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

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

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

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

Big Five Personality Traits, Social Networks, and Depression Among Older Adults in Japan: A Multiple Mediation Analysis.

This study examines the mediating effect of social network size on depression among older adults in Japan in association with the Big Five personality traits: extraversion, agreeableness, conscientiousness, neuroticism, and openness. Cross-sectional data were obtained from 739 older adults (Mean age = 75.13, SD = 6.86) residing in Tokyo. Multiple mediation analyses estimated total, indirect, and direct effects between personality and depression. Extraversion was associated with the number of kin and friend networks and agreeableness with the number of kin networks. Moreover, these social networks partially mediated the effects of extraversion and agreeableness on depression. The findings show that personality traits such as extraversion and agreeableness are associated with social network size, which contributes to better mental health in old age.

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

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

Mediators and Moderators of the Influences of Living Alone on Psychological Distress Among Japanese Older Adults.

This study explored gender differences in mediators and moderators of the association between living alone and psychological distress among 2556 Japanese older adults aged 65 years and older. Putative mediators and moderators were physical health, income, informal networks, and social support. Living alone was significantly related to psychological distress only in men. Significant mediators were income in both genders and social support only in men. Living alone in women was related to having more informal networks, which reduced psychological distress. This contributed to mitigating the effect of living alone on psychological distress among women. Effective moderators were not discovered.

Social Networks' Health Habits Over Life Course and Late-life Health Habits.

Objectives: In this study, we examined Japanese older adults' health habits (healthy diet, exercise, and nonsmoking) using 4 models: sensitive period, pathway, social mobility, and cumulative effects. Methods: A representative cross-sectional survey of people 65 years and older, living in Tokyo, produced 739 effective respondents. Health habits in social networks over the life course, at junior high school, age 20, and age 40, were measured through retrospective recall questions. Ordinary regression and logistic regression were used separately to analyze healthy diet and exercise/nonsmoking. Results: Regarding pathway effects, standardized coefficients of indirect health habits in social networks on late-life health habits were healthy diet = .073 (p < .05) and exercise = .125 (p < .001). Regarding social mobility effects, standardized coefficients of change to poorer health habits in social networks over the life course on late-life health habits, compared to maintaining healthy habits were healthy diet = -.121 (p < .01) and exercise e= -.235 (p < .05). Regarding cumulative effects, standardized coefficients of no exposure to better health habits in social networks over the life course were healthy diet = -0.103 (p < .01) and exercise = -.395 (p < .01). Conclusions: Three models - pathway, social mobility, and cumulative effects - may explain how healthy diet and exercise in social networks over the life course influence these health habits in later life.

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

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

Caregiving for Older Adults Requiring Hemodialysis: A Comparison Study.

This study examined differences in caregiving appraisal between primary family caregivers of disabled older adults receiving hemodialysis (PFCGs-wHD) and disabled older adults not receiving dialysis (PFCGs-woD). A total of 242 PFCGs-wHD and 335 PFCGs-woD were included in the analyses. We used adjustment by propensity score to control for bias by confounding factors. Caregiving appraisal was measured in terms of role strain, emotional exhaustion, and caregiving satisfaction. On the first task, PFCGs-wHD demonstrated significantly worse levels on all three appraisal indicators than did PFCGs-woD. On the second task, only higher emotional exhaustion was significantly mediated by higher role strain in PFCGs-wHD. Further, PFCGs-wHD status directly influenced lower caregiving satisfaction without mediation by higher role strain. Caregiving for disabled older adults receiving HD may be associated with significant challenges for caregivers.

[Willingness to continue working as district welfare commissioners in Tokyo: the roles of psychosocial rewards, role strain, and support].

Objectives　Factors promoting or inhibiting the willingness to continue working as district welfare commissioners who support community welfare were investigated.Methods　Questionnaires were sent by mail to all district welfare commissioners who had served 2-3 terms in all the wards and cities of Tokyo (N=1,936). The response rate in the survey was 69.5% (N=1,346).Results　Results of structural equation modeling showed the following: (1) Positive feelings such as those resulting from psychosocial rewards for their activities were strongly related to the willingness to continue working as district welfare commissioners, as compared to negative feelings such as role strain. (2) Role ambiguity was related more to the decline in the willingness to continue working, as compared to role overload and role conflict. (3) Support from formal and professional organizations had indirect effects on the willingness to continue working, which was mediated by increase in psychosocial rewards and decrease in role ambiguity.Conclusion　The results suggest the importance of management that decreases role ambiguity and increases psychosocial gains, including the sense of worth, as well as emotional, instrumental, and informational support from public and professional organizations. These were important factors for continuing volunteer activities for community residents.

Social Support, Negative Interactions, and Mental Health: Evidence of Cross-Domain Buffering Effects Among Older Adults in Japan.

This study examined the additive effects of social support and negative interactions in various relationship domains and the cross-domain buffering effects of social support on the detrimental impact of negative interactions on mental health among older adults in Japan. Data were obtained from a survey of residents of 30 municipalities in the Tokyo metropolitan area ( N = 1,592). The results indicated that family members living together may share ambivalent social ties, anchored in positive sentiments and serving as sources of support but where criticism and excessive demands may occur. We found that negative interactions had a more potent additive effect on mental health. Moreover, the interaction effects of negative interactions with family and social support from other relatives suggested reverse buffering. Our findings suggest that interventions might be more necessary to cope with the negative social exchanges of close kin relationships among the elderly Japanese.

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

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

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

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

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

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

[The effects of social networks on health check-up service use among pre-frail older adults (candidate so-called "specified elderly individuals") compared with older people in general].

OBJECTIVES: Nursing care prevention programs cannot accomplish their goals without effective screening of pre-frail older people. Health check-up services provide a very opportunity for this purpose. In the present study we examined not only the direct and indirect effects of social networks on check-up service use among candidate pre-frail older people, but also whether these effects differ from those among older people in general. METHODS: Subjects for this study were respondents of a survey for probability sampled aged 65 and over living in a city, Tokyo. Individuals who gave effective responses to items used in our analysis made up 55.8 percent of the sample. 734 candidate pre-frail older people were selected using the screening criteria provided by the ministry of Heath, Labor and Welfare. The general category of older people numbered 2,057, excluding the candidates and elderly certified for long-term care. Social networks were measured from five aspects: family size; contact with children or relatives living separately; contact with neighbors or friends; involvement in community activities; and seeing a doctor. Our model of indirect effects of social networks on check-up use included awareness of nursing care prevention programs as a mediating factor. Information about whether the subjects used the health check-up service was provided.by the regional government. Magnitude of the effects was evaluated from two aspects; using statistical tests and focusing on marginal effects. RESULTS: Although none of the social network indicators had direct significant impacts on check-up use, contact with children or relatives living separately, contact with neighbors or friends, or involvement with community activities demonstrated significant indirect influence. Contact with neighbors or friends, involvement with community activities, or seeing a doctor had direct significant effects on use among the general category of older people, but none of the social network indicators demonstrated significant indirect effects. Involvement with community activities had the strongest total (direct plus indirect) effects on the use in the social networks indicators among the candidates when viewed with the focus on marginal effects. However, it was estimated that the rate of use would raise only about 5 percent even if average frequency of contacts with community activities were to increase from less than one time to one time over a month among the candidates. CONCLUSION: It is suggested that effects of social networks on health check-up service use among candidates of pre-frail older people could be produced by improving awareness of nursing care prevention programs.

Work, Health, and Family at Older Ages in Japan.

In this paper, we investigate ways in which the relationship between health and labor force exit at older ages is moderated by family characteristics. Using two waves of data from a national sample of older Japanese men collected 1999 and 2002, we estimate logistic regression models for labor force exit beyond age 63 as a function of health change, family characteristics, and their interactions. We confirm that poor health is strongly associated with labor force exit and find evidence that moderating influences of family context depend upon the level of health. However, results are only partially consistent with hypotheses that the relationship between health and the likelihood of labor force exit should be stronger for (a) those with good health and family incentives to exit the labor force and (b) those with poor health and family incentives to remain in the labor force.

A longitudinal study of coping and burnout among Japanese family caregivers of frail elders.

OBJECTIVES: The purpose of this study is to clarify causal relations between coping strategies and burnout in family caregivers of frail elders in Japan. METHODS: Baseline and 1-year follow-up interviews were conducted with 546 caregivers living in suburban Tokyo. Using newly refined measures, five coping strategies of caregivers (Keeping Their Own Pace, Positive Acceptance of Caregiving Role, Diversion, Informal Support Seeking, and Formal Support Seeking), and caregiver burnout were measured, as well as several confounding factors. RESULTS: After controlling for these confounding factors, results of cross-lagged effects modelling showed that adoption of a Diversion coping strategy decreased caregiver burnout, while increases in burnout decreased caregiver Positive Acceptance of Caregiving Role. CONCLUSIONS: The beneficial effect of an Adaptive Avoidance Coping strategy, Diversion, on caregiver mental health was confirmed in this two-wave longitudinal study. The mechanism by which Diversion appears to work is by containing caregiving stressors from completely spilling over into caregivers' personal lives. In addition, we also show that preventing a decline in caregiver mental health (i.e. an increase in burnout) allowed caregivers to more easily embrace the caregiving role and, as a result, elder care-recipients were better positioned to receive high quality care.

Productive roles, gender, and depressive symptoms: evidence from a national longitudinal study of late-middle-aged Japanese.

Using three waves of panel data collected from a national sample of Japanese adults between the ages of 55 and 64 years, we examined the relationship between productive roles and depressive symptoms. Our particular emphasis was on multiple roles, role transitions, and gender differences. We found that, among men, engaging in more hours of paid or volunteer work was related to fewer depressive symptoms. Although men who lost their paid work role reported more depressive symptoms, volunteer work attenuated the negative effect of losing their paid work role. For women, none of the productive roles examined in this study were found to be independently linked with depressive symptoms. However, engaging in multiple productive roles, in comparison with doing only housework, was related to fewer depressive symptoms. These findings suggest the psychological benefits of paid and volunteer work for retirement-aged men in Japan, and the need to be attentive to gender differences in the impact of productive roles.

Intertwining courses of functional status and subjective health among older Japanese.

OBJECTIVES: We sought to depict how trajectories of functional status are related to the average changes in self-rated health and its underlying trajectories. METHODS: Data came from a five-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. We employed hierarchical linear models and multinomial logistic regression to depict the interrelationships among patterns of temporal change in functional status and self-rated health. RESULTS: Trajectories of functional status were associated with the average age-related changes in subjective health (i.e., linear and nonlinear slopes). Furthermore, there were significant correlations between the courses of functional health and those of self-rated health. Finally, recovery from poor self-rated health was characterized by having poor health and functional ability at baseline. DISCUSSION: Researchers can generalize prior observations of the association between functional status and subjective health at one or more points in time to their long-term trajectories. These findings provide further insights into understanding the dynamics between two key dimensions of health among older adults in Japan.