Aim Undesirable events, such as falls, aspiration, and pressure ulcers, are associated with functional decline and lower quality of life among older adults. This study describes the frequency of such events among residents of geriatric care facilities and assesses the effect of training care managers in a multidisciplinary plan‐do‐check‐adjust cycle on preventing such events. Methods This was a Japan‐based, non‐randomized cluster intervention study. The intervention group comprised geriatric care facilities from which care managers had attended a training course, while the control group comprised facilities with care managers who did not receive this training. Six‐month pre‐admission and 3‐month post‐admission incidences of undesirable events were collected from both groups, and the two groups were compared. Results Valid data were collected from 862 residents (416 and 446 from the intervention and control groups, respectively) from 130 facilities (60 and 70, respectively). Three‐month post‐admission incidences were 27.8%, 20.0%, and 11.3% for falls, fever, and pressure ulcers, respectively. There was no difference between the groups regarding post‐admission incidence for any event type. Training care managers reduced the post‐admission incidence of pressure ulcers among residents with a history of such ulcers. Conclusions The training of care managers in a multidisciplinary risk‐management cycle was not effective for preventing falls, fever, or pressure ulcers. Results underscore the difficulty of preventing risk events in geriatric care facility residents even with organizational training efforts. The authors believe it is important to share such risks with residents and their families. Geriatr Gerontol Int 2021; 21: 842–848.
Background: Undesirable risk events, such as falls, aspiration pneumonia and pressure ulcers, are associated with functional decline and cause low quality of life among the elderly. This study analyzed and compared the frequency of major risk events and the effect of standard risk management on their prevention. Methods: Subjects: This study recruited elderly persons with disabilities using Japanese geriatric intermediate care facilities (GICFs); these individuals provided written informed consent. Intervention: A standardized intervention process of risk management was in place in half of the facilities. The other half provided conventional risk-prevention models. Outcome variable: The six-month preadmission incidence and three-month postadmission incidence of undesirable events, including falls, aspiration pneumonia, pressure ulcers, dehydration, and fever, were collected. Analysis: The effect of multidisciplinary care management on the reduction of undesirable events was analyzed. Results: Overall, 862 elderly persons from 132 facilities using geriatric intermediate care facilities in Japan participated in this study. Falls (35.2%), fever (21.9%), bone fractures (18.2%), and pressure ulcers (12.1%) were frequent undesirable events. There was no reduction in postadmission incidence in the intervention group in any of the patients regardless of the previous incidence. The intervention reduced the occurrence of postadmission pressure ulcers among patients with a previous incidence (odds ratio: 0.34). There were no reductions in falls, fever, or dehydration. Conclusions: The effect of standardized risk-management implementation is limited to pressure ulcers. The improvement of risk-management processes is needed to understand their limitations in long-term care facilities.
ObjectivesThere is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents’ functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.DesignA retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.SettingEighteen nursing homes in Japan.ParticipantsData were collected from 1000 residents with a required care level of 3–5 and from 412 care staff in nursing homes between October 2017 and March 2018.Outcomes and explanatory variablesFunctional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.ResultsFunctional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents’ deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents’ functional performance.ConclusionThese results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.
ObjectiveThe purpose of the study was to develop machine learning models using data from long-term care (LTC) insurance claims and care needs certifications to predict the individualized future care needs of each older adult.MethodsWe collected LTC insurance-related data in the form of claims and care needs certification surveys from a municipality of Kanagawa Prefecture from 2009 to 2018. We used care needs certificate applications for model generation and the validation sample to build gradient boosting decision tree (GBDT) models to classify if 1) the insured’s care needs either remained stable or decreased or 2) the insured’s care needs increased after three years. The predictive model was trained and evaluated via k-fold cross-validation. The performance of the predictive model was observed in its accuracy, precision, recall, F1 score, area under the receiver-operator curve, and confusion matrix.ResultsLong-term care certificate applications and claim data from 2009–2018 were associated with 92,239 insureds with a mean age of 86.1 years old at the time of application, of whom 67% were female. The classifications of increase in care needs after three years were predicted with AUC of 0.80.ConclusionsMachine learning is a valuable tool for predicting care needs increases in Japan’s LTC insurance system, which can be used to develop more targeted and efficient interventions to proactively reduce or prevent further functional deterioration, thereby helping older adults maintain a better quality of life.
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