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Biomedical subjects

Joji Onishi

Publications and source records attributed to Joji Onishi.

10 recordsLinked to original sources

Attitudes toward disclosing the diagnosis of dementia in Japan.

BACKGROUND: The rapid increase in the elderly population in Japan has triggered a debate on whether or not patients with dementia should be informed of their diagnosis. The purpose of the present study was to investigate the attitudes of people in a large city in Japan toward the disclosure of a diagnosis of dementia. METHODS: In Study 1, 2000 residents aged 40-64 and 5000 residents aged 65 and over were sampled randomly, and a structured questionnaire was sent to them by mail. In Study 2, we administered a structured interview-based questionnaire to 3949 randomly enrolled residents of Nagoya City aged 45 and over whose family member had been certified as needing long-term care. RESULTS: In Study 1, 79.8% of the younger respondents (n = 710) stated that they would prefer the disclosure of a hypothetical diagnosis of dementia, as did 75.5% of the older respondents (n = 2162). Furthermore, 85.1% (n = 749) of the younger respondents and 82.5% (n = 2181) of the older respondents stated that they would prefer that the patient be told his or her hypothetical diagnosis of dementia. In Study 2, in the case of care recipients without dementia, 68.3% (n = 650) of their family members preferred disclosure of a hypothetical diagnosis of dementia. Among the families of care recipients who had dementia, 58.4% (n = 301) of family members preferred disclosure. CONCLUSIONS: The present survey of caregivers and non-caregivers in an urban city of Japan demonstrated that the desire for disclosure of a diagnosis of dementia is relatively high.

Adult↗

Which two questions of Mini-Mental State Examination (MMSE) should we start from?

The MMSE is a simple and commonly used instrument to evaluate cognitive impairment. With the aim of enabling the examiner to skip a large portion of the MMSE when screening subjects with lower possibility of cognitive impairment, we examined the internal distribution of the MMSE scores among 792 older adults visiting a teaching hospital, a long-term care hospital, nursing homes, and a geriatric clinic. The correlation coefficients between the summed scores of any two items of MMSE and the total score were compared. A receiver operating characteristic (ROC) curve was drawn to show the sensitivity and the specificity of predicting cognitive impairment, which was defined by the total MMSE score being less than 24. The mean MMSE score was 20.5 +/- 6.9 (+/-S.D.). A good predictor for cognitive impairment was the summed scores of the time orientation and serial sevens with a sensitivity of 98.2% and a specificity of 69.2% if cut-off was set at 7/7+. This finding appears to help streamline the screening process for cognitive impairment in general elderly population.

Aged↗

Behavioral, psychological and physical symptoms in group homes for older adults with dementia.

BACKGROUND: Despite the recent dissemination of group homes in Japan for older adults with dementia, the behavioral and psychological features of the residents remain unknown. To clarify the association of such features with the levels of difficulty encountered by caregivers in coping with these symptoms, we have conducted a survey to compare the frequencies of the symptoms among group homes, nursing homes and a long-term care hospital. METHODS: Five hundred and eighty-six older adults aged 65 years or more were sampled. Data were consecutively collected from questionnaires given to the caregivers. The questionnaire included basic activities of daily living, the Mini-mental State Examination, frequencies of behavioral, psychological and physical symptoms, and the levels of difficulty in coping with the symptoms. RESULTS: In group homes, requests to go home, urinary incontinence and frequent complaining were the most commonly observed symptoms. The symptoms associated with disorientation, anxiety and depression were frequently observed in all three care settings. Most of the symptoms were more frequently observed in group homes than in the other two care settings. However, the levels of difficulty in coping with most of the symptoms were the highest in the long-term care hospital, followed in order by the group homes and nursing homes. In group homes, inappropriate sexual behavior was the symptom creating the most stress for the caregivers, followed by verbal and nonverbal abuse and changeable mood. CONCLUSIONS: The symptomatic traits of residents in group homes were clarified in the present study. These findings could be helpful in considering desirable placement or the improvement of eligible service provision for older adults with dementia in care facilities.

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A comparison of depressive mood of older adults in a community, nursing homes, and a geriatric hospital: factor analysis of Geriatric Depression Scale.

The Geriatric Depression Scale (GDS)-15 was used in 607 adults aged 65+ years living in a community, nursing homes, and a general hospital to explore characteristics of depressive mood in different care settings. Factor analysis of GDS-15 extracted 4 factors labeled unhappiness, apathy and anxiety, loss of hope and morale, and energy loss. The scale scores labeled unhappiness, apathy and anxiety, and loss of hope and morale were negatively correlated with the Barthel Index and the Mini-Mental State Examination scores. The results classified the depressive patterns into 2 types, one fitting the nursing home residents and the other fitting the hospital patients. The dominant factors of the nursing-home type were unhappiness and loss of hope and morale, and the hospital type was highly related with apathy and anxiety. The results indicate an extended utility of the GDS-15 for a deeper understanding of depressive mood in various care settings.

Activities of Daily Living↗

The pleasurable recreational activities among community-dwelling older adults.

This study aimed to clarify what pleasurable recreational activities older adults like to participate in, and to investigate the relationship between those activities and quality of life (QOL). Questionnaires were delivered to older residents (65 years and above) in a Japanese rural area. The residents' background information, the amount of pleasure for various activities, and the QOL were surveyed. The QOL was evaluated by the revised Philadelphia Geriatric Center (PGC) morale scale. The amount of pleasure taken in a majority of the activities, such as conversation with family or neighbors showed a significant association with the happiness score, but only a few activities showed significant association between the revised PGC morale scale and the amount of pleasure. The multiple regression analyses indicated that the amount of pleasure in exercise, the difficulty in managing finances, and amount of pleasure taken in watching TV were significant variables for predicting the happiness score. The results indicated that the amount of pleasure older adults experienced when engaging in activities such as conversation with family or neighbors showed significant association with the older adults' happiness. These results may be helpful in understanding contributions of various activities to the perception of pleasure in older adults.

Activities of Daily Living↗

Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers' burden.

With increasing population of older adults in need of care, caregiver's burden is becoming a major concern. We investigated the relative contributions of BPSD of care recipients, caregiver's background and the care environment to caregiver's burden assessed by using Zarit burden interview (ZBI). Among BPSD, inability of finding the way home, inability of managing money and fecal incontinence were the most difficult symptoms to cope with. A path analysis, by which we constructed a network model to clarify the contributions of the factors examined to the caregiver's burden, indicated that the severity of dementia, the feeling of "would rather die than be in the same condition" and the physical pain of the caregivers showed great direct influences on the score of the ZBI. In conclusion, we clarified kinetic and dynamic interactions of factors affecting caregiver's burden by using a path analysis. The model indicates that the caregiver's burden can be affected not merely by the illness of the care recipients but by the caregiver's background and the care environment.

Activities of Daily Living↗

Predictive model for assessing cognitive impairment by quantitative electroencephalography.

OBJECTIVE: To assess the utility of quantitative electroencephalographic analysis as an indicator of cognitive impairment, we examined the correlation between Mini-Mental State Examination (MMSE) scores and quantitative electroencephalographic (QEEG) power values in elderly patients and constructed a regression model to predict MMSE scores. BACKGROUND: Because of the growing number of elderly individuals with cognitive deficits, there is an increasing need for simple and objective methods with which to evaluate cognitive function. Although QEEG is reportedly a useful method for this purpose, few researchers have constructed a QEEG-based model for predicting the degree of cognitive impairment in clinical settings. METHOD: We evaluated brain function using QEEG in 44 elderly patients with memory complaints and compared the results with their MMSE scores. RESULTS: In the correlation analysis, no significant correlation was found between MMSE scores and QEEG power values. However, a regression model created using relative QEEG and gender for predicting MMSE scores had an adjusted R2 of 0.471. CONCLUSIONS: This finding suggests that QEEG analysis may be a useful indicator of cognitive decline in patients with memory complaints.

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The relationship between functional disability and depressive mood in Japanese older adult inpatients.

Depression is commonly found in older adult patients and is often associated with handicaps. The authors administered the Comprehensive Geriatric Assessment (CGA), including basic activities of daily living (BADL), instrumental activities of daily living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS)-15, and a socioenvironmental questionnaire to 198 patients who were admitted to Nagoya University Hospital, to examine the relationship between depressive mood and various physical and socioenvironmental outcomes. The overall GDS-15 score was correlated with the BADL and IADL. The factor analysis extracted 4 factors from the GDS-15 subscales. The factors labeled "loss of morale and hope" and "memory loss and reduction of social activity" were highly correlated with both ADLs, social variables, and the MMSE score. The results reveal that factor analysis of GDS-15 will help in understanding the etiology of depressive mood, thereby contributing to better therapeutic approaches.

Activities of Daily Living↗

[Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital].

Although percutaneous endoscopic gastrotomy (PEG) has been widely acknowledged as a safer method for enteral feeding, its long-term impact on prognosis and quality of life (QOL) in elderly patients is not sufficiently understood. Regarding the indications of PEG, there still exist issues to be studied due to lack of convincing evidence for reduction of expected complications such as aspiration pneumonia or for improvement of prognosis in patients with severe dementia. In this study we investigated the survival rate after PEG placement and family satisfaction retrospectively in 78 elderly inpatients who underwent PEG, by sending questionnaires to the patients or their caregivers. The results of 68 cases (88%) recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three percent of families of patients showed overall satisfaction regarding the induction of PEG. The survival rate was relatively higher than that from previously reported studies. The differences we observed may be attributed to variations in patients' backgrounds (clinical, socio-economic, cultural) in therapeutic interventions. We recognized the importance of clarifying factors which would affect the prognosis and QOL in elderly patients who undergo PEG. The indication for PEG can be made based on comprehensive assessment of the relevant factors in individual cases, taking patient's or caregiver's wishes into consideration.

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