[Examination of the relationship between tasks in geriatric health service facilities and benefits of working for older assistant care workers].

Objective　In this study, we clarified the characteristics of tasks performed by older assistant care workers at geriatric health services facilities, by individual characteristics and work status. Additionally, we examined the relationship between the tasks and benefits of working for older assistant care workers.Methods　A self-administered questionnaire survey was provided to 2,571 elderly care facilities employing assistant care workers aged ≥60.　A total of 1,606 responses were obtained, and personal characteristics, working conditions, tasks, and benefits of working for older care assistants were surveyed. Thirteen work tasks were established and categorized into four broad categories; user transfer assistance, facility maintenance, meal-related assistance, and managing and talking to users. Seven benefits of working as care assistants were "contribution to society," "social connection," "purpose of life," "income," "learning from caregiving," "health maintenance and promotion," and "time utilization."Results　Most of the respondents were women and relatively young workers. Among tasks, men, younger workers, and those working >5 days weekly represented a high proportion of those performing user transfer assistance tasks. Tasks on managing and talking to users were not correlated with sex, age, and number of days worked, but those with more flexible work patterns were more likely to be engaged in such tasks. Logistic regression analysis showed that user transfer assistance was correlated with benefits of working, such as "contribution to society," "social connection," and "learning from caregiving." Moreover, facility maintenance was associated with "income," "health maintenance and promotion," and "time utilization" and meal-related assistance was associated with "learning from caregiving." Managing and talking to users was associated with "contribution of society," "social connection," "purpose of life," and "learning from caregiving."Conclusion　The tasks of the workers were associated with individual characteristics and work status. The perception of benefits between the working tasks that involved frequent contact with users and those that did not were considerably different.

[Association between the change in the job facilitating and inhibiting factors of care staff due to the employment of older assistant workers and the emotional exhaustion among care staff].

Objectives　The mental health condition of care staff in Japan is becoming problematic. Older assistant workers are currently being employed to assist care staff with their jobs and alleviate their job burden. This employment of older assistant workers is drawing attention; however, their influence on the job facilitating and inhibiting factors of care staff and the association with the care staff's emotional exhaustion remains unclear. In this study, we aim to examine how the employment of older care assistant workers relates to the job-facilitating and job-inhibiting factors of care staff and explore that association with the care staff's emotional exhaustion.Methods　Data from a mail survey of geriatric health services facilities with older assistant workers were analyzed. Among the answers obtained from the care staff, answers from 5,185 who reported working in facilities that employ older assistant workers (over the age of 60) were analyzed. The Emotional Exhaustion subscale of the Japanese Version of the Burnout Questionnaire was used as the dependent variable. The change in job-facilitating and job-inhibiting factors of care staff due to the employment of older assistant workers (improve, maintain/exacerbate) was explored for nine contents.Results　Care staff reported a decrease in the total volume of the task (63.6%), less stress during daily tasks (39.8%), and more concentration on the tasks that require expert care knowledge (38.0%). The results of multiple regression analysis showed that the emotional exhaustion score of care staff was low when the total volume of tasks decreased (ß=－0.383, 95%CI=－0.719, －0.047), when less stress was perceived during daily tasks (ß=－0.432, 95%CI=－0.796, －0.068), when concentration on tasks that required expert care knowledge increased (ß=－0.574, 95%CI=－0.937, －0.210), and when human relationships among staff improved (ß=－0.871, 95%CI=－1.263, －0.480). Conversely, an increase in tasks requiring work with regional personnel and organizations (ß=0.800, 95%CI=0.162, 1.437) was associated with a high emotional exhaustion score.Conclusion　The employment of older care workers was related to the job-facilitating or job-inhibiting factors of care staff, and the change in these factors was associated with lower emotional exhaustion. The employment of older personnel may lower the risk of burnout among care staff.

[Current conditions and challenges of employing older assistant care workers based on geriatric health services facilities' scale].

Objectives　To support care workers, some care facilities employ older individuals as care assistants for peripheral, non-professional tasks. However, the size of the facilities influences their employment needs and support systems for older care workers. Therefore, this study examined the rationale for employing older assistant care workers; the challenges they face; educational systems; and the efforts to facilitate continued employment based on facility size.Methods　Initially, a fax survey was conducted with 3,591 facilities associated with the National Association of Geriatric Health Services Facilities to determine the proportion of older assistant care workers employed. Thereafter, a questionnaire survey was administered to gather more information. Out of 3,591 facilities, 2,170 responded to the survey, and 1,261 responded to the questionnaire. In this study, care assistants aged ≥60 years were classified as older care assistants. The facilities were categorized based on admission capacity into two groups: "small/medium facilities" (≤99 residents) and "large facilities" (≥100 residents). A chi-square test was conducted for data analysis.Results　Of the all geriatric health services facilities, 31.7% employed older assistant care workers. Moreover, the questionnaire survey responses showed they are employed by 687 facilities. Further analysis revealed that larger facilities employed a higher number of older care assistants than small/medium facilities. Small/medium facilities tended to have fewer training systems for older care assistants than larger facilities (30.0% for small/medium facilities vs. 21.6% for large facilities; P=0.014). Furthermore, the work of older care assistants in small/medium facilities was more susceptible to family circumstances than those in larger facilities (15.7% for small/medium facilities vs. 10.2% for large facilities; P=0.033). Compared to small/medium facilities, larger facilities were more likely to state that their employment objective was to reduce the risk of care accidents (19.8% for small/medium facilities vs. 26.3% for large facilities; P=0.046) and provide psychological support, such as periodic interviews, to older care workers to ensure continued employment (24.1% for small/medium facilities vs. for large facilities 37.3%; P<0.001).Conclusion　Larger facilities employeda higher number of older care assistants than small/medium facilities. Furthermore, small/medium facilities were less likely to provide psychological support and had a less structured training system, compared to larger facilities. Additionally, the work of older care assistants in small/medium facilities was more susceptible to family circumstances and other factors, which could affect their work performance. Thus, developing adequate support systems in small/medium facilities is crucial to promoting the employment of older care assistants.

[Relationship between the perceived benefits of working and emotional exhaustion among older assistant care workers: A cross-sectional study].

Objectives　This study is intended to clarify the perceived benefits of working among older assistant care workers employed in geriatric health service facilities and examine the relationship between perceived benefits and emotional exhaustion.Methods　We analyzed data from a mail survey of older assistant care workers employed in geriatric health service facilities that the Japan Association of Geriatric Health Services Facilities conducted in 2020. In this survey, those aged ≥60 were defined as older assistant care workers. Responses were obtained from 1,606 older assistant care workers at 599 facilities. The dependent variable was the emotional exhaustion subscale of the Japanese version of the Burnout Questionnaire. The independent variables were the seven benefits of working as an assistant care worker: 1) I can contribute to society; 2) I am connected to society; 3) I have a sense of purpose in life; 4) I am earning the income I expected since I started working as an assistant care worker; 5) I am learning about care; 6) It has maintained and improved my health; and 7) I can use my time effectively. Latent class analysis (LCA) was performed using these seven benefits as independent variables. Multiple regression analysis was performed using emotional exhaustion and the perceived benefits as dependent and independent variables, respectively. The missing values were supplemented by the multiple imputation method.Results　Overall, 1,601 responses were analyzed after excluding 5 respondents who did not answer all the questions. Four patterns were identified from the LCA results: the "benefit-full type," who perceived all benefits; the "benefit-less type," who perceived few benefits; the "benefit-extroverted type," who perceived social contribution and connection as benefits; and the "benefit-introverted type," who perceived health maintenance and improvement and time utilization as benefits. The multiple regression analysis showed that emotional exhaustion scores were higher for the "benefit-extroverted" and "benefit-less" types than for the "benefit-full" type (b=2.465, P<.001 and b=1.931, P<.001, respectively). No difference was found in the case of the "benefit-introverted" type (b=0.050, P=.851).Conclusion　The perceptions of diverse and introverted benefits were associated with lower emotional exhaustion scores among older assistant care workers. Future intervention studies are needed to examine whether obtaining diverse or introverted benefits can decrease the emotional exhaustion score.

Older assistant workers in intermediate care facilities, and their influence on the physical and mental burden of elderly care staff.

BACKGROUND: As there is a shortage of care staff in elderly care homes, seniors are expected to work as assistants to help the care staff. This study examined the influence of older assistant workers in intermediate elderly care facilities on care staff, specifically focusing on emotional exhaustion which is a sign of burnout. These facilities provide long-term nursing and supportive care to older residents. METHODS: Data from a mail survey of intermediate elderly care facilities with older assistant workers were analyzed. Care staff were asked about the advantages and disadvantages of introducing older assistant workers in elderly care work, and their degree of emotional exhaustion. We also assessed work self-evaluations of older assistant workers, including the benefits of the work, and physical and mental burdens. RESULTS: A significantly large number of care staff reported improvements in workload with the employment of older assistant workers. Intermediate elderly care facilities enrolling more older assistant workers showed lower mean emotional exhaustion among care staff, independent of possible covariates. While older assistant workers felt that their work contributed to helping both care users and staff, they also reported a mental burden. CONCLUSIONS: Our results suggest that older assistant workers can play a significant role in reducing the physical and mental burden of intermediate elderly care facility staff. Thus, employing older assistant workers can be an effective approach to addressing shortages of care staff in elderly care homes.

Enhanced Magnetic Interaction by Face-Shared Hydride Anions in 6H-BaCrO2H.

Studies on magnetic oxyhydrides have been almost limited to perovskite-based lattices with corner-sharing octahedra with a M-H-M (M: transition metal) angle of θ ∼ 180°. Using a high-pressure method, we prepared BaCrO2H with a 6H-type hexagonal perovskite structure with corner- and face-sharing octahedra, offering a unique opportunity to investigate magnetic interactions based on a θ ∼ 90° case. Neutron diffraction for BaCrO2H revealed an antiferromagnetic (AFM) order at TN ∼ 375 K, which is higher than ∼240 K in BaCrO3-xFx. The relatively high TN of BaCrO2H can be explained by the preferred occupancy of H- at the face-sharing site that provides AFM superexchange in addition to AFM direct exchange interactions. First-principles calculations on BaCrO2H in comparison with BaCrO2F and BaMnO3 further reveal that the direct Cr-Cr interaction is significantly enhanced by shortening the Cr-Cr distance due to the covalent nature of H-. This study provides a useful strategy for the extensive control of magnetic interactions by exploiting the difference in the covalency of multiple anions.

Probucol Slows the Progression of Cataracts in Streptozotocin-Induced Hyperglycemic Rats.

We examined the effect of probucol, an antihyperlipidemic drug with potent antioxidant properties, on cataract formation in streptozotocin (STZ)-induced hyperglycemic rats that were given 5% D-glucose as drinking water. Probucol treatment was initiated immediately after the induction of hyperglycemia was confirmed. Using full horizontal-plane lens images captured with an original digital camera system, the opacity of central region of lens was assessed by measuring the opaque area in the region. Central opacities were detected after 3 weeks of hyperglycemia, and progressed in a time-dependent manner. The majority of STZ-induced hyperglycemic rats developed severe cataracts after 9 weeks of hyperglycemia. Probucol slowed the progression of cataracts in a dose-dependent manner. Levels of sorbitol and protein carbonyls in lenses of STZ-induced hyperglycemic rats were higher than those of control rats. Probucol suppressed the increase in protein carbonyls, but not of sorbitol, in lenses of STZ-induced hyperglycemic rats. Probucol had no significant effect on increases in plasma concentrations of glucose, total cholesterol, and triglyceride observed in STZ-induced hyperglycemic rats. These results suggest that probucol slows the progression of sugar cataracts, independent of its lipid-lowering effects. The beneficial effect of probucol on cataracts is partially attributable to the attenuation of oxidative damage to lens proteins.

Anti-cataract Effect of Resveratrol in High-Glucose-Treated Streptozotocin-Induced Diabetic Rats.

Resveratrol, which is a polyphenol found in grapes, peanuts, and other plants, has health benefits for various chronic diseases. The aim of the present study was to examine the effect of resveratrol on cataract formation in diabetic rats. Male Wistar rats (7-week-old) were treated with streptozotocin, and the streptozotocin-treated animals were administered 5% D-glucose in drinking water to promote the formation of cataracts by inducing severe hyperglycemia. Resveratrol supplementation (10 or 30 mg/kg/d) in drinking water was initiated immediately after induction of diabetes was confirmed. The full lens images of the horizontal plane were captured with the digital camera system which we developed. Cataract formation was assessed by an observer-based scoring method and by quantitative analysis of digital images of the lens. Cataracts at the peripheral region of the lens were detected 2 weeks after induction of hyperglycemia and progressed depending on the length of the diabetic period. The majority of them developed severe cataracts after 9 weeks of hyperglycemia. Resveratrol did not prevent the appearance of diabetic cataracts but significantly delayed the progression of cataracts compared with controls. The contents of sorbitol and protein carbonyls in lenses of diabetic rats were higher than those of control rats. Resveratrol suppressed the increase in protein carbonyls, but not of sorbitol, in diabetic lenses. These results suggest that resveratrol delays the progression of diabetic cataracts partially through attenuation of oxidative damage to lens proteins. Resveratrol may be beneficial in preventing the progression of diabetic cataracts.

Probucol prevents the attenuation of ß2-adrenoceptor-mediated vasodilation of retinal arterioles in diabetic rats.

Probucol is an antihyperlipidemic drug with potent antioxidant properties. Oxidative stress plays an important role in the pathogenesis of diabetic retinopathy. In this study, we aimed to investigate the protective effects of probucol against diabetes-induced retinal vascular dysfunction in a rat model of diabetes. Diabetes was induced by a combination of streptozotocin treatment and D-glucose feeding, and retinal vasodilator responses were assessed by measuring the diameter of retinal arterioles. The vasodilator effect of salbutamol, a ß2-adrenoceptor agonist, on retinal arterioles was significantly diminished 2 weeks after the induction of diabetes. In non-diabetic rats, vasodilator responses to salbutamol were significantly reduced after an intravitreal injection of iberiotoxin, a blocker of large-conductance KCa (BKCa) channels. However, this effect was not observed in diabetic rats. Probucol had no significant effect on salbutamol-induced changes in diameter of retinal arterioles in non-diabetic rats, whereas it could prevent the attenuation of retinal vasodilator response to salbutamol in diabetic rats. These results suggest that the reduced function of BKCa channels is involved in the attenuation of ß2-adrenoceptor-mediated retinal vasodilation in diabetic rats. Probucol preserves the BKCa channel function in retinal arterioles under diabetic conditions; therefore, it may show beneficial effects on diabetic retinopathy by preventing or slowing the impairment of the retinal circulation in patients with diabetes mellitus.

The association of change in medication regimen and use of inappropriate medication based on beers criteria with adverse outcomes in Japanese long-term care facilities.

AIM: To describe medication use including potentially inappropriate medication (PIM) and examine the association between adverse outcomes and patient factors including PIM use in Japanese elderly patients in long-term care facilities. METHODS: This was a retrospective cohort study of 470 patients in 53 Geriatric Health Service Facilities and 44 Sanatorium Type Medical Care Facilities for the Elderly Requiring Long Term Care. Standardized forms were used to collect information including oral and parenteral medication use on admission, and 1 month and 3 months after admission. PIMs were determined by the 2003 or 2012 Beers criteria. Adverse outcomes were any medical events leading to emergency department transfer, hospitalization to acute care hospitals or death. RESULTS: A total of 2,227 oral medications and 197 parenteral medications were prescribed for 470 patients on admission. PIM exposure based on the 2003 and 2012 Beers criteria was observed in 11.9% and 37.5%, respectively. Adverse outcomes within 3 months after admission were observed in 8.9% of the entire cohort, and were associated with age, sex, facility type and number of parenteral medications on admission. Adverse outcomes between one and three months after admission were associated with age, sex, number of parenteral medications at one month, and a change in the number of oral and parenteral medications within one month after admission. PIM exposure was not associated with adverse outcomes in any models. CONCLUSIONS: Use of PIM was prevalent in long-term care facilities. Our findings support the importance of comprehensive assessment of medication regimens including parenteral medication. Geriatr Gerontol Int 2017; 17: 591-597.

Intensive rehabilitation for dementia improved cognitive function and reduced behavioral disturbance in geriatric health service facilities in Japan.

AIM: To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community-based care at home and dehospitalization. METHODS: Participants were older adults with dementia newly admitted to intermediate facilities. A total of 158 in the intervention group who claimed Long-Term Care Insurance for three consecutive months, and 54 in the control group were included in the analysis. The interventions were carried out in a tailor-made manner to meet individual needs. The personal sessions were carried out three times a week for 3 months after admission by physical, occupational or speech therapists. Outcome measures were cognitive tests (Hasegawa Dementia Scale revised [HDS-R] and Mini-Mental State Examination), and observational assessments of dementia severity, activities of daily living (ADL), social activities, behavioral and psychological symptoms of dementia (BPSD) using a short version of the Dementia Disturbance Scale (DBD13), depressive mood, and vitality. RESULTS: Significant improvement in the intervention group was shown in cognitive function measured by HDS-R (interaction F[1, 196] = 5.190, P = 0.024), observational evaluation of dementia severity (F[1,198] = 9.550, P = 0.002) and BPSD (DBD13; F[1,197] = 4.506, P = 0.035). Vitality, social activities, depressive mood and ADL were significantly improved only in the intervention group, although interaction was not significant. CONCLUSIONS: Significant improvement by intervention was shown in multiple domains including cognitive function and BPSD. Cognitive decline and worsening of BPSD are predictors of care burden and hospitalization, thus intensive rehabilitation for dementia was beneficial for both individuals with dementia and their caregivers.

[Development of a staging classification for leisure activities and social communication in dependent elderly persons].

AIM: The aim of this study was to develop a simple staging classification to measure leisure activity and social communication among the elderly at geriatric health care facilities. METHODS: In order to construct a staging scale for measuring the participation of the elderly subjects, we developed a list of 28 items for three domains: leisure activities, social participation and communication. Data were obtained from users of institutional and day care services at geriatric health service facilities. The Rasch model was applied to test the degree of item fit and difficulty. Simple staging scales were constructed based on 12 leisure activity and nine social communication items. The validity and reliability were tested using these newly developed scales according to the Rasch model and assessments of the test-retest reliability. RESULTS: The participants were 3,458 elderly persons, of whom 1,560 were currently using institutional services and 1,898 were using day care services. Among the 28 items, "traveling" was identified as the most difficult and "watching television" was identified as the easiest. Because items related to "social participation," such as volunteer activities, exhibited a low frequency, they were not used in the further analyses. Simple staging scales were constructed by analyzing the remaining items of leisure activities and social communication according to the Rasch model. The thresholds within the scales were determined in order of item difficulty. Cohen's kappa, as assessed by two different evaluators, was 0.75 for leisure activities and 0.77 for social communication. CONCLUSIONS: In this study, we developed staging scales for leisure activity and social communication. The construct validity and test-retest reliability were adequate for both scales. Service providers can improve service quality by using these scales for individual case management of elderly persons in conjunction with existing scales of activities of daily living.