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Exploring End-of-life care for the Elderly


Theme Leader :
Chiho Shimada, Ph.D.
Researcher :
Ryo Hirayama, Ph.D., Mio Ito, R.N., Ph.D., Kazunori Kikuchi, C.S.W., M.A.
Adjunct Researcher :
Syu Kinoshita, Akioko Kan, Rie Kawazoe


End-of-life Care, Advance Care Planning, Quality of care, Care Coordination, Multidisciplinary Care, Bereavement care

Major Research Titles

  1. 1.Identifying Optimal End-of-Life Care for Older Adults
  2. 2.Care for Bereaved Families of Older Adults
  3. 3.Developing End-of-Life Care Systems for Long-Term Care Facilities


Our research aims to identify a care system that is necessary for older adults to live out their final days with their dignity preserved. In doing so, we focus on (a) how formal care providers can and should be involved with the end-of-life care for older patients, (b) how end-of-life care can and should be provided in different settings such as care facilities, hospitals, and patients' home, and (c) how older patients can receive end-of-life care that best satisfies their wishes.
We are currently working on the following 3 projects.
(1) We have developed a self-completed booklet to write in one's values, past experiences, and preferred end-of-life care. We seek to identify whether and how this booklet helps ensure that older adults' wishes are well reflected in end-of-life care decisions.
(2) In grief care, people tend to focus on support after patients' death. However, we believe that grief among family members is also affected by quality of care and support for patients and families before death. Our research strives to find necessary care to support families to relieve their grief after the death of a loved one.
(3) We also develop a nursing-home system that enables residents to continue to receive care until their end. Specifically, to help accumulate practical knowledge to better manage end-of-life care in each nursing home, we have proposed Collaborative Reflection Program that provides the opportunity for staff members to share and learn from each other's experiences. We are now examining whether and how the implementation of this program influences the quality of end-of-life care provided in nursing homes.


  1. 1. Shimada C, Hirayama R, Wakui, T, Nakazato K, Obuchi S, Ishizaki T, Takahashi R. : Reconsidering Long-Term Care in the End-of-Life Context in Japan. Geriatrics and Gerontology, 16(S1), 132-139, 2016
  2. 2. Shimada C, Hirayama R, Nakazato K, Arai K, Ishizaki T, Aita K, Shimizu T, Inamatsu T, Takahashi R : What has become more acceptable? Continuity and changes in older adults' attitudes toward end-of-life care in Japan. Geriatrics and Gerontology International, 15(7), 927-930, 2015
  3. 3. Shimada C, Nakazato K, Arai K, Aita K, Shimizu T, Tsuruwaka M, Ishizaki T, Takahashi R : Communication with Important Others Regarding their Preferences for End-of-Life Care. Nihon Ronen Igakkai Zassi, 52(1):79-85, 2015
  4. 4. Hirayama R : Sons as caregivers for aging parents." Women and Career, 7, 24 - 30, 2015
  5. 5. Hirayama R. : Longitudinal changes in support sources for family caregivers: An examination on the association between family members' support and public care services." Japanese Journal of Gerontology, 36(1), 39 - 42, 2014
  6. 6. Shimada C, Horiuchi F, Tsuruwaka M, and Takahashi R : End-of-life care in Nursing Homes and Related Institutional Factors. Japanese Journal of Gerontology, 34(4), 500-509, 2013