Hosting the Olympic Games provides opportunities for municipalities to re-imagine urban spaces to promote active leisure. Our research systematically assessed the pre-Olympic conditions for leisure time physical activity (LTPA) in the vicinity of multi-use venues for the Tokyo Games. Researchers conducted walking audits in the surrounds of three venues within two years of the opening ceremony, including the Olympic Stadium, Athlete Village and Musashino Sports Plaza. Audits employed the validated Physical Activity Resource Assessment (PARA) instrument, photographic protocols and GPS mapping. Audit scores for urban features, amenities and incivilities were averaged across researchers, and summative scores provided. Photographs and field notes augmented the evaluation. Six environmental challenges for LTPA legacies were identified, including limited resource accessibility, lack of amenities, health nuisance, vegetation overgrowth, heat effects and disaster risk. These findings indicate that there are important ecological considerations that should be addressed to leverage Olympic hosting in support of LTPA objectives.

Population aging may increase chronic disease prevalence in Japan without widespread health behavior change. Walking and sitting are common behaviors that are amenable to intervention. This study examined age-related variations in daily walking and sitting time among middle-aged and older Japanese who live in urban areas. An online survey including validated measures was administered with a representative sample of 4,000 middle-aged and older adults from five large cities. Walking time showed a significant association with age, and the oldest cohort walked 25% more per day compared to those in early middle age, F (3, 3996) = 8.04, p <.001. Sitting time showed a significant decline with age, F (3, 3996) = 3.83, p < .001, although gender differences were evident among the oldest cohorts. Early middle age (45-54 years) appears to be associated with less walking and more sitting time in Japan. This study has implications for healthy aging and successful transitions to retirement in Japan. Occupational and environmental interventions are recommended to facilitate increases in activity and reductions in sedentary behavior. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

This research examines physical activity (PA) parameters among urban-living middle-aged and older Japanese during the Tokyo Olympic build-up period. Population sampling was employed, and an online survey was administered with 4,000 adults across Japan’s five largest cities. The International Physical Activity Questionnaire-Short Form constituted the main outcome variable, with auxiliary measures of Olympic interest and engagement, readiness for PA behavior change, perceived environmental barriers, and demographic information. Despite interest in the Olympics (&gt;60% moderate–high interest), planned engagement with the event was low (&gt;70% planned passive engagement). Higher levels of interest and planned engagement were both significantly correlated with greater self-reported PA participation (<italic>p</italic> &lt; .001). Across the sample, the PA levels were in the low–moderate range (990 metabolic equivalent of task-min/week), with significant variations observed by the age-cohort and geographic area (<italic>p</italic> &lt; .001). Age-cohort and geographic variations were also identified with regard to readiness for PA behavior change and perceived environmental barriers to activity (<italic>p</italic> &lt; .001). Older age (65 years and above) and host city (Tokyo) residence emerged as correlates of higher levels of PA, greater readiness for behavior change, and fewer reported barriers to participation. These findings have implications for Olympic legacy management and successful transitions from middle age to later life in Japan.

Sports mega-events, such as the Olympic and Paralympic Games, have the potential to inspire increases in population physical activity, yet investigations concerning such legacy outcomes have been inconclusive. This may be due to research design limitations or inconsistent leveraging of potential hosting benefits by event organizers. This systematic review aims to identify current knowledge about the capacity of sports mega-events to inspire increases in physical activity participation among adult populations and develop a research agenda to guide future legacy evaluations. Peer-reviewed, English-language studies published on or after the year 2000 were considered. Six academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Reporting followed PRISMA conventions for systematic reviews. Nine studies were selected after quality evaluation, including previous reviews, quantitative and qualitative research. Most studies found no evidence for long-term physical activity outcomes associated with hosting sports mega-events, although limitations and gaps were identified. These included lack of longitudinal or cohort studies, limited differentiation of subpopulations, use of non-validated instruments, and lack of triangulation for qualitative findings. Only one cohort study from Japan identified sustainable and significant physical activity increases resulting from a previous sports mega-event. Considering theory, the commonly cited Demonstration Effect was reportedly an unreliable framework, although the Festival Effect and Social Ecological Model appear more promising for anticipating and explaining legacy effects. With less than two years until the Tokyo 2020 Olympiad, it is appropriate to commence high-quality legacy research drawing on lessons learned from previous studies.

Dementia is increasing in Australia in line with population ageing and is expected to peak by mid-century. The development of common forms of dementia, including Alzheimer’s disease, is associated with lifestyle-related risk factors that are prevalent among middle-aged Australians, including obesity, hypertension, high cholesterol, diabetes and depression. These risk factors can be significantly ameliorated through regular participation in moderate aerobic physical activity (PA). Current national and international guidelines recommend at least 150 min of aerobic PA per week for achieving health protective effects. Lifestyle intervention is a critical area for action as there are currently no medical or pharmaceutical interventions that can halt the progression of common dementias. Physician–patient discussions concerning risk reduction via habitual aerobic PA offers a complementary intervention as part of broader dementia management. Evidence suggests that to achieve the highest rates of adherence to PA, physician advice in primary care should be supported by wider policies, institutions and community services that offer a meaningful referral pathway and patient follow up after initial assessment. International Green Prescription programs provide examples of physician-led interventions in primary care that could inform further action in Australia.

OBJECTIVES: Best-evidence dementia knowledge has the potential to improve care practices in aged care settings, although limited research has explored understanding among the Japanese workforce. This study examines the knowledge of dementia and educational needs among aged care professionals across Japan. METHODS: An online survey methodology was used to assess the dementia experiences and knowledge among a national, random sample of 117 Japanese aged care professionals. RESULTS: Objectively measured scores on the Dementia Knowledge Assessment Scale were moderate and lower than the scores recorded with comparable international cohorts. Knowledge scores were positively correlated with formal dementia education and self-rated knowledge. Knowledge deficiencies were identified concerning differentiation of dementia symptoms, efficacy of pharmaceutical treatments, managing challenging behaviours and patient communication. CONCLUSION: These results may be used by academics, clinical educators and policy specialists to inform the development of workplace education in the Japanese aged care sector that aims to improve care quality.

One of the most difficult challenges associated with an ageing population will be a significant increase in the number of people living with dementia. In Australia, this number is estimated to triple by 2050, a situation that is reflected globally. This will place increased demands on health and long-term care providers but it should also force an examination of the ability of contemporary cities to facilitate or constrain inclusion. Globally, designers and students of this discipline are contributing their skills to the challenge of dementia but solutions are typically proposed at a product, institutional, or suburban scale. This article will present two propositional projects, created using a speculative design methodology within a design studio at The University of Melbourne, that provoke architects to more seriously interrogate what it means for a city to support social inclusion, independence, and choice for those who are ageing in place. These projects illuminate new avenues for critical and necessary research. This article will begin with a reflection on the limitations of the Hogeweyk Dementia Village (Amsterdam), considered the current gold standard in dementia design, to highlight the value of thinking speculatively within the context of dementia; to disrupt the limitations of contemporary design thinking and ask what role the architect can play in improving the lives of those living with dementia?.

Aim: Dementia prevalence is accelerating internationally commensurate with population aging. Super-aging countries, including Japan., will experience growing prevalence of this life-limiting condition in the coming decades as a result of falling fertility and mortality. The authors developed and verified a Japanese translation of the Dementia Knowledge Assessment Scale (DKAS-J) to address the paucity of reliable and valid Japanese-language measures, and to elucidate current understanding.
Methods: The present study was designed as exploratory research across five universities in Japan. The Dementia Knowledge Assessment Scale was translated into Japanese by a native speaker and bilingual physician with back translation carried out to ensure consistency of meaning. Between January and April 2016, the DKAS-J was administered to 185 health students, academics and health professionals from the disciplines of nursing, medicine and allied health in the regions of Kyushu, Kansai and Tohoku.
Results: The DKAS-J showed face and content validity, acceptable internal consistency (alpha = 0.79) and adequate sensitivity (discrimination between health professionals and health students). A principal components analysis confirmed that an 18-item iteration of the DKAS-J performed optimally as a unidimensional scale. The results of DKAS-J administration. showed low levels of dementia knowledge among participants, with particularly poor understanding related to the clinical course of the syndrome, symptomatology and the efficacy of pharmaceutical intervention for behavioral symptoms.
Conclusion: The DKAS-J provides a useful tool for conceptualizing baseline knowledge, changes in understanding and knowledge deficits. Such a measure will prove valuable for the design and development of educational interventions as dementia increases in Japan and worldwide.

BackgroundOlder adults living in residential aged care facilities (RACFs) often experience limited opportunities for social connection despite close proximity to peers, which has implications for mental health and quality of life (QoL). The introduction of large-scale undergraduate health student placements in RACFs may enhance opportunities for meaningful engagement through social connection, although this remains unexplored.
ObjectiveThis research explores whether interpersonal encounters between health students and RACF residents influence residents' opportunities for social connection and QoL.
MethodsA mixed methods design was employed which included questionnaire data from residents, and qualitative interview data from residents, family members and RACF staff. Data were collected during and after student placements to allow for an in-depth exploration of residents, family members and staff perspectives.
ResultsForty-three participants (28 residents, 10 staff and five family members) were recruited during 2014. Overall, many residents had clinical levels of depression, mild cognitive impairment and multiple morbidities, however reported moderate-to-good QoL. Thematic analysis was undertaken on interview transcripts, and three themes emerged: (i) social isolation and loneliness fostered by residents' age-related conditions, (ii) students expand socially supportive connections beyond the RACF and (iii) meaning making by sharing health experiences, which was found to help renegotiate older adults' pervasive narrative of vulnerability.
ConclusionSupported and structured health student placements in RACFs enable older adults to participate in meaningful encounters with younger people. These encounters focus on sharing health experiences and address long-standing issues of isolation and loneliness by providing opportunities for social connection.

Background: Dementia is a life-limiting condition that is increasing in global prevalence in line with population ageing. In this context, it is necessary to accurately measure dementia knowledge across a spectrum of health professional and lay populations with the aim of informing targeted educational interventions and improving literacy, care, and support. Building on prior exploratory analysis, which informed the development of the preliminarily valid and reliable version of the Dementia Knowledge Assessment Scale (DKAS), a Confirmatory Factor Analysis (CFA) was performed to affirm construct validity and proposed subscales to further increase the measure's utility for academics and educators.
Methods: A large, de novo sample of 3649 volunteer respondents to a dementia-related online course was recruited to evaluate the performance of the DKAS and its proposed subscales. Respondents represented diverse cohorts, including health professionals, students, and members of the general public. Analyses included CFA (using structural equation modelling), measures of internal consistency (alpha), and non-parametric tests of subscale correlation (Spearman Correlation) and score differences between cohorts (Kruskal-Wallis one-way analysis of variance).
Results: Findings of the CFA supported a 25-item, four-factor model for the DKAS with two items removed due to poor performance and one item moved between factors. The resultant model exhibited good reliability (alpha = .85; omega(h) =.87; overall scale), with acceptable subscale internal consistency (alpha &gt;= .65; subscales). Subscales showed acceptable correlation without any indication of redundancy. Finally, total and DKAS subscale scores showed good discrimination between cohorts of respondents who would be anticipated to hold different levels of knowledge on the basis of education or experience related to dementia.
Conclusion: The DKAS has been confirmed as a reliable and valid measure of dementia knowledge for diverse populations that is capable of elucidating knowledge characteristics across four coherent domains: 1) Causes and Characteristics, 2) Communication and Behaviour, 3) Care Considerations, and 4) Risks and Health Promotion. Importantly, the four confirmed subscales clearly distinguish between groups who might be expected to hold differing levels of knowledge about dementia, allowing for a fine-grained level of detail to be established when evaluating baseline understanding or knowledge change associated with educational intervention.

Japan is a super-ageing society that faces pressures on its aged care system from a growing population of older adults. Naturalistic observations were undertaken at eight aged care facilities in central and northern Japan to explore how aged care is configured. Four aspects of contemporary provision were identified that offer potential gains in quality of life and health. The Japanese government mandates that aged care facilities must employ a qualified nutritionist to oversee meal preparation, fostering optimal dietary intake. A concept of life rehabilitation seeks to maximise physical and cognitive performance, with possible longevity gains. Low staff to resident ratios are also mandated by the Japanese government to afford residents high levels of interpersonal care. Finally, Japanese facilities prioritise experiences of seasonality and culture, connecting frail older people to the world beyond their walls.

This research describes the development and initial results from the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) that was designed to explore perceptions of vulnerability to disasters in the context of population ageing. Few Japanese studies have explored perceptions of disaster-related vulnerability in Japan, although this issue is growing in importance due to the acceleration of population ageing and the recurrence of large-scale disasters.
Following pre-testing, the PADVS was administered with 172 health students and professionals from three Japanese regions in 2016. The reliability and validity of the PADVS were assessed using commonly employed psychometric evaluation techniques, including assessment of face and content validity, internal consistency, item-total correlations, inter-item correlations, and factorial validity. Descriptive statistics were used to ascertain total, subscale, and item scores.
With one item removed due to poor fit, a 13-item version of PADVS exhibited acceptable reliability (alpha=.87) and validity. The scale fit a four-component solution following principal components analysis, with four indicative subscales. Results of PADVS completion showed clear respondent concerns about social isolation and lack of support networks, and poor functional capacity among older adult populations.
The PADVS provides a reliable and valid measure for researchers to assess perceptions of societal vulnerability related to disasters in the context of population ageing. Preparations for recurring disasters should focus on improving supportive social network connections among older adults and providing intervention measures to improve physical, cognitive, and emotional health for older adults, particularly those who live alone in the community. (C) 2016 Elsevier Ltd. All rights reserved.

OBJECTIVES: To compare the psychometric performance of the Dementia Knowledge Assessment Scale (DKAS) and the Alzheimer's Disease Knowledge Scale (ADKS) when administered to a large international cohort before and after online dementia education.
DESIGN: Comparative psychometric analysis with pre- and posteducation scale responses.
SETTING: The setting for this research encompassed 7,909 individuals from 124 countries who completed the 9-week Understanding Dementia Massive Open Online Course (MOOC).
PARTICIPANTS: Volunteer respondents who completed the DKAS and ADKS before (n = 3,649) and after (n = 878) completion of the Understanding Dementia MOOC.
MEASUREMENTS: Assessment and comparison of the DKAS and ADKS included evaluation of scale development procedures, interscale correlations, response distribution, internal consistency, and construct validity.
RESULTS: The DKAS had superior internal consistency, wider response distribution with less ceiling effect, and better discrimination between pre- and posteducation scores and occupational cohorts than the ADKS.
CONCLUSION: The 27-item DKAS is a reliable and preliminarily valid measure of dementia knowledge that is psychometrically and conceptually sound, overcomes limitations of existing instruments, and can be administered to diverse cohorts to measure baseline understanding and knowledge change.

Background: Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care.
Methods: Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement.
Results: Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in-depth engagement with clinically challenging cases and opportunities to practice independent clinical decision making and contribute to resident care.
Conclusions: Aged care placements can improve medical student attitudes to working with older people and dementia knowledge. Clinical placements in RACFs challenge students to become more resourceful and independent in their clinical assessment and decision-making with vulnerable older adults. This suggests that aged care facilities offer considerable opportunity to enhance undergraduate medical education. However, more work is required to engender cultural change across medical curricula to embed issues around ageing, multiple comorbidity, and dementia.

ObjectivesTo develop a reliable and valid dementia knowledge scale to address limitations of existing measures, support knowledge evaluation in diverse populations, and inform educational intervention development.
DesignA five-stage, systematic scale development process was employed to construct and assess the psychometric properties of the Dementia Knowledge Assessment Scale (DKAS).
SettingData for the study were generated in an online environment and during clinical dementia care placements from Australian (n = 1,321) and international respondents (n = 446).
ParticipantsVolunteers from a dementia-related massive open online course (n = 1,651), medical students on clinical placement in a residential aged care facility (n = 40), and members of the Australian health workforce (n = 76).
MeasurementsPsychometric properties of the DKAS were established using a literature review to assess the veracity of scale items, respondent feedback during pilot testing, a Delphi study with dementia experts, construction and review by an expert panel, evaluation of item difficulty, item-total and interitem correlations. Principal components analysis (PCA) was also performed along with measures of test-retest reliability, internal consistency, construct validity, and concurrent validity.
ResultsThe pilot DKAS was reduced from 40 to 27 items during analysis. PCA identified four distinct and interpretable factors. The revised DKAS displays high levels of test-retest reliability; internal consistency; and preliminary construct, concurrent, and factorial validity.
ConclusionThe 27-item DKAS is reliable and shows preliminary validity for the assessment of knowledge deficiencies and change in those who provide care and treatment for people with dementia.

Background: Escalating numbers of people are experiencing dementia in many countries. With increasing consumer needs, there is anticipated growth in the numbers of people providing diagnostic evaluations, treatments, and care. Ensuring a consistent and contemporary understanding of dementia across all of these groups has become a critical issue. This study aimed to reach consensus among dementia experts from English speaking countries regarding essential and contemporary knowledge about dementia.
Methods: An online Delphi study was conducted to examine expert opinion concerning dementia knowledge with three rounds of data collection. A sample of dementia experts was selected by a panel of Australian experts, including a geriatrician and three professors of aged care. Purposive selection was initially undertaken with the sample expanded through snowballing. Dementia experts (N = 19) included geriatricians, psychologists, psychiatrists, neuroscientists, dementia advocates, and nurse academics from the United Kingdom, United States, and Australia. In the first round, these participants provided open-ended responses to questions determining what comprised essential knowledge about dementia. In the second round, responses were summarised into 66 discrete statements that participants rated on the basis of importance. In the third round, a rank-ordered list of the 66 statements and a group median were provided and participants rated the statements again. The degree of consensus regarding importance ratings was determined by assessing median, interquartile range, and proportion of experts scoring above predetermined thresholds. Correlation scores were calculated for each statement after the final round to identify changes in statement scores.
Results: The Delphi experts identified 36 statements about dementia that they considered essential to understanding the condition. Statements about care for a person experiencing dementia and their care giver represented the largest response category. Other statements, for which full or very high consensus was reached, related to dementia characteristics, symptoms and progression, diagnosis and assessment, and treatment and prevention.
Conclusions: These results summarise knowledge of dementia that is considered essential across expert representatives of key stakeholder groups from three countries. This information has implications for the delivery of care to people with the condition and the development of dementia education programs.

Few researchers have explored perceptions of the local environment as a potential precursor to older adults' active leisure participation; fewer still have employed visual research methods as a tool for examining the modalities of environmental influences on leisure behaviour. This article introduces leisure researchers to the visual research techniques of Q method with photographs and photovoice and highlights the opportunities and challenges resulting from the use of visual techniques with populations of older adults. Data obtained in two visual research studies undertaken in 2008 and 2011 reveal the importance of home and local environment as a nexus for leisure participation and identify conditions that may facilitate activity participation in later life. Environmental conditions that are particularly significant in the case of older adults include the home garden, natural and aesthetically pleasing settings, the local social network and functional neighbourhood facilities. Visual research methods were used to generate these findings. Such research methods provide rich and nuanced data in studies concerning environment-behaviour interactions, which may be difficult to attain using conventional research methods.

This paper explores the evidence for environmental influences on older adult health and activity participation, identifies current knowledge gaps and limitations within this literature, and offers recommendations for future research via a systematic appraisal of 83 quantitative and qualitative studies. A Cochrane-type review procedure was followed, which incorporated structured database searches, inclusion and exclusion criteria, quality appraisal of included studies, and peer review. The review findings identify support for both personal and environmental influences on health and activity participation in later life. Reported personal influences include ethnicity and cultural norms, energy and motivation, sex, age, education, genetic heritage, self-efficacy, and personal financial circumstances. Reported environmental influences on activity participation include climate, level of pollution, street lighting, traffic conditions, accessibility and appropriateness of services and facilities, socio-economic conditions, aesthetics, pedestrian infrastructure, community life, exposure to antisocial behaviour, social network participation, environmental degradation, level of urbanism, exposure to natural settings, familiarity with local environment and others. Recommendations for future research include the need for innovative research methods; involvement of older adults as research collaborators; investigation of wider aspects of the active ageing concept; in-depth assessment of the environmental characteristics of areas; investigation of the pathways leading from environment to health and activity participation; and more theoretically informed research or increased contribution of research to theory development.

Aim
To develop community-generated recommendations to inform urban environmental remediation following earthquakes in Christchurch, New Zealand, and share these with local decision-makers during a participatory action research process.
Methods
This study employed three focus group discussions to critique mixed-methods and multiphase results and develop evidence-based recommendations. Participants included 30 volunteers and 8 knowledgeable advisers aged 65 years and older.
Results
Participant recommendations addressed the remediation of earthquake-affected suburbs, access to transportation, age-friendly design, safer communities, resilient support agencies, and restoration of resources for social and cultural activities.
Conclusion
Older collaborators identified salient barriers to active ageing and options for post-earthquake redevelopment that had not previously been considered in research or policy. Independently living older adults are well placed to work with researchers to develop recommendations to improve the urban environment following natural disasters as well as in times of relative stability.

This paper examines how neighborhood deprivation potentially affects older adults&apos; participation in leisure time physical activity (LTPA). Recall surveys and semi-structured interviews were conducted with 63 elderly residents of high- and low-deprivation neighborhoods in Christchurch, New Zealand. Results showed that residing in a neighborhood of high socioeconomic deprivation was potentially associated with significantly lower levels of neighborhood-based LTPA and that this effect appeared to be partly mediated by deleterious physical and social environmental conditions. These results suggest that strategies to promote increased participation in LTPA among older adults may need to consider intervening in the physical and social environment in highly deprived neighborhoods. (C) 2008 Elsevier Ltd. All rights reserved.

This paper examines the influence of neighbourhood deprivation on older adults' preferences for and perceptions of active leisure participation using an original research approach. A mixed-methods procedure, incorporating Q methodology and semi-structured interviews, was undertaken with 63 elderly residents from high-and low-deprivation neighbourhoods in Christchurch, New Zealand. Analysis of Q sort data and interview transcripts revealed that residents of a high-deprivation neighbourhood had diverse preferences for leisure settings and generally perceived their neighbourhood as a constraint to active leisure participation. In contrast, residents of a low-deprivation neighbourhood showed distinct preferences for attractive, natural leisure settings and perceived that their neighbourhood facilitated active leisure participation. Leisure providers are encouraged to consider how environmental characteristics influence individual perceptions and preferences and potentially affect active leisure participation in high-and low-deprivation neighbourhoods when providing recreational facilities and resources for older adults. As a research tool for leisure studies, Q methodology provides a novel means for researchers to appraise preferences for neighbourhood leisure environments and may be useful in determining the accessibility and efficacy of community leisure provision.

This study explored expectations regarding aging among a diverse cohort of undergraduates in Japan. A concurrent mixed methods design was employed with online administration of the Expectations Regarding Aging scale (ERA-12), and open-format and demographic questions among 133 culturally diverse undergraduates in Tokyo. Independent samples t-tests, one-way analysis of variance (ANOVA), descriptive sta­tistics, and thematic analysis were used to explore the data. ERA-12 scores and physical and cognitive function subscale results revealed negative perceptions about the aging process, while scores on the mental health subscale were significantly higher and positive. No significant differences emerged based on gender or cultural background. Qualitative data anal­ysis revealed student awareness of lifestyle influences on health in later life, concerns about current health and risk factors, and potential to tran­scend negative physical changes by finding meaning in other aspects of life. Understanding expectations regarding aging among younger cohorts may inform gerontological education and public health promotion to sup­port a life course approach to healthy aging.

小学校におけるスタンディングデスクの導入は健康指標および学習行動へ有益な影響があることが報告されているが,アジア諸国の小学校におけるスタンディングデスクを用いた介入研究は非常に乏しい.また混合研究法を用いて,スタンディングデスクの効果を検討した研究は非常に限られている.本研究の目的は,小学校におけるスタンディングデスクの導入による主観的および客観的な効果について混合研究法を用いて明らかにすることを目的とした.長野県に在住する小学6年生22名およびクラス担任1名を対象とした.介入クラスには児童の人数分,スタンディングデスクを9ヵ月間導入した.また,児童を対象としたフォーカスグループインタビューを介入期間中に2回実施した.さらに,スタンディングデスク導入前後に,加速度計を用いて身体活動および座位活動を客観的に評価した.児童およびクラス担任を対象としたインタビューより,スタンディングデスク導入に伴い,健康指標および学習行動に好ましい効果があったことが報告された.例えば,スタンディングデスク導入後に,持久力の向上,学習中における姿勢の改善,自己表現力の向上,児童間の交流の促進,授業中の不安の軽減等が認められたことが報告された.一方,今後のスタンディングデスク普及への課題として,発達段階に合わせたデスク導入の必要性や,従来の教育スタイルとの乖離等が挙げられた.加速度計を用いた調査より,デスク導入後に児童の学校内・外における中高強度身体活動量が有意に増加したことが示された.本研究より,小学校におけるスタンディングデスクの導入は,児童の健康指標および学習行動を改善するために有用なアプローチである可能性が示唆された.今後は,より大規模な研究が実施され(例:複数の学校におけるランダム化比較研究等),小学校教諭の教育理念がどのようにスタンディングデスク使用に影響するのか検討していくことが望ましい.(著者抄録)

Research background and objectives: The Olympic Games have the potential to inspire increases in physical activity (PA) among host populations, yet such legacies are infrequently reported. While research concerning PA legacies has seldom identified positive outcomes, design and methodological limitations are common. Therefore, this study aimed to identify expert academic consensus concerning the challenges, opportunities and research needs associated with the pursuit of PA legacies to guide sports event planning prior to the Tokyo Olympics. Methods: A two-round, mixed-method Delphi study was undertaken during 2018 following international best-practice guidelines. In total, 27 academics from five regions participated with diverse expertise across sports, PA and Olympic research. Experts were particularly sought from the Asia-Pacific region, including Japan, due to their knowledge of regional issues ahead of the Tokyo Olympics. Results: Consensus (>50% participant agreement) was identified in relation to five themes and six expert-generated statements. Experts showed negative sentiment in relation to Olympic PA legacies, acknowledging only the tangible infrastructure and facility developments and highlighting failures in long-term strategic planning. Looking ahead to future Olympic Games, experts acknowledged the possibility of achieving population increases in PA under the right circumstances. They asserted, however, that such outcomes will rely on government commitments to a long-term legacy plan with defined performance measures, sustainable funding, and stakeholder support. In order to accurately capture the effects of the Olympics on population PA, experts recommended that longitudinal cohort studies need to be initiated with appropriate sub-population representation. Conclusion: Previous Olympic Games have a poor record of achieving PA legacies beyond infrastructure and facility development. A strategic, long-term approach to legacy management is required and research is needed to capture baseline data to inform longitudinal studies of hosting impacts.

Health benefits of physical activity are well known, yet available physical activity data is limited from children living in African and Asian countries. The purpose of the cross-sectional study was to evaluate and compare physical activity and sedentary behavior patterns, particularly hourly variations, among children in Kenya and Japan. Participants included 298 primary school students (122 Kenyan, 176 Japanese) aged 9–12 years. Physical activity and sedentary behavior were measured with accelerometers. Domain-specific physical activity, screen time, and proportion of children using active transport to school were measured by questionnaire. A two-way ANOVA (countries × time) was used to examine the differences in the activity patterns between Kenyan and Japanese children. The results from the present study demonstrated that Kenyan children spent more time in moderate-to-vigorous physical activity compared to Japanese children (p &lt; 0.05) with the greatest differences found for weekday evenings (for boys and girls) and weekend afternoons (for girls). This suggests that these were ‘critical periods’ to differentiate the physical activity levels between Kenyan and Japanese children. However, a higher proportion of the children from Japan used active transport to school and spent less time in television viewing and computer gaming. The results suggest that both countries have successes and challenges that can aid in developing effective and country-specific intervention strategies for promoting physical activity.

ABSTRACT

Objective

This paper reports on undergraduate health care students’ perception of societal vulnerability to disasters in the context of population aging. Forecast increases in extreme weather events are likely to have a particularly devastating effect on older members of the community.

Methods

Undergraduate paramedicine and nursing students were surveyed using the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) to determine their views on the risks posed to older members of the community by disasters. Data analysis included a comparison of subscales relating to isolation, health system readiness, declining function, and community inclusiveness.

Results

Students reported a moderate level of concern about disaster vulnerability. Students who had previously completed another university degree reported significantly higher levels of concern than those without a prior degree. Australian students reported lower concern about societal vulnerability compared to a previously reported cohort of Japanese students.

Conclusion

Our study suggests current education of future health care students does not promote adequate levels of awareness of the health-related challenges posed by disasters, particularly among older members of the community. Without addressing this gap in education, the risk of negative outcomes for both unprepared first responders and older members of the community is significant. (Disaster Med Public Health Prep. 2019;13:449-455)

The purpose of the present study was to examine the effects of height-adjustable standing desks on time-series variation in sedentary behavior (SB) among primary school children. Thirty-eight children aged 11–12 years (22 boys and 16 girls) from two classes at a primary school in Nagano, Japan, participated in this study. One class was allocated as the intervention group and provided with individual standing desks for 6 months, and the other was allocated as the control group. Time spent in SB, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) was measured using accelerometers (ActiGraph) at baseline and follow-up. Time spent in SB was significantly lower by 18.3 min/day on average in the intervention class at follow-up (interaction effects: F(1, 36) = 4.95, p = 0.035, η2 = 0.082). This was accompanied by a significant increase in time spent in MVPA (+19.9 min/day on average). Our time-series analysis showed significant decreases in SB during school time, while no change in SB was found during non-school time. This result indicates that the use of standing desks promotes an overall reduction in SB with no compensatory increase during non-school time.

BACKGROUND: The attitude of General Practitioner's (GP's) towards dementia and confidence in their clinical abilities impacts on diagnosis rates and management of the condition. The purpose of the present research is to refine and confirm the reliability and validity of the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) as a tool to measure confidence and attitude. METHODS: A sample of 194 GP volunteers attending dementia education workshops were recruited to complete the GPACS-D before and after the workshop. Volunteer respondents comprised both GP Registrars and GP Supervisors. Analyses included Confirmatory Factor Analysis (CFA), measures of internal consistency, Pearson correlations, and a comparison of subscale scores between cohorts (T-Test for independent samples). RESULTS: Findings of the CFA support a 15-item, 3-factor model with four items removed due to poor performance and one item moved between factors. The resultant model exhibited good fit (x2 = 103.88; p = .105; RMSEA = .032; PCLOSE = .915; CFI = .967; TLI = 960), with acceptable internal consistency. Subscales exhibited clear discriminant validity with no underlying relationships between subscales. Finally, total and subscale scores exhibited good discrimination between groups who would be expected to score differently based on experience and level of exposure to dementia. CONCLUSION: The 15-item, 3-subscale GPACS-D is a reliable and valid measure of GP confidence and attitudes toward dementia. The subscales clearly distinguish between groups who might be expected to score differently from each other based on their training or professional experiences. The psychometric properties of the GPACS-D support its use as a research tool.

Dementia is a growing public health problem, which may be under-recognised and poorly managed in regional hospitals. With projections of increasing dementia among older adults in regional and rural areas, knowledge about dementia and capacity of professionals to provide best-evidence care is paramount. This research investigates the challenges of dementia care in a publicly funded regional hospital in Australia. The study elucidates prevalence of dementia-related admissions, costs of treatment, length of stay and capacity for dementia care. A mixed methodology was employed in this study, including analysis of hospital records (N = 2405), dementia knowledge surveys (n = 50) and semi-structured interviews with clinical staff (n = 13). Hospital records showed that dementia-related admissions were lower than population prevalence reported in regional Australia. Dementia patients, however, attracted significantly higher treatment costs and greater length of stay than age-matched admissions who did not have a diagnosis of dementia. Clinicians reported several obstacles to effective dementia care, including staff knowledge deficits, environmental challenges, resource constraints and organisational factors.

Dementia prevalence is increasing in Japan commensurate with population ageing. This study addresses the paucity of research concerning the dementia education needs of Japanese health workers who care for older adults. A random sample of 117 aged care workers was generated from government lists of institutions and services across eight regions of Japan. Volunteer respondents completed an online survey concerning perceptions of dementia, professional educational needs and demographic information. Japanese aged care workers identified a high prevalence of dementia among their clients and acknowledged the value of professional education
however, they only reported moderate levels of dementia knowledge and confidence with care provision. Educational preferences included learning about non-pharmacological treatments for behavioural and psychological symptoms of dementia, workshop and mentor-based programmes, and incentivising education through formal certification and targeting content to professions. This research may inform the development of educational interventions for aged care workers, which may ultimately affect care for people with dementia.

The sense of taste is important as it allows for assessment of nutritional value, safety and quality of foods as well as for food enjoyment and quality of life. Several factors are suggested to be associated with taste sensitivity, and higher prevalence of taste disorder has been reported among older adults. This review focused on the reported causes and correlates of taste decline in older adults, with the aim to consolidating existing evidence and identifying gaps and limitations. Using a scoping review methodology, we sought relevant literature from the last 20 years. Search terms included taste, gustatory sense, older adults and geriatric. Considered research was limited to reports that involved research participants over 60 years old, papers written in English, and manuscripts published after 1995. We have consolidated available evidences on the influences on taste-related sensations among international cohorts of older adults. Influences can be reflected under the topics of physiological changes in the sensory organs, physiological and behavioural variables related to taste sensation. This review identified three areas of historic and current research endeavour related to studies of taste sensation in older subjects: physiological changes in the sensory organs, factors related to the ageing of the individual and behavioural variables affecting taste-related sensation. Key limitations and gaps in the current literature include notable lack of consideration of potential confounding, mediating and moderating effects, while future research is indicated in the areas of measuring the quality of health and life. As global population ageing accelerates in the coming decades, maintaining taste sensations and sensitivity in older adults will be a key measure to ensuring quality of health and life.

AimAt a time of increasing dementia prevalence, this research explores the cost of treatment and length of stay associated with the syndrome in a large regional hospital.
MethodsDatabase analysis of 4332 recorded admissions to a large regional Australian hospital among adults aged 55 years and older during winter 2013 and 2014.
ResultsCosts of hospital treatment and length of stay for people with a diagnosis of dementia who presented to a regional hospital were significantly greater than people with no diagnosis over two years. Costs were unrelated to age or likelihood of death in hospital. Prevalence of dementia admissions was low, but treated conditions indicate that the syndrome may be an underlying, and potentially unrecognised, factor in many admissions.
ConclusionDementia imposes a large cost and resource burden on a regional hospital. Improved identification of the syndrome on admission and implementation of best-evidence management of dementia in regional hospitals may improve care efficiency.

Background: International evidence suggests that dementia is under-diagnosed in the community and that General Practitioners (GPs) are often reluctant to engage to their fullest capability with patients who exhibit cognitive symptoms. This is potentially reflected by a lack of GP knowledge about the syndrome. However, it is also recognised that attitudes and confidence are important in relation to how and to what extent a GP approaches a person with dementia. This research sought to develop a reliable and valid measure of GPs attitudes and confidence towards dementia.
Methods: The General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) was developed via a four stage process, including initial content development, pretesting, pilot testing and psychometric evaluation, including Principal Component Analysis (PCA). Participants were recruited for pre-testing (n = 12), test-retest (n = 55), and dementia workshop pre- and post-education evaluation (n = 215).
Results: The process of scale development and psychometric evaluation resulted in a 20-item measure of GP attitudes and confidence towards dementia, with 4 items removed due to poor reliability, low sensitivity, or lack of model fit. Among 55 respondents who completed the scale on two occasions with no intervening education, Kappa coefficient scores per item ranged from fair (n = 2, candidates for removal), moderate (n = 5), substantial (n = 15), and almost perfect (n = 2). A test of the sensitivity of item scores to change following dementia education among 215 GPs indicated that, with the exception of one item, all scale responses exhibited significant differences between pre- and post-workshop scores, indicating acceptable sensitivity. With one further item removed due to a low communality score, the final PCA undertaken with the remaining 20 items supports a four-component solution, which accounted for 51.9 % of the total variance.
Conclusion: The GPACS-D provides a reliable and preliminarily valid measure of GP attitudes and confidence towards dementia. The scales provide useful information for medical educators and researchers who are interested in evaluating and intervening in GP perceptions of the syndrome and their capacity to provide effective care.

Introduction This paper presents findings from an exploratory pilot study in which undergraduate paramedic students trialled the use of two pain assessment tools as part of an interprofessional learning activity in residential aged care facilities (RACFs). The research sought to gain students’ perceptions of the potential utility of the Abbey Pain Scale and PAINAD tools for use by paramedics with people with advanced dementia who have limited ability to communicate. Methods Thirty-one final year undergraduate paramedic students completed a 5-day clinical placement in four RACFs in Tasmania, Australia. While on placement, students used the two clinically validated pain assessment tools to assess pain in residents with known pain issues, under the supervision of nursing staff and paramedic tutors. A mixed methods approach, utilising a quantitative survey and a qualitative open-ended questionnaire, was adopted to ascertain students’ perceptions about the potential for the tools to be used in paramedic practice. Results The research found that students considered both tools had potential for use in paramedic practice. Feedback from this cohort of students indicated they considered the Abbey Pain Scale was more useful for assessing pain in cognitively impaired older people, although students reported they considered the PAINAD Scale to be more relevant to their future role as paramedics. Recommendations were made by the students for how each of the tools might be adapted to make them more suitable for use by paramedics. Conclusion Forecast increases in the number of people living with dementia, and the changing nature of paramedic practice in the 21st century, means that paramedics are more likely to be called on to assess pain in this population in community settings. Further research is needed to inform the development of pain assessment tools specifically for use by paramedics in these settings.

This article examines the reflective discourses of medical, nursing, and paramedic students participating in interprofessional education (IPE) activities in the context of aged-care clinical placements. The intent of the research is to explore how students engage with their interprofessional colleagues in an IPE assessment and care planning activity and elucidate how students configure their role as learners within the context of a non-traditional aged-care training environment. Research participants included cohorts of volunteer medical (n = 61), nursing (n = 46), and paramedic (n = 20) students who were on clinical placements at two large teaching aged-care facilities in Tasmania, Australia, over a period of 18 months. A total of 39 facilitated focus group discussions were undertaken with cohorts of undergraduate student volunteers from three health professions between February 2013 and October 2014. Thematic analysis of focus group transcripts was assisted by NVIVO software and verified through secondary coding and member checking procedures. With an acceptable level of agreement across two independent coders, four themes were identified from student focus group transcripts that described the IPE relations and perceptions of the aged-care environment. Emergent themes included reinforcement of professional hierarchies, IPE in aged care perceived as mundane and extraneous, opportunities for reciprocal teaching and learning, and understanding interprofessional roles. While not all students can be engaged with IPE activities in aged care, our evidence suggests that within 1 week of clinical placements there is a possibility to develop reciprocal professional relations, affirm a positive identity within a collaborative healthcare team, and support the health of vulnerable older adults with complex care needs. These important clinical learnings support aged-care-based IPE as a potentially powerful context for undergraduate learning in the 21st Century.

This report describes the outcomes of a five-day, protocol-based interprofessional education (IPE) initiative to prepare undergraduate medical, nursing, and paramedic students for collaborative work with adults with dementia. Clinical placements provided a structured and supervised IPE experience for 127 students in two Residential Aged Care Facilities (RACFs) in Hobart, Australia, during 2013 and 2014. The IPE activity was based on a seven-step protocol formulated by an interprofessional team of educators and aged care practitioners that revolved around collaborative assessments of adults with complex health needs. This article describes the IPE protocol and presents the results of a pre- and post-placement attitude questionnaire and knowledge quiz administered to evaluate student attitudes towards IPE and knowledge of dementia. Data suggest that a five-day, supervised, and protocol-based IPE experience in a dementia-care setting can inculcate positive changes in student attitudes about collaborative practice and may encourage dementia-related learning outcomes.

Background Care provided by student doctors and nurses is well received by patients in hospital and primary care settings. Whether the same is true for aged care residents of nursing homes with mild cognitive decline and their family members is unknown.
Objective To investigate the perspectives of aged care residents with mild cognitive decline and their family members on interdisciplinary student placements in two residential aged care facilities (RACF) in Tasmania.
Design, setting and participants A mixed methods design was employed with both qualitative and quantitative data collected. All participants were interviewed and completed a questionnaire on residents' quality of life, during or after a period of student placements in each facility (October-November, 2012). Qualitative data were coded for themes following a grounded theory approach, and quantitative data were analysed using SPSS.
Results Twenty-one participants (13 residents and 8 family members) were recruited. Four themes were identified from the qualitative data and included (i) increased social interaction and facility vibrancy; (ii) community service and personal development, (iii) vulnerability and sensitivity (learning to care) and (iv) increased capacity and the confidence of enhanced care. Residents' quality of life was reported to be mostly good in the presence of the students, despite their high care needs.
Conclusion Residents with mild cognitive decline and their family members perceive a wide array of benefits of student provided care in RACFs including increased social interaction. Future quantitative research should focus on whether changes in care occur for residents as a result of student involvement.

Background: The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector's capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant knowledge in the performance of hygiene care in a residential aged care facility.Methods: This study was designed as an action research study. A cycle of reflection, planning, action, and evaluation is described to illustrate the carer mentor capacity to engage with and contribute to the learning of nursing students. Participants were second year student nurses (n = 10) on a four-week placement in a Tasmanian aged care facility in 2013 and their nurse/carer mentors (n = 17). Mentors participated in six action research meetings, and nursing students engaged in a parallel series of four feedback meetings during the placement.Results: At the beginning of the placement, nursing students exhibited a disregard for the clinical value of care provision. Students considered provision of hygiene care, in particular, the preserve of care workers and an inappropriate training exercise in the context of an undergraduate nursing qualification. To assist students to make links between core nursing competencies and hygiene care as well as to engender respect for their role within the aged care facility, carer mentors developed the Carer Assessment and Reporting Guide. Once implemented during the final weeks of the placement, the Guide improved student perceptions of resident hygiene care (reframed as assessment) and the role of facility care workers, as well as reinforcing carer self-esteem.Conclusion: Hygiene care is replete with nursing competencies that are valuable for undergraduate learners, including assessments of skin integrity, mobility, cognitive function, bowels and urine, and basic hygiene. Nurse education programs should strive to address student misconceptions about care work in facilities to account for population level increases in care needs.

The number of people with dementia is increasing rapidly worldwide. Commensurate with population ageing, the use of nursing homes in Australia (known as residential aged care facilities) for individuals with dementia is growing. As a terminal condition, dementia is best managed by instituting a palliative approach to care. A good knowledge of dementia, including its progression and management, among staff and families of people living with dementia is essential for clear decision making and the provision of appropriate care. Yet there is limited information regarding relative levels of dementia knowledge. This paper reports the results of a study that assessed dementia knowledge among these two cohorts using the Dementia Knowledge Assessment Tool; the study surveyed 279 staff members and 164 family members of residents with dementia. Dementia knowledge deficits were evident in both cohorts across a range of areas. It is critical that dementia knowledge deficits are identified and addressed in order to support evidence-based dementia care.

This article highlights immediate psychological challenges faced by older adults in the city of Christchurch, New Zealand, following an atypical sequence of earthquakes. Data are derived from a study of active ageing that coincided with the disasters. Participants included 355 community dwelling older adults who completed surveys, and a subgroup of 67 of these individuals who used activity diaries in the weeks following two major earthquakes.

This paper reports on a project relating to the development of a National Research Strategy for Leisure, Arts, Outdoor Recreation, Sport, and Community Recreation in New Zealand. The purpose of the strategy - as was the case with an earlier project in Australia, the Australian Leisure Research Agenda - is to stimulate the development, dissemination, and use of research in leisure-related fields. In addition to raising selected issues in the development of research strategies, the paper describes the research approach, aims, and methodology adopted for the project and presents preliminary results. It also provides critical insights regarding possible future directions for research strategies in leisure-related fields.