Yasuhiko Shirayama

Factors Influencing the Zarit Burden Interview in a Japanese Community: Activities of Daily Living and Depressive State

Objective: Reducing the burden on the caregiver contributes to maintaining or enhancing quality of life of people with disability since caregiver support is indispensable to them. Methods: The Japanese short version of the Zarit Caregiver Burden Interview (J-ZBI_8) was administered to 167 families of 243 community-dwelling disabled Japanese adults covered by the long-term care insurance system in Japan to clarify the relationship between burden of care and the disability. The status of the disabled adults was evaluated by the Functional Independence Measure (FIM), Frenchay Activity Index (FAI), and Japan Stroke Scale (Depression Scale) (JSS-D). J-ZBI_8 was predicted from the FIM using the classification and regression tree (CART) method. Results: Rank correlation coefficients between the J-ZBI_8 score and disabled adults’ motor and sensory subscores of the FIM, FAI, and JSS-D were -0.205, -0.249, -0.205 and 0.396, respectively. J-ZBI_8 score showed a relatively high relationship to depression. According to the CART method, FIM motor subscore (FIMM) was divided to 3 groups, FIMM less than 20, FIMM from 20 to 79, and FIMM of 80 or more. Scattergram indicated that FIM motor subscore of subjects whose caregiver had a high J-ZBI_8 score ranged at the mid-level of activities of daily living. Conclusion: Since assisting movement of subjects who need a great deal of help is a harder burden of care than simply moving the subject without considering the subject’s desires, the burden of the care of subjects who can perform a few ADL is more severe than the burden of care of completely bedridden subjects.

Development of an Oral Assessment Sheet for Evaluating Older Adults in Nursing Homes

A new general use oral assessment sheet (OAS), comprising three items each in three categories (i.e., oral hygiene, biting and chewing, and oral function), was developed to improve the oral health of older adults requiring nursing care. Seventy-nine care workers used the assessment sheet to evaluate oral conditions in 188 institutionalized older adults. Forty-five care workers and three dental professionals then assessed oral conditions in 45 institutionalized older adults using the test-retest method before and after dental professional guidance. Cronbachs alpha of the OAS was 0.72, and 0.65, 0.57, and 0.82 for the three subcategories of oral hygiene, biting and chewing, and oral function, respectively. After dental professional intervention, absolute and relative agreement coefficients increased to more than 0.6 and 0.89, respectively. Reliability and validity of the OAS were verified, and difficulties in oral assessment experienced by care workers were identified. [Res Gerontol Nurs. 2017; 10(5):234-239.].

Factors associated with regular dental visits among hemodialysis patients

AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify the barriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialysis treatment at two facilities, one with a dental department and the other without a dental department. We used a structured questionnaire to interview participants about their awareness of oral health management issues for dialysis patients, perceived oral symptoms and attitudes about dental visits. Bivariate analysis using the χ(2) test was conducted to determine associations between study variables and regular dental check-ups. Binominal logistic regression analysis was used to determine factors associated with regular dental check-ups. RESULTS There were no significant differences in patient demographics between the two participating facilities, including attitudes about dental visits. Therefore, we included all patients in the following analyses. Few patients (4.3%) had been referred to a dentist by a medical doctor or nurse. Although 80.9% of subjects had a primary dentist, only 34.0% of subjects received regular dental check-ups. The most common reasons cited for not seeking dental care were that visits are burdensome and a lack of perceived need. Patients with gum swelling or bleeding were much more likely to be in the group of those not receiving routine dental check-ups (χ(2) test, P < 0.01). Logistic regression analysis demonstrated that receiving dental check-ups was associated with awareness that oral health management is more important for dialysis patients than for others and with having a primary dentist (P < 0.05). CONCLUSION Dialysis patients should be educated about the importance of preventive dental care. Medical providers are expected to participate in promoting dental visits among dialysis patients.

Current status of collaborative relationships between dialysis facilities and dental facilities in Japan: results of a nationwide survey.

BackgroundRecent studies have reported an association between periodontal disease and mortality among dialysis patients. Therefore, preventive dental care should be considered very important for this population. In Japan, no systematic education has been undertaken regarding the importance of preventive dental care for hemodialysis patients—even though these individuals tend to have oral and dental problems. The aim of this study was to investigate the current state of collaborative relationships between hemodialysis facilities and dental services in Japan and also to identify strategies to encourage preventive dental visits among hemodialysis outpatients.MethodsA nationwide questionnaire on the collaborative relationship between dialysis facilities and dental facilities was sent by mail to all medical facilities in Japan offering outpatient hemodialysis treatment.ResultsResponses were obtained from 1414 of 4014 facilities (35.2%). Among the 1414 facilities, 272 (19.2%) had a dental service department. Approximately 100,000 dialysis outpatients were receiving treatment at these participating facilities, which amounts to one-third of all dialysis patients in Japan. Of those patients, 82.9% received hemodialysis at medical facilities without dental departments. Only 87 of 454 small clinics without in-house dental departments (19.2%) had collaborative registered dental clinics. Medical facilities with registered dental clinics demonstrated a significantly more proactive attitude to routine collaboration on dental matters than facilities lacking such clinics.ConclusionsOur nationwide survey revealed that most dialysis facilities in Japan have neither an in-house dental department nor a collaborative relationship with a registered dental clinic. Registration of dental clinics appears to promote collaboration with dental facilities on a routine basis, which would be beneficial for oral health management in hemodialysis patients.

Survey on Nursing Home Caregivers’ Basic Knowledge of Oral Health Management: Dental Terminology

With the increasing numbers of the elderly requiring care in Japan, the management of their oral health care will require cooperation between medical and dental professionals, and we need to transfer dental knowledge from dental professionals to caregivers. With the help of a questionnaire, we examined 181 caregivers’ depth of understanding regarding 20 typical dental terms with a view to improving the educational instruction provided to them. It was found that except for “clasp”, popular dental terms have largely been accepted. The differences in their degrees of understanding could be owing to the lack of systematic education for caregivers.