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ABSTRACT: Social isolation among the elderly is a concern in developed countries. Using a randomized trial, this study examined the effect of a social isolation prevention program on loneliness, depression, and subjective well-being of the elderly in Japan. Among the elderly people who relocated to suburban Tokyo, 63 who responded to a pre-test were randomized and assessed 1 and 6 months after the program. Four sessions of a group-based program were designed to prevent social isolation by improving community knowledge and networking with other participants and community "gatekeepers." The Life Satisfaction Index A (LSI-A), Geriatric Depression Scale (GDS), Ando-Osada-Kodama (AOK) loneliness scale, social support, and other variables were used as outcomes of this study. A linear mixed model was used to compare 20 of the 21 people in the intervention group to 40 of the 42 in the control group, and showed that the intervention program had a significant positive effect on LSI-A, social support, and familiarity with services scores and a significant negative effect on AOK over the study period. The program had no significant effect on depression. The findings of this study suggest that programs aimed at preventing social isolation are effective when they utilize existing community resources, are tailor-made based on the specific needs of the individual, and target people who can share similar experiences.
Archives of gerontology and geriatrics 05/2012; 55(3):539-47. · 1.36 Impact Factor
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ABSTRACT: Previous research has indicated that informal caregivers' personal activities are disrupted by their caregiving role, leading to psychological stress and lower life satisfaction. However, the extent to which engagement in personal activities affects caregivers' psychological health remains unclear. This study examines the relationship between different types and frequencies of activities and both positive and negative parameters of the psychological health of caregivers.
A mail survey was conducted with 727 family caregivers of older persons using adult day-care services in the Tokyo metropolitan area. Perceived caregiver burden, care satisfaction, life satisfaction, and depression were used as psychological health outcomes. Engagement in home, outside leisure, social, and peer activities, as well as caregiver and care-recipient characteristics and caregiving situations, were assessed using a multivariate regression analysis.
Engagement in home activities was related to lower scores on burden and depression and greater care satisfaction after controlling for care needs and caregiver characteristics, and social and peer activities were associated with greater life satisfaction. More frequent engagement was also associated with better psychological health, but a moderate involvement in home activities was most strongly associated with better care satisfaction. The amount of outside leisure activity was not significantly related to any of the outcomes.
This study shows that activity type and frequency are associated with caregivers' psychological health, extending previous findings and providing practical implications for the support of family caregivers through programs to improve their participation in specific types of activities.
Aging and Mental Health 02/2012; 16(4):500-6. · 1.37 Impact Factor
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ABSTRACT: A valid and reliable self-administered scale to measure multidimensional aspects of female sexual function is needed in Japan, as sexual dysfunction is quite common in Japanese women.
The aim of this paper is to develop a Japanese translation of the Female Sexual Function Index (FSFI-J), 3-month version, and to measure its psychometric reliability and validity.
Following a language validation process and pilot tests, we modified the scale by adding some instructions and answer options. A cross-sectional survey to examine psychometric reliability and validity of FSFI-J was conducted with 126 healthy Japanese women in partnered relationships. Reliability studies on test-retest and on internal consistency were conducted using the intraclass correlation coefficient (ICC) and Cronbach's α coefficient, respectively. A validity study was conducted on aspects of face, construct, concurrent, and discriminant validity.
The main outcome is the psychometric reliability and validity of FSFI-J.
FSFI-J showed high test-retest reliability (ICC > 0.78) and high internal consistency (Cronbach's α > 0.84). In terms of face validity, FSFI-J was found to be understandable and can adequately measure various aspects of female sexual function. Regarding construct validity, exploratory factor analysis of FSFI-J supported a five-factor solution, consisting of desire/arousal, lubrication, orgasm, satisfaction, and pain. This domain structure was identical to that of the original FSFI. Regarding concurrent validity, FSFI-J total score and domain scores showed significant correlations (Pearson's r = -0.613 for total score) with the sexual function domain of the perimenopausal subjective symptom inventory and overall sexual satisfaction as measured by a visual analog scale (Pearson's r = 0.387). For discriminant validity, the regular menstruation group showed significantly higher FSFI-J scores than the menopause group in the total score and all subdomain scores except sexual satisfaction.
The FSFI-J is a valid and reliable instrument to measure multidimensional aspects of sexual function in healthy Japanese women who are in partnered relationships.
Journal of Sexual Medicine 04/2011; 8(8):2246-54. · 3.55 Impact Factor
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ABSTRACT: The aim of this study was to analyze the situation of social support exchange among elderly men and women and to study the cross-cultural validity of predictors of loneliness in two Nepalese castes/ethnicities of older adults. Data for this study were taken from a cross-sectional study of the elderly at least 60 years old living in one ward of Kathmandu City, conducted in 2005. Loneliness was measured using a three-item loneliness scale based on the University of California at Los Angeles (UCLA) Loneliness Scale. Sources of social support were classified as spouse, children living with their elders, children living apart, and friends/neighbors. Study findings indicate that the main social support exchange for the elderly was with adult children living together, spouse, and friends/neighbors. Results also show gender difference in social support. Significant variables of loneliness were social support received from spouse, social support provided to spouse, and children living together with both elderly parents. This finding shows there is a high degree of cross-cultural invariance in the predictor sources of social support on loneliness among two Nepalese castes/ethnicities older adults.
The International Journal of Aging and Human Development 01/2010; 71(2):115-38. · 0.62 Impact Factor
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ABSTRACT: The objective of this study was to identify the correlates of life satisfaction in elderly Nepalese adults living with a son. A convenience sample of 489 urban elderly was recruited from Kathmandu, Nepal. Socio-demographic, economic, health, and social support variables were used as correlates of life satisfaction. Life satisfaction was measured using 9 of the 11 items of the Life Satisfaction Index by Liang. Results showed that the strongest correlate of life satisfaction was perceived financial satisfaction (p < 0.0001). High life satisfaction was also more likely reported by elderly who were educated (p < 0.05), had fewer functional limitations (p < 0.005), and better perceived health (p < 0.0001). Other correlates with high life satisfaction were instrumental support (p < 0.05) but not emotional support from the son. Further research on correlates of life satisfaction in developing countries will assist health care practitioners and policy makers involved in the well-being of aged populations.
Bioscience trends 10/2008; 2(5):187-92. · 0.97 Impact Factor
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Public Health 05/2008; 122(4):394-6. · 1.35 Impact Factor
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ABSTRACT: Previous literature pointed out that the role of care managers is ambiguous. In 2000, Japan instituted a new policy for long-term care of the elderly (the National Long-Term Care Insurance Policy), within which the work of care managers was recognized as a new profession providing care management services for the elderly needing care. We conducted a random-sampled mail survey on 530 care managers in 268 organizations to clarify the association between role ambiguity and care managers' work environments, including role clarification, organizational profit-seeking climate, and the utilization of professional and personal support. The results showed that fewer opportunities for role clarification and increased organizational profit-seeking climate were associated with greater role ambiguity for care managers. Furthermore, emotional and instrumental support from colleagues and external resources were positively associated with role ambiguity, while informational support from superiors was negatively associated with role ambiguity. Role clarification and the utilization of support within and outside of work organizations would be beneficial to reduce the role ambiguity of care managers.
Care Management Journals 02/2008; 9(3):113-21.
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ABSTRACT: This study aimed to examine the scope of activities performed by hospital volunteers. A survey was conducted on 3055 hospitals, randomly selected throughout Japan. Attention was also paid to the accident-prevention systems instituted by those facilities. Almost one-third (36.5%) of all hospitals had some hospital volunteers. About 60% (59.9%) of hospitals conducted volunteer activities more than once a week. Recreation (50.1%) was the most common role of the volunteers. The other activities in decreasing order were: conversation partners (45.8%), music and entertainment (43.7%), wheelchair pushing (41.8%) and helping administration (36.3%). Both direct and indirect contact between volunteers and patients was prevalent. Less than half of the hospitals had accident-prevention systems, such as guidelines for volunteer activities (except for Volunteer Insurance). Hospitals that had a volunteer coordinator tended to have significantly more accident-prevention systems. It is, therefore, important to establish volunteer coordinators in order to prevent accidents during hospital volunteer activities.
Health Services Management Research 12/2007; 20(4):220-6.
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ABSTRACT: The purpose of this study is to examine participation in volunteer work among older adults in Japan; in particular, to identify the determinants of volunteer participation and reasons for non-participation. Subjects were 593 older peoples aged 60-74 residing in a suburb of Tokyo, Japan. Multivariate logistic regression analyses were conducted to examine the relationship between relevant characteristics and volunteer participation. Among females, those who had lived in the community longer, residing in a single household, actively participating in hobbies or continuing education, not working and reporting better self-rated health were more likely to participate in volunteer activities. By contrast, there were no specific correlations among males. 51.0% of the non-participants reported that they would like to participate in volunteer work in the future. The most frequently given reason for non-participation was "Don't have time to participate". Additional concerns were related to accessibility such as "Don't know where I should go to participate". For promoting volunteer activities among older Japanese, diverse volunteer activities should be offered with consideration to differences in lifestyle by gender and also by available flexible time. A plan for improving the accessibility to volunteer work is also needed.
Archives of Gerontology and Geriatrics 10/2007; 47(2):173-87. · 1.45 Impact Factor
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ABSTRACT: Self-reported health is an easy measure of overall health and is useful in identifying persons at risk of a decline in health and the risk of disability in older adults. The purpose of this paper is to identify the correlates of self-reported health for older adults in Nepal. The subjects (N = 137) were members of the Chhetri caste who were 60 years or older (mean age 69.1 +/- 7.2 years; 54% women) and living in Katmandu City. Data were collected by face-to face interviews using three self-reported health questions. A single scale was developed from the three self-reported questions. Bivariate analysis and multiple regression analysis were used to analyze the results. The findings show a correlation between self-reported health and sex, household status, living arrangements, social participation, chronic health problems, functional disability in activities of daily living (ADL), employment status, and economic satisfaction. Results of multiple regression analysis indicate that factors for self-reported health among older adults are chronic health problems, economic satisfaction, functional disability in ADLs, and social participation.
Bioscience trends 10/2007; 1(2):102-7. · 0.97 Impact Factor
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ABSTRACT: The purpose of this study was to identify significant factors for loneliness in older adults
The subjects (N = 195) were members of the Newar caste/ethnicity, aged 60 years and above (mean(+/- SD) 68.81 (+/- 7.69) years and 52% male) and living in Katmandu City. Data were collected by face-to-face interview using a three-item loneliness scale, developed based on the University of California at Los Angeles (UCLA) Loneliness Scale and prepared with a translation and back translation technique from English into Nepalese. The data were analyzed using logistic regression analyses.
More than two-thirds of Newar elderly experience some type of loneliness. A statistically significant correlation was found between feelings of loneliness and age, sex, household status, total family size, network size, social participation, self-reported health, chronic health problems, working status, instrumental activities of daily living (IADL), and perceived economic satisfaction. Results of logistic regression analyses showed age, network size, and perceived economic satisfaction to be significant factors for loneliness.
Loneliness is an important public health issue, predicting low quality of life among older adults. The present results indicate many elderly Nepalese experience some form of loneliness, with age, network size and perceived economic satisfaction as significant factors. However, this result may not be generalized to the greater population of Nepalese older adults and the external validity of the UCLA Loneliness Scale is an important criterion to examine in future research.
[Nippon kōshū eisei zasshi] Japanese journal of public health 08/2007; 54(7):427-33.
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ABSTRACT: Involvement in activities has been found to be beneficial for improving quality of life and successful aging for older adults. Little is known, however, about the involvement in activities and depression of older adults in Asian developing countries. This study explores whether participation in leisure social and religious activities are related to depression and satisfaction with life in older adults of Nepal. Gender differences are also explored.
The study sample was derived from a survey which aimed to determine the intergenerational relationships between older adults and their married sons. A cross-sectional quantitative study of older adults sixty years and over in Nepal was conducted with face-to-face interviews using structured instruments. A convenience sample of 489 community dwelling older adults, 247 men and 242 women, were included in the study. The dependent variables, depression and satisfaction with life, were measured by the Geriatric Depression Scale (GDS) and Satisfaction With Life Scale (SWLS) respectively. Age, gender, marital status, education, perceived health, financial satisfaction, social support received and provided by older adults, and social activity were independent variables in the study.
Saying prayers (B = -2.75; p < 0.005), watching television and listening to the radio (B = -1.88; p < 0.05), and participating in physical activity (B = -1.05; p < 0.05) correlated to lower depression for older men, but only watching television and listening to the radio (B = -2.68; p < 0.005) related to lower rates of depression for women. Socializing with others (B = 1.22; p < 0.05) was related to higher satisfaction with life for men, but for women visiting friends (B = 1.29; p < 0.05), socializing with others (B = 1.45; p < 0.005), and watching television and listening to the radio (B = 0.92; p < 0.05) related to improved satisfaction with life. Activity engagement significantly improved mental health in older adults.
Specific activity participation was a significant correlate of lower levels of depression and higher levels of satisfaction with life among older adults in Nepal. The findings explore the need for further research on activity participation in developing countries so that it can be useful for health care practioners and those involved with the activities of aged populations in developing countries.
BMC Public Health 01/2007; 7:299. · 2.00 Impact Factor
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ABSTRACT: In Japan, a National Long-Term Care Insurance that provides care for older and infirm people was started in 2000 and the role of care manager (CM) was established to coordinate care plans. As a new profession, CMs have experienced difficulties. This study aimed to clarify CMs' perceived problems regarding case management of difficult cases.
A nationwide mail survey was conducted with CMs in 500 public and privately run home care management organizations who were randomly sampled in 10 prefectures. A total of 556 CMs in 268 organizations returned the questionnaire, which asked questions about the demographics of CMs, their training background, employment experience, caseloads, hours worked, whether full-time or part-time, social support, and training given in the previous year. Questions about 12 different types of difficult cases, devised from a previous study by the authors were further developed in this research's preliminary interviews. The difficult cases identified included: clients with dementia, clients living alone, conflict laden families, over-demanding clients and/or family members, individuals with economic difficulties, reluctance to accept formal services, absence of a responsible family member, clients with medical needs, clients and/or family members with mental or psychological disorders, subjects of mistreatment and abuse, and those having disagreement with service providers. Bivariate analysis was conducted on the variables.
More than 40% of the CMs felt difficulties in all of the 12 case types. Among those who have taken charge of these cases within the previous year, around 80% of the CMs felt difficulties in nearly all cases. From the bivariate analysis, CMs with a registered nursing background reported less difficulty in dealing with clients with medical needs (P<.001) and clients and/or family members with mental or psychological disorders (P< .01). Paradoxically, CMs with longer experience in the job felt greater difficulty with a majority of the 12 case types. This result might be explained by the fact they are given charge of more difficult cases.
These results suggest that registered nurses have a background suitable for dealing with medical and psychological cases, while those with other backgrounds may need further training and support in these areas. Furthermore, there is a need to provide more intensive training and support to CMs with longer experience in the job who are providing care management to more difficult cases.
[Nippon kōshū eisei zasshi] Japanese journal of public health 02/2006; 53(1):29-39.
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ABSTRACT: To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams.
During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed.
Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively.
The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.
BMC Public Health 02/2006; 6:272. · 2.00 Impact Factor
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ABSTRACT: To address delayed language development associated with severe-to-profound congenital hearing loss (CHL), universal newborn hearing screening (UNHS) has been implemented in many countries. In Japan, approximately 27,000 neonates (2.5% of newborn) are screened annually through public-funded programs. While foreign literature highlights the need for assessment, in Japan this has hitherto not been evaluated in detail.
To investigate the efficacy of UNHS in Japan.
We used two criteria to evaluate UNHS; accuracy of screening and the effectiveness of early detection, and searched the major medical and social research journal data bases for related research papers. Eleven articles were identified providing information on accuracy of screening tests and two on effectiveness of early detection.
1) In two prefecture-based studies, 900 and 1,272 newborns were screened to find one case of bilateral CHL. In nine hospital-based programs, the number tested ranged from 313 to 1,910. None of the studies measured the sensitivity and specificity against a best practice standard. 2) The two studies suggested that early intervention might be beneficial, but neither provided conclusive evidence.
The effectiveness of UNHS in Japan is still equivocal because of the difficulties associated with differential diagnosis of hearing loss and normal hearing at the early stage of life and the lack of evidence on effectiveness of early intervention. Before nationwide implementation of UNHS, these issues should be fully investigated and evaluated.
[Nippon kōshū eisei zasshi] Japanese journal of public health 12/2005; 52(11):928-33.
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ABSTRACT: This study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis.
The researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose.
Amongst respondents who wanted full disclosure about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes.
The greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways.
BMC Medical Ethics 01/2005; 5:E7. · 1.74 Impact Factor
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ABSTRACT: Public health nurses (PHNs) played the major role in providing care management for the frail elderly before the Long-term Care Insurance started in 2000. Although the role of care management has now shifted to care managers, PHNs are still consulted by such care managers, service providers and families of the elderly about long-term home care. The purpose of this study was to explore the factors that make a case difficult to deal with from PHNs' viewpoint. This study focuses on the factors related to family living in the same household (living-together family).
The informants of this study were seven PHNs who worked for a city with a population of 67,000 (proportion of elderly in the whole population is 19%) in Nagano Prefecture. First, a focus group interview (about 90 minutes) with the six PHNs was conducted to extract an outline of difficult cases. Next, semi-structured interviews (about 60 minutes each) with five PHNs were conducted to obtain detailed information on difficult cases. The interviews were tape-recorded and transcribed verbatim. KJ analysis was conducted by defining characteristics, finding similar factors, and grouping these together to form categories.
Categories of family related problems emerged for each of two major categories: family characteristics and care related problems. Firstly, existing family characteristics, including the existence of mental or psychological disorders, low motivation towards providing long-term care, conflictual familial relationships, objections to having service providers in the home, and economic difficulties contribute to problems in providing long-term care with living-together families. These characteristics can lead to a second set of problems, relating to the actual provision of care by the living-together family to frail elderly patients. These care related problems include including insufficient care, rejection of formal care services, and deviation from care directives, including to the point of physical mistreatment.
This study points to the need for care providers to consider the living-together family's background and the potential for the phenomena, indicated in this study, to negatively impact on the provision of care for the frail elderly.
[Nippon kōshū eisei zasshi] Japanese journal of public health 08/2004; 51(7):522-9.
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ABSTRACT: Social support, subjective well-being (SWB), and loneliness are issues of central importance in research concerned with the quality of life (QOL) of elderly people in the 21st century. However, very little is known about the situation in low-income countries such as in Nepal. The purpose of this paper is to identify the relationships significant in social support (received (SSR) and provided (SSP)) and analyze their connections with loneliness and SWB. The subjects, not suffering from dementia, were 60 years and above living in Kathmandu city. The data was analyzed using logistic regression with some confounding variables controlled. The results indicate that loneliness is high and SWB is low amongst Nepalese older adults. SSR from children living together and SSP to spouse, children living together and friends and neighbors reduce loneliness. SSP to children living apart increases SWB-life satisfaction. SSR from children living together and SSP to children (living together and apart) increases SWB-life stability. However, SSP to relatives reduces SWB-life satisfaction and SSR from relatives reduces SWB-life stability in Nepalese older adult men.
Archives of Gerontology and Geriatrics 44(3):299-314. · 1.45 Impact Factor
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ABSTRACT: This study aims to describe the present caregiving situation of Filipino adult-child caregivers (CGs) particularly aiming to identify the predictors of CG burden and to assess the effect of social support on stressors and perception of burden. A cross-sectional survey employing face-to-face interviews with 193 adult-child CGs in Davao City, Philippines, measured the perception of burden using the Cost of Care Index (CCI) by Kosberg and Cairl. Results indicated the majority were daughter CGs living with their elderly parents, who were receiving high levels of informal social support. A moderate to high level of burden perception (mean+/-S.D. score of 47.0+/-9.1) was found among respondents. CGs with higher educational attainment showed low burden perception. However, higher family income and higher State-Trait Anxiety Inventory (STAI) anxiety scores were associated with higher burden perception. Also, longer caregiving hours, a male care recipient (CR), and the presence of CR's memory and behavior problems predicted higher CG burden. The interaction between stressors and perceived burden showed that social support provided a buffering effect for CGs experiencing higher burden perception. This suggests that respite and support resources including community-based counseling and education programs to assist CGs in dealing with stress may positively contribute to reduce burden.
Archives of Gerontology and Geriatrics 45(1):27-41. · 1.45 Impact Factor
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ABSTRACT: In Japan, few studies have investigated the effects of moving residence among the elderly, despite the fact that Japanese elderly will be increasingly required to switch residence in the future. Here, we used representative sampling to examine the characteristics of elderly persons who had moved residence to a Tokyo suburb and compared results with those of non-moving residents of the suburb. Movers aged 65 years old or older who had relocated within the previous 2 years (movers) and residents aged 65 years old or older and had lived in the area longer than 5 years (non-movers) were surveyed by mail in 2004, with a focus on health and psychosocial measures. Compared with non-movers (N=117), movers (N=97) were more depressed, socially isolated, and fulfilled less active social roles among family members. The majority of movers had moved to find affordable housing or to live with or near family. Two factors preceded co-residence with family, namely retirement and imminent loss of functional independence. Our findings suggest that movers require community support to prevent social isolation, dependency and health declines.
Archives of Gerontology and Geriatrics 45(2):217-32. · 1.45 Impact Factor
