Ayumi Kono

Subepidermal Moisture Predicts Erythema and Stage 1 Pressure Ulcers in Nursing Home Residents: A Pilot Study

OBJECTIVES: To examine the relationship between a measure of subepidermal moisture (SEM) and visual skin assessment (VSA) of erythema and Stage 1 pressure ulcers (PUs) performed a week later in nursing home (NH) residents.

Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial

BACKGROUND The aim of this study was to examine the effects on functional and psychosocial parameters and long-term care utilization of a preventive home visit program for ambulatory frail Japanese elders. METHODS Eligible participants (n = 323) were randomly assigned to intervention (n = 161) or control group (n = 162). Nurses and care managers provided structured preventive home visits to the intervention group participants every 6 months over 2 years. Activities of daily living (ADLs), instrumental activities of daily living (IADLs), depression, and social support were collected via mail questionnaire at baseline and at 12- and 24-month follow-up points. The utilization of long-term care insurance was documented over the period. RESULTS Two-way analysis of covariance did not show significant outcome differences overall. In a pre-planned subgroup analysis for participants who had at least one ADL dependency at baseline, those in the intervention group (N = 105) were significantly less likely to deteriorate over 2 years in their function and depression than those in the control group (N = 100): ADLs (p = .0311), IADLs (p = .0114), depression (p = .0001). The total long-term care costs over 2 years in the intervention group (36,001 credits) were higher than in the control group (26,022 credits) (nonsignificant), and elders in the intervention group utilized significantly more community and institutional long-term care services than those in the control group over the period 7 months to 15 months after the intervention started. CONCLUSIONS The results suggest that a preventive home visit program might be ineffective on functional and psychosocial status among ambulatory frail elders overall, although it might significantly improve ADLs, IADLs and depression for those with ADL dependency.

Preventive home visit model targeted to specific care needs of ambulatory frail elders: preliminary report of a randomized trial design

Aim: The aim of this article is to describe the program and study design of our preventive home visit model that targets the specific care needs of Japanese ambulatory frail elders living at home. Methods: The program focused on ambulatory frail elders who were certified as being in the two lowest levels of care need in the Long-Term Care Insurance system and eligible for care, but who were currently not using long-term care services. To provide efficient community-based preventive care, we developed a program model composed of structured assessments and individualized care recommendations conducted by community care nurses or workers. The assessment protocol focused on locomotion, activities of daily living, social activities, health status, and possibility of abuse. Care needs were clarified every six months over two years. The effectiveness of the program is being assessed in a randomized controlled trial. Results: A total of 243 elders were assigned randomly to the preventive home-visit intervention (n=122) or control group (n=121). Their mean age was 80 years, 76% were women, and 25% lived alone. Outcomes including ADLs, IADLs, depression, and social support were measured by postal questionnaire at baseline, and at 12- and 24-month follow-ups. Utilization of public health or long-term care insurance and service uses over the period is also being documented. Conclusions: The design’s unique elements of regular evaluation of healthcare needs for targeted individuals within the long-term care insurance context will allow new understanding of the role and effectiveness of preventive home visits.

Development of a Community Commitment Scale with Cross-sectional Survey Validation for Preventing Social Isolation in Older Japanese People

BackgroundElderly social isolation could be prevented by facilitating communication or mutual helping at the neighborhood level. The helping of elderly neighbors by local volunteers may relate to their community commitment (CC), but ways to measure CC have not been identified. The aim of the present study was to develop a Community Commitment Scale (CCS) to measure psychological sense of belonging and socializing in the community among local volunteers, for research in prevention of elderly social isolation. We also tested the CCS in a general population of the elderly.MethodsA pilot test of 266 Japanese urban residents was conducted to examine face validity for 24 identified items, of which 12 items were selected for the CCS, based on a 4-point Likert-type scale. The CCS was developed via self-report questionnaires to 859 local volunteers in two suburban cities and to 3484 randomly sampled general residents aged 55 years or older living in one of the cities. To assess concurrent validity, data were collected using the Brief Sense of Community Scale (Peterson; 2008) and two types of single questions on self-efficacy for helping elderly neighbors.ResultsItem analysis and factor analysis identified 8 items, which were classified between two datasets under the domains of “belonging” and “socializing” in the local volunteers and the general residents. Cronbach’s alpha (which conveyed the internal consistency of the CCS) was 0.75 in local volunteers and 0.78 in general residents. The correlation coefficients between the scores of the CCS and BSCS were 0.54 for local volunteers and 0.62 for general residents. ANOVA comparing the CCS between the confidence levels of the two types of single question of self-efficacy on helping elderly neighbors showed a strong relationship in the volunteers and residents.ConclusionsThese results demonstrate acceptable internal consistency and concurrent validity for the CCS, with the two dimensions “belonging” and “socializing”, among the local volunteers and general residents in urban Japanese areas. Community commitment measured by the CCS was related to the degree of confidence for self-efficacy in helping elderly neighbors to prevent elderly social isolation.

Cross-sectional online survey of research productivity in young Japanese nursing faculty.

AIM To investigate the factors affecting the research productivity of young nursing faculty in Japan. METHODS An online survey targeting young nursing scholars (aged ≤ 39 years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3 years were regressed onto personal characteristics, such as academic degree and type of university. RESULTS The mean numbers of publications in English and Japanese in the past 3 years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (e(β) = 5.78 and e(β) = 1.89, respectively). Working at a national university (e(β) = 2.15), having a research assistant (e(β) = 2.05), and the ability to read research articles in English (e(β) = 2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (e(β) = 1.67) was related to a larger number of Japanese publications. The lack of mentoring (e(β) = 0.97) and university workload (e(β) = 0.96) were associated with a lesser number of Japanese publications. CONCLUSION The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken.

Development of a community’s self-efficacy scale for preventing social isolation among community-dwelling older people (Mimamori Scale)

BackgroundAmong older people in developed countries, social isolation leading to solitary death has become a public health issue of vital importance. Such isolation could be prevented by monitoring at-risk individuals at the neighborhood level and by implementing supportive networks at the community level. However, a means of measuring community confidence in these measures has not been established. This study is aimed at developing the Community’s Self-Efficacy Scale (CSES; Mimamori scale in Japanese) for community members preventing social isolation among older people.MethodsThe CSES is a self-administered questionnaire developed on the basis of Bandura’s self-efficacy theory. The survey was given to a general population (GEN) sample (n = 6,000) and community volunteer (CVOL) sample (n = 1,297). Construct validity was determined using confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha. The Generative Concern Scale (GCS-R) and Brief Sense of Community Scale (BSCS) were also administered to assess criterion-related validity of the CSES.ResultsIn total, 3,484 and 859 valid responses were received in the GEN and CVOL groups, respectively. The confirmatory factor analysis identified eight items from two domains—community network and neighborhood watch—with goodness of fit index = 0.984, adjusted goodness of fit index = 0.970, comparative fit index = 0.988, and root mean square error of approximation = 0.047. Cronbach’s alpha for the entire CSES was 0.87 and for the subscales was 0.80 and higher. The score of the entire CSES was positively correlated with the GCS-R in both the GEN (r = 0.80, p < 0.001) and CVOL (r = 0.86, p < 0.001) samples.ConclusionsThe CSES demonstrated adequate reliability and validity for assessing a community’s self-efficacy to aid in its preventing social isolation among older people. The scale is potentially useful for promoting health policies, practices, and interventions within communities. This may help prevent social isolation among older people and contribute to overall well-being in aging societies in Japan and abroad.

Cognitive training on elderly Japanese in Osaka: Major outcome (ADAS) from prospective, randomized, open, blind-endpoint trial

number of community-dwelling AD patients with only minor cognitive and functional deficits. Depressive symptoms are however frequent in these patients, leading to social withdrawal, underachievement, decreased quality of life and increased caregiver burden. Methods: We developed a 12-week therapy program targeting at increasing pleasant activities, establishing daily and weekly routines, applying individualized memory aids, and strengthening personal identity. The program includes both individual therapy sessions and sessions involving the primary caregiver. The efficacy of the program in comparison to standard medical treatment is currently evaluated in a multicentered, randomised, controlled study (‘‘CORDIAL’’) in 200 patients with early Alzheimer’s disease (MMSE< 21). Outcome measures are the patients’ functional ability, mood, quality of life, and non-cognitive symptoms. Results: So far, 190 patients have been recruited (mean age 74 years). The therapy program is well accepted among patients and caregivers, with continuous attendance and few drop-outs. Awareness of cognitive deficits and the relationship between patients and caregivers seem to be crucial for subjectively perceived therapy outcome. Information on the efficacy of the intervention will be presented. Conclusions: Cognitive-behavioral psychotherapy for patients with early Alzheimer’s disease and their caregivers is feasible, therapy methods need however to be adapted to the needs and preserved capacities of this patient group. Especially for early AD patients with depressive symptoms, psychotherapy might become a valuable treatment option.

P3-436: Effects of learning therapy on elderly Japanese in Osaka: A randomized controlled single-blind multi-center trial

ceived this change. The usual care group showed significant deterioration on the FES, Frenchay and Barthel over 12 months. Participants in the exercise group remained stable on these measures. Conclusions: Participants in the usual care group deteriorated on their range and frequency of daily activities. They were more dependent and their fear of falling increased with a resultant decrease in quality of life over 12 months. The provision of a home exercise program allowed people to retain their level of independence and continue their usual activities, which helped them retain their quality of life. Maintaining people with dementia at home has personal, social and financial benefits. Involving the carer in a targeted home exercise program may allow people with dementia to stay at home for longer.