A Survey of Emergency Nurses' Perceptions and Practices to Support Patients' Families as Surrogate Decision Makers.

INTRODUCTION: Family members acting as surrogate decision makers for severely ill patients in emergency and critical care centers face psychological burdens. This study aimed to investigate the actual situation of emergency nurses' perceptions and practices to support patients' families and its structural elements. METHODS: We created an original 25-item questionnaire and surveyed 164 emergency nurses from 64 emergency and critical care centers regarding their perceptions of caring for people making surrogate decisions. Participants averaged 35.6 years old and 5.1 years as emergency nurses. RESULTS: Cronbach's α coefficients for importance and practice on the original questionnaire were 0.936 and 0.933, respectively. We identified 4 elements of necessary support for patient families making surrogate decisions according to emergency nurses: "collaboration in understanding the condition of the patient as well as empathetic support," "care that addresses the needs of patient's family members," "confirming the role of nurses and surrogate decision making," and "participation in meeting with a doctor and patient families." In addition, we identified 5 elements that indicate the current state of practice: "support from specialists such as nurses and other professionals," "compassionate care for family members and those who are providing support to family members," "empathetic support for family members," "support for making arrangements that address the needs of family members," and "considerations for family members." DISCUSSION: According to the findings of this study, emergency nurses should coordinate with other professionals and talk with family members and physicians to increase their understanding of the need to assist in surrogate decision making. In addition, emergency nurses also need to explain to patients' relatives how to support them in surrogate decision making.

Effect of pulmonary training for community-dwelling frail older adults with chronic stroke: A randomized controlled pilot trial.

Background: Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community-dwelling, frail elderly people with chronic stroke. Method: This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group (n = 15) and control (n = 15). All participants (65-94 years) attended twelve 20-min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8ï½¥PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6-min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions. Results: The intervention group showed significant improvement in %MIP (95% CI, 2.9-31.6; p < 0.01), DRACE (95% CI, -4.1-0.1; p < 0.01), and SF8ï½¥PCS (95% CI, 2.5-7.2; p < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction. Conclusions: These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.

Work engagement, well-being, and intent to continue working based on educational support among foreign care workers in Japan.

BACKGROUND: Global aging continues to progress. The shortage of human resources involved in long-term care (LTC) is a serious problem worldwide. It is necessary to promote the stable employment of foreign care workers. The purpose of this study was to identify which factors, including well-being, work engagement, and original items, contribute to foreign care workers' intent to continue working. METHODS: We conducted an anonymous self-administered questionnaire survey of 259 foreign LTC workers at LTC facilities in Japan. The questionnaire survey items included the Japanese version of the Subjective Well-being Scale (J-SWBS), the Japanese version of the Utrecht Work Engagement Scale (J-UWES), and original items related to educational needs and issues. We used multiple regression analysis to predict variability from correlations among variables. And after that, we conducted a path analysis using structural equation modeling (SEM), and added that the explanatory variables (IV) were well-being, work engagement, and the original item component, and that the outcome variable (DV) was intention to continue working. We set a hypothetical model based on structural equations, corrected by path analysis, and examined its suitability. RESULTS: The number of returned questionnaires for 259 foreign care workers was 147 (response rate 56.7%), and the number of analyzable questionnaires was 129 (valid response rate 49.8%). For intention to continue working, the results of structural equation modeling showed direct effects for satisfaction with low back pain measure guidance (ß = .255), satisfaction with the national examination guidance method (ß = .217), well-being (ß = .046), and work engagement (ß = .026). In work-engagement, there was a direct effect of happiness (ß = .715), willingness to learn good care (ß = 4.849), and confidence in my ability (ß = 2.902,), whilst in well-being, satisfaction with low back pain measure guidance (ß = 1.582) and confidence in my ability (ß = 1.999) were found to have direct effects. CONCLUSIONS: To increase the intent of foreign care workers to continue working, appropriate guidance should be given related to the development of lumbago. In addition, to provide a place and scene where they can learn good care, having a relationship in practice where foreign care workers can feel that their abilities are being utilized, and developing and maintaining educational support that motivates them to learn good care may be effective.

Ratio of serum creatinine to cystatin C is related to leg strength in predialysis CKD patients.

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) patients have lower levels of physical function. Especially, leg strength is important for daily living and preventing falls. However, physical function screenings are difficult to perform at clinical sites. To find clinically useful method to evaluate physical function in predialysis CKD patients, we tried to evaluate the relationship between the ratio of serum creatinine to serum cystatin C (Cre/CysC), and knee extensor muscle strength/body weight (KEMS) which reflects their leg strength. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We recruited 147 outpatients with CKD (87 men; mean age, 61.6 ± 9.8 years; mean eGFRcreat, 40.7 ± 12.9 mL/min/1.73m2) in this cross-sectional study. KEMS was assessed using a wire strain gauge dynamometer. Skeletal muscle mass and body fat mass were assessed by bioelectrical impedance analysis. RESULTS: The mean value of Cre/CysC was 1.01 ± 0.18. The mean value of KEMS was 1.60 ± 0.47 Nm/kg. In multivariate linear regression analysis, skeletal muscle mass (p < 0.01), body fat mass (p < 0.01), hemoglobin (p = 0.01), and Cre/CysC (p < 0.01) was independently related to KEMS. The correlation between Cre/CysC and KEMS is stronger in high quantile of Cre/CysC. CONCLUSIONS: In predialysis CKD patients, KEMS showed lower as CKD stage advanced. Cre/CysC is significantly related to KEMS independently. Cre/CysC may be an alternative marker for leg strength in CKD patients and even more valuable to utilize in cases with high Cre/CysC.

Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study.

[Purpose] In stroke rehabilitation, gait assessment measures the maximal walking speed and six-minute walking distance, both of which have not been thoroughly investigated as determinants of walking ability. Here, we assessed the methods for evaluating these gait parameters using clinical data on hybrid assistive limb treatment compared with conventional training. [Participants and Methods] In total, 20 stroke patients (hybrid assistive limb group, n=9; conventional group, n=11) participated in this randomized controlled trial. For 12 sessions (three times per week in 4 weeks), the hybrid assistive limb and conventional groups performed gait treatment with hybrid assistive limb and conventional gait training, respectively. Short physical performance battery and walking ability (maximal walking speed and six-minute walking distance) were evaluated pre- and post-intervention. Subsequently, the patients were divided further into two groups: low- and high-balance score groups. [Results] Maximum walking speed and six-minute walking distance were significantly associated, with a positive relationship observed post-intervention. The high-balance score group showed a significant improvement in the six-minute walking distance compared to the low-balance score group. However, no significant improvement in maximum walking speed was observed between both groups. [Conclusion] Due to its sensitivity in detecting differences in balance, six-minute walking distance may be a useful assessment parameter for stroke rehabilitation, particularly in the recovery of physiological walking ability.

[Educational support for obtaining national qualifications of foreign care workers: A qualitative analysis].

OBJECTIVES: The purpose of this study was to clarify the needs and issues of continuing employment and educational support for foreign care worker candidates (hereinafter referred to as candidates) to acquire national qualifications. METHODS: Semi-structured interviews were conducted with 12 people who took and passed the National Examination for Care Workers. The data was analyzed using the constant comparative method of the grounded theory approach. The validity of the results was examined by member checks and peer debriefing. RESULTS: With "the wall in the process of acquiring national qualifications" as the core category, four categories were extracted as factors related to foreign care workers and accepting facilities, and six categories were extracted as factors related to accepting facilities and educational support. CONCLUSIONS: We considered that the needs and issues of continuation of employment and educational support from the perspective of successful applicants are diverse across both training and practical aspects, and are related to the protection of the rights of foreign candidates. Educational support for acquiring national qualifications should meet various needs related to working and learning at the same time, and there are limitations to current training programs. It is necessary to evaluate and improve the current program based on this new knowledge.

Factors related to physical and mental components of quality of life in the community-dwelling frail older persons.

[Purpose] The aim of this study was to investigate factors associated with changes in both the physical and mental components of quality of life (QOL) in of community-dwelling frail older persons in long-term care and to clarify which aspects are important to maintaining physical and mental components of QOL. [Participants and Methods] In this 1 year follow-up cohort study, participants were older persons from a single day care rehabilitation center in Japan. The Medical Outcome Study 8-Item Short-Form Health Survey (MOS-SF8), which gives both physical component summary (PCS) and mental component summary (MCS) scores, was used as the main QOL assessment. Participants were divided according to their level of QOL maintenance according to changes in PCS and MCS scores over the study period, and the variables were compared between the groups. [Results] PCS domain was significantly associated with forced vital capacity and the MCS domain was significantly associated with the Geriatric Depression Scale and Dysphagia Risk Assessment for the Community-Dwelling Elderly Test. [Conclusion] Depression, reduced pulmonary function, and reduced deglutition ability were independently related to low QOL. Assessment of these factors could be beneficial for maintaining the physical and mental components of QOL in community-dwelling frail older persons in long-term care.

Factors associated with overweight status, obesity, and sedentary behavior in elementary and junior high school students.

BACKGROUND: Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases. METHOD: A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated. RESULTS: In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (ß = 0.02, (95%CI: 0.00 to 0.04)) and HDL-C (ß = -0.59, (95%CI: -0.81 to -0.38)) as independent predictors of children's excess weight. CONCLUSION: Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

Effect of respiratory rehabilitation for frail older patients with musculoskeletal disorders: a randomized controlled trial.

OBJECTIVE: To investigate the effects of respiratory rehabilitation on respiratory function, swallowing in community-dwelling frail older patients with musculoskeletal disorders. DESIGN: Randomized open-label controlled trial. SETTING: Day-care facility in a rehabilitation hospital in Japan. SUBJECTS: A total of 63 participants with musculoskeletal disorders (intervention group: n = 31; control group: n = 32) completed the randomized controlled trial. INTERVENTIONS: All participants received 12 20-min sessions twice a week for 6 weeks of either typical rehabilitation (control) or typical rehabilitation with respiratory rehabilitation (intervention). MAIN MEASURES: Outcome measures were assessed prior to rehabilitation and after 12 sessions. The measures included: respiratory function, swallowing function, exercise tolerance, 6-min walk distance, thorax flexibility, muscle strength (grip and abdominal), activities of daily living, and quality of life. RESULTS: Participants in the intervention group showed significantly greater improvement in respiratory function (95% confidence interval (CI), 3.8-6.6; p = 0.01), swallowing function (95% CI -1.8-0.6; p = 0.01), and quality of life (SF8 Physical Summary Score) (95% CI 2.4-7.1; p = 0.01) compared with those in the control group. CONCLUSION: Addition of respiratory rehabilitation to a typical rehabilitation programme could improve not only respiratory and swallowing function, but also quality of life, in frail older patients.

Effects of gait training using the Hybrid Assistive Limb® in recovery-phase stroke patients: A 2-month follow-up, randomized, controlled study.

BACKGROUND: Gait training using the Hybrid Assistive Limb® (HAL®) may have beneficial effects on post-stroke gait function and independent walking. However, the long-term and medium-term efficacies of gait training using HAL® in stroke patients remain unclear. OBJECTIVE: To compare the medium-term efficacy of gait training using a single-leg version of the Hybrid Assistive Limb® (HAL®) on the paretic side with conventional gait training (CGT) in recovery-phase stroke patients. METHODS: Twenty-four post-stroke participants (HAL® group: n = 12, CGT group: n = 12) completed the trial. Over 4 weeks, all participants received twelve 20-min sessions of either HAL® (using the single-leg version of HAL® on the paretic side) or conventional (performed by skilled and experienced physical therapists) gait training. Outcome measures were evaluated prior to training, after 12 sessions, and at 8 and 12 weeks after intervention initiation. Functional Ambulation Category (FAC) was the primary outcome measure. RESULTS: The HAL® group showed significant improvement in FAC after 12 sessions, and at 8 and 12 weeks compared to the conventional group (P = 0.02). CONCLUSIONS: The results suggested that a gait training program based on HAL® may improve independent walking more efficiently than CGT at 1 and 2 months after intervention.

Factors associated with the recovery of activities of daily living after hospitalization for acute medical illness: a prospective cohort study.

[Purpose] This study investigated the factors associated with the recovery rate of activities of daily living of elderly patients hospitalized for acute medical illness. [Subjects and Methods] A total of 238 elderly patients were enrolled in this study. The main outcome measure was the functional independence measure score which was used as an assessment of activities of daily living. The participants were divided into 2 groups based on their activities of daily living before onset: the independent group and the partially dependent group. The participants of each group were further divided into 2 subgroups based on recovery rates of activities of daily living: the high-recovery group (80%) and the low-recovery group (<80%). The factors associated with the recovery rate were examined using multivariate logistic regression analysis. [Results] The factors associated with the recovery rate were: days of inactivity and cognitive status at the start of rehabilitation for the independent group, and days of inactivity and nutritional status at the start of rehabilitation for the partially dependent group. [Conclusion] The results of this study suggest that the important factors for return to normal activities of daily living are: days of inactivity and cognitive status for the independent group; and days of inactivity and management of nutrition for the partially dependent group.

Improvement of gait ability with a short-term intensive gait rehabilitation program using body weight support treadmill training in community dwelling chronic poststroke survivors.

[Purpose] Most previous studies have shown that body weight support treadmill training (BWSTT) can improve gait speed poststroke patients. The purpose of this study was to evaluate effectiveness of a short-term intensive program using BWSTT among community dwelling poststroke survivors. [Subjects] Eighteen subjects participated in this study. The treatment group was composed of 10 subjects (2 women; 8 men; mean age, 59.1 ± 12.5 years; time since stroke onset, 35.3 ± 33.2 months), whereas the control group was made up of 8 subjects (3 women; 5 men; mean age, 59.8 ± 6.3 years; time since stroke onset, 39.3 ± 27.3 months). [Methods] The treatment group received BWSTT 3 times a week for 4 weeks (a total of 12 times), with each session lasting 20 minutes. The main outcome measures were maximum gait speed on a flat floor, cadence, and step length. [Results] No differences were observed in the baseline clinical data between the 2 groups. The gait speed in the treatment group was significantly improved compared with that in the control by 2-way ANOVA, while the other parameters showed no significant interaction. [Conclusion] These results suggested that short-term intensive gait rehabilitation using BWSTT was useful for improving gait ability among community dwelling poststroke subjects.

Locomotion improvement using a hybrid assistive limb in recovery phase stroke patients: a randomized controlled pilot study.

OBJECTIVE: To compare the efficacy of gait training using a single-leg version of the Hybrid Assistive Limb (HAL) on the paretic side with conventional gait training in individuals with subacute stroke. DESIGN: Randomized open controlled pilot trial. SETTING: Hospitalized care. PARTICIPANTS: Convenience sample of 44 patients who met the criteria; 12 patients refused. After randomization (N=32), 10 patients withdrew and a total of 22 poststroke participants (HAL group: n=11; conventional group: n=11) completed the randomized controlled trial. INTERVENTIONS: All participants received twelve 20-minute sessions in 4 weeks of either HAL (wearing the single-leg version of the HAL on their paretic side) or conventional (performed by skilled and experienced physical therapists) gait training. MAIN OUTCOME MEASURES: Outcome measures were evaluated prior to training and after 12 sessions. Functional Ambulation Category (FAC) was the primary outcome measure, whereas secondary outcome measures included maximum walking speed, timed Up and Go test, 6-minute walk distance, Short Physical Performance Battery, Fugl-Meyer Assessment of Lower Extremity, and isometric muscle strength (hip flexion and extension, knee flexion and extension). RESULTS: No participants withdrew because of adverse effects. Participants who received gait training with the HAL showed significantly more improvement in the FAC than those who received conventional gait training (95% confidence interval, .02-.88; P=.04). Secondary measures did not differ between the 2 groups. CONCLUSIONS: The results obtained in this randomized controlled trial suggest that a gait training program with the HAL could improve independent walking more efficiently than conventional gait training.

[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

Effects of gait rehabilitation with a footpad-type locomotion interface in patients with chronic post-stroke hemiparesis: a pilot study.

OBJECTIVE: We developed a footpad-type locomotion interface called the GaitMaster. The purpose of this pilot study was to examine the effects of gait rehabilitation using the GaitMaster in chronic stroke patients. DESIGN: Randomized cross-over design. SETTING: An outpatient department. SUBJECTS: Twelve patients with chronic post-stroke hemiparesis. INTERVENTION: In group A, patients underwent an 'intervention phase' followed by a 'non-intervention phase', whereas in group B, patients underwent the non-intervention phase first, followed by the intervention phase. In the four- or six-week intervention phase, participants underwent twelve 20-minute sessions of gait rehabilitation using the GaitMaster4. MAIN OUTCOME MEASURES: We measured gait speed and timed up-and-go test. RESULTS: No differences between the two groups were observed in the baseline clinical data. For the combined groups A and B, the maximum gait and timed up-and-go test speeds improved significantly only in the intervention phase (P = 0.0001 and P = 0.003, respectively). The percentages of improvement from baseline at the end of GaitMaster training were 16.6% for the maximum gait speed and 8.3% for the timed up-and-go test. The effect size for GaitMaster4 training was 0.58 on the maximum gait speed and 0.43 on the timed up-and-go test. CONCLUSIONS: This pilot study showed that gait rehabilitation using the GaitMaster4 was a feasible training method for chronic stroke patients. Calculation of the sample size indicated that a sample size of 38 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation for chronic stroke patients in a future randomized controlled trial.

[Intervention effects of inclusive support in an "exercise and a nutritional community-based prevention program" for pre-frail elderly individuals].

OBJECTIVES: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care). METHODS: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention. RESULTS: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study. CONCLUSION: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

[Examination of effects of alfacalcidol vitamin D supplement and renal function on improvement in the physical fitness of pre-frail elderly persons attending a nursing care prevention class].

AIM: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people. METHODS: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m(2)) was calculated using a new formula. Alfacalcidol 1 µg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed. RESULTS: The prevalence of eGFR <60.0 ml/min/1.73 m(2) was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)(2)D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests. CONCLUSIONS: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

[Factors affecting burden of caregivers for the elderly of Han Chinese and the Korean minority living in a community in northeast China].

UNLABELLED: Objective In the People's Republic of China (China), caregivers carry a large burden because of the rapid aging of the population, the one-child policy and the uncertainty of the social security system. The situation is further complicated by the fact of 56 ethnic groups in the country. Few studies on caregiver burden in different ethnic groups have been reported, although different customs, cultures and methods of caring for the elderly do certainly exist. The aim of the present study was to compare the caregiver burden for the elderly among Han Chinese and the Korean Minority living in a community and to examine the factors affecting this burden. METHODS: An investigation was conducted using a questionnaire for 76 pairs of elderly people and their caregivers in Yanji City, China (Korean Minority pairs 52, Han pairs 24). The questionnaires for the elderly included their characteristics, economic conditions, ADL, behavioral disturbances associated with dementia, etc. For the caregivers, their characteristics, the state of their health, daily length of care time, social support, intent to continue home care, and Zarit Caregiver Burden Interview (ZBI) score were investigated. RESULTS: The rate (70.8%) of caregivers with a "high caregiver burden," i.e., those with a median ZBI total score of 33 or more, and the personal strain scores of the Han Chinese were significantly higher than in the Korean Minority. As for who was a suitable caregiver, a high percentage of Han caregivers answered the "children" of the elderly, while Korean Minority caregivers answered the "spouses". When the caregiver was a child of the elderly receiving care, the Hans' ZBI score was higher than that for the Korean Minority. Factors most affecting caregiver burden in the Korean Minority were behavioral disturbances associated with dementia of the elderly, ADL, and degree of life independence of the elderly, along with disorders, sex and health state of the caregivers, relations, length of daily care time, number of vice-caregivers, and social support. Factors affecting caregiver burden in the Han group were the presence of private rooms for the elderly, their life satisfaction and family economic conditions. About 80% of caregivers of both groups had the intention to continue home care, and about 50% of the elderly of both groups answered that entering an institution was not acceptable. CONCLUSION: Factors affecting caregiver burden differ between these two ethnic groups, although in both cases about 80% of caregivers intend to continue home care. Therefore, it is necessary to support the elderly and caregivers in ways that suit their ethnic characteristics.

Effects of serum 25-hydroxyvitamin D(3) levels on physical fitness in community-dwelling frail women.

The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D(3) (25(OH)D(3)) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36 degrees north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D(3), intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D(3)<50 nmol/l or 25(OH)D(3)<75 nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), "timed up & go" (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D(3) levels greater than 67.5 nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D(3) levels <47.5 nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D(3) level of greater than 47.5 nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5 nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.