Institutionalization among the elderly in Japan and China: a comparative study

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Factors Associated with Depression amongst Family Caregivers Involved in Care for Community-dwelling Persons of Middle Age and Older: Based on Data from Indonesia Family Life Survey

Caring for frail elderly individuals tends to induce depression and stress in caregivers, which constitutes a risk factor for their discontinuance of at-home care. The maintenance of family caregivers’ mental well-being is important for both family caregivers and care recipient. The aim of this research was to identify factors associated with depression amongst family caregivers involved in the care of community-dwelling persons of middle age and older in Indonesia. We analysed 1,569 dyads of community-dwelling persons of middle age and older and their family caregivers from Indonesia Family Life Survey 4, which was initiated by Research and Development (RAND, USA) in 2007. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure caregivers’ depression. In total, 53.32 % of caregivers were female family caregivers, and 8.00 % presented with depression. A multivariable analysis showed that the factors related positively to the high depression for family caregivers in Indonesia were living in an urban area, having higher per capita monthly household expenditures, having poor self-rated health, and experiencing more symptoms and feeling pains, while those related negatively to the depression were being of an older age, and having paid work. Current policies and programmes for supporting older persons in Indonesia tend to cover the lower income class; however, our results indicate that family caregivers living in urban areas and with higher monthly expenditures are associated with greater instances of depression. As an addition to the current programmes for supporting the poor elderly, we suggest that support programmes and services may be helpful for improving depression among family caregivers in Indonesia for those living in urban areas who belong to middle and upper classes. Keywords: Depression, Family caregivers, Urban, Middle and upper class, Indonesi

Relation between Mental Health Status and Psychosocial Stressors among Pregnant and Puerperium Women in Japan: From the Perspective of Working Status

Mental health problems during pregnancy and postpartum periods are one of the alarming health issues among women in Japan. This study analyzed data on the Japanese version of the Kessler 6 (K6), specific psychosocial stressors, and working status of pregnant and puerperium women (n=1126) from respondents in the Comprehensive Survey of People’s Living Conditions (CSPLC) conducted in 2007 by Ministry of Health, Labour and Welfare in Japan. Multiple logistic analyses showed the significant associations between mental health and psychosocial stressors: “family relationship,” “pregnancy and birth,” and “incomes/ family budgets/ debts”, regardless of “employed” or “unemployed”. After stratified by working status, whereas “one’s job” stressor had an association with mental health only for employed females, stressors for “one’s disease/long -term care” and “housework” had associations only for unemployed ones. For employed women, the primary factor for mental health was “family relationship” stressor. Although mental health status measured by K6 was not different between employed or unemployed female population, primary stressors related mental health was revealed to differ with working status. Especially, “family relationship” stressor was the highest risk factor of mental health in employed women. More importantly, the results provided evidence on the differences in associations between mental health and specific psychosocial stressors by working status. Psychosocial risk assessments and interventions on working status among pregnant and puerperium women should be imperative to pay attention for social politics.DOI: http://dx.doi.org/10.11591/ijphs.v1i2.80

The relationship between perceived social support and depressive symptoms in informal caregivers of community-dwelling older persons in Chile

AIM: Depression among caregivers of older persons is a serious concern, but it is often overlooked and neglected in developing countries. The aim of this study was to examine the relationship between perceived social support and depression in informal caregivers of community-dwelling older persons in Chile. Methods: We analyzed cross-sectional secondary data on 377 dyads of community-dwelling older persons and their informal caregivers from a nationwide survey in Chile. The Duke-UNC Functional Social Support Questionnaire (FSSQ) was used to measure caregivers’ perceived social support, and the Center for Epidemiologic Studies Depression Scale assessed their depression. Results: In this study, 76.9% of the caregivers perceived a high level of social support, and 46.9% were assessed as having depression. Based on multivariable analysis, factors that decrease the likelihood of being depressed are a high level of social support (odds ratio (OR) = 0.311, 95% confidence interval (CI): 0.167–0.579) and having taken holidays in the past 12 months (OR = 0.513, 95%CI: 0.270–0.975). Factors that increase the likelihood of being depressed are being a female caregiver (OR = 2.296, 95%CI: 1.119–4.707), being uninsured (OR = 4.321, 95%CI: 1.750–10.672), being the partner or spouse of the care recipient (OR = 3.832, 95%CI: 1.546–9.493), and the number of hours of care (OR = 1.053, 95%CI: 1.021–1.085). Conclusion: Higher levels of perceived social support and holidays were associated with lower levels of depression. However, being female, being the care recipient's partner or spouse, being uninsured, and having long care periods had detrimental effects. Interventions to preserve and enhance perceived social support could help improve depressive symptoms in informal caregivers. Additionally, support should be available to caregivers who are women, uninsured, and the care recipient's partner or spouse, as well as those who provide care for long hours, to ensure they have respite from their caregiving role

Doctors’ Opinion Papers in Long-term Care Need Certification in Japan: Comparison between Clinic and Advanced Treatment Hospital Settings

The Doctor’s Opinion Paper (DOP) in long-term care insurance addresses the patient’s chronic conditions of daily life. It is expected to be written by a doctor who knows the patient well. However, DOPs are sometimes written by doctors at advanced treatment hospitals (ATHs) who might not know the patient well. Japanese government is promoting functional differentiation of medical care. We discuss appropriateness that specialists of ATH who have to provide a higher medical care take on a role to write DOP which addresses the patient’s chronic conditions of daily life. The purpose of this study is to compare DOPs completed by clinic doctors with those completed by ATH doctors, in order to examine who should write a DOP. Data: The DOPs which were used at the Care Need Certification Committee meeting held in March 2012 in Tokyo. Subjects: 403 DOPs for patients aged 65 or older. Results indicated that DOPs written by doctors in ATHs included less information than DOPs written by doctors in clinics. We need to discuss who would be appropriate doctors to write DOPs and how to educate older adults to choose the right health care facility and their doctors for their health condition. Keywords: Doctor’s opinion paper, certification of need for long-term care, long-term care insurance, advanced treatment hospital, clinic, family doctor, Japa

Relation Between Mental Health Status and Psychosocial Stressors Among Pregnant and Puerperium Women in Japan - From the Perspective of Working Status-

Background Mental health problems during pregnancy and postpartum periods are one of the alarming health issues among women in Japan. Many studies have reported that psychosocial risk factors could be correlated with maternal mental health status. Although increased numbers of women who are employed during the pregnancy and postpartum periods have been observed, it is unclear about the link between mental health and psychosocial stressors in terms of working status during pregnancy and postpartum periods. Therefore, this study examined difference in mental health status and the association between mental health and psychosocial stressors by working status amongpregnant and puerperium women, using nationally representative data in Japan. Methods This study analyzed data on the Japanese version of the Kessler 6 (K6), specific psychosocial stressors, and working status of pregnant and puerperium women (n=1126) from respondents in the Comprehensive Survey of Peoples Living Conditions (CSPLC) conducted in 2007 by Ministry of Health, Labour and Welfare in Japan.. The univariate logistic regression analysis and a forward multiple regression analysis were used to examine K6 and related factors including specific psychosocial stressors for working status (employedand unemployed).Results Those who scored five or higher in K6 accounted for 33.2% of 1126 respondents, and mental health had no significant association with working status among pregnant and puerperium women. Multiple logistic analyses showed the significant associations between mental health and psychosocial stressors: family relationship, pregnancy and birth, andincomes/ family budgets/ debts,regardless of employed or unemployed. After stratified by working status, whereas ones job stressor had an association with mental health only for employed females, stressors forones disease/long -term care and housework had associations only for unemployed ones. For employed women, the primary factor for mental health wasfamily relationship stressor. Conclusion Although mental health status measured by K6 was not different between employed or unemployed female population, primary stressors related mental health was revealed to differ with working status. Especially, family relationship stressor was the highest risk factor of mental health in employed women. More importantly, the results provided evidence on the differences in associations between mental health and specific psychosocial stressors by working status. Psychosocial risk assessments and interventions on working status among pregnant and puerperium women should be imperative to pay attention for social politics

Factors Related to Positive Feelings of Caregivers Who Provide Home-Based Long-Term Care for Their Family Members in Japan

Background. The objective is to elucidate the factors related to the positive feelings of family caregivers who are engaged in home-based elderly care. Methods. The study utilized the data of a cross-sectional citywide survey in Japan. The survey was conducted with 1,821 subjects and the final analysis was performed on 435 subjects. Questions for recipients such as those on their care levels, causes of care, whereas the primary caregivers were asked about whether they had positive feelings toward caregiving, and whether their opinion was reflected in care policies. Results. The factors s that showed a positive association with positive feelings were “the caregiver’s opinion is reflected in care policies” (OR: 5.05, 95% CI: 2.60–9.87) and “the caregiver is in good health condition” (OR: 2.02, 95% CI: 1.02–3.93). The factors that showed a negative association were “the caregiver is a daughter-in-law of the care recipient” (OR: 0.42, 95% CI: 0.21–0.82) and “the care recipient is an elderly person with cognitive impairment” (OR: 0.36, 95% CI: 0.18–0.70). Conclusions. The study suggests the necessity of providing support for caregivers in terms of empowerment and health management. Furthermore, they suggest that special attention should be paid to caregivers at risk of being unable to sustain positive feelings toward caregiving

Unintentional Injury Deaths among Children: A Descriptive Study Using Medico-legal Documents in Okayama Prefecture, Japan (2001−2015)

According to the World Health Organization’s World Report, approx. 950,000 children and young people < 18 years old die from an injury each year, and unintentional injury deaths account for a large portion of these cases. Here we used medico-legal documents to epidemiologically analyze the cases of unintentional injury deaths among children < 5 years old in Okayama Prefecture, Japan from 2001 to 2015. Age, sex, manner/cause of death, and various circumstances of the incident were investigated. There were 73 unintentional injury deaths during the study period. Drowning (n=29), suffocation (n=24), and transport accidents (n=13) were the major categories of unintentional injury deaths. Twenty-two cases (30.1%) were autopsied. Differences in the characteristics of the unintentional injury deaths by age were observed. Information which cannot be obtained from Vital Statistics was available from medico-legal documents, and detailed characteristics of unintentional injury deaths among children < 5 years old were elucidated. Investigating medico-legal information is one of the meaningful measures for the prevention of unintentional injury deaths among children in Japan

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