: subjects with surgical interventions and conservative treatments. We compared the rates of survival and achieving homecare between the groups. RESULTS Gestational age and birth weight were 37 (27-43) weeks and 1,700 (822-2,546) g, respectively. There were 68 patients with congenital heart disease and 20 patients with digestive disease. Surgical interventions including cardiac and digestive surgery were provided in 41% of individuals. There was no difference in gestational age (p=0.30), birth weight (p=0.07), gender (p=0.30), and fetal diagnosis (p=0.87) between the groups. During the median follow up duration of 51 (2-178) months, overall survival rates in 6, 12 and 60 months were 57%, 43% and 12%, respectively. Survival to hospital discharge occurred in 23 patients, and the rates of achieving homecare in 1, 6, and 12 months are 1%, 18% and 30%, respectively. There was no significant difference in survival rate (p=0.26) but in the rate of achieving home care (p=0.02) between the groups. Cox hazard analysis revealed that prenatal diagnosis (hazard ratio 0.30, 95%CI: 0.13-0.75), cardiac surgery (hazard ratio 2.40, 95%CI:,1.03-5.55), and digestive surgery (hazard ratio 1.20, 95%CI: 1.25-3.90) were related to the rate of achieving homecare. CONCLUSION Aggressive surgical interventions contribute not to the long-term survival but to achieve homecare among individuals with trisomy 18. EVIDENCE LEVEL Level 3 (Prognostic study, Case-Control study).
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Affiliation(s)
- Chiaki Iida
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan.
| | - Junko Yamamoto
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Chie Yokota
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Junya Ohmura
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Tetsuro Kamimura
- Department of Pediatric Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Naoko Matsumoto
- Department of Pediatrics, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakitaku, Kitakyushu, 802-0077, Japan
| | - Shunsuke Araki
- Department of Pediatrics, University of Occupational and Environmental Health, 1-1-1, Iseigaoka, Yatahanishiku, Kitakyushu, 807-8556, Japan
| | - Daisuke Shimizu
- Department of Pediatrics, University of Occupational and Environmental Health, 1-1-1, Iseigaoka, Yatahanishiku, Kitakyushu, 807-8556, Japan
| | - Kenichiro Yamaguchi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, 10-1, Harugaoka, Kokuraminamiku, Kitakyushu, 802-8533, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, 10-1, Harugaoka, Kokuraminamiku, Kitakyushu, 802-8533, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
| | - Yasuhiko Takahashi
- Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishiku, Kitakyushu, 806-8501, Japan
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Takase Y, Okuyama K, Nozawa M, Mizukami K. [A case of late-onset paraphrenia in a very elderly patient receiving home medical care]. Nihon Ronen Igakkai Zasshi 2019; 55:675-678. [PMID: 30542035 DOI: 10.3143/geriatrics.55.675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 94 year old woman with a late-onset paraphrenia was referred to our clinic from a community care center. The patient showed symptoms of paranoia and auditory hallucination. The patient was in conflict with her neighbors regarding noise-related problems and was experiencing loss of appetite. Because the patient had a strong aversion to outpatient treatment due to difficulty in commuting, home visits were commenced. Improvements were observed after administration of 2.5 mg per day of olanzapine.In home medical care, precise definitive diagnosis and determination of treatment approach is necessary under limited time and resources. The fact that elderly people often exhibit psychological symptoms such as hallucinations is well known among clinical professions. However, this is not well known among home care patients, families and other professionals, and, therefore, is often overlooked. As the population ages further, it can be predicted that cases of elderly patients requiring treatment for psychological symptoms will increase in home medical care situations. In Japan, with a super-aging society, understanding and continuously supporting late-onset paraphrenia among elderly people is a pressing issue for all communities in advancing home medical care and nursing.
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Affiliation(s)
| | | | - Motohiro Nozawa
- Matsuzaki Hospital Medical Corporation, Calm Medical Clinic Hiroo
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Science, Faculty of Health and Sports Sciences, University of Tsukuba
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