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Abstract: The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor–employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. [Copyright &y& Elsevier]

Abstract: Homebound status is associated with poorer health and disability; however, the impact of community factors on the decision to remain homebound is unclear. We applied multilevel analyses to examine the association between neighborhood environment and homebound status among Japanese community-dwelling elderly. A cross-sectional survey was conducted in February 2009 using a mailed questionnaire. A total of 4123 participants aged 20years and over living in 72 small districts of Kashiwa, Japan, were randomly selected for the survey. Of the 1735 returned questionnaires, the 588 that were completed by individuals aged 65years and over were used for analysis. Frequency of going outdoors was assessed and respondents going outdoors once a week or less were defined as homebound. Neighborhood environment was assessed using three subscales of the Neighborhood Environment Walkability Scale (NEWS-A) (land use mix-access, aesthetics and crime safety). Multilevel logistic regression analysis indicated that the lower score of land use mix-access at the district level was associated with the elderly being homebound after adjustment for individual demographic data, physical, psychological and social factors and district prevalence of population aged 65years or more. This finding could contribute to devising a successful community-based strategy for homebound prevention of community-dwelling elderly individuals. [Copyright &y& Elsevier]

Abstract: Although an association between SA concentrations and mortality in the patients is well known, this association is not conclusive in elderly community-dwelling populations. We therefore attempted to determine whether this association could be extended to a Japanese 70-year-old community-dwelling population. Seventy-year-old subjects residing in Niigata City, Japan participated. Baseline examinations including a determination of SA concentrations were performed in June 1998 in 600 participants, and they were followed for 10 years. During the 10-year follow up, 80 subjects died. Albumin levels were divided into four groups (highest>45g/l, higher 43–44g/l, lower 41–42g/l, lowest <40g/l). The survival rate using Kaplan–Meier methods was longer in the highest and higher albumin groups than in the lowest and lower groups. No differences were found between the four groups in the mortalities from cancer, cardiovascular disease (CVD) or pneumonia. Individuals with the lowest albumin levels had 2.7 or 2.9 times higher total mortality, whether adjusted with confounding factors or not, using Cox regression analysis. The mortality hazard ratio (HR) found in the lowest group was compared to the highest group. In an elderly 70-year-old Japanese community-dwelling population, lower SA concentrations were an independent predictor of total mortality, but not mortality due to cancer, CVD, or pneumonia. [Copyright &y& Elsevier]

Abstract: This study aimed to examine useful items for screening the fall risk of community dwelling elderly from various perspectives, including fall experience, physical function level, and age level difference. 968 independently living elderly persons over the age of 60 (age: 70.0±7.0) responded to 80 fall risk items representing 7 factors (physical function, fall history, using devices, fear of falling and inactivity, dosing, disease and disability, and environment) and an ADL questionnaire. The high fall risk response rate was calculated for each item and tested for statistical significance among age groups and those with and without fall experience. Cramer''s V was calculated to examine the relationship between each item and the ADL. In addition, we selected items with significant differences in the high fall risk response rates between the faller and the non-faller groups, a significant relationship with ADL, and a significant difference among age groups. A total of 40 useful items were selected from each fall risk factor (decrease in physical function: 21 items, fall history: 2 items, device usage: 3 items, fear of falling and inactivity: 5 items, dosing: 0 items, disease and disability: 8 items, and environment: 1 item). Selected items can comprehensively and properly assess the fall risk of the healthy elderly as compared with existing questionnaires. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to determine the interrelationships between lower limb muscle performance, balance, gait and falls in older people using structural equation modeling. Study participants were two hundred and thirteen people aged 65 years and older (mean age, 80.0±7.1 years), who used day-care services in Japan. The outcome measures were the history of falls three months retrospectively and physical risk factors for falling, including performance in the chair stand test (CST), one-leg standing test (OLS), tandem walk test, 6m walking time, and the timed up-and-go (TUG) test. Thirty-nine (18.3%) of the 213 participants had fallen at least one or more times during the preceding 3 months. The fall group had significantly slower 6m walking speed and took significantly longer to undertake the TUG test than the non-fall group. In a structural equation model, performance in the CST contributed significantly to gait function, and low gait function was significantly and directly associated with falls in older people. This suggests that task-specific strength exercise as well as general mobility retraining should be important components of exercise programs designed to reduce falls in older people. [Copyright &y& Elsevier]

Abstract: Previous research suggests that water exercise (WE) improves bodily functions of the frail elderly, but there is as yet no research on the effect of once weekly WE. This study aims to compare the effects of once and twice weekly WE on bodily functions of frail elderly requiring nursing care in six months. The design is a prospective cohort study. Participants were assigned to two different exercise groups (once weekly group or twice weekly group; n =35). Once weekly group participate in a 60-min exercise session once a week, for six months while twice weekly group attended the session twice a week. Exercise sessions were divided into a 10-min warm-up on land and 50min of exercise in water. The 50-min WE program consisted of 20min walking, 10min activities of daily living (ADL) exercise, 10min stretching and strength exercises, and 10min relaxation in water. Muscle strength, flexibility, balance, mobility and ADL disability were measured before the beginning of intervention and three months and six months after the program had started. Significant differences between the once and twice weekly groups were found in flexibility and balance at 3-months and 6-months and lower muscle strength and ADL disability only at 3-months. These results from present study suggested that the effects of WE frequency in the fail elderly who require nursing care were different for each bodily function. [Copyright &y& Elsevier]

Abstract: Studies have associated hearing impairment with adverse health outcomes, but the actual impact of hearing difficulty has been barely investigated. We investigated among older adults (i) the prevalence of hearing difficulty, (ii) the association of hearing difficulty with a composite outcome of dependence in activities of daily living (ADL) and death, and (iii) the population attributable risk fraction (PAF) of hearing difficulty. In 2005, a home-visit survey of 1364 Japanese older adults aged ≥65 (participation proportion=95.5%) was conducted to evaluate self-reports of hearing difficulty. Over 3 years, 99.4% of the initial sample was followed. Outcomes were measured by incidence of death or dependence in ADL. In the sample, the prevalence of hearing difficulty was 17.7% (age ≥65) and 25.7% (age ≥75). Hearing difficulty at high levels was associated with a composite outcome of dependence in ADL and mortality (adjusted odds ratio=OR and 95% confidence interval=95% CI=6.19 (1.92–19.92)) as well as with each outcome independently. Improving the hearing difficulty from high to moderate or no difficulty would reduce the composite outcome in 4.3% (age ≥65) and in 6.3% (age ≥75) of the target population. In conclusion, hearing difficulty was common, was associated with and had substantial impact on adverse health outcomes. [Copyright &y& Elsevier]

Abstract: Physical activity in the elderly has a significant influence on their health status. Studies have shown that elderly caregivers have fewer physical activities relative to non-caregivers. The present study aimed to identify factors associated with lower physical activity in elderly caregivers of demented patients. A cross-sectional survey of 50 elderly caregivers living with patients diagnosed with Alzheimer''s-type dementia showed that the Zarit caregiver burden interview (ZBI) scores were significant predictors of physical activity measured by the questionnaire score (QS) of physical activities. Among the three subscales of the QS, it was only leisure time activity scores (LS) that the ZBI scores significantly predicted. The numbers of chronic diseases were associated with lower household activity scores (HS) and sport activities scores (SS). Physical activities, in particular leisure activities, were found to be inversely associated with care burden assessed by the ZBI. Interventions to increase the physical activity levels of older caregivers may improve their health status and quality of life. [Copyright &y& Elsevier]

Abstract: Meeting the information needs of family caregivers in a timely and appropriate way is a key concern of home care. The present study aimed to explore the following two areas: (a) the priority information needs and sources of family caregivers of home elderly patients and (b) the differences in information needs according to severity of dementia. The subjects were 475 family caregivers of home elderly patients residing in Nagoya city. Data was collected through questionnaires. Severity of dementia was evaluated according to the criteria of the public long-term care insurance policy (levels 0–5). The top 3 items they perceived as of most concern were dementia, first aid, and available public long-term care insurance services. A few respondents felt the need for information on public long-term care insurance services. Nearly half of the caregivers were interested in food and nutrition. The respondents were more likely to receive information from their care managers or physicians than any other source. Caregivers of elderly dependents with severe dementia reported a greater need for information on the spread of dementia, dementia-specific care, or the negative effects of dementia on family and neighborhood. Our results provide useful information on how family caregivers should be educated. [Copyright &y& Elsevier]

Abstract: The aim of this study was to clarify the relationship between dental occlusion and physical fitness by a longitudinal survey. A sample of 348 subjects (171 men and 177 women) aged 71 was investigated by Eichner index (EI) as an occlusal condition (Class A: no loss; Class B: partial loss; Class C: complete loss) and five types of physical fitness tests and were re-examined 8 years later. The upper 50% were sampled to analyze the correlation between each physical fitness decline and the EI at the baseline by logistic regression models. Logistic regression analyses revealed that leg extensor power (Class B vs. Class A; odds ratio=OR=4.61, p =0.010) and one-leg standing time with eyes open (Class C vs. Class A; OR=4.27, p =0.031) showed significant correlations with the EI at the baseline. In this study, partial or complete loss of occlusion was associated with a decline in leg extensor power or a decrease in one-leg standing time with eyes open. These findings suggest that maintenance of dental occlusion may prevent a decrease in activities of daily living in the elderly. [Copyright &y& Elsevier]

Abstract: Although a number of studies have examined depression risk factors for elderly persons, little attention has been paid to the prediction of individuals at risk. This study constructed a predictive model for discrimination between individuals at a higher risk of depression and normal subjects in Japanese community-dwelling elderly persons, using linear discriminant analysis. Data were collected from 754 non-institutionalized elderly men and women aged 65 years and older living in the community in Japan, using face-to-face interviews in 2002. Stepwise linear discrimination analysis was used to construct a predictive model to select individuals who have a higher risk of depression. The stepwise discriminant analysis selected the five predictor variables (frequent hearing problems, poor appetite, less financial leeway, low emotional support and less subjective usefulness) and yielded a statistically significant function (λ =0.816; χ 2 =113.0, df=5, p <0.001). This function showed that the rate of correct prediction was 78.2% for depressed. The calculated discriminate function based on the above five predictor variables (hearing problem, less appetite, less financial leeway, low emotional support and less subjective usefulness) is useful for detecting individuals at high risk of depression and preventing its development among community-dwelling elderly persons. Prospective studies are needed to confirm the validity and feasibility of the model for earlier screening for depression among such people. [Copyright &y& Elsevier]

This study assessed the effects of multidimensional exercises on functional decline, urinary incontinence, and fear of falling in community-dwelling Japanese elderly women with multiple symptoms of geriatric syndrome (MSGS). Sixty-one participants were randomly assigned either to an intervention (n =31) or to a control group (n =30). For 3-month period, the intervention group received multidimensional exercise, twice a week, aiming to increase the muscle strength, walking ability, and pelvic floor muscle (PFM). Outcome variables were measured at baseline, and after intervention and follow-up. The functional decline of the intervention group decreased from 50.0% at baseline to 16.7% after intervention and follow-up (Q =16.67, p <0.001). For urinary incontinence, the intervention group decreased from 66.7% at baseline to 23.3% after intervention and 40.0% at follow-up (Q =13.56, p =0.001), whereas the control group showed no improvement. Intervention group showed greater and significant decrease in the score of MSGS compared to control group (F =12.66, p =0.001). Within the subjects that showed improvement to normal status of MSGS, a significantly higher proportion demonstrated increased maximum walking speed at follow-up (Q =6.50, p =0.039). These results suggest that multidimensional exercise is an effective strategy for reducing geriatric syndromes in elderly population. An increase in walking ability may contribute to the improvement of MSGS. [Copyright &y& Elsevier]

Abstract: We aimed to compare and identify high and low risk of frailty in community-dwelling older women by using five mobility performance tests. The participants were 166 older women at high risk and 171 age-matched controls at low risk of frailty according to the long-term care insurance (LTCI) system (age: 65–90 years). The mobility performance tests included 5-chair sit-to-stand (STS), alternate step, timed up-and-go (TUG), timed rapid gait (TRG), and usual gait speed (UGS). Data analysis showed that high-risk individuals (81.9%) were more likely to be pre-frail than low-risk individuals (55.0%) by Fried''s frailty phenotype. The four mobility performance tests, except the 5-chair STS, had the largest areas under the curve (AUC) for discriminating older women at high and low risk (AUC>0.80, p <0.001). The optimal cutpoint (6s) for the TRG test had the highest sensitivity (78%) and specificity (83%) in identifying high risk of frailty. Our results suggest that walking ability tests are clinically useful in screening older individuals at high risk of frailty. In particular, the TRG test is more likely than other tests to discriminate older women at high risk of frailty based on the LTCI system. [Copyright &y& Elsevier]

Abstract: Inflammatory cytokines may contribute to lower physical function in elderly. The purpose of this study was to clarify the relation between circulating level of C-reactive protein (CRP) and physical performance among the community-dwelling elderly in Japan. Participants were 803 (329 men and 474 women) aged 65 years and over. Four physical performances were assessed using hand-grip strength, length of time standing on one leg, and walking speed (usual and maximal). Low physical performance was defined as the lowest 25% of study sample in each sex. Multiple logistic regression analysis showed that CRP was negatively associated with physical performance in hand-grip strength (odds ratio=OR=1.86, 95% confidence interval=95% CI=1.32–3.05, OR=2.92, 95% CI=1.53–5.58, for the middle and highest, respectively), time of one leg standing (OR=1.96, 95% CI=1.28–3.00, OR=2.16, 95% CI=1.19–3.92, for the middle and highest, respectively) and maximal walking speed (OR=2.46, 95% CI=1.23–4.93, for the highest) when adjusted for the confounding factors. The results showed the negatively associated between CRP level and physical performance when adjusted for the confounding factors. CRP level may be a useful indicator for detecting the lower physical performance in elderly. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people. [ABSTRACT FROM AUTHOR]