Relationship between healthy elderly individual social capital and health according to ward level in Tomi City, Nagano Prefecture: an ecological study.

Objectives: The aims of this study were 1) to elucidate the relationship between social capital and health by ward in Tomi City, Nagano Prefecture, in order to clarify the regional social resources available to support long-term care prevention utilizing self- and mutual support of regional residents and 2) to comprehensively investigate the activation of regional networks. Materials and Methods: We analyzed elderly (aged 65 years or older) individual survey data from 7,199 residents from all wards within Tomi City in 2014 (number of valid responses: 5,546; valid response rate: 77.0%). The social capital indicators used for the analysis included participation in community activities, regional managerial position experience, and general trust. The health indicators included self-rated mental health, activities of daily living, and depression. Standards for a "good" result for each indicator were established, and the percentages of each were tallied up by ward. Spearman's rank correlation coefficient and principal component analysis were used to investigate correlations between social capital and health. Results: The results for overall respondents indicated correlations between participation in sports and hobbies and activities of daily living (p<0.01) and self-rated mental health (p<0.05). Participation in nonprofit organizations/volunteer activities and participation in community center workshops exhibited correlations with activities of daily living (both p<0.05). In respondents aged 65-74 years, participation in community center workshops and general trust were found to be correlated with activities of daily living (both p<0.05). Meanwhile, in respondents aged 75 years or older, correlations were noted between participation in sports and hobbies and participation in nonprofit organizations/volunteer activities and activities of daily living (p<0.05 and p<0.01, respectively). By creating a distribution map using principal component analysis, we were able to grasp the characteristics of the distribution of "community participation/connections with people" and "health" in each ward. Conclusions: Our results point the way forward for future long-term care prevention support in Tomi City by clarifying the correlation between social capital and health by ward.

[Muscle and bone health as a risk factor of fall among the elderly. Fall prevention strategy in dementia].

Fall prevention interventions for patients with dementia are broadly classified into those aimed at the patients themselves and those aimed at caregivers and the living environment. The former includes exercise programs, but these interventions have a low adherence and have not led to decreases in the incidence of falls. The latter includes comprehensive, multidisciplinary measures that are conducted at medical and welfare facilities commonly used by elderly with dementia, such as fall risk assessment, dementia care management, and education for caregivers. Although comprehensive, multidisciplinary interventions for fall prevention that focus on fall risk management were shown to be effective, their effects with specific regard to elderly with dementia have not been sufficiently elucidated, and remain a future issue.

[Prevention of falls].

Falls among the elderly mainly result from aging, lack of exercise, and physical and/or mental disorders. They cause fractures and other injuries. It is necessary that likelihood of falling should be evaluated from the view point of both decreased physical function and fear of falling. General exercise including balance training is considered to be most effective to reduce falls. We must take good care not to cause falling and resultant fracture due to exercise of falls prevention program. Many sided intervention, including a check and counseling on medication and environmental improvement, walking in the sunshine, which stimulates vitamin D biosynthesis and so on, are needed. Further studies on falls prevention among the elderly with dementia and males receiving hormonal therapy with prostatic cancer are necessary.

Change in Calcaneal Bone Strength in Long-Term Care Residents Treated With Low-Intensity Pulsed Ultrasound.

OBJECTIVE: We examined the effect of low-intensity pulsed ultrasound (LIPUS) on bone strength in osteoporotic elderly residents. MATERIALS AND METHODS: This was a randomized controlled trial. Elderly residents with osteoporosis in a long-term care facility were treated with LIPUS (oscillation frequency 100 KHz) that involved treatment of the heel bone for 2 minutes a day. The selection of the treated heel was decided randomly with a personal computer. The heel bone mineral density before and after treatment was measured by calcaneal quantitative ultrasound (GE-1000 Express). RESULTS: The study included 23 residents but 3 patients developed fractures and 1 withdrew from the study. Nineteen elder residents (average age 86.9 years) completed the study with ultrasonic quantitation before and after treatment. The average speed of sound (following SOS) of the treated and non-treated side was 1438.3 and 1437.4 m/s, respectively at baseline. After 3 months, the SOS was increased to 1450.8 and 1450.5 m/s, respectively, and after 8 months it increased to, 1452.8 and 1451.6 m/s. There were no significant changes between the treated and the non-treated side of the heel bone. DISCUSSION: LIPUS had no effect on increasing bone density in the elderly residents when treatment duration was 2 minutes per day. We suggest that therapy for osteoporosis with LIPUS for the elderly should be studied in the future to reduce the number of prescribed oral agents.

Effect of a maternal and child health handbook on maternal knowledge and behaviour: a community-based controlled trial in rural Cambodia.

Maternal and child health (MCH) handbooks are comprehensive home-based booklets designed to integrate MCH records. Although empirical evidence suggests the handbooks are more effective than current card-type records, this has not been scientifically demonstrated. The objectives of this study were to evaluate the impact of the MCH handbook on maternal knowledge and behaviour as measured by antenatal care (ANC) attendance, delivery with skilled birth attendants (SBAs) and delivery at a health facility. The Cambodian version of the MCH handbook was developed and introduced in two health centres, and two other health centres served as controls. Pre-intervention and post-intervention surveys were conducted with 320 women from the intervention areas and 320 women from the control areas who had given birth within 1 year before the survey. We evaluated the impact of the handbook by using difference-in-differences (DID) analysis and calculated adjusted odds ratios for pre-post changes in key indicators by using logistic regression. In addition, we interviewed multiparous women, health staff and health volunteers to assess the acceptance and cultural appropriateness of the handbook. Content analysis was performed with the English-translated transcriptions. The DID analyses revealed that all key indicators increased in the intervention group against counterfactual assumptions. The intervention also increased maternal knowledge of all topics addressed except for the risk of severe bleeding after delivery; this may be attributable to the influence of cultural belief. Logistic regression showed that the intervention increased ANC attendance, delivery with SBAs and delivery at a health facility, even after adjusting for maternal age, education and economic conditions. The qualitative data indicated that the handbook was well received and culturally appropriate. Thus, the MCH handbook is a reasonable and superior alternative to current card-type maternal records.

[Life with fear of falling after hip fracture].

Elderly people who experienced hip fracture often experience complicated psychological reaction as well as decline in physical functions. In order to avoid falls and re-fractures, they limit various activities resulting to worsening physical performance. This article reports perception among the community dwelling elders who experienced hip fracture, it includes quotation from the interviews conducted with focus clients. Elders were always worried about falling and some avoid the activities that were major cause of hip fracture. Also, they complained of feeling a foreign substance coming dull pain resulting from the bipolar hip prosthesis. They were also worried about being bed-ridden so that they tried to expand their level of mobility, which tend to increase their risk of falling.

[Fall and fracture prevention exercise and self-efficacy].

This article is to comment on the scale for fall-related self-efficacy and the fall prevention program that is focused on Bandura's self-efficacy theory. Fall-related self-efficacy is the confidence to carry on the activities of daily living without falling. There are four sources of information that influence a fall-related self-efficacy. These are " inactive mastery experience", " vicarious experience", " verbal persuasion" and " physiological and affective states".