Family caregiving problems of suspected elderly neglect: A review of forensic autopsy cases in Japan

Background. Elder abuse is a severe violation of human rights, and the most recent domestic violence issue to gain the attention of public and medical communities especially highly aged country like Japan. Methods. To clarify family caregiving problems related to elder neglect in Japan, we reviewed 178 autopsies conducted between 2000 and 2003 at one centre. Results. Of the 178 cases (134 males and 44 females), 53 involved people were 65 years old and over (30%). A careful investigation of these 53 autopsy reports (39 males and 14 females) allowed us to exclude obvious causes of death, such as traffic and other accidents, drowning, poisoning, alcoholism, and clear disease pathology. We were left with nine cases of suspected neglect (three males and six females). The mean age of victims was 82.1 years (range, 68–91). According to the autopsy reports, two were severely starved, two were putrefied or mummified, three had pressure sores, two had dementia and three would have had difficulty in performing the activities of daily living. Each victim had lived with one family member; their sons in five cases, and a grandson, brother, wife or husband in each case. The caregivers’ ages ranged from 27 to 76 years, and five were unemployed; in three cases, the family incomes were very low. Of the caregivers, two were depressed, one was an alcoholic and one had dementia. Conclusions. This investigation indicated that elderly parents living with their sons are a high-risk group for neglect. A family support system is needed to target male caregivers who are likely isolated from social services. Autopsy cases provide valuable information for public health to prevent similar cases in future. Keywords: Elder abuse, Elder neglect, Male caregivers, Family caregiving, Autopsy records

Reliability and Validity of a Device to Measure Muscle Hardness

Although clinicians judge muscle tenseness by palpation, methods to quantify this have not become established. We examined the reliability and validity of a commercially available myotonometer to assess the biceps brachii and brachioradialis. Torques ranging from 0-72% of maximum effort were isometrically resisted in five men and five women, all healthy and 21-23 years of age. Root-mean-square of surface electromyographic response was also measured. Intraclass correlations were 0.80 or higher within sessions but decreased to 0.57 between sessions except for myotonometry of the biceps brachii. Correlation with isometric load was 0.79 or higher for both myotonometry and electromyography, but these relations were consistently curvilinear. The myotonometer is more useful for fleshy muscles like the biceps brachii than for thin muscles like the brachioradialis. Because hardness has a curvilinear relation with tension in the muscle, hardness cannot be considered strictly equivalent to tension

Predictors of volunteerism: A study of older adults in Japan

Volunteerism has risen steadily as a viable activity at old age in Japan for it gives older adults ways to contribute to society as well as enhancing their quality of life. It has also been addressed by the national government and adopted by many local municipalities under the long-term care insurance program as a health promotion and preventive care activity. However, studies examining why older adults volunteer and why some don’t are limited. Using a modified version of Baltes and colleagues’ model of competence, this study examines the predictors of volunteerism among older adults in Japan. Data from a city located northeast of Tokyo was used (n=703). Results indicated that basic competence does not predict volunteerism, but rather competence gained from experiences. To increase the number of older volunteers, the study suggests that civic engagement must start at an earlier age coupled with financial stability. Keywords: volunteerism, older adults, Japan, competence, long-term care insuranc

Relationship between home care service use and changes in the care needs level of Japanese elderly

<p>Abstract</p> <p>Background</p> <p>With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.</p> <p>Methods</p> <p>The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.</p> <p>Results</p> <p>In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.</p> <p>Conclusion</p> <p>There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.</p

Progressive structural changes in the putamen in a case of recurrent diabetic chorea with late-onset reduced arm swing

The detailed mechanism underlying diabetic chorea remains uncertain. We present a male patient with recurrent diabetic hemichorea with late-onset reduced arm swing. We explored the association between hyperglycemia, changes in neurological manifestations, and brain magnetic resonance imaging findings. Hyperglycemic control did not prevent the following progressive structural changes in the putamen. Slow progressive structural changes in the putamen may lead to the recurrence of chorea and the appearance of late-onset reduced arm swing. We speculated that hyperglycemia-related vasculopathy and subsequent structural changes in the putamen may play a crucial role in diabetic chorea