Cohort Study of Advance Directives and End of Life Care

• Project/Area Number: 15K08549
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Medical sociology
• Research Institution: Kyoto University
• Principal Investigator: Wada Taizo 京都大学, 東南アジア地域研究研究所, 連携准教授 (90378646)
• Co-Investigator(Kenkyū-buntansha): 松林 公蔵 京都大学, 東南アジア地域研究研究所, 名誉教授 (70190494)
• Project Period (FY): 2015-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,550,000 (Direct Cost: ¥3,500,000、Indirect Cost: ¥1,050,000); Fiscal Year 2018: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2017: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2016: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2015: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 事前指示 / 終末期ケア / アドバンス・ケア・プランニング / 人工的水分・栄養方法 / 胃瘻 / 認知症 / 総合機能評価 / 地域在住高齢者 / アドバンスケアプランニング / 事前指示書 / 認知機能 / 老研式活動能力指標 / 抑うつ / 中心静脈栄養 / 死亡 / 生命予後 / GDS / 主観的健康感 / Advance care planning / 事前ケア計画

Outline of Final Research Achievements

To promote advance care planning, leaflet that specifically describes the advantage and disadvantages of artificial nutritional hydration methods were distributed to all participants at the time of annual comprehensive geriatric assessment. Participants who were willing to have documents of advance directives could receive it. In a nursing home, 77% of the resident have completed the document of advance directives after advance care planning. In rural area, 55.3% of the participants preferred to inform their value for applying artificial nutritional hydration to their attending physician in case they would not take food nor water orally. It became clear that many of the elderly wanted to express their intention to care at the final stage of their life to start advance care planning.

Academic Significance and Societal Importance of the Research Achievements

人生最終段階における人工的水分・栄養方法の導入について、本人にとっての最善（Best Interest）を理解をするためには意思決定能力喪失以前の価値観共有が必要である。本研究は、生活機能が比較的保たれた高齢者を対象に人工的水分・栄養方法を含んだACPを総合機能評価時に開始することが可能であり、農村部在住高齢者の半数以上、有料老人ホーム在住者の3／4以上のものがACPに積極的であることを示した点で意義がある。本邦では死について考えたり、議論したりする文化的背景が乏しいが、人工的水分・栄養方法などの医療面に関して積極的に利点・難点をふくめて情報発信することもACP推進に重要と考えられる。

Research Products

• [Journal Article] Combined effect of poor appetite and low masticatory function on sarcopenia in community‐dwelling Japanese adults aged???75 years: A 3‐year cohort study (2020)
  • Author(s): Senoo Soichiro、Iwasaki Masanori、Kimura Yumi、Kakuta Satoko、Masaki Chihiro、Wada Taizo、Sakamoto Ryota、Ishimoto Yasuko、Fujisawa Michiko、Okumiya Kiyohito、Ansai Toshihiro、Matsubayashi Kozo、Hosokawa Ryuji
  • Journal Title: Journal of Oral Rehabilitation Volume: n/a Pages: 643-650
  • DOI: 10.1111/joor.12949
  • Peer Reviewed
• [Journal Article] Association between anorexia and poor chewing ability among community‐dwelling older adults in Japan (2019)
  • Author(s): Kimura Yumi、Iwasaki Masanori、Ishimoto Yasuko、Sasiwongsaroj Kwanchit、Sakamoto Ryota、Wada Taizo、Fujisawa Michiko、Okumiya Kiyohito、Miyazaki Hideo、Matsubayashi Kozo
  • Journal Title: Geriatrics & Gerontology International Volume: 19 Pages: 1290-1292
  • DOI: 10.1111/ggi.13792
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study (2019)
  • Author(s): Iwasaki Masanori、Kimura Yumi、Ogawa Hiroshi、Yamaga Takayuki、Ansai Toshihiro、Wada Taizo、Sakamoto Ryota、Ishimoto Yasuko、Fujisawa Michiko、Okumiya Kiyohito、Miyazaki Hideo、Matsubayashi Kozo
  • Journal Title: J Periodontal Res. Volume: 54 Pages: 233-240
  • DOI: 10.1111/jre.12623
  • Peer Reviewed
• [Journal Article] Self-rated health is associated with subsequent functional decline among older adults in Japan (2017)
  • Author(s): Hirosaki Mayumi、Okumiya Kiyohito、Wada Taizo、Ishine Masayuki、Sakamoto Ryota、Ishimoto Yasuko、Kasahara Yoriko、Kimura Yumi、Fukutomi Eriko、Chen Wen Ling、Nakatsuka Masahiro、Fujisawa Michiko、Otsuka Kuniaki、Matsubayashi Kozo
  • Journal Title: Int Psychogeriatr. Volume: 29 Pages: 1475-1483
  • DOI: 10.1017/s1041610217000692
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Sleep quality among elderly high-altitude dwellers in Ladakh (2017)
  • Author(s): Ryota Sakamotoa, Kiyohito Okumiya,Tsering Norboo, Norboo Tsering, Takayoshi Yamaguchi, Mitsuhiro Nose, Shinya Takeda et.al.
  • Journal Title: Psychiatry Res. Volume: 249 Pages: 51-57
  • DOI: 10.1016/j.psychres.2016.12.043
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] The association between dentition status and sarcopenia in Japanese adults aged 75 years. (2017)
  • Author(s): Iwasaki M, Kimura Y, Ogawa H, Wada T, Sakamoto R, Ishimoto Y, Fujisawa M, Okumiya K, Ansai T, Miyazaki H, Matsubayashi K.
  • Journal Title: J Oral Rehabil Volume: 44 Pages: 51-58
  • DOI: 10.1111/joor.12460
  • Peer Reviewed / Open Access / Int'l Joint Research / Acknowledgement Compliant
• [Journal Article] Humanosphere Potentiality Index Appraising Existing Indicators from a Long-term Perspective (2016)
  • Author(s): Takahiro Sato, Mario Lopez, Taizo Wada, Shiro Sato, Makoto Nishi and Kazuo Watanabe
  • Journal Title: The International Journal of Social Quality Volume: 6(1) Pages: 32-66
  • DOI: 10.3167/ijsq.2016.060103
  • Peer Reviewed
• [Journal Article] Relationship between oral dysfunction, physical disability, and depressive mood in community-dwelling elderly adults in Japan. (2016)
  • Author(s): Chang NY, Kimura Y, Ishimoto Y, Wada T, Fukutomi E, Chen WL, Sakamoto R, Fujisawa M, Okumiya K, Matsubayashi K.
  • Journal Title: Journal of the American Geriatrics Society Volume: 64 Pages: 1734-1735
  • DOI: 10.1111/jgs.14211
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Predictors of difficulty in performing basic activities of daily living among okd-old: a two year community-based cohort study (2016)
  • Author(s): Sakamoto R, Okumiya K, Ishine M, Wada T, Fujisawa M, Imai H, Ishimoto Y, Kimura Y, Fukutomi E, Chen W, Sasiwongsaroj K, Kato E, Otsuka K, Matsubayashi K.
  • Journal Title: Geriatrics & Gerontology International Volume: inpress Pages: 214-22
  • DOI: 10.1111/ggi.12462
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Buddhist social networks and health in old age: A study in central Thailand. (2016)
  • Author(s): Sasiwongsaroj K, Wada T, Okumiya K, Imai H, Ishimoto Y, Sakamoto R, Fujisawa M, Kimura Y, Chen WL, Fukutomi E, Matsubayashi K
  • Journal Title: Geriatr Gerontol Int Volume: in press Pages: 1210-1218
  • DOI: 10.1111/ggi.12421
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Association between risk perception, subjective knowledge, and depression in community-dwelling elderly people in Japan. (2015)
  • Author(s): Imai H, Okumiya K, Fukutomi E, Wada T, Ishimoto Y, Kimura Y, Chen WL, Tanaka M, Sakamoto R, Fujisawa M, Matsubayashi K.
  • Journal Title: Psychiatry Research Volume: inpress Pages: 27-31
  • DOI: 10.1016/j.psychres.2015.03.002
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Postcard intervention for depression in community-dwelling older adults: A randomised controlled trial. (2015)
  • Author(s): Imai H, Furukawa TA, Okumiya K, Wada T, Fukutomi E, Sakamoto R, Fujisawa M, Ishimoto Y, Kimura Y, Chen WL, Tanaka M, Matsubayashi K.
  • Journal Title: Psychiatry Research Volume: 229(1-2) Pages: 545-50
  • DOI: 10.1016/j.psychres.2015.05.054
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Social cohesion and health in old age: a study in southern Taiwan. (2015)
  • Author(s): Chen W, Okumiya K, Wada T, Sakamoto R, Imai H, Ishimoto Y, Kimura Y, Fukutomi E, Fujisawa M, Shih HI, Chang CM, Matsubayashi K.
  • Journal Title: International Psychogeriatrics Volume: 27(11) Pages: 1903-11
  • DOI: 10.1017/s1041610214002907
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Effect of early diagnosis and lifestyle modification on depressive symptoms in community-dwelling elderly adults with glucose intolerance: 5-year longitudinal study. (2015)
  • Author(s): Okumiya K, Fujisawa M, Sakamoto R, Wada T, Chen WL, Imai H, Ishimoto Y, Kimura Y, Fukutomi E, Sasiwongsaroj K, Kato E, Tanaka M, Hirosaki M, Kasahara Y, Nakatsuka M, Nose M, Ishine M, Yamamoto N, Otsuka K, Matsubayashi K.
  • Journal Title: Journal of the American Geriatrics Society Volume: inpress Pages: 393-395
  • DOI: 10.1111/jgs.13269
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Presentation] 有料老人ホーム入居者の昼寝習慣と総合機能評価の関連 (2019)
  • Author(s): 和田 泰三, 石本 恭子, 中本 宇彦, 青山 薫, 木村 友美, 加藤 恵美子, 竜野 真維, 藤澤 道子, 松林 公蔵, 坂本 龍太
  • Organizer: 第61回 日本老年医学会 学術集会
• [Presentation] 「高齢者在宅医療・介護サービスガイドライン2019」をどのように活用できるか? (2019)
  • Author(s): 和田泰三
  • Organizer: 第一回 日本在宅医療連合学会大会
  • Invited
• [Presentation] 有料老人ホーム入居高齢者におけるCGA項目の経時的変化に関する検討 (2019)
  • Author(s): 石本 恭子, 和田 泰三, 中本 宇彦, 木村 友美, 笠原 順子, 加藤 恵美子, 竜野 真維, 坂本 龍太, 藤澤 道子, 松林 公蔵
  • Organizer: 第61回 日本老年医学会 学術集会
• [Presentation] 「高齢者在宅医療・介護サービスガイドライン2019年版」の臨床応用に向けて 担がん患者に対する在宅医療・介護サービスのエビデンスと臨床応用 (2019)
  • Author(s): 和田泰三
  • Organizer: 第61回 日本老年医学会 学術集会
  • Invited
• [Presentation] 丸木舟でいく神経難病調査―インドネシア・パプア州の経験― (2019)
  • Author(s): 和田泰三
  • Organizer: 第26回 多文化間精神医学会 学術総会
  • Invited
• [Presentation] 地域包括ケアにおけるアドバンス・ケア・プランニングの試み―人工的水分・栄養補給を中心として― (2019)
  • Author(s): 和田泰三
  • Organizer: 第6回 釧路生命倫理フォーラム
• [Presentation] 総合機能評価時におけるアドバンス・ケア・プランニングの試み (2018)
  • Author(s): 和田泰三
  • Organizer: 第60回日本老年医学会学術集会
• [Presentation] 農村部在住高齢者の抑うつと生命予後 ―11年間の検討―― (2017)
  • Author(s): 和田泰三、石根昌幸、石本恭子、木村友美、山中学、藤澤道子、中塚晶博、奥宮清人、松林公蔵、坂本龍太
  • Organizer: 第59回日本老年医学会学術集会
• [Presentation] 有料老人ホーム在住高齢者の孤独感とその関連因子 (2016)
  • Author(s): 和田泰三
  • Organizer: 第58回日本老年医学会学術集会
  • Place of Presentation: 金沢
  • Year and Date: 2016-06-08
• [Presentation] How to appreciate the patients preference？----From the view point of advance care planning--- (2015)
  • Author(s): Wada T
  • Organizer: Korea Geriatric Society. KGS Korea-Japan Joint Symposium.
  • Place of Presentation: ソウル
  • Year and Date: 2015-11-28
  • Int'l Joint Research / Invited
• [Presentation] 多職種連携により在宅看取りが可能であった独居高齢がん患者の一例 (2015)
  • Author(s): 和田泰三 他9名
  • Organizer: 第26回日本老年医学会近畿地方会
  • Place of Presentation: 京都
  • Year and Date: 2015-11-14
• [Presentation] Visual Analogue Scaleで測定したQOLとSF-8 の関連 (2015)
  • Author(s): 和田泰三 他9名
  • Organizer: 第57回日本老年医学会学術集会
  • Place of Presentation: 横浜
  • Year and Date: 2015-06-12
• [Book] 高齢者在宅医療・介護サービスガイドライン2019年版 (2019)
  • Author(s): 日本老年医学会・日本在宅医学会・国立長寿医療研究センター
  • Total Pages: 138
  • Publisher: ライフ・サイエンス
  • ISBN: 9784898016534
• [Book] 第7章 ヒトの寿命 「老化生物学 老いと寿命のメカニズム」 (2015)
  • Author(s): 和田泰三 （編 近藤祥司）
  • Total Pages: 408
  • Publisher: メディカルサイエンス・インターナショナル