Risk Factors and Specific Prescriptions Related to Inappropriate Prescribing among Japanese Elderly Home Care Patients

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.

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A comparative risk assessment of dialysis care processes in the home and hospital care contexts

International Journal of Systems Assurance Engineering and Management ◽

10.1007/s13198-020-01032-4 ◽

2020 ◽

Vol 11 (5) ◽

pp. 985-1002

Author(s):

Peter Chemweno ◽

Liliane Pintelon

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Home Care ◽

Domain Knowledge ◽

Assessment Process ◽

Hospital Environment ◽

Negative Consequences ◽

Comparative Risk Assessment ◽

Care Givers ◽

Comparative Risk

Abstract Dialysis processes within the home care context is associated with risk factors which are not very prominent in the hospital context. This includes risk factors such as unanticipated device malfunction, or erroneous operation of the equipment, which exposes the patient to injury while undergoing dialysis. Importantly, the mentioned risk factors are further attributed to technical aspects such as sub-optimal equipment maintenance or following improper clinical procedures when administering care to the patient. Hence, it is important to follow a methodological approach to identify and assess hazards embedded within the dialysis treatment process, and on this basis, formulate effective strategies to mitigate their negative consequences on patient safety. This paper presents a comparative risk assessment for in-hospital versus in-home dialysis care. For the two cases, the risk assessment considers expertise of care givers involved in administering dialysis. The findings show that performing risk assessment for hospital environment, is more structured owing to expertise of clinicians and care givers responsible for administering dialysis. However, assessing risks for the home-care environment is more challenging owing to absence of domain knowledge, hence a survey approach to structure the risk assessment process is necessary. Moreover, risks in the home care context is influenced by logistical aspects, and lack of domain knowledge for maintaining dialysis equipment. Overall, insights from the comparative studies yields important learning points expected to improve dialysis care as more healthcare providers transfer care to the home environment.

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Long-Term Effects of Dietary .ALPHA.-Linolenic Acid from Perilla Oil on Serum Fatty Acids Composition and on the Risk Factors of Coronary Heart Disease in Japanese Elderly Subjects.

Journal of Nutritional Science and Vitaminology ◽

10.3177/jnsv.45.759 ◽

1999 ◽

Vol 45 (6) ◽

pp. 759-772 ◽

Cited By ~ 54

Author(s):

Osamu EZAKI ◽

Mayumi TAKAHASHI ◽

Takashi SHIGEMATSU ◽

Kyoko SHIMAMURA ◽

Junji KIMURA ◽

...

Keyword(s):

Risk Factors ◽

Fatty Acids ◽

Coronary Heart Disease ◽

Heart Disease ◽

Elderly Subjects ◽

Fatty Acids Composition ◽

Long Term Effects ◽

Alpha Linolenic Acid ◽

Japanese Elderly

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Reader response: Prevalence of and risk factors for cerebral microbleeds in a general Japanese elderly community

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000564 ◽

2018 ◽

Vol 8 (6) ◽

pp. 464.1-464

Author(s):

George K. Vilanilam ◽

Neethu Gopal ◽

Anjali Agarwal ◽

Mohammed K. Badi

Keyword(s):

Risk Factors ◽

Reader Response ◽

Cerebral Microbleeds ◽

Japanese Elderly

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Urinary incontinence in home care: a representative multicenter study on prevalence, severity, impact on quality of life, and risk factors

Aging Clinical and Experimental Research ◽

10.1007/s40520-017-0816-6 ◽

2017 ◽

Vol 30 (6) ◽

pp. 589-594 ◽

Cited By ~ 8

Author(s):

Ralf Suhr ◽

Nils Axel Lahmann

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Urinary Incontinence ◽

Home Care ◽

Multicenter Study

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Comparison of Fall Risk Assessment Tools for Older Indonesian Adults in the Elderly Home and the Community

The Indonesian Journal of Occupational Safety and Health ◽

10.20473/ijosh.v8i3.2019.241-249 ◽

2019 ◽

Vol 8 (3) ◽

pp. 241

Author(s):

Indri Hapsari Susilowati ◽

Susiana Nugraha ◽

Sabarinah Sabarinah ◽

Bonardo Prayogo Hasiholan ◽

Supa Pengpid ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Fall Risk ◽

Assessment Tool ◽

The Elderly ◽

Risk Assessment Tool ◽

Fall Risk Assessment ◽

Elderly Home ◽

Balance Confidence ◽

Confidence Scale

Introduction: One of the causes of disability among elderly is falling. The ability to predict the risk of falls among this group is important so that the appropriate treatment can be provided to reduce the risk. The objective of this study was to compare the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative from the Centers for Disease Control and Prevention (CDC) and The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) from the Johns Hopkins University. Methods: This study used the STEADI tool, JHFRAT, Activities-Specific Balance Confidence Scale (ABC), and The Geriatric Depression Scale (GDS). The study areas were in community and elderly home in both public and private sectors and the samples were 427 after cleaning. Results: The results for the STEADI and JHFRAT tools were similar where the respondents at highest risk of falling among women (STEADI: 49%; JHFRAT: 3.4%), in Bandung area (63.5%; 5.4%), in private homes (63.3%; 4.4%), non-schools (54.6%; 6.2%), aged 80 or older (64.8%; 6.7%) and not working (48.9%;3.3%). The regression analysis indicated that there was a significant relationship between the risk factors for falls in the elderly determined by the JHFRAT and STEADI tools: namely, region, type of home, age, disease history, total GDS and ABC averages. Conclusion: Despite the similarity in the risk factors obtained through these assessments, there was a significant difference between the results for the STEADI tool and the JHFRAT. The test strength was 43%. However, STEADI is more sensitive to detect fall risk smong elderly than JHFRATKeywords: Activities-Specific Balance Confidence scale, elderly, fall risk,The Johns Hopkins Fall Risk Assessment Tool, the Stopping Elderly Accidents, Deaths, & Injuries

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