title: Reconsidering long-term care in the end-of-life context in Japan.
abstract: In this article, we propose expanding the scope of long-term care such that it involves caring for dying individuals; that is, end-of-life care. In doing so, we identify challenges that families and care/medical professionals face in attempts to design and provide end-of-life care under Japan's societal contexts. Because of the difficulty judging whether an individual is in an end-of-life phase, as well as a growing number of older adults who are unable to communicate their care preferences as a result of cognitive impairment, efforts were almost automatically made to prolong older patients' lives. To respect patients' desires and values, communication among older adults, their families, and care/medical professionals has been increasingly encouraged to make a mutually agreeable end-of-life care decision. At the same time, older adults are expected to indicate their care preferences earlier because their ability to express their ideas should be limited when approaching the end-of-life phase. We thus suggest including advance care planning in the course of long-term care such that older adults, with the help of care/medical professionals, can tell their preferences to their families, who are required to serve as surrogate decision makers in Japan. Our research, however, has shown that Japanese older adults are hesitant to discuss end-of-life issues with their families. On the basis of our findings suggesting older adults' concern that they might make trouble for their families by clarifying their care preferences, we discuss how care/medical professionals should facilitate family discussions on end-of-life care.
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Shimada
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.|Japan Society for the Promotion of Science (JSPS), Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hirayama
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakui
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nakazato
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Obuchi
authors.affiliation: Human Care Research Team, Tokyo Metropolitan Institute of Gerontology (TMIG), Tokyo, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
authors.affiliation: Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D003142:Communication; D003657:Decision Making; D006801:Humans; D007564:Japan; D008134:Long-Term Care / Q000458:organization & administration*; D013727:Terminal Care / Q000379:methods*
keywords: advance care planning; communication; end-of-life care; family; long-term care