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[Purpose] To investigate reliability and discriminant validity of a single question about total lying time for assessing physical inactivity in community-dwelling older people. [Participants and Methods] The participants were 54 healthy older individuals (mean age, 72.5 years), who were asked to recall retrospectively their mean total lying and sleep times per day in the previous week (7 days). The total lying and sleep times per day in the forthcoming week (7 days) were also investigated prospectively after confirming the mean total lying and sleep times per day in the previous week, and their mean values per day were calculated. [Results] Intraclass reliability of total lying and sleep times per day in the forthcoming week were acceptable [ICC (1, 1) for total lying time=0.835, ICC (1, 1) for sleep time=0.707]. No significant difference in average total lying time between the previous (8.4 ± 2.0 hours/day) and forthcoming (8.7 ± 1.7 hours/day) weeks was seen. In the forthcoming week, average total lying time was significantly higher than average sleep time (7.1 ± 1.3 hours/day). There was low significant correlation between total lying time and sleep time. [Conclusion] Total lying time can be measured with acceptable reliability and discriminant validity, and is a different outcome than sleep time in community-dwelling older adults.

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BACKGROUND: The objectives of this study are to clarify the differences between the difficulties in daily life experienced by patients with both mild cognitive impairment (MCI) and chronic disease and those experienced by healthy elderly individuals. METHODS: We assessed (a) cognitive function; (b) gait ability; (c) behavioral and psychological symptoms (observed at home); (d) activities of daily living (observed at home); (e) family caregiver burden, and (f) intention to continue family caregiving of 255 cognitively normal and 103 MCI subjects attending adult day care services covered by long-term care insurance, and compared the two groups. RESULTS: Subjects with MCI display more behavioral and psychological symptoms than cognitively normal subjects, posing a heavy caregiver burden (p < 0.01). Behavioral and psychological symptoms most commonly observed in subjects with MCI are apathy, hallucinations, delusions, agitation, and aberrant motor behavior. CONCLUSION: Information regarding the behavioral and psychological symptoms displayed at home by patients with MCI can only be obtained from family caregivers living with the patients. To provide early-stage support for elderly patients with MCI, adult day care workers should collect information from family caregivers regarding behavioral and psychological symptoms observed at home.

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OBJECTIVES: In order for activities preventing cognitive decline in the elderly and burdens of the caregiver to be effective and efficient, it is important to assess cognitive impairment and the behavioral and psychological symptoms of dementia (BPSD) in community-dwelling elderly people with cognitive impairment. The purpose of this study was to investigate differences in BPSD between assessment at home and assessment at an adult day-care facility, and to assess the relationship, between BPSD and caregiver burden in disabled elderly people with and without mild cognitive impairment (MCI) or dementia. METHODS: We studied 594 participants with activity limitations out of a target population of 917 community-dwelling elderly persons utilizing adult day-care service. Dementia and MCI were determined using a clinical history of dementia, the Clinical Dementia Rating scale, and/or the Mini-Mental State Examination (MMSE); 116 were diagnosed with dementia, 103 as having MCI, and 243 as cognitively normal controls (CN). BPSD were assessed at home and at the adult day-care facility with the Neuropsychiatric Inventory (NPI) and the Dementia Behavior Disturbance Scale (DBD). Activities of daily living (ADL) were evaluated using the Barthel index, and caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8). RESULTS: People diagnosed with dementia were found to be significantly more impaired on the DBD, MMSE, BI, and J-ZBI_8, than CN or those with MCI. Those with MCI also showed significantly more impairments relative to CN. The scores on the NPI and DBD assessed at home were higher than that assessed at the adult day-care facility in each group. The differences of NPI and DBD scores between home assessment and assessment at the adult day-care facility were greater for people with dementia than for people with MCI or CN. Multiple regression analysis revealed that the best explanatory variables for J-ZBI_8 are home assessments of NPI and DBD, the MMSE for people with dementia, home assessment of DBD and MCI, and home assessment of NPI and BI for CN. Both NPI and DBD were not associated with the J-ZBI_8 when assessed at the adult day-care facility regardless of level of cognitive impairment. CONCLUSION: The scores of the BPSD and caregiver burden worsened with increasing severity of cognitive impairment, and the BPSD was more apparent when assessed at home compared to at the adult day-care facility. These findings suggest that the assessment of BPSD at home is important in determining MCI or dementia and to estimate caregiver burden in community-dwelling elderly people with basic ADL limitations.

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OBJECTIVE: Life-space is a spatial measure of mobility defined by the distance a person routinely travels to perform activities over a specific time period. Life-space assessment (LSA) has been widely applied, but measurement properties have not been investigated in a Japanese population. The purpose of this cross-sectional study was to describe distributions of maximal life-space and to clarify the validity of composite scores of an LSA scale among community-dwelling older adults using preventive health care services in Japan. METHODS: Surveys were conducted between November 2007 and February 2008 with a specially prepared Japanese LSA version. The sample was composed of 2,147 participants using preventive health care services provided by the Japanese long-term care insurance system, all being aged 65 and over, with adequate cognitive functions and living at home in the community (29.5% men, mean age +/- [SD] 79.4 +/- 6.9 years). First, the levels of life-space, based on how far a person had travelled on leaving his or her place of residence during the month preceding the assessment, were investigated. Second, LSA scores were calculated considering the degree of independence as well as frequencies for individuals at each level, then descriptive statistics were checked. Finally, it was tested whether the scores could be related to external criteria and functional or socio-psychological variables stated in previous studies. RESULTS: Sixty-four percent of individuals attained the highest level of life-space (i.e. outside town). The average of the composite scores was 51.4 +/- 25.2 points and the distribution was almost normal. The dispersion of the scores tended to be large. Values correlated with the hierarchical mobility level classification as an external criterion (0.539). As hypothesized, the scores were correlated with age (-0.296), functional mobility (time up and go test) (-0.387), and instrumental activities of daily living (0.533), and were discriminated by sex, depressive mood, and perceived health status, in the expected directions. CONCLUSIONS: The present study described the extent of life-space in older adults using preventive health care services in Japan, and provided preliminary support for criterion-related (concurrent) and construct validity of scores with the LSA Japanese version. The LSA composite scoring method may have advantages for detecting differences in life-space among individuals, as compared to simply using the maximal level attained.

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OBJECTIVE: To determine predictive validity for cut points of the Timed Up & Go (TUG) test and life-space assessment (LSA) on decline in instrumental activities of daily living (IADLs) among older adults. DESIGN: Cross-sectional and 1-year follow-up study. SETTING: Preventive health care services. PARTICIPANTS: In a cross-sectional study, 2404 older adults (65-100 y) were recruited to determine cut points for the TUG and LSA for IADLs limitation. For longitudinal analysis, 436 older adults (65-100 y) were followed over 1 year to explore the validity of a classification model using the cut points to predict incident IADLs decline. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TUG, LSA, and Tokyo Metropolitan Institute of Gerontology index of IADLs measurement. RESULTS: The cut points associated with IADLs limitations for the TUG and LSA were 12 seconds and 56 points, respectively. Participants were classified into fast/high (most able; TUG <12 and LSA >56), fast/low, slow/high, and slow/low (vulnerable; TUG > or =12 and LSA < or =56) groups; there were 813 (34%), 385 (16%), 246 (10%), and 960 (40%) participants in each group, respectively. The proportions of participants with IADLs limitation in the most able, fast/low, slow/high, and vulnerable groups were 19%, 64%, 61%, and 89%, respectively. The vulnerable group included significantly more participants with IADLs limitation than any other group (P<.001). Compared with a most able group, the odds ratios of IADLs decline for the fast/low and vulnerable groups were 2.52 (95% confidence interval 1.15-5.53, P<.05) and 2.87 (95% confidence interval 1.38-5.96, P<.01), respectively. CONCLUSIONS: The combination of TUG and LSA identifies persons with future IADLs decline and has the potential to be used by community health care services to target individualized interventions.

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