Effects of Two Short-Term Aerobic Exercises on Cognitive Function in Healthy Older Adults during COVID-19 Confinement in Japan: A Pilot Randomized Controlled Trial.

Aerobic exercise improves executive function-which tends to decline with age-and dual-task training with aerobic exercise improves the global cognitive function. However, home-based older adults could not follow these programs due to social isolation during the coronavirus disease 2019 pandemic. Therefore, we conducted a single-blind randomized controlled trial with 88 healthy older adults without dementia or sarcopenia who were randomly assigned into the Nordic walking (aerobic exercise), dance (dual-task training with aerobic exercise), or control group. The participants in both exercise intervention groups trained for 30 min, three times per week, for 4 weeks. All groups consumed amino acid-containing foods three times per week. We found that both exercise intervention groups showed improvements in executive function, while the dance group showed additional improvement in global cognitive function. The dance group showed a higher maximum gait speed, greater improvement in imitation ability, and improved executive function and cognitive function than the Nordic walking group. The intervention programs did not significantly affect the muscle mass or muscle output than the control group; however, both programs improved the participant neurological functions such as the heel lift, with dance training being the most effective intervention. In conclusion, dance training effectively improves cognitive function.

Relationship among motor function, ADL disability, and psychological concerns in elderly people with locomotive disorders.

BACKGROUND: Locomotive disorders are one of the main causative pathologies for the condition requiring assistance on activities of daily living (ADL). Although psychological concerns such as feeling of depression and anxiety are prevalent in elderly people, the causal relation among motor function, ADL disability, and psychological concerns is controversial. PURPOSE: Purpose of this study was to investigate causal relationship among motor function, ADL disability, and psychological concerns in elderly people with locomotive disorders. METHODS: The data for this study were from a community-dwelling sample of 314 elderly persons with locomotive disorders aged 65 and older who visited orthopedic clinics and/or affiliated institutions. Motor function was assessed by one-leg standing time with eyes open, leg extension power and grip power. We assessed ADL disability using the 25-question Geriatric Locomotive Function Scale (GLFS-25), and psychological concerns by three self-reported questions. We constructed two models and tested fitness of the models to the data using a structural equation modeling (SEM). Model 1: motor function affects ADL disability and ADL disability affects psychological concerns, Model 2: motor function affects psychological concerns and psychological concerns affects ADL disability. RESULTS: The fit indices were chi-square = 23.152 (p = 0.081), RMSEA = 0.042, GFI = 0.981, AGFI = 0.955, CFI = 0.987 for Model 1, and chi-square = 84.583 (p < 0.001), RMSEA = 0.119, GFI = 0.935, AGFI = 0.854, CFI = 0.892 for Model 2. These fit indices indicated a good fit of the model 1 and inadequate fit of model 2 to the data. CONCLUSION: Decline of motor function contributed toward psychological concerns via ADL disability in elderly people with locomotive disorders.

Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan.

OBJECTIVE: To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey. METHOD: All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16). RESULTS: Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia). CONCLUSION: This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.

Validation of the Japanese Osteoporosis Quality of Life Questionnaire.

The Japanese Society for Bone and Mineral Research developed the Japanese Osteoporosis Quality of Life Questionnaire (JOQOL) to evaluate the disease-specific Health-Related QOL, which is specific for osteoporosis of Japanese patients. JOQOL was revised in 2000; it consisted of 38 items with the scale graded from 0 to 4 and a total full score of 152. To elucidate the reliability and validity of the revised JOQOL, we enrolled 193 postmenopausal women as subjects and diagnosed them as having osteoporosis or osteopenia. The mean age of the subjects was 68.2 +/- 8 years; 58 subjects (30.1%) had at least one vertebral fracture. Among them, 83 patients were retested for reliability. The mean lapse from the time of test to that of retest was 23.7(+/- 9.5) days. The subjects were questioned using the JOQOL, Medical Outcomes Study Short Form 36 (SF-36), along with questions on subjects' characteristics and their ADL. The JOQOL scores at the test and the retest were significantly correlated (r = 0.973) without significant difference between their mean scores. All the JOQOL items showed significant correlations at the test and the retest (Kendall's tau = 0.599-0.947). Cronbach's alpha coefficient of JOQOL was 0.918. These results proved the high reliability of JOQOL. The JOQOL score showed negative correlation with age (r = -0.183). The subjects with vertebral fractures had significantly lower JOQOL scores than the subjects without fractures. The JOQOL showed a significant correlation with all the scores in each domain of eight of SF-36 (r = 0.350-0.839). These results were consistent with that of the preceding study. It is concluded that the reliability and the validity of JOQOL were demonstrated in this study.

Factors related to potentially harmful behaviors towards disabled older people by family caregivers in Japan.

OBJECTIVE: The purpose of the present study was to examine factors related to potentially harmful behaviors (PHB) by family caregivers towards their older family members. METHODS: Four hundred and twelve pairs of disabled older adults and their family caregivers participated in the study. All of these disabled older adults were users of visiting nursing services under the public Long-Term Care insurance system, who resided in one of the eight catchment areas of visiting nursing services in Kyoto Prefecture, Japan. The caregivers were asked to complete questionnaires in relation to their PHB towards their older family members, caregiver burden, patient-caregiver kinship, behavioral disturbances of their older adult, age and sex. Visiting nurses obtained the following information regarding the older adults: the severity of dementia; the severity of physical impairment; age and sex. RESULTS: More than 30% of the caregivers admitted PHB towards their older family members. The most frequently reported PHB included verbal aggression (16.8%) and ignoring (13.6%). A logistic regression analysis revealed that adult children (OR = 2.69, 95%CI = 1.23-5.89, p = 0.013) and caregivers of disabled older people with behavioral disturbances (OR = 3.61, 95%CI = 1.65-7.90, p < 0.01) were more likely to show PHB. CONCLUSIONS: In the present study, PHB towards the older people by family caregivers was associated with patients' behavioral disturbances and patient-caregiver kinship, i.e. an adult child as a caregiver. These findings should be taken into account when planning strategies to prevent PHB by family members.

[Validation of the Home Care Quality Assessment Index (HCQAI)].

AIM: To confirm the convergent validity of the Home Care Quality Assessment Index (HCQAI), developed by Dr. Arai et al., which is used for overall assessment of home care in three areas: 1) conditions of the disabled elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input), based on professional staff observation. METHODS: We surveyed 102 pairs of disabled elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. The validity of HCQAI was investigated by computing the Spearman rank correlation coefficient between the subscales of the HCQAI and the variables measuring "outcome", "process" and "input", respectively. "Yokaigodo" (Government-Certified Disability Index), the Activities of Daily Living (ADL) of the disabled elderly, severity of dementia, the Short-Memory Questionnaire (SMQ) and Troublesome Behavior Scale (TBS) were used for the "outcome" variables."The impression of home care", a new scale developed for this study, was used as a variable to evaluate "process and input". RESULTS: The HCQAI subscales for "outcome" indicators were significantly correlated with the other above-described variables measuring "outcome", but not with "the impression of home care", the variable evaluating "process and input". All 5 HCQAI subscales for "process" and "input" were significantly correlated with "the impression of home care", but 4 out of 5 HCQAI subscales were not significantly correlated with the variables measuring "outcome". CONCLUSION: These findings indicate that each subscale of the HCQAI has the expected properties. Therefore, the convergent validity of the HCQAI is confirmed.

Use of home care services effectively reduces feelings of burden among family caregivers of disabled elderly in Japan: preliminary results.

BACKGROUND: Relatively few observational studies have been conducted on the impact of home care services on burden or other aspects of the caregiver's experience. OBJECTIVES: To examine whether the use of care services reduces the feelings of burden among family caregivers in Japan. Specifically, the study was aimed at testing the following three hypotheses: (1) The severity of impairment and the dementia among the disabled elderly increases the feelings of burden among family caregivers and the support from family members decreases burden: (2) the amount of services used by older people and their caregivers is affected by the severity of dementia and ADL deficiencies among the disabled elderly and the amount of support from family members: and (3) controlling for severity, the use of care services under the LTC insurance program serves to reduce the feelings of burden among family caregivers. METHODS: A structural equation model using the data obtained from 82 pairs of community-dwelling disabled elderly and their principal family caregivers. The model included the following variables: age of the disabled elderly; the severity of ADL deficiency and behavioral disturbances; use of formal (public) care services; support from family members; and feelings of burden among family caregivers. RESULTS: The structural equation model revealed that, after controlling for the effects of severity on service use, home care services effectively reduce feelings of burden among family caregivers. CONCLUSIONS: The findings suggest that care services provided under the LTC insurance have been successfully reducing burden among family caregivers in the study area.

[Development of the Home Care Quality Assessment Index (HCQAI)].

AIM: To develop a Home Care Quality Assessment Index (HCQAI) that may be used for overall assessment of home care in three areas: 1) conditions of the impaired elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input). METHODS: To develop the HCQAI, a list of items for assessment was drawn up, and the reliability of each item was verified. Reliability was investigated by a) test-retest reliability, and b) inter-rater reliability. Impaired elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. A kappa coefficient of 0.4 or greater generally served as the inclusion criteria for test-retest and inter-rater reliability of each item. A factor analysis was conducted for items satisfying the above criteria, using 10 scales. RESULTS: Cronbach's alpha showing internal consistency (reliability) for these scales was 0.6-0.9. Two scales corresponded to care within the home: the "barrier-free" and "improvement of water facilities"; three to the caregiver situation: "dressing appropriate for the season," "mistreatment by the elderly," and "hygiene and assistance"; and five involved conditions of the impaired elderly: "cognition," "paralysis," "vision and hearing," "ADL," and "gross motor." CONCLUSION: The HCQAI developed in the present study, consisting of 41 items, can assess quality of home care both objectively and comprehensively, based on professional staff observation. Few indexes of this kind exist worldwide to scientifically assess input, process and outcome in the delivery of quality home care for the impaired elderly.

Reliability and validity of the Craig Handicap Assessment and Reporting Technique for Japanese individuals with spinal cord injury.

It is necessary and important to quantify the handicap sustained by individuals with spinal cord injury (SCI); however, few instruments are available to measure the level of the disability. One of the best developed and most often used measures is the Craig Handicap Assessment and Reporting Technique (CHART). Nevertheless, a Japanese version has not yet been developed and tested for SCI individuals. The purpose of this study was to develop a Japanese version of the CHART (CHART-J) and to investigate its test-retest reliability and discriminant validity in SCI in Japan. Fifty-four individuals with SCI participated in the test-retest reliability study and 293 participated in the discriminant validity analysis. We have shown that the test-retest reliability coefficients of the CHART-J range from 0.57 to 1.00. In addition, its discriminant validity is acceptable for individuals with SCI in Japan. Therefore, the CHART-J is useful as a measure of disability for Japanese individuals with SCI.

Validation of 'personal strain' and 'role strain': subscales of the short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8).

The eight-item short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8) has been confirmed for reliability and validity, and its two subscales (personal strain and role strain) are based on the factor structure of the ZBI. It has been demonstrated that these subscales have good reliability. The aim of the present study was to confirm their construct validity. A total of 51 impaired elderly who had been receiving regular nurses' visits in Kyoto Prefecture, Japan and their family primary caregivers, participated in the present study. Each caregiver was asked to complete a questionnaire which included the J-ZBI_8, the hours spent in caregiving, and the physical and cognitive disability of the impaired elderly. A principal component analysis identified the following two principal components of these variables: 'Activities of Daily Living deficits' and 'behavioral disturbances'. Consequently, Barthel Index (BI) and Troublesome Behavior Scale (TBS) were selected as the representative variable, respectively, for each component. We subsequently calculated the Spearman's rank correlations among the subscales of J-ZBI_8, BI and TBS. Personal strain was found to be correlated with TBS (rho = 0.48, P < 0.01), while role strain was correlated with the BI (rho = -0.29, P = 0.04). The correlation between personal strain and BI was not significant, nor was the correlation between role strain and TBS. These findings indicate that the personal strain and role strain measured by J-ZBI_8 correspond to the personal strain and role strain of the ZBI originally described by Whitlatch et al. Therefore, the construct validity of the J-ZBI_8 subscales is confirmed.

Factors related to feelings of burden among caregivers looking after impaired elderly in Japan under the Long-Term Care insurance system.

Since the 1970s, the burden of caregiving has been the subject of rather intense study, a trend that will continue with the rapid graying of populations worldwide. Since the Long-Term Care insurance system began in 2000, few cross-sectional studies have attempted to identify factors related to the feelings of burden among caregivers looking after the impaired elderly in Japan. In the present report, among 46 pairs of caregivers and impaired elderly, the elderly receiving regular nurses' visits in Kyoto Prefecture, Japan were assessed for problems with activities of daily living, the severity of dementia, the presence of behavioral disturbance, and cognitive impairment. The caregivers were asked to complete questionnaires in relation to their feelings of burden and caregiving situation. The results indicated that caregivers of impaired elderly with behavioral disturbances were more likely to feel a 'heavier burden.' Those temporarily relieved of caregiving three or more hours a day were less likely to experience 'heavier' caregiver burden than those who were not. Moreover, caregivers who found it 'inconvenient' to use care services tended to be more likely to feel a 'heavier' caregiver burden than those who did not. Recourse to respite services, which are ideally positioned to help, proved inconvenient because of their advance reservation system. More ready access to respite services in emergencies could do much to reduce caregiver burden.

[Cross-validation of the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8)].

This study was aimed at confirming the cross-validity and construct validity of the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8) developed by Arai and colleagues. A total of 169 family members caring for disabled elderly were assessed by a self-administered questionnaire which included the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI). Cronbach's alpha of the J-ZBI_8 was 0.88, indicating a high reliability of this instrument. A confirmatory factor analysis revealed that the two factor model of J-ZBI_8 fitted the data. Pearson's correlation coefficient between J-ZBI_8 and J-ZBI was 0.92; and the correlation coefficient between J-ZBI_8 and item 22 (a single global burden) was 0.66. These data indicated that J-ZBI_8 had a high concurrent validity. The J-ZBI_8 was found to be significantly correlated with Barthel Index, duration of caring, hours of caregiving/day, physical fatigue and mental fatigue among caregivers, but not with the duration of caring (months). Caregivers of disabled elderly who did not have any behavioral disturbances had a significantly lower J-ZBI_8 score than those who were caring for elderly with such behaviors. Also, caregivers who declared that they did not abuse disabled elderly had a significantly lower J-ZBI_8 score than those who replied they abused them, when compared by t-test. These results indicated that J-ZBI_8 had a high construct validity. It is concluded that the J-ZBI_8 had a high cross-validity and construct validity. This instrument can thus facilitate the assessment of family caregiver burden in clinical settings.