Categorization using the Dementia Assessment Sheet for Community-Based Integrated Care System 8-items (DASC-8) based on cognitive function and activities of daily living predicts frailty, disability and mortality in older adults.

AIM: This longitudinal study aimed to determine whether categorization by the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is associated with risk of frailty onset, disability, and mortality. METHODS: We analyzed longitudinal data from outpatients aged 65 years and older evaluated for the DASC-8 at the Frailty Clinic. The outcomes during the 3-year follow-up period were (Study A) frailty onset (Kihon Checklist ≥8) and (Study B) disability (new certification of nursing care needs) or mortality. Multivariate Cox regression analyses were performed to examine independent associations between the DASC-8 category and outcomes, and hazard ratios and 95% confidence intervals (CIs) were calculated after adjustment for age, sex, and the presence or absence of diabetes, hypertension, and dyslipidemia. RESULTS: (Study A) Out of the 216 patients without frailty in Categories I or II at baseline, 40 (20.4%) and 11 (55.0%) developed frailty, respectively. The adjusted hazard ratio was 3.62 (95% CI: 1.69-7.76, P < 0.001). (Study B) Out of the 350 patients who did not require long-term care at baseline, disability or death occurred for 20 (7.3%) in Category I, 14 (23.0%) in Category II, and 9 (56.3%) in Category III. The adjusted hazard ratios were 2.40 (Category I vs. II; 95% CI: 1.13-5.11, P = 0.023) and 5.43 (Category I vs. III; 95% CI: 2.23-13.3, P < 0.001). CONCLUSION: Categorization according to DASC-8 is associated with the risk of frailty, disability, and mortality in older patients. Geriatr Gerontol Int 2024; 24: 150-155.

Exploratory study on the factors related with the early detection of missing older persons with dementia living alone in Japan.

AIM: To clarify the factors related to the early detection of missing older persons with dementia (PwD) who lived alone in Japan. METHODS: We carried out a multiple regression analysis with data from 88 missing PwD. RESULTS: The location of the discovery was within the municipality where the missing PwD lived. Furthermore, the use of long-term care insurance services was significantly associated with early detection. CONCLUSION: Missing PwD were located within the municipality in which they lived, which meant that the individual was found before they went far. In addition, with the long-term care insurance services, professionals should regularly visit the home of PwD according to a care plan. Planned regular visits might trigger the early recognition of a missing person with dementia and enable early search activities. Therefore, use of long-term care insurance services might lead to the early detection of missing PwD living alone. Geriatr Gerontol Int 2023; 23: 362-365.

[Comprehensive health assessment of community-dwelling older people using mail method and its association with future transition to need for long-term care and dementia].

Objectives　We selected assessment items that can be used to evaluate the physical, mental, and social functions of community-dwelling older people comprehensively and easily, and examined whether these items could predict a future transition to the requirement for nursing care and dementia.Methods　We conducted a self-administered mail survey of 4,439 community-dwelling older people, who were not certified as requiring nursing care in 2011. The items for the survey were shortlisted out of a total of 54 items that were selected by referring to existing scales, and the evaluation items were determined by pass rate and factor analysis. The cut-off point of the total scores was estimated by ROC analysis using the certification of requiring long-term care (support level 1 or higher) and level of independence in the daily lives of older people with dementia (independence level I or higher) in 2014 as external criteria. The predictive validity was examined by binomial logistic regression analysis using the cut-off point of the total score and the score of the sub-domains as explanatory variables, and the requirement of nursing care and independence level of dementia in 2014 as objective variables.Results　A factor analysis of 1,810 subjects with no deficiencies in the 54 items identified 24 items in five domains (mental health, walking function, Instrumental Activities of Daily Living (IADL), cognitive function, and social support). During the ROC analysis, the cut-off point of the total score was estimated to be 20/21 points (nursing care: AUC 0.75, sensitivity 0.77, specificity, 0.56; dementia: AUC 0.75; sensitivity 0.79, specificity 0.55). The binomial logistic regression analysis showed that persons with a total score of less than 20 points in 2011 were significantly more likely to be certified as requiring nursing care (odds ratio 2.57, 95%CI 1.69-3.92, P<0.01) or show a decline in their independence level of dementia (odds ratio 3.12, 95%CI 1.83-5.32, P<0.01) in 2014. The scores of mental health, walking function, and IADL were significantly associated with certification of requiring nursing care, while walking function and cognitive function were significantly associated with dementia.Conclusion　We believe that the selected items in this study can successfully predict a transition to needing nursing care and dementia in the future. In the sub-domains, the results suggested an association with physical and mental function, as has been previously reported, but little association with social function.

Factors associated with inability to attend a follow-up assessment, mortality, and institutionalization among community-dwelling older people with cognitive impairment during a 5-year period: evidence from community-based participatory research.

BACKGROUND: The aim of the present study was to explore factors associated with (i) the inability to attend a follow-up assessment in the community-based participatory research (CBPR) framework; (ii) mortality; and (iii) institutionalization, across a 5-year period among older people with cognitive impairment identified via an epidemiological survey. METHODS: The participants were 198 older people whose score on the Mini-Mental State Examination was below 24, and who were living in our CBPR region in the Tokyo metropolitan area. Baseline data included sociodemographic factors, health-related factors, social factors, and assessments by healthcare professionals. Over the following 5 years we observed what happened to the subjects within the CBPR framework. Bivariate and stepwise multiple logistic regression analyses were performed to explore the factors associated with the inability to attend a follow-up assessment, 5-year mortality, and institutionalization. RESULTS: Participants who did not attend a follow-up assessment tended to live alone. Being older (>80), living with others, frailty, and the need for rights protection and daily living support were associated with increased mortality. Long-term care insurance certification was strongly associated with institutionalization as a natural consequence of the health-care system. Having dementia and low access to doctors were also positively associated with institutionalization. CONCLUSIONS: Older people with cognitive impairment who are living alone are at higher risk of being overlooked by society. To move toward more inclusive communities, the following are recommended: (i) more interventions focusing on older people living alone; (ii) social interventions to detect daily life collapse or rights violations; and (iii) more support to help people with dementia continue living in the community.

DASC-21: a novel geriatric assessment for discriminating best supportive care in older patients with inoperable advanced non-small cell lung cancer.

OBJECTIVE: This study investigated whether the Dementia Assessment Sheet for the Community-based Integrated Care System is useful for decision-making or problem detection in the treatment and care of older patients with inoperable advanced non-small cell lung cancer compared with the current standard model using performance status. METHODS: This study retrospectively examined 1595 cases admitted to the Department of Respiratory Medicine at the Tokyo Metropolitan Geriatric Hospital between 26 July 2016 and 28 January 2020. Among these, 29 and 31 patients who received pharmacotherapies and best supportive care were extracted, respectively. The performance in identifying best supportive care using the Dementia Assessment Sheet for the Community-based Integrated Care System was evaluated in comparison with performance status. The ability to detect impairments in each Dementia Assessment Sheet for the Community-based Integrated Care System domain was also assessed. RESULTS: The Dementia Assessment Sheet for the Community-based Integrated Care System total score had an area under the curve of 0.831 (95% confidence interval, 0.694-0.914), which was statistically equivalent to performance status. The discriminatory cut-off value for identification of best supportive care was set at 29 with a sensitivity and specificity of 0.742 and 0.897, respectively. Dementia Assessment Sheet for the Community-based Integrated Care System total score showed good concordance with performance status especially when reported by family members or caregivers. Deficits other than activities of daily living were recognized (2.8-19.4%) in patients with good performance status. Impairments were more frequently detected when reported by family members or caregivers. CONCLUSIONS: The Dementia Assessment Sheet for the Community-based Integrated Care System discriminates the best supportive care for older patients with inoperable advanced non-small cell lung cancer. Moreover, it can identify vulnerabilities especially when reported by family members or caregivers that cannot be detected by performance status.

Use of Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) for the screening of frailty and components of comprehensive geriatric assessment.

AIM: We examined whether the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is useful for screening frailty and as a comprehensive geriatric assessment (CGA). METHODS: Outpatients (N = 431; 269 women; Mage = 78.9 ± 6.8 years) with cardiometabolic disease from a frailty clinic participated. Frailty status was assessed using modified Cardiovascular Health Study criteria, the Clinical Frailty Scale and the Kihon Checklist. Cognition, higher-level activities of daily living, sarcopenia, physical activities, depression, nutrition, medication adherence, social network and quality of life were assessed as CGA components. We examined the association of DASC-8 category with frailty or CGA components using multiple logistic regression analyses, adjusted for age and sex. RESULTS: Most participants (n = 310, 71.9%) were in Category I, 90 (20.9%) were in Category II and 31 (7.1%) were in Category III. There were no significant differences in sex, body mass index, or past medical history, except regarding age or cerebral infarction. Logistic regression analyses showed that, for all definitions of frailty, the odds ratios of frailty significantly increased as category progressed. Cognitive function, higher-level activities of daily living, handgrip strength, gait speed, physical activities, medication adherence, social network and quality of life decreased as the category increased. Although depressive tendency increased in Category II, there was no significant difference in muscle mass or prevalence of sarcopenia among the categories. Malnutrition was observed in Category III. CONCLUSIONS: DASC-8 category was associated with frailty and several CGA components in older patients with cardiometabolic disease. Geriatr Gerontol Int 2020; 20: 1157-1163.

Childhood socioeconomic disadvantage as a determinant of late-life physical function in older Japanese people.

BACKGROUND: In this study, we examined the relationship between childhood socioeconomic status and physical function among older Japanese people, and investigated whether there is a sex variation in this association. METHODS: We administered a cross-sectional questionnaire survey to all independent community-dwelling individuals ≥65 years old, living in Adachi Ward, Tokyo (N = 132,005). Participants self-reported their physical function using the Motor Fitness Scale, and we divided the scores into quartiles for analysis. Childhood socioeconomic status was retrospectively assessed according to a single item. RESULTS: We analyzed 75,358 questionnaires. The average age of participants was 73.8 ± 6.0 years, and 55.0% were women. An ordered logistic regression analysis showed that lower childhood socioeconomic status was associated with lower physical function, independent of adult sociodemographic factors, health behaviors, and health conditions. This association was stronger in women than in men. CONCLUSIONS: Our findings indicate that low childhood socioeconomic status might have a long-term influence on physical function in late life and that this influence varies by sex. Assessment of socioeconomic disadvantage in childhood is important for developing strategies to help older people maintain their physical function longer.

The Differential Effects of Age on the Association Between Childhood Socioeconomic Disadvantage and Subjective Symptoms of Dementia Among Older Japanese People.

BACKGROUND: Despite increasing evidence of an association between childhood socioeconomic disadvantage and cognitive outcomes, such as dementia and cognitive decline, in Western countries, there are no studies on this association from non-Western societies. We investigated the relationship between childhood socioeconomic status (SES) and subjective symptoms of dementia among community-dwelling older Japanese people and examined age and sex variations in this association. METHODS: Data were derived from a cross-sectional survey for all community-dwelling individuals aged 65 years and over in Adachi, Tokyo (n = 132,005). We assessed subjective dementia symptoms using a self-administered dementia checklist, which was validated by comparison with the Clinical Dementia Rating scale. RESULTS: Data from 75,358 questionnaires were analyzed. After adjusting for potential covariates, lower childhood SES was associated with greater likelihood of subjective dementia symptoms. We found a significant interaction between childhood SES and age on subjective dementia symptoms but no interaction between childhood SES and sex. Age-stratified analysis indicated that the association between lower childhood SES and subjective dementia symptoms was stronger in the ≥75 years subgroup than in the 65-74 years subgroup, indicating an effect modification of age on this association. CONCLUSIONS: Our findings suggested that low SES in childhood might have a long-term influence on dementia symptoms in late life and that this influence varied by age. This differential association might be explained by the social and historical context in Japan (ie, World War II, postwar chaos, and high economic growth) that has shaped participants' early experiences.

Prevalence of depressed mood and loss of interest among community-dwelling older people: Large-scale questionnaire survey and visiting intervention.

AIM: Late-life depression is identified less often by general practitioners than depression in younger adults, but failure to have late-life depression recognized in a primary care setting can have fatal consequences. The aim of the present study was to examine the prevalence of depressed mood and loss of interest, and identify associated factors among community-dwelling older adults in a large-scale study. METHODS: A questionnaire was mailed to all residents (n = 132 005) aged ≥65 years in one Tokyo district. The questionnaire asked about depressed mood and loss of interest. It also included items measuring sociodemographic variables, physical health-related variables, psychological variables, socioeconomic variables, attitude to the community and the Dementia Assessment Sheet for Community-based Integrated Care System - 21 items. RESULT: In total, 19.5% of community-dwelling older people had experienced a depressed mood or loss of interest during the past month. This group also showed increased frailty and a negative attitude towards the community, and were less likely to be economically disadvantaged (although more likely to have had a childhood economic disadvantage). The multivariate analysis showed that increased frailty had the strongest relationship with depressed mood. Survey respondents who had either of these conditions were more likely to receive support from the community-based integrated support center. CONCLUSIONS: The present study showed a high prevalence of depressed mood and loss of interest among older people. Frailty was a significant factor, suggesting that collaboration is essential between primary care geriatrics and geriatric psychiatry. Geriatr Gerontol Int 2018; 18: 1567-1572.

Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions.

AIM: The present study aimed to: (i) examine the reliability and validity of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items for classifying patients to the appropriate categories for glycemic targets in older patients; and (ii) develop a short version of the tool and examine its reliability and validity. METHODS: A total of 410 older individuals were recruited for this multicenter cross-sectional study. We classified them into three categories used for determining the glycemic target in older patients in Japan based on cognitive functions and activities of daily living. Exploratory factor analyses were used to select the eight items of the shorter version. The reliability and validity of the assessment tools were assessed using Cronbach's alpha coefficients and receiver operating characteristic analyses, respectively. RESULTS: The Dementia Assessment Sheet for Community-based Integrated Care System 21-items had three latent factors: cognitive function, instrumental activities of daily living and basic activities of daily living. The Dementia Assessment Sheet for Community-based Integrated Care System 8-items was developed based on each factor load quantity and was confirmed to have a strong correlation with the original version (r = 0.965, P < 0.001). Both tools significantly discriminated older adults belonging to category I from those belonging to category II or III, and category III from category I or II. CONCLUSIONS: Both tools had sufficient internal consistency and validity to classify older patients into the categories for determining the glycemic target in this population based on cognitive and daily functions. Geriatr Gerontol Int 2018; 18: 1458-1462.

Development of the dementia assessment sheet for community-based integrated care system.

A series of our studies on the development of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC-21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC-21. Then, the Mini-Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini-Mental State Examination and the Frontal Assessment Battery (FAB). Cronbach's coefficient alpha of the DASC-21 was 0.808-0.950. Scores of the DASC-21 significantly correlated with CDR total and box scores, Mini-Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC-21. Receiver operating characteristic analysis showed that the DASC-21 had sufficient discriminatory ability between dementia (CDR1+) and non-dementia (CDR0 or CDR0.5; area under the curve = 0.804-0.895). When using a cut-off point of 30/31, sensitivity was 83.3-94.1% and specificity was 77.3-86.4%. The DASC-21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community.

[Consideration of national policies to support the development of medical services for dementia].

UNLABELLED: To consider national policies to support the development of medical services for dementia, we conducted three studies. Study 1: We evaluated the dementia management capacity of clinics using a questionnaire on medical services for dementia FINDINGS: 1) Clinics that employed doctors who had attended a lecture on dementia management had a superior capacity to provide primary care services, make diagnoses, manage behavioral and psychological symptoms of dementia (BPSD), provide home healthcare for dementia, and promote community integration compared to clinics that did not employ such doctors. 2)Clinics that employed"dementia support doctors"had a superior capacity to provide such dementia management as mentioned above compared to clinics employing doctors who had attended a lecture on dementia management. However, 3) the questionnaire data suggested that only some clinics that employed "dementia support doctors" could provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in their regular clinical practice. Study 2: We evaluated the current activities of Medical Centers for Dementia (MCDs). FINDINGS: 1) MCDs had more efficient activities in general compared to Dementia Centers for the Elderly (DCEs) established in 1989 and suspended in 2007. However, there was a large disparity among the facilities in terms of their activities. 2) Many MCDs thought that they could not provide adequate services due to the size of their catchment area. 3) Emergency services for dementia patients with concurrent medical conditions were supported by staff of many MCDs located in general hospitals without the designation of a special MCD for providing emergency services. 4) Inpatient stays tended to be longer in psychiatric hospitals where MCDs were located. Study 3: We conducted a preliminary investigation on activities in possible "dementia support clinics". FINDINGS: These clinics had an inferior capacity to provide inpatient services but a similar capacity to make diagnoses, provide management of BPSD, and promote community integration compared to MCDs. From these findings, we made recommendations as follows: (1) It is necessary to not only increase the number of "dementia support doctors", but also to develop adequate numbers of "dementia support clinics" that provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in cooperation with community general support centers in regular clinical practice. (2) It is necessary to monitor the level of activities and develop adequate numbers of MCDs based on the size of the area and population. MCDs should take part in establishing community-based, integrated care systems in cooperation with the local government. Equipping "dementia support teams" might be indispensable in general hospitals that provide emergency medical services for dementia patients. (3) It would be significant to arrange "dementia support clinics" as a medical resource to make diagnoses, provide management of BPSD, and promote community integration for dementia in local dementia planning by a municipality.

Suicidal behavior among homeless people in Japan.

PURPOSE: The purpose of this study is to investigate the frequency and correlates of suicidal behavior among homeless people in Japan. METHODS: A face-to-face survey was conducted in two districts of Tokyo, Japan, with 423 subjects who resided on streets and riversides and in urban parks and stations (street homeless) or who were residents of shelters, cheap hotels, or welfare homes for homeless people (sheltered homeless). RESULTS: When questioned about suicidal ideation in the previous 2 weeks, 51 subjects (12.2% of valid responses) had a recurring wish to die, 29 (6.9%) had frequent thoughts of suicide, and 22 (5.3%) had made suicide plans. In addition, 11 (2.9%) subjects had attempted suicide in the previous 2 weeks and 74 (17.7%) reported that they had ever attempted suicide. In univariate logistic regression analyses, street homelessness, lack of perceived emotional social support, poor subjective health perception, visual impairment, pain, insomnia, poor mental well-being, and current depression were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Among these, current depression had the greatest significance. In multivariate logistic regression analyses after controlling for depression, street homelessness and lack of perceived emotional social support were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. CONCLUSION: Comprehensive interventions including housing and social support as well as mental health services might be crucial as effective strategies for suicide prevention among homeless people.

[Reliability and validity of the simplified Japanese version of the WHO-Five Well-being Index (S-WHO-5-J)].

OBJECTIVES: To examine the reliability and validity of the simplified Japanese version of the WHO-Five Well-Being Index (S-WHO-5-J), which reduces the original 6-point scale to a 4-point scale. METHODS: Subjects were selected from 4,439 community-dwelling elderly living in Tokyo. Their mean age +/- SD was 74.2 +/- 6.6 years, and 2,475 (55.8%) were female. We mailed a questionnaire to all potential subjects, and collected 3,068 (69.1%). We analyzed the data from 1,356 questionnaires that had no missing values for the following items: S-WHO-5-J, Geriatric Depression Scale short version (GDS-15), age, gender, persons living together, need of care, subjective rating of health, physical pain, subjective memory impairment, activities of daily living (TMIG Index of Competence), social support, housebound, and subjective feeling of economic affluence. The mean age +/- SD of the sample was 73.2 +/- 5.9 years, and the proportion of females was 51.1%. An additional analysis compared the number of missing values between a simplified version and an original version using the data of 2,034 subjects from another study. RESULTS: A factor analysis identified only one factor and showed high correlation coefficients between total score and items (0.79-0.87) and between all items (0.52-0.82) and a high Cronbach's alpha (0.889). The S-WHO-5-J was correlated to the GDS-15, to the item on mental health and to factors that affected mental health, physical health (subjective rating of health, physical pain, illness), physical function (walking, falling, nutritional status, oral health care), memory impairment, activities of daily living, and social function (housebound, interaction with others, social support). Additional analysis showed that there were fewer missing values for the S-WHO-5-J than for the WHO-5-J. CONCLUSION: The S-WHO-5-J is a reliable, valid, and convenient measure of mental health for large samples of community-dwelling elderly persons.

[Factors associated with mental health well-being of urban community-dwelling elders in Japan: comparison between subjects with and without long-term care insurance certification].

AIM: The present study aimed to (1) examine the mental health well-being of urban community-dwelling elderly individuals; and (2) examine factors related to mental health well-being of those with long-term care insurance certification (LTCI+) and those without LTCI certification (LTCI-). METHODS: We conducted a community-based, cross-sectional study that included 3,905 subjects aged 65 years or older living in Tokyo, Japan. A self-administered questionnaire was mailed to each participant. Mental health well-being was assessed using the Japanese version of the World Health Organization Mental Health Wellbeing Index--five items (WHO-5). RESULTS: Of the 2,431 respondents (response rate, 63.5%), 1,954 who completed WHO-5 were analyzed (241 LTCI+; 1,713 LTCI-). The total score of WHO-5 was 15.61±6.08 among all subjects; when a cut-off criterion of 12/13 was used, the frequency of low mental health well-being was 29.5% among all subjects. In a stratified analysis according to LTCI certification using multivariate logistic regression analysis, small social support network, heart disease, and daytime sleepiness were independently associated with low mental health well-being for the LTCI+ group; low education level, small social support network, low subjective health, daytime sleepiness, and worries about forgetfulness were independently associated with low mental health well-being for the LTCI- group. CONCLUSION: To improve mental health well-being of community-dwelling elderly individuals with LTCI certification, attention should be focused on those with small social network or daytime sleepiness. To improve mental health well-being of community-dwelling elderly individuals without LTCI certification, attention should be focused on those with small social network, low subjective health, or worries about forgetfulness.

[Depression and the risk of long-term care insurance certification: the Tsurugaya project].

OBJECTIVE: The purpose of this study was to examine the relationship between depressive status and subsequent certification of long-term care insurance use, and to investigate sex differences in this relationship in an elderly Japanese population. METHODS: The Tsurugaya Project was a comprehensive geriatric assessment conducted for community-dwelling elderly persons aged 70 years or older in the Tsurugaya area, Sendai, Japan (N = 2,925). Of those who participated (N = 958), the 841 who gave informed consent and were not qualified for certification of long-term care insurance use at the baseline survey were analyzed. Depression was asessed using the 30-item Geriatric Depression Scale (GDS). We classified the subjects into three categories: normal (GDS less than 10), mild depression (GDS between 10 and 13), and moderate to severe depression (GDS more than 13 and/or taking antidepressive medication). The hazard ratio of incident certification of long-term care insurance use by depressive status was calculated using the Cox proportional hazards model. RESULTS: During 4 years of follow-up, a total of 151 subjects were certificated for long-term care insurance and 46 subjects died. Particularly in men, the depressive status was related to subsequent incident certification of long-term care insurance use. In men, the age-adjusted hazard ratios (HRs) were 1.77 (95% confidence interval (CI): 0.91-3.48) for mild depression, and 2.26 (1.11-4.64) for moderate to severe depression (P for trend = 0.023). The relationship between depressive status and subsequent certification of long-term care insurance use in men was significant even after adjustment for age, comorbid conditions, social factors and lifestyle (multivariate-adjusted HR: 1.31 (95% CI: 0.65-2.65); mild depression 2.19 (1.06-4.54); moderate to severe depression: P for trend= 0.034). In women, there was no significant association between depressive status and certification of long-term care insurance use. In both sexes, there was no significant association between depressive status and death. CONCLUSION: The relationship between depressive status and subsequent certification of long-term care insurance use was significant only in men. In men, the relationship was significant even after adjustment for age, comorbid conditions, social factors and lifestyle. These results suggest a sex difference in the relationship between depressive status and subsequent certification of long-term care insurance use in elderly Japanese.

Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients.

The present study had two aims. The first was to evaluate the reliability and the validity of the Japanese version of the World Health Organization (WHO)-Five Well-Being Index (WHO-5-J) as a brief well-being scale. The second was to examine the discriminatory validity of this test as a screening tool for current depressive episodes in diabetic patients. A sample of 129 diabetic patients completed the WHO-5-J. Of these, 65 were also interviewed by psychiatrists to assess whether they had any current depressive episodes according to DSM-IV. The internal consistency was evaluated using Cronbach's alpha, the Loevinger coefficient of homogeneity, and factor analysis. The external concurrent validity was evaluated by correlations with the external scales potentially related to subjective well-being. Discriminatory validity was evaluated using receiver operating characteristic (ROC) analysis. Cronbach's alpha and the Loevinger coefficient were estimated to be 0.89 and 0.65, respectively. A factor analysis identified only one factor. The WHO-5-J was significantly correlated with a number of major diabetic complications, depression, anxiety, and subjective quality of life. ROC analysis showed that the WHO-5-J can be used to detect a current depressive episode (area under curve: 0.92; 95% confidence interval: 0.85-0.98). A cut-off of <13 yielded the best sensitivity/specificity trade-off: sensitivity, 100%; specificity, 78%. The WHO-5-J was thus found to have a sufficient reliability and validity, indicating that it is a useful instrument for detecting current depressive episodes in diabetic patients.