[Elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role].

Objectives　The purpose of this study was to identify elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role.Methods　A qualitative inductive research was conducted. Introductions to potential participants were obtained from a patient association that agreed to help with the study. Interviews were conducted from July through October 2014, using an interview guide, with cancer peer supporters who consented to participate in the study. Elements they perceived as important to the performance of their role were inductively identified from interview transcripts. The analysis consisted of coding phrases in the text and organizing the codes generated into categories and subcategories.Results　The study participants consisted of 10 cancer peer supporters (2 men, 8 women), in the age range of 40 to 70 years, who provided private counseling and worked in cancer support groups in hospitals. The analysis generated 129 codes, 11 subcategories, and 5 categories. These 5 categories were: [1.Help service users determine their own paths by listening to and accepting what they say with a non-judgmental attitude]; [2.Offer a perspective distinct from that of the medical staff]; [3.Think of ways to achieve a good balance between one's personal life and cancer peer support work while maintaining a stable state of mind]; [4.Ensure that one maintains the necessary knowledge and skills, and continually improve oneself]; and [5.Build relationships of trust with medical staff and the hospital].Conclusion　Category [1] and category [2] were behaviors regarded as important when interacting with users. They were "matters regarded as important during the practice of cancer peer support working for users," and comprised the core of matters that were regarded as important. Next, as for matters regarded as important in relation to the supporters themselves, the categories were [3] and [4]. These were "matters regarded as important for continuity and qualitative improvement of cancer peer support working." Areas that call for improvement in relation to this are preparation of support systems and learning environments. Another matter regarded as important was category [5]. This was a "matter regarded as important to smoothen and facilitate cancer peer support working." Placing importance on relationships of trust with medical staff and hospitals could be considered a distinctive characteristic of cancer peer supporters working at hospitals.

[Support that cancer peer supporters working at medical institutions currently receive and the support they actually need].

Objectives　This research aims to ascertain the kinds of support cancer peer supporters at medical institutions currently receive and the support they actually need.Methods　Participants in the study were ten cancer peer supporters who were recommended by a patient association and who agreed to participate in the study. Using a qualitative descriptive method, interviews were conducted using an interview guide from July to October 2014. Codes were extracted from the interview transcript and divided into categories and subcategories. Accuracy was ensured by checking the data with the participants. The study was conducted with the approval of the Ethics Committee of Mejiro University.Results　Research participants consisted of two men and eight women aged forty to seventy years, who were private counselors, telephone counselors, or members of cancer salons at hospitals. Four categories were generated on the basis of the support that cancer peer supporters are currently receiving: mutual learning and support among peer supporters, learning and encouragement from patients, self-improvement in peer supporters, and cooperation with hospitals and the government. Seven categories were generated on the basis of the support that cancer peer supporters need: opportunities for peer supporters to learn from and support each other, further studies on cancer peer support, reliable and up-to-date information, society's understanding and cooperation regarding cancer, financial support for support activities and patient associations, improvement of cancer peer support system, and quality assurance of peer supporter training courses.Conclusion　Cancer peer supporters were supporting each other, gaining encouragement from patients, improving themselves, and gaining support from others. However, they also needed additional assistance such as opportunities for supporters to learn from and support each other and reliable and up-to-date information. Moreover, peer supporters needed advice and emotional support from hospital staff as they experienced difficulties during consultation. Various other types of support were needed, such as society's understanding and cooperation regarding cancer, financial support for support activities and patient associations, institutionalization of peer supporter placement in hospitals, and quality assurance of peer supporter training courses. Overall, support for cancer peer supporters is still not sufficient; thus, further help is necessary.

Early impact of depression symptoms on the decline in activities of daily living among older Japanese: Y-HALE cohort study.

OBJECTIVE: It is well known that depression deteriorates basic activities of daily living (ADLs), such as eating and bathing, among the elderly, but little is known about the early impact of depression symptoms on the next higher level of functioning, namely higher-levels ADLs, such as instrumental self-maintenance, intellectual activities, and social roles. The objective of this study was to determine whether symptoms of depression are associated with a subsequent decline in higher-level ADLs within a 12-month period of time. METHODS: The study cohort consisted of a random sample of 587 non-institutionalized adults aged ≥ 65 years living in Yamanashi prefecture, Japan. The baseline survey was conducted in 2003. After 12 months, a mailed follow-up survey evaluated changes in higher-level ADLs (follow-up rate 98.6%). RESULTS: After adjusting for sociodemographic and behavioral confounders, logistic regression indicated that baseline severe depression symptoms were associated with a 3.2-fold (95% confidence interval 1.6-6.3) higher chance of a subsequent decline in higher-level ADLs compared to those without severe depression symptoms. The presence of severe depression symptoms was selected by stepwise logistic regression in all models, except for the model with intellectual activities as an outcome, while other lifestyle factors were not selected. CONCLUSIONS: Symptoms of severe depression may adversely affect higher-level ADLs even in a relatively short time-frame. In addition, the early effects of depression symptoms may be stronger than those of other traditional lifestyle risk factors. Monitoring a wide range of ADLs in elderly individuals showing signs of depression may be important to prevent a functional decline in health and the need for long-term care.

Impact of mental health on daily living activities of Japanese elderly.

OBJECTIVE: We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability. METHODS: Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox's proportional hazard model was used. RESULTS: Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35-7.71), 3.11 (1.38-6.98), and 2.41 (1.07-5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65-74 years was also statistically significant. Social inactivity partly explained the excess risk. CONCLUSIONS: Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced.

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses.

BACKGROUND: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan. METHODS: In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density. RESULTS: Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders. CONCLUSIONS: These three factors could potentially explain the differences in DFLE of the older population in Japan.