Influence of social interaction on behavioral and psychological symptoms of dementia over 1 year among long-term care facility residents.

This study investigated the effect of social interaction including activity participation, relationships with residents, and communication with family/relatives and friends at baseline on the behavioral and psychological symptoms of dementia (BPSD) among long-term care facility residents over 1 year. This follow-up study was conducted among older adult residents with dementia or similar symptoms. Generalized linear mixed effect models were used to examine associations between social interaction and changes in the number and severity of BPSD symptoms over 1 year. Among 220 participants, rare participation in activities and poor relationships with other residents at baseline were associated with greater baseline BPSD. Less communication with family/relatives at baseline was associated with increased severity of BPSD over 1 year. Active interaction with family and relatives may prevent progression of BPSD severity among long-term care facility residents for at least 1 year.

Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long-term care facility residents.

AIM: Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a first-line treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD, as well as their association, should be observed over a longer period. We investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over 1 year among long-term care facility residents. METHODS: A 1-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at follow-up) by using a care staff questionnaire in 10 long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. RESULTS: Among residents followed up for 1 year, new users of PD-particularly anxiolytics and hypnotics-had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs. CONCLUSIONS: Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD.

Behavioral and psychological symptoms of dementia in older residents in long-term care facilities in Japan: a cross-sectional study.

OBJECTIVE: To investigate the prevalence of the behavioral and psychological symptoms of dementia (BPSD) and associated factors in residents in long-term care (LTC) facilities. METHOD: We conducted a cross-sectional survey of older residents with dementia or similar symptoms (n = 312) using a questionnaire for care staff in 10 selected LTC facilities in Hokkaido, Japan. The questionnaire included sociodemographic characteristics, health conditions, living environments, and a brief questionnaire form of the Neuropsychiatric Inventory for assessing BPSD. RESULTS: We revealed that the prevalence of BPSD in LTC facilities (percentage of people exhibiting at least one BPSD) in residents with dementia or similar symptoms was 64%. Having Alzheimer's disease, an imbalance between activities of daily living and cognitive function, poor relationships with other residents, and persistent requests in daily life were significantly associated with having BPSD. CONCLUSION: The prevalence of BPSD in LTC facilities was relatively low compared with other countries. The factors found to relate to BPSD may provide useful information for developing care methods to address BPSD in LTC residents.

The use of psychotropic drugs for behavioral and psychological symptoms of dementia among residents in long-term care facilities in Japan.

OBJECTIVE: To examine whether the use of psychotropic drugs (PDs) was related to behavioral and psychological symptoms of dementia (BPSD) focusing on the prevalence, numbers of symptoms, severity, and care burden among the elderly with BPSD living in long-term care facilities in Japan. METHOD: We conducted a cross-sectional survey among older people with dementia or similar symptoms (n = 312) using a questionnaire for care staff in 10 selected long-term care facilities. A brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. RESULTS: PDs were used in 45% among all participants and 47.5% among those exhibiting at least one BPSD. We found that use of PDs was associated with greater numbers, severity, and care burden of BPSD. Also, there was significantly more use of PDs among people who had specific BPSD symptoms, such as delusions, anxiety, and disinhibition, compared with those who did not. CONCLUSION: The use of PDs among residents in long-term care facilities with dementia or similar symptoms was relatively low compared with previous reports from other countries. Nonetheless, the greater numbers, severity, and care burden of BPSD were associated with the use of PDs.

The creation and dissemination of downloadable information on dementia and driving from a social health perspective.

BACKGROUND: Driving cessation is a likely consequence of progressive dementia. Patients and families can benefit from support through this transition, both to safeguard the patient and public and to help preserve healthy social activity of the patient. METHODS: To provide appropriate supportive information, we developed a 35-page manual ('Supporting family caregivers of older drivers with dementia') available as a free download from our department website. We then informed municipal governments of its availability, tracked website access metrics, and followed up 7 months later with a postal survey to the heads of each municipal government's department of welfare for older citizens. RESULTS: From February to September 2010, the manual was accessed 33 494 times. Of the 1750 municipalities sent surveys, we received 1067 responses (61%). The responses showed that 943 professionals (94.6%) were able to obtain information they needed from the manual, 247 (23%) had used the manual to help residents during the 7 months, and 89% of those who used the manual used it to provide relevant advice to family caregivers. The responses also showed that significantly more use occurred in towns and villages as opposed to cities, consistent with the limited public transportation options in smaller municipalities (P = 0.002). CONCLUSIONS: We anticipate that use of this manual will raise general awareness of this social health issue and facilitate collaborations to provide more social support for those with dementia and their family members.

Awareness and attitudes towards HIV/AIDS among residents of Kandy, Sri Lanka.

Currently, interventions for HIV/AIDS control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18-64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/AIDS-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/AIDS but the knowledge on HIV/AIDS was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/AIDS. The participants showed more positive attitudes towards HIV/AIDS and people living with HIV/AIDS (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/AIDS-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/AIDS to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/AIDS-related knowledge score, targeted HIV/AIDS-related health education interventions maybe recommended in this regard.

Gender gaps in life expectancy: generalized trends and negative associations with development indices in OECD countries.

BACKGROUND: Life expectancy (LE) is a major marker of individual survival. It also serves as a guide to highlight both the progress and the gaps in total social and societal health. Comparative LE in concert with measures of gender-specific experience, indices of empowerment and societal happiness and development offer a comparative tool to examine trends and similarities of societal progress as seen through the lens of cross-national experience. METHODS: To determine the gender gaps in LE (GGLE) trends, we performed a longitudinal analysis, covering a period of 49 years (1960-2008). To examine the association of GGLE with development indices, we used the 2007 GGLE data, the newest happiness data mostly drawn from 2006; the 2006 Human Development Index (HDI) data and the 2006 Gender Empowerment Measure (GEM) data. RESULTS: It revealed that most of the Organization for Economic Co-operation and Development (OECD) countries had a GGLE trend that occurred in an inverted U-curve fashion. We divided them into three subgroups based on the peak years of respective GGLE. The earlier the peak year, the happier the countries, the higher the HDI and the smaller the current GGLE are. Association analysis indicates that Happiness, HDI and GEM are all negatively associated with GGLE. CONCLUSION: This pattern suggests that GGLE undergoes three phases of growth, peak and stability and decline. Japan will soon be seeing its GGLE gradually shrinking in the foreseeable future. The continuing increases in Happiness, HDI and GEM are associated with a decrease in GGLE, which should be carefully taken into consideration.

Which categories of social and lifestyle activities moderate the association between negative life events and depressive symptoms among community-dwelling older adults in Japan?

BACKGROUND: Social and lifestyle activities may serve as potential moderators of the association between negative life events (NLEs) and depressive symptoms among older adults. In this study, we examined whether social and lifestyle activities moderate the association between NLEs and depressive symptoms among older adults, and which activities are significant moderators. METHODS: The data came from a community-based sample of non-institutionalized adults aged 65 years or older. Of the 731 eligible older adults, 682 completed the Japanese version of the 30-item Geriatric Depression Scale. We measured 15 specific negative life events as well as 17 social and lifestyle activities which were grouped into four categories. RESULTS: Specific NLEs pertaining to human relationships, physical condition and financial status were all or were mostly associated with depressive symptoms. Significant moderating roles of social and lifestyle activities on the association of NLEs with depressive symptoms were observed between "loss of a significant other" and "contact with family members and friends" (ß = -0.282, SE = 0.091, p = 0.002); "change in human relationships" and "contact with family members and friends" (ß = -0.270, SE = 0.137, p = 0.048); and "change in human relationships" and "community involvement" (ß = -0.344, SE = 0.133, p = 0.010). CONCLUSIONS: The most statistically significant variable moderating the associations between negative life events and depressive symptoms was "having frequent contact with family members". Depressive symptoms arising from troublesome interpersonal relationships in one's proximal network might be moderated by positive interpersonal relationships.

Differences in perceptions regarding driving between young and old drivers and non-drivers in Japan.

OBJECTIVE: The issue of driving cessation for dementia patients is one of the urgent public health priorities in Japan and is often complicated, with family or social barriers yet to be sufficiently addressed. Because the possibility of dementia or family caregiving can befall anyone, we focused on the disparity in people's perceptions of driving as possible barriers. The present study aimed to assess perceptions of driving among the general public and examine differences in perceptions based on age and driving status. METHODS: A survey was conducted in a sample of the general public aged 40 and over in Japan. Respondents were 1010 people who received a self-administered questionnaire that included questions regarding perceptions about driving and sociodemographic factors. RESULTS: The drivers that participated in this study tended to highly agree that 'driving is a "right" which we all deserve', compared with the non-drivers. The most common reason for reluctance to stop driving among drivers was the possible loss of personal mobility. Apart from transportation, older drivers were more likely than younger drivers to value the qualitative aspects of driving, for example, driving was viewed as 'a motivating factor in my life'. CONCLUSIONS: These disparities in the general public's perceptions about driving may be possible family or social barriers to driving cessation in the case of drivers with dementia. Our findings also suggest that when addressing the need for driving retirement, not only mobility but also the qualitative aspects of driving be paid more attention.

[Attitudes towards family caregiving of people with dementia among the general public in Japan: scale development and validation].

AIM: To develop a scale for attitudes towards family caregiving of people with dementia among the general public in Japan. METHODS: We conducted a postal self-administered questionnaire survey in a sample of the general population aged 20 and over: there were 2,161 (86%) valid responses. Question items in the survey included sociodemographic characteristics, attitude towards family caregiving for people with dementia, and the following three variables associated with dementia and caregiving: respondents' personal anxiety about developing dementia, their knowledge about the Long-Term Care insurance service, and their experiences of caregiving. RESULTS: Factor analysis revealed the following four subscales within this scale: feelings of obligation towards family caregiving (F1), expected feelings of caregiving burden (F2), expectation of personal growth through family caregiving (F3), and negative attitudes towards family caregiving (F4). The Cronbach alpha coefficients for these four subscales ranged from 0.73 to 0.82. In addition, analysis of covariance (ANCOVA), with sociodemographic characteristics as covariates, showed significant relationships (1) between personal anxiety about developing dementia and both F1 and F2, (2) between personal experience of caregiving and F3, and (3) between each of the three variables associated with dementia and caregiving and F4. CONCLUSIONS: The present study confirmed the reliability and validity for the scale of attitudes towards family caregiving of people with dementia among the general public in Japan.

The cleavage program in the 2d cell lineage of Tubifex embryos.

Early development in clitellate annelids is characterized by a highly stereotyped sequence of unequal, spiral cleavages. Cell 2d (i.e., the second micromere of the D quadrant) in the oligochaete Tubifex tubifex also undergoes an evolutionarily conserved sequence of cell division to produce four bilateral pairs of ectodermal teloblasts that act as embryonic stem cells. This study was conducted to characterize each of the 15 rounds of cell division that occur in the 2d cell lineage in this clitellate. After its occurrence, cell 2d undergoes three rounds of highly unequal divisions, giving off the first smaller daughter cell toward the posterior right of the larger daughter cell, the second cell toward the posterior left, and the third cell toward the anterior side of the cell; the larger daughter cell that results from the third division (i.e., the great-granddaughter cell of 2d) then divides equally into a bilateral pair of NOPQ proteloblasts. Cell NOPQ on either side of the embryo undergoes 11 rounds of cell division, during which ectoteloblasts N, Q, and O/P are produced in this order. After its appearance, NOPQ undergoes highly unequal divisions twice cutting off the smaller cells toward the anterior end of the embryo and then divides almost equally into ectoteloblast N and proteloblast OPQ. After its appearance, OPQ undergoes highly unequal divisions twice giving off the first smaller cell toward the anterior and the second smaller cell toward the posterior of the embryo and then divides almost equally into ectoteloblast Q and proteloblast OP. Finally, OP undergoes highly unequal division four times after its birth budding off the smaller cells toward the anterior and then cleaves equally into ectoteloblasts O and P. In the unequally dividing cells of the 2d cell lineage, the mitotic apparatus (MA), which forms at the cell's center, moves eccentrically toward the cortical site where the smaller cell will be given off. The moving MA is oriented perpendicular to the surface it approaches, and its peripheral pole becomes closely associated with the cell cortex. In contrast, the MA involved in the equal divisions remains in the cell center throughout mitosis. The key features of the cleavage program in the 2d cell lineage are discussed in light of the present observations. The mechanical aspects of unequal cleavage in the 2d cell lineage and the modes of specification of MA orientation are discussed. A comparison of the cleavage mode in the 2d cell lineage is also performed among six selected clitellate annelid species.

[Advance care planning among the general public in Japan: association with awareness about dementia].

AIM: To explore attitudes towards advance care planning among the general public in Japan and to examine the association between the advance care planning and awareness about dementia. METHODS: We conducted a postal self-administered questionnaire survey in a sample of the general population aged 40 and over and 86% (n=2,161) of the sample were eligible for analysis. The question items included sociodemographic characteristics, awareness about dementia (anxiety about dementia and knowledge about dementia), and advance care planning (decision making on own care preference if extra assistance were required and disclosure of their care preferences to family members). RESULTS: More than a half of the participants had yet to consider what kind of care they preferred to receive if extra assistance were required, especially in men and younger people. Although some people had made a decision regarding care preferences, only 39% of those had disclosed their wishes for care to family members. People who had higher awareness (anxiety and knowledge) about dementia were more likely to consider or make a decision about care preferences, irrespective of age and gender. On the other hand, the disclosure of care preferences to family members was associated with the age groups but not with the extent of awareness about dementia. CONCLUSIONS: The general public in Japan are not used to determining and disclosing their own preferences on advance care planning. There is clearly a need for greater public awareness and further study about an effective method for enhancement of advance care planning.

[Preferred and actual place of death among community-dwelling disabled older people: findings from a survey of visiting nurses].

AIM: The purpose of this study was to examine the relationship between preferred and actual place of death in community-dwelling disabled older people, based on a survey of visiting nurses. METHODS: The present study was a two-year longitudinal study. At Time 1, 398 disabled older people were living together with their family caregivers. At Time 2 (two years later), the visiting nurses responded to a survey for these 398 disabled older people. The relationship between preferred and actual place of death of disabled older people was examined. RESULTS: Of these disabled older people, 26.4% had died by Time 2. The preferences of the place of death of 60% of the disabled older people were not identified by the visiting nurses. Approximately 40% of the family caregivers' preferences concerning the place of death for their older adults were not identified by the visiting nurses. The disabled older adults tended to die at their preferred place of death if the visiting nurses had identified the preferences. CONCLUSION: In order to assist disabled older people to die at their preferred place of death, visiting nurses should identify the preferences of disabled older people or their family concerning the place of death of the disabled older people.

Contribution of falling and being homebound status to subsequent functional changes among the Japanese elderly living in a community.

Using the data from the community-based longitudinal study of the elderly persons aged 65 or older, this study examined relationships between the occurrence of falls varied by their activity level and subsequent functional decline over time. Of the 705 respondents at baseline, 662 and 632 subjects were assessed at first and second follow-ups. Falling and homebound status at baseline and health function (self-rated general health, activities of daily living (ADLs), instrumental activities of daily living (IADLs), intellectual activity, and social role) at baseline and follow-ups were assessed, and changes in each health function were compared among four groups defined by baseline falling/homebound status. Baseline falling/homebound status was significantly associated with subsequent decline in ADLs over 1 year, and in ADLs, IADLs, intellectual activity, and social role over 2 years. Being homebound might act as a stronger risk factor for ADLs disabilities rather than the occurrence of falls. Moreover, the homebound elderly with no experience of falls was at the greatest risk of the decline of social role. We consider that prevention program and home-based care for homebound elderly should be provided in the community.

Depression among older people in Sri Lanka: With special reference to ethnicity.

AIM: To ascertain if the factors associated with depression differ among ethnic groups in community-dwelling older people in Kandy District, Sri Lanka. METHODS: A cross-sectional survey was carried out of people aged ≥60 years living in a single divisional secretariat of Kandy District. The participants were asked about ethnicity (Sinhalese, Tamil and Muslim), sociodemographic characteristics and depression status by face-to-face interviews with a structured questionnaire. Depression was measured by the 15-item Geriatric Depression Scale, and the total score of ≥6 was considered as depression. The χ2 -test and multivariate logistic regression with two-way interaction terms between sociodemographic characteristics and ethnicity were carried out. RESULTS: Participants (n = 778) consisted of 56.6% Sinhalese, 22.1% Tamils and 21.3% Muslims. Of the participants, the prevalence of depression was 31.8% (27.3% in Sinhalese, 42.1% in Tamils and 32.9% in Muslims). Multivariate analyses showed that there were no significant interactions between sociodemographic characteristics and ethnicity. However, low economic status, low perceived social support and more than two self-reported diseases were significantly associated with depression in all ethnic groups. CONCLUSIONS: Some factors were found to be significantly associated with depression, but did not differ among ethnic groups. The findings would help practitioners to identify older people with a high risk of depression, and to intervene in its development or exacerbation. Geriatr Gerontol Int 2017; 17: 2414-2420.

Self-assessed driving behaviors associated with age among middle-aged and older adults in Japan.

With the increasing number of older drivers, road traffic safety is an urgent public health issue. It is not easy for older drivers or their relatives to detect early signs of dangerous driving behaviors. We examine the types of driving behavior that increase in frequency with age. We surveyed people aged 40 and over among the general public in Japan using a self-administered questionnaire on sociodemographic factors, driving status, frequency of driving, 12-items on physical symptoms possibly related to driving performance, and 28-items on driving behaviors. Multiple logistic regression models were used to estimate the odds ratios (OR) of occurrence of each of the 28 driving behaviors for a 5-year increase in age. Significant associations with a 5-year increase in age after adjusting for confounding factors were found for the following directly unsafe driving behaviors: (1) little or no sign of attempts to avoid dangerous situations (OR for a 5-year increase in age=1.38, 95% CI: 1.18-1.63); (2) lack of attention to other people and cars (1.33, 1.12-1.60); (3) improper maneuvering around curves (1.33, 1.09-1.65); and (4) improper or no turn signals (1.33, 1.06-1.69). Information about these driving behaviors should be given to drivers and their stakeholders and used to caution participants when implementing educational programs for older drivers. Self-assessment of driving ability in older drivers provides useful information to raise awareness of their driving performance.

Mental Health and Its Associated Variables Among International Students at a Japanese University: With Special Reference to Their Financial Status.

We attempted to identify the risk factors that may affect mental health status of the international students and we conducted the survey using a self-administered questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The students were divided into two groups; (1) those who received scholarships and (2) those who didn't since we thought the division represented practical patterns of their financial status. The associations of socio-demographic characteristics with depressive symptoms were examined. Of the 726 students, 480 (66.1%) responded and 207 (43.1%) had depressive symptoms. The logistic regression analysis indicated that quality of sleep, amount of exercise, and housing conditions--but not financial status--were statistically associated with the risk of developing depressive symptoms. Although the inversion of the cause and effect is yet to be ascertained, the students who are unsatisfied with their housing conditions, quality of sleep and less exercise need more attention.

Gender-based seasonality of suicide in Japan, 2005-2012.

This study aimed to explore the gender-based seasonal patterns of suicide in Japan between 2005 and 2012. With data from Japanese official reports, we carried out Prais-Winsten regression and Wilcoxon signed-rank test analysis with Stata 12.0 and SPSS 14.0. The suicide number was significantly higher in March, April, May, June, July, and October for both genders. The suicide number in men was markedly higher than that in women in every month. The suicide number in 2010 was lower than that in 2009 for men, while that in 2011 was higher than that in 2010 for women. The findings displayed that the nationwide television and publicity intervention campaigns might have positive effects on decreasing suicide of men while women suffered a post-earthquake increase. In terms of interventions, we should not only square up the seasonal patterns but also the gender differences in vulnerability.