Impact of caregiver burden on adverse health outcomes in community-dwelling dependent older care recipients.

OBJECTIVE: To determine whether caregiver burden is associated with subsequent all-cause mortality or hospitalization among dependent community-dwelling older care recipients. METHODS: A prospective cohort study of 1,067 pairs of community-dwelling 65-year-old or older care recipients and their informal caregivers was conducted. The 1,067 pairs completed the baseline assessment including caregiver burden assessed by the Zarit Burden Interview and a 3-year follow-up for all-cause mortality and hospitalization. RESULTS: During the 3-year follow-up, 268 recipients died and 455 were admitted to hospitals. The multivariate Cox proportional hazards model revealed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risks of all-cause mortality and hospitalization, respectively, in comparison with those with caregivers in the lowest quartile after adjustment for potential confounders. The highest quartile of caregiver burden was associated with all-cause mortality and hospitalization within nonusers of respite services including day-care services, home-help services, and nursing-home respite stay services. No apparent association was observed within the users of these services except for day-care services, for which users showed a statistically significant association between the highest quartile and the risk of hospitalization. CONCLUSIONS: Heavy caregiver burden is associated with mortality and hospitalization among community-dwelling dependent older adults, even after adjusting for potential confounders. The reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.

Risks of CHD identified by different criteria of metabolic syndrome and related changes of adipocytokines in elderly postmenopausal women.

The objective of this study was to assess the capacity of different criteria of metabolic syndrome (MetS) to identify risks of coronary heart diseases (CHDs) and related changes of adipocytokines in postmenopausal women. A cross-sectional study was carried out in 225 community-dwelling, elderly postmenopausal Chinese women (age, 66.77+/-5.09 years) without hormone replacement therapy (HRT). Baseline data such as blood pressure, body mass index (BMI), serum lipid profiles, and fasting glucose were analyzed, and insulin sensitivity was estimated via the homeostasis model assessment for insulin resistance. Serum tumor necrosis factor alpha (TNFalpha), interleukin-6 (IL-6), and adiponectin were measured simultaneously. The prevalence of MetS identified by the Third Report of the National Cholesterol Education Programme Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, the International Diabetes Federation (IDF), the Chinese Diabetes Society (CDS), and the Japanese Society of Internal Medicine (JPN) were 27.31%, 37.34%, 23.29%, and 13.65%, respectively. No significant differences of baseline data were found among different MetS groups, except for a significant higher waist circumference in the JPN-MetS group as compared with other MetS groups. The prevalence of confirmed CHD in the four MetS groups were 26.2%, 18.6%, 26.9%, and 32%, respectively. Odds ratios for CHD were 1.905 (95% CI=1.273-2.851), 1.208 (95% CI=0.778-1.876), 1.997 (95% CI=1.238-3.221), and 2.336 (95% CI=1.119-4.876), respectively. The JPN-MetS group had higher levels of TNFalpha and IL-6, whereas the CDS-MetS group correlated better with lower adiponectin levels. The IDF definition for MetS is the most sensitive one with regard to metabolic disorders, whereas JPN and CDS definitions correlate better with CHD and changes of adipocytokines among the four criteria studied.

A Questionnaire Survey of Attitudes About Cancer Disclosure, Brain Death, and Organ Transplantation Among Fifth-Year Medical Students / 医学教育

We conducted a questionnaire survey of attitudes about cancer disclosure, brain death, and organ transplantation among fifth-year medical students at Nagoya University from 2001 through 2003. Their attitudes about these topics did not change markedly during the period. Most students favored receiving information about their own diagnosis of cancer, but significantly fewer students favored informing their parents about their diagnosis. Students did not have a strong interest in brain death or organ transplantation. Less than 30% of students possessed donor cards. This survey indicates that attitudes about cancer disclosure, brain death, and organ transplantation among Japanese medical students remain different from those among Western medical students. Instruction designed to address these differences may be beneficial.

Activities Contributing to Happiness of Older Adults in Rural Communities / 日本農村医学会雑誌

Older adults tend to lose the opportunities and abilities to pursue hobbies and perform various activities. Club activities provided in the community for old people seem to be beneficial in that the activities prevent them from becoming housebound, and improve overall QOL. In the present study, we conducted a survey by sending out self-answered questionnaire to 424 elder residents in rural areas. We collected information about their life circumstances, the presence or absence of physical pain, activities of Daily Living (ADLs), the degree of enjoyment from activities on the list, the frequency of going out, PGC morale scale and so on. The activities enjoyed frequently by the elderly were bathing, eating and watching TV. The degrees of enjoying eating and bathing showed positive correlations with the PGC morale scale, but the degree of enjoying gambling correlated negatively with the scale. A regression analysis was performed with the PGC morale scale as dependent variables. As a result, a significant model was structured to predict the life sati of the aged by making interpersonal distress, enjoyment derived from gambling, basic ADLs, physical pain and dwelling alone as indepeudent variables. These results will assist us in providing adequate health care to pelple of advanced age.