title: Caregiver daily impression could reflect illness latency and severity in frail elderly residents in long-term care facilities: A pilot study.
abstract: OBJECTIVE
  To propose a caregiver daily impression (CDI) rating instrument for personal caregivers of residents living in long-term care facilities (LTCF) to comprehensively evaluate residents' daily health condition, and to investigate whether the CDI reflects illness latency and severity in residents transferred emergently.
  
  
  METHODS
  We carried out a retrospective review of facility care records from 20 LTCF in Hyogo, Japan. The participants were 169 LTCF residents with episodes of transfer to emergency hospitalization facilities during a 3-month period. We determined specific CDI variables by interviewing experienced LTCF caregivers, and then carried out a principal component analysis to determine the major parameter set. The generated components were incorporated into a regression model to investigate the association with hospitalization.
  
  
  RESULTS
  The mean age was 87.9 ± 6.5 years, 68% were women and 28% of transfers resulted in hospitalization. The interview procedure identified 12 specific CDI variables, and the principal component analysis generated five distinct components: "change in feeding," "change in emotion," "disengaged or listless gaze," "decrease in eye reactivity" and "change in movement." By multivariate logistic regression, hospitalization was associated with "decrease in eye reactivity" (adjusted OR 1.78, 95% CI 1.07-2.97) and poor vital signs (adjusted OR 2.84, 95% CI 1.15-6.98), but not with body temperature (adjusted OR 1.29, 95% CI 0.52-3.21).
  
  
  CONCLUSIONS
  The CDI might reflect underlying illness severity beyond quantitative physical findings. Once the CDI can be appropriately validated, quantified and linked to physical findings, it could be used by caregivers for daily resident assessments and as a practical triage tool in emergency situations. Geriatr Gerontol Int 2016; 16: 612-617.
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Ae
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kojo
authors.affiliation: Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Okayama
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsuboi
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Makino
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kotani
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Aoyama
authors.affiliation: Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities
keywords: caregivers; geriatric assessment; hospitalization; long-term care; transfer