Effects of a progressive muscle relaxation intervention on dementia symptoms, activities of daily living, and immune function in group home residents with dementia in Japan.

AIM: To evaluate the effects of progressive muscle relaxation on the behavioral and psychological symptoms of dementia, activities of daily living, and immune function of elderly patients with dementia in group homes. METHODS: The participants were ranked by their group home unit. Odd ranks were assigned to the intervention group and even ranks to the control group. The intervention group participated in progressive muscle relaxation for 15 min each day for 90 days in the group environment; the control group members continued with their normal routine. All the participants' secretory immunoglobulin A was measured and they were assessed with the Neuropsychiatric Inventory-Nursing Home version, Nishimura Mental State Scale for the Elderly, and Nishimura Activities of Daily Living Scale. RESULTS: The intervention group comprised 18 participants from six units and the control group comprised 19 participants from five units. After the intervention, the Neuropsychiatric Inventory scores were significantly better in the intervention group, particularly for Agitation and Anxiety. The intervention group also showed significantly lower Apathy and Irritability scores and significant improvement in the Interest, Volition, and Social relationships scores on the Mental State Scale, with improvement in the activities of daily living total. However, there was no difference in the secretory immunoglobulin A level between the groups. CONCLUSION: The results suggest that progressive muscle relaxation improves the behavioral and psychological symptoms of dementia and activities of daily living in group home residents with dementia, but does not affect their immune function.

Ethical issues in practice: a survey of home-visiting nurses in Japan.

AIM: The purposes of this study were to identify specific components and frequencies of ethical issues that home-visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. METHODS: A self-administered questionnaire was distributed to home-visiting nurses in Japan. Usable data (1961) were analyzed. RESULTS: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care-taking views among home-visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home-visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home-visiting nurse, and type of nursing education; age was significantly negatively related. Home-visiting nurses noted that programmed continuing education systems and staff-training programs were not sufficiently available. CONCLUSION: The findings of this study indicated the characteristics of ethical issues that home-visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home-visiting nurses ethical concerns and traits and continuing education systems are needed.

[Investigation of pain assessment trends among residents in Japanese long-term care facilities].

AIM: Pain management is vital for both the maintenance and improvement of the quality of life of residents, in Japanese long-term care facilities. However, few studies examining pain assessment in older populations have been published. The purpose of this study is to investigate the actual conditions related to pain assessment of residents by nurses in Japanese long-term care facilities. Included in this investigation are the actual frequency of pain assessments, the nurses own perceptions of the pain assessment of their residents, whether or not nurses have undertaken any training related to pain assessment, and the need for a pain assessment training period. METHODS: A questionnaire was distributed to 487 nurses in 60 Japanese long-term care facilities. RESULTS: A total of 443 valid responses were collected. The data revealed that 74.7% of these nurses lack the confidence to suitably assess the residents' pain and 44.2% of these nurses do not conduct pain assessments on a regular basis. Additionally, only 9.9% of the nurses surveyed have participated in seminars concerning pain in older people. CONCLUSION: The results indicate that over 70% of nurses lack the confidence to suitably assess their residents' pain. In addition, the number of residents who cannot self-report their pain because of cognitive impairment is increasing. Therefore, it is necessary to develop new approaches which provide nurses with sufficient knowledge and confidence to conduct appropriate pain assessments on their residents.

Life worth living for caregiving and caregiver burden among Japanese caregivers of the disabled elderly in Japan.

The aim of this study is to determine the relationship between life worth living and caregiver burden among caregivers in Japan. We used 111 caregivers of frail elders who completed a self-administered questionnaire including the 8 items developed by Arai et al. (J-ZBI) used as a scale to measure subjective burdens and psychological factors used as covariates other than life worth living. Total score (0-32) of the J-ZBI was dichotomized into "high burden" (> or =21 points) and "low burden" (<21 points). Multivariate logistic regression analysis revealed that only life worth living was significantly associated with caregiver burden. The direct effect of life worth living on caregiver burden (92.9%) was much greater than the indirect effect (7.1%). Our findings suggest that the increase of the sense of life worth living may play an important role in the prevention of the development of caregiver burden.

Gender differences in the relationship between self-rated health (SRH) and 6-year mortality risks among the elderly in Japan.

The purpose of this study was to investigate the relationship between SRH and mortality among 784 non-institutionalized community-living elderly in Japan from 1995 to 2001. The data were collected by face-to-face interviews. The direct effect was estimated by the ratio of regression coefficient of two adjacent models (full model entered all covariates to total effect of SRH), and composed of the direct and indirect effect. Cox analysis stratified by gender was employed to examine the relationship between SRH and mortality. At follow-up in 2001, 148 (18.9%) died, and 636 (81.1%) were alive. Mortality rates were significantly increased with worsening SRH responses for men, but not for women. Men had a significant dose-response association between SRH and mortality, in comparison with fair or poor SRH, the odds ratio for good SRH were multiplied by 0.63 and 0.48, respectively. The magnitude of the direct effect of SRH on mortality was much larger in men (95.7%) than in women (52.5%). These findings suggest that SRH may be more strongly and directly associated with mortality in men, compared to women. Further researches are needed to explore the relationship between the changes in SRH and mortality among elderly people.

Risk factors for 6-year mortality by gender in a Japanese elderly population.

The aim of this study is to examine gender differences in the factors associated with 6-year mortality among 784 elderly residents (mean age=73 years) in Japan from 1995 (baseline) to 2001. Survival status during 6 years of follow-up was confirmed by either inquiries of older participants or family members or data from official death certificates, or both in 2001. Information on variables associated with mortality was elicited by using a face-to-face interview at baseline (1995). Results of longitudinal analyses showed that self-rated health (SRH) was not an independent predictor of mortality among men or women after adjustment of the other factors. Instead of SRH, having much feeling of usefulness among men and being married among women were significantly associated with increased mortality risk, suggesting that these findings may play an important role in enhancing survival in the elderly.

Much communication with family and appetite among elderly persons in Japan.

The purpose of this study is to examine cross-sectionally the factors associated with appetite among the elderly persons living in the community in Japan. The subjects of this study were 754 non-institutionalized elderly men and women aged 65 years and older living in community in Japan. The data were collected by face-to-face interviews. The factors related to subjective health was examined using multiple logistic regression analyses. Four hundred and forty-nine (56.4%) participants evaluated appetite as very good; 239 (30.0%) as somewhat good; 92 (11.6%) as little/not at all. Subjects with good appetite were more physically active, had less depressive symptoms, subjective stress, much more communication with family and much more social support, as compared to those without appetite. Appetite was significantly associated with better subjective good health after controlling for other variables in the model. Only communication with family was significantly associated with good appetite after controlling for other variables (odds ratio, OR=2.43; 95% confidence interval, CI=1.30-4.74). The indirect effect of communication with family on appetite was much greater than the direct effect. These findings suggest that communication with family may be beneficial promoter of the appetite in the elderly.

Role of the second immunoglobulin-like loop of nectin in cell-cell adhesion.

Nectin is a Ca(2+)-independent immunoglobulin (Ig)-like cell-cell adhesion molecule that forms cell-cell adherens junctions cooperatively with E-cadherin in a variety of cells. Nectin has one transmembrane segment and three Ig-like loops in the extracellular region. The first Ig-like loop is essential for the trans-dimer formation of nectin of two neighboring cells, causing cell-cell adhesion. We show here that the second Ig-like loop is essential for the cis-dimer formation of nectin on the same cell, and that the cis-dimer formation is essential for the trans-dimer formation.

Restoration of E-cadherin-based cell-cell adhesion by overexpression of nectin in HSC-39 cells, a human signet ring cell gastric cancer cell line.

Nectin is an immunoglobulin-like adhesion molecule that comprises a family consisting of four members, nectin-1, -2, -3, and -4. Nectin is associated with the actin cytoskeleton through afadin, a nectin- and actin filament-binding protein. The nectin-afadin and cadherin-catenin systems are associated with each other and cooperatively form cell-cell adherens junctions in intact epithelial cells. HSC-39 cells, a human signet ring cell gastric cancer cell line, express E-cadherin but do not form cell-cell adhesion. The beta-catenin gene has been shown to be truncated at the N-terminal region including the alpha-catenin-binding domain in HSC-39 cells, but overexpression of normal beta-catenin failed to form cell-cell adhesion. HSC-39 cells expressed nectin-1, -2, and afadin, but not nectin-3. Overexpression of nectin-3 or -2 formed cell-cell adhesion and accumulation of E-cadherin, but not actin filaments, at the cell-cell adhesion sites. Overexpression of a truncated form of nectin-2 incapable of interacting with afadin failed to form cell-cell adhesion. However, the nectin-formed cell-cell adhesion was not so strong as that observed in epithelial cells, such as CaCo-2 cells. Co-expression of nectin-2 and normal beta-catenin did not form strong cell-cell adhesion. These results suggest that an unidentified mechanism, by which nectin and E-cadherin form the actin cytoskeleton-associated adherens junctions to form strong cell-cell adhesion, is impaired in HSC-39 cells.

Family caregiving of the elderly and Long-Term Care Insurance in rural Japan.

In this study, data were used from a qualitative research study and a literature review to present the characteristics of family caregiving for the elderly in rural Japan, and changes and issues related to home care since the recent implementation of Long-Term Care Insurance (LTCI) for the Elderly. The results of a quantitative study are also used to describe the perceptions of public health nurses about their role in the LTCI, and the future role of Japanese nurses in rural Japan is discussed.