Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.

BackgroundDementia and behavioural and psychological symptoms of dementia affect older adults' care‐need levels. With aging comes an increase in the incidence of sensory impairments, which promotes the development of dementia. We investigated the association between sensory impairments – visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), the behavioural and psychological symptoms of dementia, and dementia incidence.MethodsThis was a retrospective study that used Japanese long‐term care insurance certification data from 2010 to 2017 of City A. The 2190 older adults who did not have dementia in 2010 were classified into four impairment categories: VI, HI, DSI, and no sensory impairment. The incidence of dementia was examined using Kaplan–Meier survival analysis and log‐rank testing. Cox proportional hazards analysis was used to investigate the risk of developing dementia associated with sensory impairments, compared to the risk for no sensory impairment. Pearson's χ2 tests were used to compare the prevalence of behavioural and psychological symptoms of dementia among the four groups.ResultsHI and DSI were associated with a higher cumulative dementia incidence compared to no sensory impairment (log‐rank χ2 = 10.42; P  < 0.001, and log‐rank χ2 = 39.92; P  < 0.001, respectively), and DSI showed higher cumulative dementia incidence than HI (log‐rank χ2 = 11.37; P  = 0.001). Cox proportional hazards analysis showed that DSI is the greatest risk factor for developing dementia among sensory impairments (hazard ratio, 1.45; 95% CI, 1.22–1.71; P < 0.001). Older adults with VI had a significantly higher prevalence of day‐night reversal than the other groups.ConclusionsOur results indicate that older adults with sensory impairments have a high incidence of dementia, with DSI presenting the greatest risk. Older adults with VI were found to be more likely to have day‐night reversal symptoms when dementia occurs.

ObjectiveIn Japan, the number of elderly individuals living alone is continuing to increase as society ages. Although studies have considered quality of life, life expectancy, and gender differences in elderly individuals living alone, only a few have considered the health and lifestyle of these individuals. Therefore, we aimed to investigate the factors that affect the self-rated health of elderly individuals living alone to understand this group and how best to offer them support.ResultsWe include 113 individuals. There was a significant difference (P < 0.05) in some characteristics (e.g., age, chronic illness, frequency of hospital visits in 1 month, and caregivers), activities of daily living (e.g., motor tasks), and instrumental activities of daily living (e.g., household affairs, heavy housework, outdoor household, and outdoor activities).

Background Various types of therapy, including occupational therapy, are utilised for the treatment of moderate to severe dementia. In order to determine the optimal rehabilitation strategy for such patients and examine the treatment efficacy, an assessment scale for engagement in various group activities that can be easily applied in clinical situations is required. We herein report the development of the Assessment Scale for Engagement in Activities (ASEA) and its clinical utility. Methods The ASEA was developed by nine occupational therapists and a psychiatrist with experience in developing measures for dementia, in accordance with the COSMIN (COnsensus‐based Standards for the selection of health status Measurement INstruments) checklist. This assessment comprises 10 items covering four domains: Engagement in the Activity, Interaction, Arousal, and Affect. Participants with moderate to severe dementia who resided in a psychiatric acute phase hospital in Japan were assessed in terms of engagement in activities using the ASEA and Todai‐shiki Observational Rating Scale (TORS), and in terms of cognitive function using the Mini‐Mental State Examination (MMSE). We examined the internal consistency, inter‐ and intra‐rater reliability, content validity, and concurrent validity of the ASEA. Results Cronbach's alpha of the ASEA was 0.889. The overall inter‐rater reliability was 0.937 (Spearman rank correlation, P < 0.001), and the intraclass correlation (ICC) for each item was 0.490–0.965 (P < 0.018–0.001). The overall test–retest reliability was 0.778 (Spearman's rank correlation, P < 0.001), and the ICC for each item was 0.498–0.863 (P < 0.023–0.001). The test–retest correlations were significant for almost all items, aside from ‘Interaction with others’ (P = 0.051). The concurrent validity, examined using the TORS and MMSE, was 0.920 and 0.304 (Spearman's rank correlation, P < 0.001–0.006). Conclusions The ASEA has confirmed reliability and validity, aside from ‘Interaction with others’ regarding test–retest reliability. Generally, this assessment tool has clinical utility and allows the evaluation of activity engagement among patients with moderate to severe dementia.

Factors related to aggravation of the level of care for elderly individuals with behavioral and psychological symptoms of dementia requiring support 丸田道雄 1) ，田平隆行 2) ，佐賀里昭 3) ，宮田浩紀 4) ，堀田牧 5) ，吉満孝二 2) ， 韓 侊熙 6) ，髙橋弘樹 7) ，川越雅弘 8)