Participation in health and frailty check-ups predicted functional outcomes and mortality in older adults in Japan.

AIM: This study aimed to examine the association between participation in health and frailty check-ups and functional outcomes and mortality, controlling for physical and cognitive function, or self-rated health among Japanese community-dwelling older adults. METHODS: A cohort of 5093 participants aged ≥65 years (not disabled or institutionalized), completed the baseline survey in April 2013. Functional outcomes and mortality served as follow-up data from April 2013 to March 2018. However, the data did not include events, such as certified cases for long-term care and death for 12 months from the start of follow-up. We collated data on the use of the annual health check system in 2012 and frailty check-ups using the postal Kihon Checklist in 2013. Cox proportional hazards regression models were used to determine the association between participation in the check-ups, and functional outcomes and mortality, adjusting for potential confounders. RESULTS: Long-term care and mortality risks were significantly lower among those aged <75 years who used health screening than among those who did not, despite adjusting for confounding factors (hazard ratios: 2.1-3.5). In those aged ≥75 years, the risk for long-term care was lower in individuals participating in both health and frailty check-ups and in those who participated in the frailty check-ups only, than in those who did not participate. CONCLUSIONS: The association between participation in health and frailty check-ups and adverse health outcomes differed among the age groups, indicating the potential benefit of health and frailty check-ups in older adults. Geriatr Gerontol Int 2023; 23: 348-354.

Development and Testing of the Foot Care Scale for Older Japanese Diabetic Patients.

We aimed to develop and test the reliability and validity of a foot care self-management assessment tool for older Japanese patients with diabetes. In this cross-sectional observational study, which was carried out according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, additional items were developed and selected to reflect older Japanese patients' needs a thorough investigation with experts in diabetes and geriatrics. A total of 200 older patients with diabetes in a foot care outpatient clinic were included in the study to finalize the scale items and verify the scale's reliability and validity. A factor analysis yielded a 4-factor, 9-item scale. Factors 1 to 4 were "skin condition" (3 items), "nail clipping" (2 items), "attention to wounds" (2 items), and "relationships with others" (2 items). The Cronbach's α coefficients for the 4 factors were .852, .900, .820, and .571, respectively. The overall scale was 0.797, indicating good internal consistency. Spearman's correlation coefficients for each of the 4 factors with the scale's total score showed good stability; all correlations were significant. In Japan's super-aged society, it is important to focus on foot care practices among older adults and to promote good foot care practices among early older adults so that they can practice self-care at home. Therefore, a scale for comprehensively evaluating foot care in elderly patients with diabetes is needed. The Foot Care Scale for Older Diabetics could be useful as a tool for assessing the ability to self-manage foot care in older Japanese patients with diabetes.

Associations between diabetes-related foot disease, diabetes, and age-related complications in older patients.

PURPOSE: To examine the relationship of diabetes-related foot disease (DFD) with diabetes and age-related complications in older patients with diabetes mellitus (DM). METHODS: We examined 562 outpatients with diabetes, aged ≥ 65 years, for DFD. The variables collected in this study were demographics, DM-related complications, treatment method, and age-related complications. Differences in the complications were compared between patients with and without DFD. Logistic regression analysis was used to determine the associations of DFD with DM and age-related complications. RESULTS: A total of 246 patients (43.8%) had DFD. Logistic regression analysis identified low grip strength [Odds ratio (OR): 1.83, 95% confidence interval (CI) 1.21-2.76), hypertension (OR: 1.81, 95% CI 1.09-3.00), and diabetes-related peripheral neuropathy (DPN) (OR: 1.92, 95% CI 1.24-2.98) to be significantly associated with DFD. Patients with DPN and hypertension had a higher risk of DFD than patients with DPN or hypertension alone. Individuals with DPN and low grip strength (OR: 1.74, 95% CI 1.09-2.81) were at a lower risk than those with low grip strength alone. CONCLUSION: Hypertension, DPN, and low grip strength were significantly associated with DFD in older patients with DM, with the risk of DFD being higher in patients with both DPN and hypertension. When considering DFD in older patients with DM, low grip strength should be considered equally important as a DM-related complication.

Microvascular complications and frailty can predict adverse outcomes in older patients with diabetes.

AIM: We aimed to assess whether frailty and diabetes-related factors could predict the occurrence of adverse events in older patients with diabetes, who constitute a patient population prone to physical decline and reductions in skeletal muscle mass. METHODS: This retrospective cohort study comprised 477 patients who were being managed by outpatient diabetes care, and the reductions in their muscle strength and walking speed were assessed. Patients were evaluated using the Kihon Checklist, Mini Nutritional Assessment and Mini Mental State Examination, and followed up for 1 year, during which adverse events were monitored and confirmed from past medical records and face-to-face interviews. Intergroup comparisons of participants with and without adverse events during the observation period were undertaken by the paired-sample t-, Mann-Whitney U- and chi-square tests. Multiple logistic regression analysis, adjusted for sex and age, was conducted to determine significant predictors of adverse event incidence. RESULTS: Overall, 12.4% (n = 59; age 74.2 ± 6.2 years) of the patients experienced adverse events. We observed significant between-group differences in the Kihon Checklist total score, walking speed, hypoglycemia episodes, nephropathy, retinopathy, and neuropathy. Microvascular complications and frailty were significant predictors of adverse event incidence (respective odds ratio [95% confidence interval]: 1.403 [1.109-1.775] per additional complication; 2.419 [1.331-4.397] for frailty; both P < 0.05). CONCLUSIONS: In this study, we found that frailty, which was assessed using the Kihon Checklist, and the number of microvascular complications predicted adverse events in older patients with diabetes and should to be assessed. Geriatr Gerontol Int 2021; 21: 359-363.

The Process of Structuring Community Health Needs by Public Health Nurses Through Daily Practice: A Modified Grounded Theory Study.

PURPOSE: It is extremely difficult to apply the model learned in basic education for public health nurses (PHNs) to conduct community health assessments. The purpose of this study was to clarify the process by which community health needs can be structured through PHNs' daily practice. METHODS: Semistructured interviews were conducted in 29 PHNs, and continuous comparative analysis using a qualitative study was performed with a modified grounded theory approach. RESULTS: The participants "used their five senses to understand the relationship between the health and life of people" and "considered those who do not attend" by "learning from stakeholders." To verify such subjective feelings sourced from vague phenomena within the communities, subjective phenomena were converted into qualitative data. CONCLUSION: The application of the findings to organizational continuous education systems may not only help appropriately improve community health assessment methods but can also help improve the evaluation of daily practice and contribute to professional human-resource development.

Two-Year Weight Loss but Not Body Mass Index Predicts Mortality and Disability in an Older Japanese Community-Dwelling Population.

OBJECTIVE: Previous studies in older populations have shown a cardioprotective effect for obesity, an observation known as the obesity paradox. However, whether a decrease or increase in body weight over a certain period affects disability and mortality in older adults remains unknown. Hence, we examined whether the percent body weight change can predict the risk of mortality and disability in older Japanese adults. DESIGN: We performed a longitudinal prospective cohort study. SETTING AND PARTICIPANTS: We investigated 1229 community-dwelling older adults (aged ≥65 years) living in Japan. METHODS: Participants were divided into 3 groups (weight loss, stable weight, and weight gain) based on percentage body weight change (using 1 standard deviation from the mean as cutoff points) between 2011 and 2013. Death and disability incidences were monitored between April 2013 and March 2016. Disability was defined as the need for new long-term care insurance (LTCI). RESULTS: The rates of death and new LTCI requests over the 3-year follow-up were 2.4% and 4.7%, respectively. The weight loss group (reduction >4.8%) had a 5.0% death rate and an 11.1% new LTCI rate, which were significantly higher than those in the stable weight (1.6% and 3.8%, respectively) and weight gain (ie, gain >3.1%) groups (3.9% and 4.7%, respectively). Cox regression analysis confirmed a higher risk for death [hazard ratio (HR) = 3.10, 95% confidence interval (CI) = 1.31-7.31] and new LTCI requests (HR = 3.03, 95% CI = 1.69-5.43) only in the weight loss group. The body mass index did not significantly influence the risk of death or disability. CONCLUSIONS/IMPLICATIONS: Weight loss over 2 years but not body mass index was associated with a higher death and disability risk during the subsequent 3-year follow-up period among older participants. Weight change surveillance can improve the quality of health care by early identifying frailty and death risk population.

Community activities predict disability and mortality in community-dwelling older adults.

AIM: With aging, it is important to maintain older community dwellers' regular engagement with familiar community activities (CA) engaged in close to home to protect them from frailty. Thus, the present study aimed to examine whether CA items or CA score were associated with mortality or the need for care under the new long-term care insurance service requirements over 3 years among community-dwelling older Japanese adults. METHODS: We analyzed cohort data for older adults from a prospective cohort study in Kami town, Japan. The response rate to the self-reported questionnaire was 94.3% (n = 5094), and we followed these participants for 3 years. Our final sample comprised 5076 older adults. Missing data were filled in using multiple imputation. We used seven items to assess CA: (i) volunteer activity; (ii) regional activity related to the neighborhood; (iii) visiting friends; (iv) hobbies or favorite lessons; (v) earning an income; (vi) farm work and growing vegetables; and (vii) shopping daily by oneself. The Kihon Checklist and new long-term care insurance service certifications were used as the frailty screening and disability indices, respectively. RESULTS: During the follow-up survey, 705 participants obtained new long-term care insurance service certifications and 262 died. Using the receiver operating characteristic curve, the desirable cut-off of the CA score to predict disability and mortality was at least two items for all elderly age groups in rural areas. CONCLUSIONS: CA items and CA score could predict disability and mortality in community-dwelling older adults in Japanese rural areas. Therefore, it is recommended that older adults from all age groups participate in CA. Geriatr Gerontol Int 2018; 18: 1114-1124.

Attitudes and values expected of public health nursing students at graduation: A delphi study.

BACKGROUND: The skills and knowledge of the competencies expected of public health nursing (PHN) students at graduation have been clarified; however, the attitudes and values have not yet been studied in Japan. OBJECTIVES: The objective of this study was to identify and reach a consensus among experts on the attitudes and values expected of PHN students at graduation. DESIGN: This survey was conducted as a two-stage Delphi study. PARTICIPANTS: We selected the following experts: 248 teachers in the faculty of public health nursing at a university as academic experts, and 250 public health nurses who were also experienced clinical instructors as clinical experts. METHODS: The round 1 mailed survey was conducted using a questionnaire about the necessity and importance of attitudes and values, and 211 experts responded (42.4%, clinical; n = 124, academic; n = 87). In the Round 2 survey, the experts consisted of 60.2% of the round 1 participants (clinical; n = 73, academic; n = 54). Descriptive statistics were used for multiple imputation. RESULTS: We identified a total of 13 attitudes and values expected of PHN students, and reached ≥90% consensus for most items (except for one). Regarding the expected achievement level at graduation, there was no difference between clinical and academic experts except for one item. CONCLUSIONS: Consensus was clearly achieved for 13 attitudes and values expected of PHN students, as well as importance and expected achievement level at graduation. In the future, it is important to examine strategies that can effectively develop these attitudes and values through basic and continuous education.

Health checkup behavior and individual health beliefs in older adults.

AIM: Despite Japan being a developed nation, half of its older population does not attend regular health checkups. The aim of the present study was to examine the individual health beliefs and personal recommendations that strongly influence health checkup attendance among community-dwelling older adults. METHODS: In 2013, questionnaires were sent to 5401 community-dwelling older adults who were not receiving long-term institutionalized care. The response rate was 94.3%. We analyzed response data from 4984 older adults using multiple imputation to manage missing data. Participation in health checkups was defined as having undergone at least one checkup in the past 3 years, and non-participation as having attended no checkups in this period. RESULTS: The participants' mean age was 75.8 years, and 57.9% were women. The adjusted odds ratio of health checkup participation ranged from 1.35 (95% confidence interval [CI] 1.13-1.61) to 1.62 (95% CI 1.34-1.95) for positive individual health beliefs about health checkups, and was 2.21 (95% CI: 1.51-3.24) and 1.28 (95% CI: 1.17-2.08) for recommendations to participate from family and neighbors, respectively. All odds ratios were adjusted for age, sex, driving by oneself to daily shopping or clinic, paid work, method of response, internal medical therapy, polypharmacy, serious disease, periodic blood test, frailty and neighborly relationships. CONCLUSIONS: The present findings suggest that both individual and community approaches might be effective in promoting participation in health checkups among community-dwelling older adults. Geriatr Gerontol Int 2018; 18: 338-351.

Self-Assessed Kyphosis and Chewing Disorders Predict Disability and Mortality in Community-Dwelling Older Adults.

OBJECTIVE: It is clear that each trend of kyphosis with increased age and the ability to eat firm foods with the back teeth (chewing ability) has a strong influence on both the physical and mental condition of older people. Thus, this study aimed to examine whether the combination of kyphosis and chewing disorders was associated with mortality or the need for care under the new long-term care insurance (LTCI) service requirement, over 3 years in community-dwelling older Japanese adults. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: We analyzed the cohort data for older adults (65 years or older) from a prospective study in Kami town. The response rate was 94.3%, and we followed 5094 older individuals for 3 years. Thus, we analyzed 5083 older adults using multiple imputation to manage missing data. OUTCOME: The outcomes were mortality or new certifications for LTCI services in a 3-year period. MEASUREMENTS: We developed 3 groups by asking 2 self-reported questions on both "no kyphosis" and "good chewing ability." The groups were no kyphosis and good chewing ability (GG), kyphosis and poor chewing ability (BB), and kyphosis and good chewing ability or no kyphosis and poor chewing ability (GB/BG). RESULTS: The prevalence of BB, BG/GB, and GG were 8.9%, 40.3%, and 50.8%, respectively, in our survey. During the 3-year follow-up period, 5.2% (n = 262) died and 13.9% (n = 708) individuals were newly certified as needing LTCI services. As determined by multivariate analyses, BG/GB older adults (adjusted hazard ratio: 1.3 [95% CI 1.1-1.6]) and BB older adults (adjusted hazard ratio: 2.0 [95% CI 1.5-2.4]) had a significantly higher risk of needing LTCI services than GG older adults. Similarly, BG/GB older adults (adjusted hazard ratio: 1.5 [95% CI 1.1-2.0]) and BB older adults (adjusted hazard ratio: 2.3 [95% CI 1.5-3.3]) had a significantly higher risk of mortality than GG older adults did. CONCLUSION: The presence of kyphosis or poor chewing ability was related to mortality and new certifications for LTCI services, and we found an additive effect of these 2 factors related to frailty.

The relationship of community activities with cognitive impairment and depressive mood independent of mobility disorder in Japanese older adults.

AIM: This study aimed to examine the relationship of participating in community activities (CA) with cognitive impairment and depressive mood independent of mobility disorder (MD) among older Japanese people. METHODS: Elderly residents in institutions or those requiring long-term care insurance services were excluded; questionnaires were mailed to 5401 older adults in 2013. The response rate was 94.3% (n=5094). We used multiple imputation to manage missing data. The questionnaire addressed physical fitness, memory, mood, and CA. Participants were divided into two groups (good and bad) based on the median scores for physical fitness, memory, and mood. We identified items related to periodically performed CA, cognitive impairment, and depressive mood, and examined correlations between scores on these sets of items. RESULTS: The mean age was 75.9 years; 58.4% of participants were women. The following CA significantly predicted reduced cognitive impairment and depressive mood independent of MD: volunteer activity, community activity, visiting friends at home, pursuing hobbies, paid work, farm work, and daily shopping. These results were corrected for age, sex, and response method (mail or home-visit). Higher CA scores were associated with lower cognitive impairment and lower depressive mood independent of MD. CONCLUSIONS: CA is negatively associated with cognitive impairment and depressive mood among community-dwelling elderly independent of MD; promoting CA may protect against cognitive impairment and depressive mood in this population. However, MD, cognitive impairment, and depressive mood may lead to reduced CA.

Effect of self-reported quality of sleep on mobility in older adults.

AIM: Quality of sleep (QOS) has been shown to have an affect on mental and physical well-being, and quality of life. However, few studies have investigated how sleep affects mobility in older adults. The aim of the present study was to examine the relationship between QOS and mobility disorder (MD) in community-dwelling older adults. METHODS: Data collected through self-administered questionnaires was analyzed for 4564 Japanese older adults. Sleep outcomes included two self-reported questions regarding QOS. Logistic regression analysis was used to analyze the association between sleep and MD both by the QOS questions independently and grouped together by the two QOS questions into three groups: often sleeps well and good awakening (GG), does not often sleep well and bad awakening (BB) and a group with one of each (GB/BG). RESULTS: After adjustment for age, sex and depression, both those who did not often sleep well and those with poor awakening were more likely to show MD (OR 1.45, 95% CI 1.29-1.75), (OR 1.77, 95% CI 1.50-2.08), respectively. When grouped by both questions, those in the BB group had the least favorable outcome with increased odds ratio for possessing a MD (OR 1.95, 95% CI 1.61-2.37), compared with GB group (OR 1.40, 95% CI 1.18-1.67). CONCLUSIONS: Often sleeping well and good morning awakening were both associated with MD, suggesting that self reported QOS is associated with MD. Further research is required to investigate whether improving sleep quality could be a possible means of preventing and reversing MD in older adults.

[Development of a scale to measure career orientation in public health nurses working in Japanese administrative agencies and relationships with demographic characteristics].

OBJECTIVES: The aim of this study was to develop a career-orientation scale for public health nurses (PHNs) working in local government agencies in Japan, and to examine the relationships of the scale with PHNs' demographic characteristics. METHODS: Self-administered questionnaires were mailed to 7,170 PHNs in 10 prefectures. Items for the scale were determined by conducting a principal factor analysis using varimax rotation. Reliability was examined by calculating a cumulative contribution ratio and a Cronbach's alpha coefficient. A second survey was performed with participants who had given the relevant consent. RESULTS: For the first questionnaire, we received replies from 2,065 PHNs (28.8%), of whom 2,003 (97.0%) provided valid responses. For the second questionnaire, we received valid responses from 222 out of the 252 participants. Five orientation factors were selected, managerial, engagement, service, professional, and stability, along with 19 items. The cumulative contribution ratio was 46.9% and the Cronbach's alpha reliability coefficient was 0.863. The average exact match ratio for the responses from the first and second questionnaires was 59.7% (each item; 47.7-72.10%, each participant; 12.0-92.0%). Multiple regression analysis extracted the following four autonomous variables: experience of start-up of organization-making, presence of a role model, cooperative family, and years of experience as PHN (R2 = 0.052). CONCLUSION: The results indicate that the number of factors and items in our scale was appropriate for simple self-assessment. High values for factor loadings and reliability coefficients indicate a high intrinsic consistency. However, reproducibility requires further investigation, because the average exact match ratio of each participant greatly varied from individual to individual.

Examination of the relationship between the working conditions of young workers and the content of the meals they buy at convenience stores.

The aim of this study was to investigate the relationship between the working conditions of young workers and the meals they buy at convenience stores, and to consider the prevention of obesity. The subjects of this study were 284 workers under 29 yr of age employed at a transportation company in Ishikawa prefecture. Questionnaires were sent to participants, and 193 valid responses were obtained. Working types, night duty and working time were correlated with convenience store patronage, although working situations were not obviously associated with the content of meal selection at convenience stores. The study results revealed a tendency for the proportion of the fat in meals to be greater than 25% for the majority of working situations. It was also shown that foods selected with high frequency contained a high proportion of fat. There results suggest that this situation increases the risk of obesity. In addition, the more days per week convenience stores were patronized, the greater the number of participants felt "The need to improve meals." Therefore, we believe it is essential that young workers consider the prevention of obesity by observing nutritional information when selecting foods. An environment in which such information is easy to obtain at convenience stores should be arranged.

[A study by the Delphi technique of expected competencies of public health nurses working in government organizations].

PURPOSE: The purpose of this study was to clarify, using the Delphi technique and by the consensus of Experts, the expected competencies of Public Health Nurses (PHNs) working in government organizations according to their number of years' experience. METHODS: Experts were nurses who had a PHN license in academic, administration and service areas. The criteria for selecting are as follows: Academic: professors of community nursing department, in nursing college. Administration: chief PHNs working in prefectural government organization, with the role of supervising and controlling PHNs. Service: recommended by each administration Expert and fulfilling all the following 3 points; (1) PHN experience of 10 years or more in a government organization, (2) a supervisory position over at least one junior PHN, and (3) an effective practical record as a PHN. 209 Experts who were chosen by the specified criteria were approached for their participation. At Round 1, Experts were asked to list competencies important for PHN under 3 headings: knowledge, skills and attitudes. From the response in Round 1, competency items were categorized. A list was obtained and used in Round 2, when Experts were asked to select and rate the importance of competencies for 4 ranges of PHN years of experience. At Round 2, these competencies were analyzed on the basis of importance. At Round 3, Experts were asked whether they agree or not with the results of Round 2. The criterion for consensus was set as an agreement rate of 90%. RESULTS: Of the total, 63 agreed to participate; 14 in the academic, 23 in the administration and 26 in the service area. Response were turned 63 from all at Round 1, 52 at Round 2 and 44 at Round 3. The result clarified the expected competencies into 47 items and 7 categories related to their importance in the experience year ranges. The 7 categories were: Conducting nursing processes; Conducting community health activities; Providing health care; Management; Information application; Human relations; and Personal characteristics. The very important competencies PHNs should have were regarded as follows: (1) At 1-3 years' experience, PHNs should have 2 categories (2) At 4-10 years, they should have the 5 categories (3) At 11-20 years they should have all 7 categories (4) At 21 or more years they should have at least 6 categories. At all levels PHNs were required to have the 2 categories of Providing health care and Personal characteristics. CONCLUSIONS: It was expected as PHNs gain experience they should obtain wider and more faranding competencies stepwise, from basic nursing care to community care, and on to administration.