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Purpose. This study aims to elucidate the gender gaps in the strategies for maintaining the social participation and interaction of older adults with people in a local community. Methods. The subjects were 130 older adults aged 65 years or older and independently living in their homes in Saitama, Saitama Prefecture, Japan. The authors conducted an anonymous questionnaire survey on paper and performed multiple regression analysis for men and women separately using the Lubben Social Network Scale-6 (LSNS-6) as the dependent variable. Results. Among the independent variables used for the analysis, those that significantly influenced LSNS-6 in men were social activities related to the daily life satisfaction of the elderly (SARDS). The independent variables that significantly influenced LSNS-6 in women were SARDS, sense of coherence-13 (SOC-13), and the number of family members living with the subjects. Discussion. Health promotion is not associated with interaction with people in men compared with women. [ABSTRACT FROM AUTHOR]

This study examined the interaction of living alone and cognitive decline in relation to the well-being of older men and women. We analyzed the data from a cross-sectional, self-administered questionnaire survey of community-dwelling older adults in Tokyo, who were aged 65+ and not on long-term care. The questionnaire included the 10-item self-administered dementia checklist (SDC), the WHO-5 Well-Being Scale, a question on their living arrangement, and participants' baseline characteristics and social support and social contact. The analyses were stratified by sex and fitted with linear regression models with interaction. A total of 34,255 men and 41,056 women participated. Sample mean age was 73.5 (SD 6.1) for men and 73.6 (SD 6.0) for women, and 18.5% and 26.0% lived alone. The distribution of SDC scores indicated 95.9% and 97.0% had a cognitive status varying from intact to possible mild dementia. Cognitive decline showed a linear association with lower well-being in men (beta −0.53; 95% CI −0.58, −0.48; p < 0.001) and women (beta −0.38; 95% CI −0.42, −0.34; p < 0.001). Compared to men and women living with others, those living alone experienced lower well-being as their cognitive function declined, and the interactions (living arrangements ∗ SDC) were statistically significant. After controlling participants' characteristics and social support and social contact, the interaction was significant in men (p < 0.001) but not in women (p = 0.46). Our findings support that older men and women living alone experience a slightly steeper downward trajectory of cognitive decline and poor well-being than their counterparts living with others. The unequivocal effects of controlling confounding factors between men and women indicate the need for gendered countermeasures by welfare services. [ABSTRACT FROM AUTHOR]

Enhancing the voluntary supportive actions of older adults towards other community‐dwelling citizens is an important measure for a healthy community. Volunteering action in adulthood is related to the volunteering actions of older adults' parents, which they remember from their youth. In this study, the association between parents' former voluntary supportive actions and the current voluntary supportive actions of older adults is explored. Questionnaires were distributed to community‐dwelling citizens aged 65 years and above, in Tokamachi city, Niigata Prefecture, Japan (response rate: 81.7%). Participants self‐reported their current voluntary supportive actions and reported on their parents' former voluntary actions during their youth. The results indicated that the current voluntary supportive actions of the study participants were related to the former voluntary actions of their parents (OR: 2.28, 95% CI: 1.62–3.20). Moreover, the participants were more likely to extend support in contexts which are more closely related to one's private life, only when their parents provided support in those private contexts. The study provides implications for the importance of considering life experiences when facilitating voluntary supportive actions and renders information on how unique strategies should to be implemented to involve individuals who are unfamiliar with volunteering actions. [ABSTRACT FROM AUTHOR]

Family caregivers provide long‐term, home‐based, informal medical care to patients with special healthcare needs. We examined whether informal care involving medical device use is associated with caregiver burden, considering potential risk variables as moderators. Data were collected from March to May 2019 through a Japanese public visiting care system. This system is offered to patients with severe chronic or intractable disease or impairment. After contacting government‐certified offices that provide visiting care systems, the offices that agreed to participate invited dyads of patients and caregivers to complete our questionnaire. To focus on new parameters other than the caregiver factor that had been clarified previously, we aimed to analyse the data from patient–caregiver dyads. Using a questionnaire‐based cross‐sectional design, we asked participants about caregiver and patient characteristics, care types, and caregiver burden using the Zarit Caregiver Burden Interview. Logistic regression analyses were conducted to test the association between caregiver burden and informal medical care. Data from 371 complete patient–caregiver dyads were analysed; 49.3% showed high caregiver burden, and 40.4% were administering at least one informal medical care procedure. Univariate analyses indicated a relationship between high caregiver burden among caregivers who slept less, provided care for longer periods daily, performed medical care procedures and cohabited with patients. Importantly, logistic regression analyses indicated a significant relationship between high caregiver burden and care involving multiple medical procedures (i.e. 4–6 procedures with medical devices; adjusted odds ratio (AOR) = 2.03, 95% confidence intervals (95% CI) = [1.01, 4.09]). In propensity‐matched participants (n = 314), results continued to show that multiple medical care procedures were significantly related to high caregiver burden (AOR = 2.19, 95% CI [1.14–4.22]). The effects of non‐medical informal care on caregiver burden were moderate. This result suggests that more intensive interventions are required for patients with multiple medical care needs to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

Older adults' preference regarding where they want to spend their end‐of‐life (EOL) has been reported to be a significant predictor of the actual EOL location. Home‐care nurses have often been reported to try involving single older adults' neighbours in the support network of the older adults (community involvement activities) to allow them to stay at home. Hence, nurses' community involvement activities may be among the significant factors of older adults' preference to stay at home during EOL. Therefore, this study explored home‐care nurses' community involvement activities and its association with single older adults' EOL preference. A cross‐sectional questionnaire survey was conducted with older adults (aged 65 years or older) who lived alone and used home‐care nursing services for more than 6 months, their home‐care nurses, and managers of their home‐care nursing agencies. Questions included participants' characteristics, nurses' community involvement activities and older adults' preference to remain at home during EOL. We conducted multiple logistic regression analyses to explore the relationship between nurses' community involvement activities and older adults' preference to remain at home during EOL while controlling for their demographic variables. In total, 103 pairs of home‐care nurses and single older adults from 27 home‐care nursing agencies participated. Approximately 70% of older adults preferred to remain at home during EOL, and 50% of nurses implemented community involvement activities. Older adults' preference to remain at home during EOL was associated with implementation of community involvement activities (Odds Ratio [OR]: 3.4; 95% Confidence Interval [95%CI]:1.1–9.8), home‐care nurses' higher practical clinical ability (OR: 1.4, 95%CI:1.0–1.8), and older adult's longer use of home‐care nursing service (OR: 2.2, 95%CI:1.2–4.1). Community involvement activities may be essential in helping single older adults to stay at home as per their preference for EOL. [ABSTRACT FROM AUTHOR]

Abstract: Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end‐of‐life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual‐ and facility‐level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency‐level factors. The other 28 studies identified individual‐level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in‐facility resident deaths were associated with healthcare service provision, confirmation of resident/family end‐of‐life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. [ABSTRACT FROM AUTHOR]

Studies of aspirational ideals of medical care generally focus on patients rather than on ordinary people receiving or not receiving medications at the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medical care as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20 years or more in one of the four types of communities classified as either 'metropolitan area', 'provincial city', 'mountain/fishing village' or 'remote island' in Japan. Interviews were transcribed from digital audio recordings and then analysed (in tandem with non-verbal data including participants' appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medical care. The common themes observed among the four community types included 'peace of mind because of the availability of medical care' and 'trust in medical professionals'. Themes that were characteristic of urban communities were the tendency to focus on the content of medical care, including 'high-level medical care', 'elimination of unnecessary medical care' and 'faster, cheaper medical care', whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medical care such as 'support for local lifestyles', 'locally appropriate standards of medical care' and 'being free from dependence on medical care'. The sense of ideal medical care in urban communities tended to centre around the satisfaction with the content of medical care, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medical care from the geographical point of view, we found out the significant relationship between communities and perceptions of medical care ideals. [ABSTRACT FROM AUTHOR]

Limited time away from the child is cited as the main factor that increases the burden for the primary caregiver of severely disabled children. The aim of this study was to quantitatively elucidate the factors related to the desire to use social services and the actual use of respite care services by the primary caregivers of severely disabled children in Japan. In this study, we investigated the use of respite care services in accordance with the primary caregivers' wishes by examining inhibiting or promoting factors associated with respite care service use only among those who wished to use social services. A total of 169 Japanese mothers participated and answered the questionnaires. We conducted a logistic regression analysis and a multiple regression analysis to investigate the factors related to respite care service use. The most important factors affecting a primary caregiver's desire to use social services were the belief that the child would enjoy using social services and the family's approval of the social service use. The most important factors affecting respite care service use were the family's approval of the use and a large care burden on the primary caregiver. Respite care services should be sought out before the care burden becomes too great to enable the primary caregiver to more easily contribute to the continuation of home care. A background of mother-child separation anxiety disrupted the use of respite care. However, believing that the child enjoys using social services may reduce primary caregivers' psychological resistance to being separated from their child, which is supported by tradition. Thus, it is also important for respite care service providers to provide information about the children to their primary caregivers and families while they are using respite care services. [ABSTRACT FROM AUTHOR]