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Purpose The aim of this study was to explore and describe changes in expressed emotion (EE) among family caregivers of dementia and its associated factors at different time points over 3 months. Method: A longitudinal observation study using a 3-month survey was conducted in home care settings, Japan. We collected data on the demographic details of family caregivers currently providing care, which included care burden (Zarit Burden Inventory, ZBI), closeness of the caregiving relationship (Relationship Closeness Scale, RCS), depression (Geriatric Depression Scale, GDS). We used the validated Family Attitude Scale (FAS) to assess EE, in which higher scores indicate a greater intensity of emotional expression. Results To date, 45 family caregivers completed the present study. FAS scores were 39.67 ± 24.90 at month 1 (T1), 38.64 ± 23.28 at month 2 (T2), and 39.69 ± 24.52 at month 3 (T3). The change in FAS scores did not show a statistical difference over the three-month period (p=0.816). Multiple regression analysis of FAS at T1 showed that the main influencing factors were gender, marriage, RCS, care burden, and depression (R2=0.763, p < 0.001); the main influencing factors at T2 were marriage and care burden (R2=0.584, p < 0.001); the main influencing factors at T3 were care burden and depression (R2=0.674, p < 0.001). Conclusions: Early identification of risk factors may help in the development of interventions to prevent high levels of EE in family caregivers. We plan to continue refining our analyses to test the validity of our hypothesis.

In Japan, annual medical checkups are carried out to prevent lifestyle diseases. Studies have found that skipping breakfast is a risk factor for diabetes, and potentially also dementia. This retrospective cohort study aimed to evaluate the relationship between skipping breakfast and dementia in people with diabetes. The eligible cohort was anyone on the National Health Insurance Database of Osaka who had a checkup in FY 2013 and had diabetes (N = 283,410). The cohort was divided into two groups, those who skipped breakfast more than three times a week (7.38%) and those who did not. The database does not allow individuals to be identified. People with diabetes were defined as those prescribed diabetes drugs in the year before the checkup or with HbA1c of 6.5% or higher at the checkup. People with dementia were defined as those prescribed anti-dementia drugs between April 2014 and December 2017. Data also included body mass index (BMI), smoking, sex , age, and prescription of hypolipidemic or blood pressure drugs. Logistic regression analysis was used, with odds ratio (OR) and 95％ confidence interval . Being male, younger, smoking, having lower BMI or HbA1c levels, and drug prescriptions were associated with skipping breakfast. Skipping breakfast was associated with dementia (OR 1.26, 1.14–1.41), as was lower BMI and being older. For people with diabetes, skipping breakfast is a risk factor for obesity and dyslipidemia, which are associated with dementia. This study therefore provides evidence for a health behavior approach to eating breakfast in people with diabetes.

In Japan, the public long-term care insurance system supports a super-aged society. The long-term care service (LTCS) system is designed to prevent deterioration of care levels. We conducted a retrospective cohort study to clarify whether using LTCS prevents the deterioration of care levels. We use anonymized data of the Osaka National Health Insurance Database. We analyzed 16,469 subjects who were 65–74 years of age and certified at the mild care level from 2012 to 2015 at the time of initial certification. A baseline measurement was conducted 1 year after initial certification, and observation was continued until the subject’s care level deteriorated. Statistical analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model. The results revealed that the period until the deterioration of care level (which occurred in 25% of subjects) was 6 months in the service use group and 22 months in the service non-use group. Although we included sex, care level, dementia, and Parkinson’s disease as variables in the statistical analysis, service users were more likely to deteriorate than non-service users (Hazard Risks: 1.89; 95% confidence interval: 1.79–2.00). It is likely that other factors, such as heart disease, may also be involved, and there may be a bias related to family caregiver factors. In conclusion, the current findings suggest that using LTCS cannot prevent the deterioration of care levels. Future studies should verify the effectiveness of LTCS by adding further variables and data regarding family caregivers and changes in outcomes.

As populations age worldwide, older people with dementia are increasing. Caregivers are also aging, necessitating arrangements like social services. How to prolong the home care desired by older people remains unclear. Using data from the Osaka National Health Insurance Database from 2012 to 2017 on insured persons’ registers, medical notes, and care benefits, this study included 9591 people aged ≤74 years with first dementia drug prescription between April 2013 and December 2017. Using the prescription as baseline and hospitalization or nursing home admission as outcomes, home care duration and characteristics of medical and nursing care services during the year before baseline were evaluated. Survival was compared by Kaplan–Meier curves and the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. During follow-up, the outcomes were observed in 1473 patients : 317 admission , 1145 hospitalized and 11 both. Mean duration of home care in patients with the outcomes was 11.5 months, which differed significantly from patients without these outcomes. When patients were grouped by hospitalization in year before first prescription, the survival curves differed significantly. In multivariate analysis, sex, renin-angiotensin system agonists, hyperlipidemia drugs, hospitalization history in past year, care level, and diabetes drugs were significantly associated with the outcomes. Taken together, hospitalization history, female sex, and diabetes were associated with home care disruption. Those undergoing cardiovascular disease treatment continued to live at home. For people with dementia, it is important to intervene by focusing on past medical and nursing care to continue life at home.