In Japan, more people require care activities at home. In particular, patients with an invasive mechanical ventilator in the home require extensive care by family caregivers. Collaboration between their nurses and paid caregivers in the provision of care activities, especially tracheal suctioning, is necessary. This three-round Delphi study identifies the essential items required by nurses to instruct the paid caregivers in how to carry out tracheal suctioning on patients with an invasive mechanical ventilator in the home. By the final round, three competencies were found to be important by the home-visit nurses and paid caregivers: the anticipation of risk, the manner of handling an emergency situation, and the observation of a patient's breathing. The Delphi technique was used to obtain consensus between the home-visit nurses and the paid caregivers regarding the essential knowledge, skills, and attitudes required to carry out tracheal suctioning for patients with an invasive mechanical ventilator in the home.
With respect to care burden, positively associated factors were sekentei or social pressure [odds ratio (OR) 4.25, 95% confidence interval (CI) 1.39-13.04], caregiving obligation (OR 3.11, 95% CI 1.43-6.77), spouse carer (OR 2.58, 95% CI 1.05-6.35), daughter-in-law carer (OR 3.68, 95% CI 1.31-10.34), and depression (OR 50.58, 95% CI 13.85-184.67). With respect to positive appraisal, negatively associated factors were caregiving obligation (OR 0.29, 95% CI 0.15-0.53), male carer (OR 0.44, 95% CI 0.21-0.92), and daughter-in-law carer (OR 0.29, 95% CI 0.12-0.74).
Recent increases in the number of those with health care needs who live at home in Japan highlight the importance of maintaining a healthy community environment for long-term care. This study characterized continuing long-term home-based care for patients with health care needs in a rural community through an examination of influential factors, as perceived by family caregivers of patients with care needs. Semistructured interviews revealed self-reliance as the most important factor. Promoting the quality of a family caregiver's life was also found to be important. Family caregiver support is required considering the character of a rural community and residents' ideologies.
This quantitative study aimed to determine the differences between rural and urban residencies related to home-based appraisal (including care burden and positive appraisal) for Japanese primary family caregivers of the elderly with extensive care needs. The study examined a sample of 196 caregivers (106 rural, 90 urban), and stepwise multiple regression analysis was performed. Resident location was significantly associated with care burden, and each factor associated with the appraisal, especially care burden, differed between rural and urban areas. The social and physical environment is thus a necessary consideration to support family caregivers and the elderly requiring home-based care.
This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: "urban", "rural", "comparison of community", "elderly health", and "comparison of community health". A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.
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