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Several studies have demonstrated that the loss of a sense of one's own self-worth has an influence on the health status, psychological functioning, and quality of life in the aged. We used longitudinal data from 784 elderly residents (mean age = 73 years) to examine the relationship between subjective usefulness and 6-year mortality. We hypothesized that subjective usefulness is an important indicator of quality of life among the elderly population, and subsequently of mortality. We elicited information on subjective usefulness at baseline by using a self-administered questionnaire. Results of longitudinal analyses showed that subjective usefulness may be significantly associated with self-rated health and subsequent mortality. This indicates that subjective usefulness plays an important role in enhancing survival in the elderly population.

Background: Vision and hearing impairments among elders are common, and cognitive impairment is a concern. This study assessed the association of vision and hearing impairments with cognitive impairment and mortality among long-term care recipients.Methods: Data of 1754 adults aged 65 or older were included in analysis from the Gujo City Long-Term Care Insurance Database in Japan for a mean follow-up period of 4.7 years. Trained and certified investigators assessed sensory impairments and cognitive impairment using a national assessment tool. Five-level scales were used to measure vision and hearing impairments. Cognitive performance was assessed on two dimensions, namely communication/cognition and problem behaviors. We performed logistic regression analysis to estimate odd ratios (ORs) and 95 % confidence intervals (CIs) for the association of vision and hearing impairments with cognitive impairment. Using Cox proportional hazard regression models, we obtained hazard ratios (HRs) for mortality.Results: Of 1754 elders, 773 (44.0 %) had normal sensory function, 252 (14.4 %) vision impairment, 409 (23.3 %) hearing impairment, and 320 (18.2 %) dual sensory impairment. After adjusting for potential cofounders, ORs of cognitive impairment were 1.46 (95 % CI 1.07-1.98) in individuals with vision impairment, 1.47 (95 % CI 1.13-1.92) in those with hearing impairment, and 1.97 (95 % CI 1.46-2.65) in those with dual sensory impairment compared to individuals with normal sensory function. The adjusted HR of overall mortality was 1.29 (95 % CI 1.01-1.65) in individuals with dual sensory impairment and cognitive impairment relative to normal sensory and cognitive functions.Conclusions: Cognitive impairment was most common in individuals with dual sensory impairment, and those with dual sensory impairment and cognitive impairment had increased mortality. [ABSTRACT FROM AUTHOR]

Therapeutic communication and interpersonal relationships in care homes can help people to improve their mental wellbeing. Assessment of the efficacy of these dynamic and complex processes are necessary for psychosocial planning and management. This paper presents a pilot application of photoplethysmography in synchronized physiological measurements of communications between the care-giver and people with dementia. Signal-based evaluations of the therapy can be carried out using the measures of spectral distortion and the inference of phylogenetic trees. The proposed computational models can be of assistance and cost-effectiveness in caring for and monitoring people with cognitive decline. [ABSTRACT FROM AUTHOR]

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]

Abstract: This study sought to determine the factors associated with subjective health in caregivers of the frail elderly living at home, using multivariate regression analysis. Data were collected from 130 caregivers of frail elderly persons listed on a roster for utilization of day service or short stay service from two Home Visit Nursing Care Stations, using self-administered questionnaire from January to February of 2005. Family caregivers were defined as co-residents family members who provided a minimum of 1h of daily care for at least 3 months. Multiple logistic regression analysis was performed to examine the factors associated with subjective health in caregivers of the frail elderly at home. Subjects with good health had less depressive symptom (p =0.001), much emotional support (p =0.003) and low caregiver burden (p =0.03). Multivariate logistic regression analysis showed good health had a significantly positive association with only much emotional support after adjustment for confounders. Of the total effect of emotional support on subjective health, the direct effect (84.7%) was much greater than the indirect effect (15.3%). Results indicate that much emotional support from family member for caregiver is essential for better subjective health in caregivers. [Copyright &y& Elsevier]

Purpose: We examined the associations between lifestyle factors and the risk of amyotrophic lateral sclerosis (ALS) using a case-control study in Aichi Prefecture, Japan. Methods: The study comprised 183 ALS patients diagnosed by the El Escorial World Federation of Neurology criteria as well as 366 gender- and age-matched controls randomly selected from the general population with the use of the basic register of residents. Detailed information on lifestyle factors was obtained through a mailed self-administered questionnaire. The strength of association between ALS and a potential risk factor was assessed by calculating odds ratios (ORs) and 95% confidence intervals (CIs). Results: Vigorous physical activity, self reported stress, a type A behavior pattern, and less frequent intakes of green-yellow vegetables were significantly associated with increased risk of ALS, whereas smoking and drinking habits were not. The greatest effect on risk for ALS was posed by the combination of a type A behavior pattern and less frequent intakes of green-yellow vegetables (adjusted OR, 11.2; 95% CI, 3.8 to 33.0). Conclusion: These data suggested that imbalances between excessive productions of oxidants as patient-specific factors and a diminished or missing antioxidant defense system in motor neurons may increase the risk of ALS. [Copyright &y& Elsevier]

Abstract: The aim of this study is to determine the relationship between life worth living and caregiver burden among caregivers in Japan. We used 111 caregivers of frail elders who completed a self-administered questionnaire including the 8 items developed by Arai et al. (J-ZBI) used as a scale to measure subjective burdens and psychological factors used as covariates other than life worth living. Total score (0–32) of the J-ZBI was dichotomized into “high burden” (≥21 points) and “low burden” (<21 points). Multivariate logistic regression analysis revealed that only life worth living was significantly associated with caregiver burden. The direct effect of life worth living on caregiver burden (92.9%) was much greater than the indirect effect (7.1%). Our findings suggest that the increase of the sense of life worth living may play an important role in the prevention of the development of caregiver burden. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to investigate the relationship between SRH and mortality among 784 non-institutionalized community-living elderly in Japan from 1995 to 2001. The data were collected by face-to-face interviews. The direct effect was estimated by the ratio of regression coefficient of two adjacent models (full model entered all covariates to total effect of SRH), and composed of the direct and indirect effect. Cox analysis stratified by gender was employed to examine the relationship between SRH and mortality. At follow-up in 2001, 148 (18.9%) died, and 636 (81.1%) were alive. Mortality rates were significantly increased with worsening SRH responses for men, but not for women. Men had a significant dose–response association between SRH and mortality, in comparison with fair or poor SRH, the odds ratio for good SRH were multiplied by 0.63 and 0.48, respectively. The magnitude of the direct effect of SRH on mortality was much larger in men (95.7%) than in women (52.5%). These findings suggest that SRH may be more strongly and directly associated with mortality in men, compared to women. Further researches are needed to explore the relationship between the changes in SRH and mortality among elderly people. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to examine cross-sectionally the factors associated with appetite among the elderly persons living in the community in Japan. The subjects of this study were 754 non-institutionalized elderly men and women aged 65 years and older living in community in Japan. The data were collected by face-to-face interviews. The factors related to subjective health was examined using multiple logistic regression analyses. Four hundred and forty-nine (56.4%) participants evaluated appetite as very good; 239 (30.0%) as somewhat good; 92 (11.6%) as little/not at all. Subjects with good appetite were more physically active, had less depressive symptoms, subjective stress, much more communication with family and much more social support, as compared to those without appetite. Appetite was significantly associated with better subjective good health after controlling for other variables in the model. Only communication with family was significantly associated with good appetite after controlling for other variables (odds ratio, OR=2.43; 95% confidence interval, CI=1.30–4.74). The indirect effect of communication with family on appetite was much greater than the direct effect. These findings suggest that communication with family may be beneficial promoter of the appetite in the elderly. [Copyright &y& Elsevier]

Abstract: The aim of this study is to examine gender differences in the factors associated with 6-year mortality among 784 elderly residents (mean age=73 years) in Japan from 1995 (baseline) to 2001. Survival status during 6 years of follow-up was confirmed by either inquiries of older participants or family members or data from official death certificates, or both in 2001. Information on variables associated with mortality was elicited by using a face-to-face interview at baseline (1995). Results of longitudinal analyses showed that self-rated health (SRH) was not an independent predictor of mortality among men or women after adjustment of the other factors. Instead of SRH, having much feeling of usefulness among men and being married among women were significantly associated with increased mortality risk, suggesting that these findings may play an important role in enhancing survival in the elderly. [Copyright &y& Elsevier]

Only a few human studies have reported the relationship between dietary factors and the risk of amyotrophic lateral sclerosis (ALS). We therefore analyzed the relationship between macronutrients (carbohydrate, protein and fat) and the risk of ALS using a case-control study in Japan. The study comprised 153 ALS patients diagnosed by the El Escorial World Federation of Neurology criteria, and 306 gender- and age- matched controls randomly selected from the general population. A self-administered food frequency questionnaire was used to estimate pre-illness intakes of food groups and nutrients. The strength of association between ALS and a potential risk factor was assessed by calculating odds ratios (ORs) and 95% confidence intervals (CIs). A high intake of carbohydrate was significantly associated with an increased risk of ALS (adjusted OR = 2.14, 95% CI 1.05-4.36; the highest versus the lowest tertile). ORs for the second and third tertile of total fat were 0.57 and 0.41 (95% CI 0.21-0.80), respectively. ORs for the highest tertile of intake versus the lowest were 0.41 (95% CI 0.21-0.80) for total fat, 0.30 (95% CI 0.16-0.5) for saturated fatty acids (SFAs), 0.35 (95% CI 0.18-0.69) for monounsaturated fatty acids (MUFAs) and 0.58 (95%CI 0.40-0.96) for polyunsaturated fatty acids (PUFAs). Our findings suggest that high intakes of carbohydrate and low intakes of fat and some kinds of fatty acids may, when combined, increased the risk of ALS. [ABSTRACT FROM AUTHOR]

The incidence of ALS in Wakayama Prefecture has been markedly higher than that elsewhere in the world. Recently, however, the incidence has gradually decreased, especially in men, and the age at onset has shifted to the elderly, indicating the possible role of exogenous factors in the development of ALS. To evaluate factors related to the disease, we conducted a retrospective study. This study examined 108 patients with definite ALS diagnosed according to El Escorial criteria and 302 neurological controls (older than 40 years old) consecutively admitted to Wakayama Medical Hospital between 1999 and 2004. Having past history of cervical spondylosis or spinal spondylotic myelopathy (CS/SSM) with/without surgical treatment, cervical MRI findings, history of bone fracture, and occupation at onset were compared between the ALS patients and the neurological controls. Among 108 ALS patients, 45.4% had past history of CS/SSM compared to 19.4% of the neurological controls (p<0.0001, OR: 3.725, 95% CI 2.173-6.387). Among the ALS patients, 13% had had surgical treatment for CS/SSM, which was significantly higher than the 4.3% of the neurological controls (p<0.003, OR: 4.333, 95% CI 1.647-11.401). Cervical MRI findings were classified into four grades according to the severity of canal narrowing and compression of the spinal cord. Regarding cervical MRI findings, the percentage of ALS patients who showed canal narrowing and compression of the spinal cord was significantly higher than that of the controls (ALS: 72.0%, the controls: 29.5%, OR: 4.799, 95% CI 2.65-8.70). Comparison of the occupation at disease onset revealed that primary and secondary industrial occupations significantly increased the risk of ALS (2.69, 95% CI 1.40-5.16, 2.81, 95% CI 1.45-5.46, respectively). Conversely, tertiary industrial occupations significantly decreased the risk of ALS (age- and sex-adjusted OR: 0.54, 95% CI 0.30-0.98). In conclusion, CS/SSM, surgical treatment for CS/SSM and occupation at onset are suspected to be risk factors for developing/triggering or worsening ALS. [ABSTRACT FROM AUTHOR]

Purpose: A case-control study was conducted in Japan to examine the joint effects of oxidative stress and antioxidants on the risk of subarachnoid hemorrhage (SAH). Methods: The study included 201 consecutive patients with first spontaneous SAH aged 30 to 79 years who had aneurysm(s) confirmed by angiography and/or computed tomographic scan and were admitted to two medical hospitals in Nagoya, Japan, from April 1992 to March 1997. Community control subjects were identified and matched to each case by gender and age (±2 years). Conditional logistic regression modeling was used to compute odds ratios (ORs) adjusted for body mass index, physical activity, family history of SAH, a history of hypertension, drinking habit, and frequency of green-yellow vegetables and fruits, and tea consumption. Results: The greatest risk for SAH was posed by combination of current smoking and a less frequent intake of soy products (adjusted OR = 5.3; 95% confidence interval [CI], 2.0 to 14.3). Less frequent intake of soy products significantly elevated SAH risk, independent of smoking habits. Conclusion: These data suggested that enhancement of the antioxidant defense system such as much intake of soy products may be important in preventing SAH rather than the reduction of such oxidants as smoking. Our findings should prove useful for targeting individuals/populations in programs for primary prevention of SAH. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to examine the factors associated with life expectancy at the age of 65 years used as the index of longevity, using published data in Japan. Life expectancy at the age of 65 years was obtained from the 19th life table in 2000 published by the Ministry of Health, Labour and Welfare of Japan. The associations between life expectancy at the age of 65 years and environmental factors were assessed by Spearman correlation coefficients. Life expectancy at the age of 65 years was higher in females (22.54 years) than in males (17.42 years). In this study, the number of public health nurses and leisure time per day were found significantly associated with life expectancy at the age of 65 years in both men and women. For men, life expectancy at the age of 65 years was significantly associated with leisure time for sports and exercises and higher proportion of participation in volunteer activities in the community; for women, it was associated with a higher number of hospitals and proportion of participation in educational classes for the aged. Our ecological study might provide some clues to more practical planning for longevity in consideration of gender differences. [Copyright &y& Elsevier]

Background. Adequate vitamin C (AsA) intake may lower the risk of arteriosclerotic cardiovascular disease, but little is known about its influence on the progression of atherogenic disease in the elderly.Methods. We examined whether AsA intake was associated with serum lipids, apolipoprotein A-1 (ApoA1) and apolipoprotein B (ApoB), in 680 Japanese elderly persons.Results. There were no significant gender differences among mean serum lipids and apolipoprotein concentrations and intakes of macronutrients. AsA intake had a significant positive association with serum concentrations of high-density cholesterol and ApoA1, but an inverse association with serum concentrations of low-density cholesterol and ApoB, after adjusting for age, body mass index, total energy, and macronutrients. AsA intake was strongly inversely related to ApoA1/ApoB.Conclusion. Increased AsA intake could play an important role in lipid composition and could be of potential importance in the genesis and prevention of atherogenic disease in the elderly. [Copyright &y& Elsevier]

Abstract: In order to classify the caregivers at high risk of increase in their burden early, linear discriminant analysis was performed to obtain an effective discriminant model for differentiation of the presence or absence of increase in caregiver burden. The data obtained by self-administered questionnaire from 193 caregivers of frail elderly from January to February of 2005 were used. The discriminant analysis yielded a statistically significant function explaining 35.0% (Rc=0.59; d.f.=6; p =0.0001). The configuration indicated that the psychological predictors of change in caregiver burden with much perceived stress (1.47), high caregiver burden at baseline (1.28), emotional control (0.75), effort to achieve (−0.28), symptomatic depression (0.20) and “ikigai” (purpose in life) (0.18) made statistically significant contributions to the differentiation between no increase and increase in caregiver burden. The discriminant function showed a sensitivity of 86% and specificity of 81%, and successfully classified 83% of the caregivers. The function at baseline is a simple and useful method for screening of an increase in caregiver burden among caregivers for the frail elderly at home. [Copyright &y& Elsevier]