Influence of medical care tasks on subjective burden and gain among older adults' family caregivers: structural equation modeling for testing the role of formal and informal support.

BACKGROUND: The number of caregivers performing medical care tasks at home for older adults is expected to increase. Family caregivers, who are not healthcare professionals, are likely to find these activities difficult and burdensome. However, appropriate support may decrease the negative and increase the positive aspects of caregiving. This study investigated direct associations between caregivers providing medical care at home and their negative and positive appraisals of caregiving (burden and gain), indirect associations through healthcare professional support and informal support, and whether the associations between medical care tasks and caregivers' appraisals of caregiving differed based on the support received. METHODS: Interview surveys were conducted in 2013, 2016, and 2019 in a Tokyo Metropolitan Area city with family caregivers of community-dwelling older adults who were certified as requiring care in Japan's long-term care insurance system. This study analyzed the combined data from each survey (n = 983). Structural equation modeling (SEM) analysis was utilized to examine direct associations between providing medical care and caregiver appraisals and indirect relationships through healthcare professional support and informal support. The modulating effects of these forms of support on the relationship between medical care and caregiver appraisals were assessed using multigroup SEM analyses. RESULTS: Approximately 9% of family caregivers provided medical care at home. The results of SEM analyses, controlled for care recipients' physical and cognitive difficulties; caregivers' age, sex, and economic condition; and survey year, revealed no direct associations between providing medical care and caregivers' sense of burden and gain. They also did not reveal any indirect effects through either healthcare professional support or informal support. However, the results of multigroup SEM analyses indicated that caregivers providing medical care who used home-visit services by physicians and/or nurses, compared to those who did not, tended to exhibit a greater sense of gain. CONCLUSIONS: These results suggest that family caregivers providing medical care at home can positively change their appraisals of caregiving if they receive appropriate support. Home medical care services provided by healthcare professionals can effectively support caregivers. Developing strategies and policies to make medical care services at home more accessible to caregivers is crucial.

[Psychosocial mediators between socioeconomic status and oral health among urban-dwelling older adults].

Objectives　This study examined the psychosocial mediators that most effectively mediate the socioeconomic status (SES)-based differences in oral health (OH) among urban-dwelling older adults.Methods　A representative sample of individuals aged ≥65 years living in two areas with different residential SES in Tokyo produced 739 effective participants. OH was based on the total score of subjective sense of health, number of remaining teeth, and oral function. SES was evaluated by education and income. Based on the socioecological model, mediators were assessed using self-esteem, social support, and depression.Results　 Based on the multiple mediation analysis, no significant effects were observed for specific psychosocial factors. However, the overall psychosocial factors showed significant effects as the mediating factor between income and OH. The mediating effect of overall psychosocial factors was not significant regarding years of education and oral health.Conclusion　A hybrid of life-stage preventive activities and overall reduction of psychosocial risk factors may eliminate the differences in OH by SES.

Mediators of Life-Course and Late-Life Financial Strain on Late-Life Health in Japan: Based on a Cross-Sectional Survey.

Purpose: Few studies have examined together the psychosocial mediators of how life-course and late-life socioeconomic status (SES) influence late-life health. This study explored psychosocial mediators of influences of not only life-course but also late-life financial strain on late-life health in Japan, using a cross-sectional survey. It was hypothesized that: 1) both life-course and late-life financial strain will influence late-life health through common mediators, and 2) such mediating influences will be large on health indicators strongly related to psychosocial resources, such as depressive tendencies and self-rated health. Methods: The participants (N = 739) were aged 65 years and older and lived in metropolitan Tokyo, Japan. Life-course financial strain was measured retrospectively by the number of financially strenuous experiences over the participants' life-courses. Possible mediators included stressors (life-course and late-life major traumatic life events) and psychosocial resources (self-esteem, sense of control, health literacy, social networks, and social support). Health indicators included multimorbidity, disabled activities of daily living (ADL), depressive tendency, and poorer self-rated health. Results: Having a sense of control mediated the significant influences of both life-course and late-life financial strain on disabled ADL. Furthermore, self-esteem significantly mediated the influences of both life-course and late-life financial strain on depressive tendencies and poorer self-rated health. All such mediating influences were significant at p < 0.05. Psychosocial resources did not mediate significant influences of life-course and financial strain on multimorbidity. Conclusion: The results support our hypotheses and make three main contributions on the mechanism through which SES influences late-life health: 1) psychosocial resources mediate the effect of life-course SES on late-life health; 2) the influence differs depending on health type; and 3) these results can generalize to older adults in not only Japan but also Western countries.

Time perspectives as mediators of the associations between socio-economic status and health behaviours in older Japanese adults.

Objective: Few studies have used time perspective (TP) theory to examine the factors mediating the association between socio-economic status (SES) and health behaviours (i.e. the psychological mechanisms that underlie SES differences in health behaviours). The purpose of this study was to examine the mediating effects of TPs on the relationship between SES and health behaviours in older Japanese adults. Design: In total, 761 participants living in the Tokyo metropolitan area participated in face-to-face interviews in 2016. Outcome measures: Health behaviours were measured using three indicators: participation in exercise, healthy dietary habits and smoking status. SES was composed of educational attainment and annual income. TPs were measured using the Zimbardo Time Perspective Inventory, which consisted of five subcategories: the past-negative, past-positive, present-hedonistic, present-fatalistic and future perspectives. Results: Among these five subcategories, none mediated both SES and health behaviours. Conclusion: TPs might not contribute to the appearance of SES differences in health behaviours in older adults.

Socioeconomic status disparities in late-life disability based on age, period, and cohort in Japan.

INTRODUCTION: Effects of disparities in socioeconomic status (SES) on late-life disabilities have been reported around the world. However, there are only a few studies that have examined age, period, and cohort dependent influences of SES disparities on late-life disabilities. We investigated associations between SES disparities and late-life disability based on the Age-Period-Cohort. We also investigated how macro-economic conditions unique to a period, or a cohort might explain the period or the cohort trends. METHODS: Data were obtained from people aged 65 and over that responded to the Comprehensive Survey of Living Conditions, which had been conducted every three years from 1989 to 2013. SES was assessed via household income. Disability was assessed as disabilities in performing Basic Activities of Daily Living (BADL). Income disparities were evaluated by the slope index of inequality (SII) and the relative index of inequality (RII). Each Age-Period-Cohort dimension was simultaneously controlled using a model for cross-classification of random effects. RESULTS: Differences in BADL disabilities due to income disparities decreased with age and reversed after approximately 80 years of age. Income disparities in BADL disability changed across periods, by increasing in periods with a high unemployment rate, which started two to four years before the period. Moreover, results of using SII and RII were nearly identical. CONCLUSIONS: Higher mortality in elderly with lower income might be related to a reduction of income disparities in BADL disability in Japan. Furthermore, exposure to harsh economic conditions might contribute to increased disparities in BADL disability a few years later.

Socioeconomic status and self-rated health of Japanese people, based on age, cohort, and period.

BACKGROUND: Differences in health resulting from differences in socioeconomic status (SES) have been identified around the world. Age, period, and cohort (A-P-C) differences in health are vital factors which are associated with disparities in SES. However, few studies have examined these differences simultaneously. Moreover, although self-rated health (SRH) has been frequently used as an indicator of health, biases in reporting SRH that depend on the socioeconomic characteristics of respondents have been scarcely adjusted in the previous studies. To overcome these limitations, we investigated the associations between disparities in SES and adjusted SRH based on A-P-C, by using a repeated, cross-sectional survey of a nationally representative sample of Japanese people. In addition, we further investigated how exogenous (macroeconomic) conditions unique to a period or cohort would explain trends across successive periods and cohorts. METHODS: Data were obtained from a sample of 653,132 Japanese people that responded to the Comprehensive Survey of Living Conditions (CSLC), which is a cross-sectional survey that had been conducted every three years from 1986 to 2013, on over 10 occasions. In the CSLC, SES has been assessed by household income. We simultaneously controlled for each A-P-C dimension by using the model for cross-classification of random effects, and adjusting SRH data for reporting biases caused by differences in income and A-P-C. RESULTS: Differences in adjusted SRH associated with income differences decreased with age and reversed after 76 years of age. Period differences indicated that income differences peaked in 1992 and 2007. Moreover, differences in adjusted SRH associated with income differences decreased in periods with high unemployment across all periods. Furthermore, there were no cohort differences in adjusted SRH that were associated with income differences. CONCLUSION: In Japan, there are age and period variations associated with adjusted differences in SRH as assessed by income. Moreover, exogenous conditions in each period could help explain periodic trends across successive periods.

[Possibilities for detection of homebound elderly people through the welfare commissioner (Minsei-iin)].

OBJECTIVES: The purposes of this study were (1) to evaluate the percentage of homebound elderly people that could actually be detected through commissioners who consciously tried to detect and provide information regarding these people, and (2) to identify difficulties that commissioners experienced when attempting to detect and provide information about such people. METHODS: This study was conducted in one of the districts of a city in Kanto area. The percentage of detection of homebound elderly people was calculated by following the 3 steps described below. First, the number of homebound elderly people was estimated by using the probability sample survey on elderly people living in the district. Second, detection and information activities were conducted by the commissioner in the district over a 2-month period. Finally, the detection rate through the commissioner's efforts was calculated. The detection rate was calculated by dividing the number of homebound elderly people detected through commissioners by the estimated number of homebound elderly people in the district. The difficulties that commissioners experienced were analyzed by using the KJ method to analyze qualitative data obtained from focus group interview surveys for commissioners. RESULTS: The commissioners actually detected and reported 1.4% of homebound elderly people. The difficulties in detection and reporting included the lack of opportunities for detection and hesitation in providing information about homebound elderly people. CONCLUSION: Although the commissioners are not completely responsible for detection of homebound elderly people, the rate of detection through these commissioners can be higher. To improve this rate of detection, the commissioner's other responsibilities need to be limited and the anonymity of the commissioners who provided information regarding homebound elderly people should be restricted to avoid harming their relationships with the elderly.

[Effects of volunteering on the mental and physical health of senior citizens: significance of senior-volunteering from the view point of community health and welfare].

In such an aging society as Japan, with decreasing number of children. Social activity of senior citizens is important for the well-being and the activation of whole societies. Promoting volunteer activities of senior citizens may serve as one useful plan; however, few researchers have examined the impact of volunteer work on the physical and mental health of senior citizens in Japan. In this study, a survey of previous studies that appeared after 1970 in North America, several findings were obtained: (1) Volunteering among senior citizens improves their mental well-being; (2) Few previous studies reported volunteering improves physical health such as protection for mortality and incidence of disability, compared to mental well-being; (3) Effects of volunteering might depend on gender, race, health status, socioeconomic conditions, and social networks of senior citizens--more impact can be expected on physical health of persons of advanced age; (4) Few previous studies focused on interactions of contents of volunteering programs; (5) Although several studies have reported that 40-100 volunteering hours per year were best quantitative level for health, this remains equivocal; (6) The conventional hypothesis that volunteering, through improvement in psychological, physical, and social factors, may improve ones health, needs assessment in terms of actual impact. Moreover, mechanisms of any influence remain to be clarified. From the point of practical use of volunteering as a health promotion program, it is necessary to explore better content and time engaged, as well as the numbers of groups to which senior citizens belong. Long-term longitudinal and intervention studies are desirable in this area in Japan, focusing on older candidates who are still healthy.

Factors relating to organizational commitment of older male employees in Japan.

Recently, an increasing number of employers have provided employment opportunities for older adults. Yet, few studies pay attention to older employees' perceptions of their employment. Using a Japanese national sample of 995 male employees aged 55 to 64, this study examined whether the existing research on organizational commitment applies to older employees, whether measures that are unique to older employees have significant relationships to their organizational commitment, and whether the effects of these factors differ by retirement status. The results of hierarchical multiple regression analyses showed significant relationships between employee organizational commitment and employment security, personal relationships in workplaces and job characteristics. Negative ageism and employer-sponsored programs for older employees also had significant relationships to organizational commitment. The effects of salary, job autonomy, job demands, and employer-sponsored programs differed by retirement status. While the study was consistent with the existing research, it also suggested the importance of measures that are unique to older employees.

[Factors related to under-utilization of in-home services under the long-term insurance system].

PURPOSES: This study was conducted to examine factors associated with under-utilization of in-home services covered by the long-term care insurance. Under-utilization was measured in terms of the discrepancy rate between benefits limits and service costs for individuals. Based on the behavioral model, possible predictors were chosen; the level of nursing care as the need factor, living arrangements and income as enabling factors, and family caregiving consciousness as a predisposing factor. Both direct and interaction effects of those factors were examined. METHODS: 1,500 people were randomly selected from all people certified as needing long-term care in one ward, Tokyo to be interviewed. People categorized as "requires assistance" or "requires nursing care level 1" were interviewed directly. With people categorized as "level 2" to "level 5", their primary caregivers were interviewed. Information about in-home service utilization was collected from the insurer. RESULTS: People who were categorized as requiring a lower level of nursing care, lived with others, had a low income, or had high family caregiving consciousness demonstrated significantly greater under-utilization rate as compared with others. An interaction between living arrangements and the level of nursing was observed in this regard. While people who lived alone exhibited low a level of under-utilization rate without regard of the level of nursing care, the rate changed by those who lived with other. CONCLUSIONS: Under the new system, informal support might have a significant impact on under-utilization of in-home services. The responsibility for paying 10% of total care costs might be related to under-utilization by people with low income, though reduction of individual co-payments has been introduced for individuals in difficult financial conditions.