Factors Related to Care Managers’ Experiences of Making Proxy Decisions about Older Adults Living Alone: A Cross-Sectional Study

Round 1

Reviewer 1 Report

It was a pleasure reading and learning from your work. Very sound, and thoroughly articulated. I strongly believe this study holds scholarly merit to the research community and the care of the older adult population. While I commend the efforts of the authors, I have a few comments and concerns which I think will enhance the quality and readability of this wonderful piece if considered and addressed. Wish you the best! See comments below:

Reviewer comments NR

 

 

Introduction

 

“The global population is aging rapidly, and the largest increase is in individuals aged over 65 years”

 

Provide a citation for this claim please.

 

“As of October 2020, the population of 65-year-olds in Japan comprised 28.8% of the total population, and it is estimated that this population will continue to increase until 2042. [2] The number of older adults living alone continues to increase, and the ratio of older adults living alone to the population of 65-year-olds increased from approximately 15% in 1980 to approximately 35% in 2015 [3].”

 

This statement is redundant being you have established the rising older adult population in preceding sentences.

 

“Advance care planning interventions have been reported to have a positive effect on the quality of end-of-life care in older adults [14,15]. Advance care planning for older adults has been demonstrated to reduce stress, depression, and anxiety in surviving family members [16].”

 

These two sentences ca be combined into one to aid readability.

 

 

Methods

 

Confirm your use of the term binomial logistic regression to mean multivariate logistic regression. The term is understood synonymous to univariate in some circles. It would be good to clarify like you did on line 150-152.

 

Discussion

“Considering that most care managers have more than 5 years of experience [22], it is likely that the participants in this study were representative of the general care manager population”

 

This statement throws me off because you have more participants with ≥10 years work experience. Can you further explain how this statement is implicated in the context of your work? I don’t agree it with this rationale for non-generalization.

 

“For older adults living alone who can perform administrative tasks, care manager relative evaluation that identifies cognitive decline may indicate a prodromal state in which clients are unable to decide the direction of their own lives. “

Was the definition for making administrative task tied to cognitive deficits only in your study? Or are you implying cognitive frailty among older adult residents in LTC homes because of their inability to carry out administrative task? I find that a bold statement to make giving that was not the case finding in your study. Did you consider other physical, and non-physical (including co-morbidities or multimorbid) conditions that influence cognition asides cognitive frailty?

 

“Given the above, it is important for care managers to monitor older adults living alone for early signs of an inability to make decisions about life direction and take early preventative measures.” And

“In Japan, where the number of older adults living alone continues to increase, a new monitoring perspective may be important to enable older adults living alone to lead decisions about the final stages of their life.”

 

Great points you raised in the anteceding sentences here and valid too. Just worried the conclusion in the above doesn’t tie to the findings in your study per say (or did you find this from previous studies?). Can you rephrase or recommend other strategies based on your study findings and use this statement to support it?

 

References

 

Revise references for especially #1,#2. #3, #4, and other web-based citations. Ensure journal citations have journals not abbreviated and respective dois where possible.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Author/s,

 

Your topic is actual, but your manucript can be improve if you clearly present how you choosen participants, present references and reliability for the questionnaire, presented how you decided which factors you will included. 

In Discussion you have to clearly present and discussed about your the most important results according to your aim.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

please see attached file 

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

I have reviewed the revised manuscript. The revisions answer all the queries and suggested amendments. I consider that the revised manuscript is now suitable for publication

Author Response

Dear Academic Editor, 

We have revised data availability as follows: 
The data presented in this study are available on request from the corresponding author.

We have added STROBE reporting guidelines for observational research as follows: 
The study is reported according to STROBE reporting guidelines for observational research [29,30].

Author Response File: Author Response.docx