[Managing heat stroke in long-term care facilities: A text mining analysis of interview data]

Objectives　Rising heat stress due to climate change has increased the urgency of developing resilient long-term care systems for older adults. This study examined preparedness for heat-related risks in Japanese nursing homes.Methods　This qualitative descriptive study used semi-structured interviews with eight nursing home managers across four regions of Japan: Tohoku, Kanto, Chubu, and Kyushu. Interviews addressed six domains: recognition of extreme heat as a crisis and its impact on care delivery; heat stroke prevention strategies; implementation challenges; essential prevention requirements; gaps in current practices; and concerns about future risks from heat and other disasters. Data were analyzed through text mining using KH Coder (version 3.02).Results　Co-occurrence network analysis identified 10 semantic subgraphs, categorized into three domains. (1) Heat perception included "limitations on outdoor activities" as a measure and "risk of heat-related illness" as a challenge. (2) Living environment management included "indoor temperature management," "ensuring airflow," and "maintenance of air conditioning system" as measures, and "managing localized temperature variations" and "increased electricity consumption and risk of power outages" as challenges. (3) Workload burden included "providing hydration to residents" and "differences in temperature perception between older adult residents and caregivers" as challenges.Conclusion　Preventive measures, including temperature control and adequate hydration, are implemented but increase caregiver workload as temperatures rise. Sustaining long-term care services under these conditions requires strategies that reduce routine staff burden.