Search

Aim: To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA‐J), a multidimensional assessment scale for caregiver experiences. Methods: The internet survey involved 934 Japanese informal caregivers aged 20–79 years (mean age = 58.8 years; 50.2% women) who completed questionnaires, including the CRA‐J 18 items (CRA‐J‐18), consisting of five domains, such as impacts on schedule and finances and positive experiences of caregiving. A 10‐item short version of the CRA‐J (CRA‐J‐10; 0–50 points), which was prepared by selecting the two items with the highest factor loadings from each domain, was tested for model fit by confirmatory factor analysis (CFA) and was analyzed for correlations with the CRA‐J‐18, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Scale (PACS), Patient Health Questionnaire‐9 (PHQ‐9), and WHO‐Five Well‐Being Index (WHO‐5). The area under the curve (AUC) in the receiver operating characteristic was evaluated as discriminability for depressive symptoms (PHQ‐9 ≥ 10 points). Results: The CFA indicated a good model fit in the CRA‐J‐10. The CRA‐J‐10 correlated well with the CRA‐J‐18 and other variables (CRA‐J‐18, r = 0.970; ZBI, r = 0.747; PACS, r = −0.467; PHQ‐9, r = 0.582; WHO‐5, r = −0.588) and showed good discriminant performance for the presence of depressive symptoms (AUC = 0.793, 95% confidence interval = 0.762–0.823). Conclusions: The CRA‐J‐10 allows a simple assessment of caregiver experiences, helping support informal caregivers. Geriatr Gerontol Int 2024; 24: 290–296. [ABSTRACT FROM AUTHOR]

Background: The decision‐making of older adults and people with dementia is attracting more attention among healthcare professionals. While cognitive impairment has been examined as a factor related to decision‐making, it can also be assumed that involvement in decision‐making leads to the maintenance of cognitive function. This study examined the association of the decision‐making process with the onset of cognitive impairment. Methods: We analyzed data from a 2‐year longitudinal panel survey of community‐dwelling care recipients aged ≥65 years in Japan. The sample included 406 participants who responded to both baseline and follow‐up surveys, were cognitively intact at baseline, and had no missing cognitive impairment data regarding onset at follow‐up. The status of decision‐making involvement was assessed using a single item and classified into four categories: 'very involved,' 'less involved,' 'unclear about desired care,' and 'having no one to share the decision.' Results: Among the participants (women, 65.0%; ≥75 years old: 68.2%), the incidence of cognitive impairment during the follow‐up was 26.6%. Multivariable logistic regression showed that, compared with highly involved participants, those who lacked clarity about desired care were more likely to develop an onset of cognitive impairment (odds ratio: 5.49; 95% confidence interval: 1.63–18.54; P = 0.006). Conclusion: Even among cognitively intact care recipients, those who are not able to formulate their desired care may be at risk of cognitive decline. Therefore, support for the decision‐making process, not limited to the final decision, is essential to improving the prognosis of community‐dwelling care recipients. [ABSTRACT FROM AUTHOR]

Background: Exposure to chronic psychological stress (CPS) is a risk factor for thrombotic cardiocerebrovascular diseases (CCVDs). The expression and activity of the cysteine cathepsin K (CTSK) are upregulated in stressed cardiovascular tissues, and we investigated whether CTSK is involved in chronic stress-related thrombosis, focusing on stress serum-induced endothelial apoptosis. Methods and results: Eight-week-old wild-type male mice (CTSK+/+) randomly divided to non-stress and 3-week restraint stress groups received a left carotid artery iron chloride3 (FeCl3)-induced thrombosis injury for biological and morphological evaluations at specific timepoints. On day 21 post-stress/injury, the stress had enhanced the arterial thrombi weights and lengths, in addition to harmful alterations of plasma ADAMTS13, von Willebrand factor, and plasminogen activation inhibitor-1, plus injured-artery endothelial loss and CTSK protein/mRNA expression. The stressed CTSK+/+ mice had increased levels of injured arterial cleaved Notch1, Hes1, cleaved caspase8, matrix metalloproteinase-9/-2, angiotensin type 1 receptor, galactin3, p16IN4A, p22phox, gp91phox, intracellular adhesion molecule-1, TNF-α, MCP-1, and TLR-4 proteins and/or genes. Pharmacological and genetic inhibitions of CTSK ameliorated the stress-induced thrombus formation and the observed molecular and morphological changes. In cultured HUVECs, CTSK overexpression and silencing respectively increased and mitigated stressed-serum- and H2O2-induced apoptosis associated with apoptosis-related protein changes. Recombinant human CTSK degraded γ-secretase substrate in a dose-dependent manor and activated Notch1 and Hes1 expression upregulation. Conclusions: CTSK appeared to contribute to stress-related thrombosis in mice subjected to FeCl3 stress, possibly via the modulation of vascular inflammation, oxidative production and apoptosis, suggesting that CTSK could be an effective therapeutic target for CPS-related thrombotic events in patients with CCVDs. [ABSTRACT FROM AUTHOR]