This study aimed to evaluate the impact of the regular provision of information on the oral function and nutrition to members of senior citizens clubs, with the goal of promoting voluntary health behaviors and examining their effects on the oral function and dietary intake status. Information on the oral function and nutrition was provided biannually to members of senior citizens clubs. The study included 60 participants who attended the measurement events in March 2022 and February 2024. Pre- and post-comparisons were conducted for awareness of oral frailty (OF), risk of OF, implementation of oral exercises, and tongue pressure. Participants were categorized into groups based on whether their oral function was maintained or improved or whether it deteriorated, and factors associated with the risk of OF were analyzed. The dietary intake status was assessed using a food frequency questionnaire comparing intake across 17 food groups and 23 nutrients before and after the intervention. A two-sided significance level of < 5% was set for all the analyses. The participants included 36 men and 24 women, with a mean age of 78.0±4.2 years and a mean BMI of 23.8±2.7 kg/m2. No significant differences were observed between the sexes. While no significant differences were observed in the risk classification of OF before and after the intervention (p=0.359), significant increases were noted in awareness of OF (40% to 98%, p<0.001), the proportion of participants performing oral exercises (13% to 40%, p=0.002), and tongue pressure (31.6±7.2 kPa to 33.1±7.3 kPa, p=0.020). Age category and number of event participants were associated with the risk of OF. Conversely, significant increases or decreases were observed in 16 food groups and nutrients, but no clear improvements in dietary intake status were detected. Providing information to a relatively health-conscious group of senior citizens club members improved their oral function. However, no improvement in dietary intake was observed. These findings suggest that while voluntary health behaviors can be promoted by providing information, the modification of daily dietary habits may be more challenging than incorporating oral exercises into daily routines.
Peer support, including family associations and dementia cafés, helps reduce the psychological burden on patients with dementia and their caregivers. By considering various aspects of peer support, this study aimed to determine its psychological impact on caregivers, efficacy, and related challenges. In June 2023, we conducted a web-based questionnaire survey of caregivers of people with dementia. Among 3,318 respondents, 29.3% were aware of peer support, but only 14.0% participated. The important determinants of participation were low time-related and psychological barriers. Among the participants, 46.4% learned about peer support from a care manager, which is a significantly higher proportion than from other sources (p<0.001). The question of whether the means of obtaining information was "psychologically positive" was answered positively by more peer support participants (62.4%) than by non-participants (individuals who obtained information outside of peer support; 59.5%; p=0.390). Participation was rated as "psychologically positive" by a significantly higher proportion (93.9%) of caregivers still participating in peer support than by those who no longer participated (55.9%; p<0.001). Reasons for continued participation included ease of participation and enjoyment. The survey revealed a positive psychological impact of peer support, which was higher among those who continued to participate. Caregivers of people with dementia need to be informed about the availability and efficacy of peer support soon after a dementia diagnosis. To ensure the continuous provision of support, the convenience and design of peer support needs to be improved in response to various care needs.
To develop a dementia and delirium nursing education program for nurses in acute care hospitals with the aim of enhancing their practical competencies. The program, based on person-centered care, included a 60-minute workshop and regular case conferences held two to three times per week. This study aimed to evaluate the effects of the program by examining changes in nurses' knowledge and self-efficacy regarding dementia and delirium nursing, as well as patient outcomes, including falls, self-removal of tubes or catheters, and the use of physical restraints. The program was conducted over a three-month period from November 2023 to January 2024 in a gastrointestinal surgical ward of an acute care hospital with a 7:1 nurse-to-patient ratio. Twenty-five nurses participated in this study. Questionnaires assessing knowledge and self-efficacy were administered before and after intervention. Patient outcome data, including falls, self-removal of tubes or catheters, and use of physical restraints, were collected from the medical records and compared before and after the intervention. Nurses' knowledge and self-efficacy significantly improved after the intervention. Although the total number of patients with dementia and delirium increased significantly, the incidents of self-removal of tubes or catheters and the use of physical restraints significantly decreased. Falls decreased from two to zero, although this difference was not statistically significant. The program was effective in improving nurses' knowledge and self-efficacy in dementia and delirium care and in reducing self-removal of tubes or catheters, as well as reducing the use of physical restraints.
The dementia support team (DST) is an initiative established based on the knowledge that, when individuals with dementia or older people at risk for delirium are hospitalized because of physical illnesses, there are often cases in which their cognitive symptoms rapidly deteriorate. However, the activities of each hospital are unknown. Therefore, a nation-wide survey of DSTs was conducted. A questionnaire survey was conducted among 1,032 hospitals throughout Japan. A total of 422 responses were obtained, of which 292 were valid. The main results were as follows: number of beds (200 to <500 beds, n=171), number of types of medical staff (≥4 types, n=248), number of patients for intervention/month (30 patients to <100 patients, n=164), number of team meetings/week (1/week, n=240), cognitive function assessment (Hasegawa Dementia Scale Revised [HDS-R], n=141), advice regarding medication (n=279), rehabilitation (n=243), reduction of physical restraint (n=274), nutrition (n=200) and discharge adjustment (n=233). Patients were divided into 2 groups for analyses: those requested by the other divisions (n=121; 41.4%) and those managed by DST (n=171; 58.6%). There was a higher rate of requested by the other divisions than the managed by the DST related advice for medications and rehabilitation. However, the differences were not statistically significant. The present study revealed that requests from other divisions involved a higher rate of advice on medication and rehabilitation than the managed by the DST. Further studies are required to confirm this hypothesis.
Previous studies have reported that migration is associated with cognitive impairment, and that disconnections from local communities affect cognitive function. This study examined the association between the duration of residence and cognitive impairment. The survey consisted of designed a 4-year longitudinal study that was conducted in 2013 and 2017 in Kami Town, Hyogo Prefecture, Japan. Among the 3,605 completed questionnaires, 2,051 were selected, excluding those with cognitive impairment in 2013 and/or missing data. The duration of residence until 2013 was categorized as ≤ 5 or ≥ 6 years. Cognitive impairment was defined as a person who was determined to have cognitive decline on the Kihon checklist. Odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive impairment were calculated according to sex and participation in community activities using multivariate logistic regression analysis after adjusting for age, mobility impairment, and depression. Of the 2,051 respondents, there were 1,299 women (63.3%; mean age, 74.1±6.2 years old) and the prevalence of cognitive impairment was 514 (25.1%). Multivariate logistic regression showed that women with a residence duration ≤ 5 years were more likely to have an impaired cognitive function than a residence duration ≥ 6 years; the adjusted ORs (95%CIs) were 1.65 (0.55-4.91) in those who participated in community activities and 3.86 (1.33-11.24) in those who did not. In contrast, no significant association was observed among the men. This finding suggests that among community-dwelling older adults, women who have lived in the community for less than 5 years and who do not participate in community activities may be at increased risk of deterioration in the cognitive domains of the KCL after 4 years.
To explore the factors associated with the quality of life among institutionalized elderly people with dementia. The subjects included 68 elderly patients with dementia who had lived in a nursing home for at least three consecutive months. The Japanese version of the Quality of Life in Late-stage Dementia (QUALID-J) scale was used to measure the quality of life (QOL). In addition, information on their backgrounds, as well as physical, psychological, and social data, were collected. Spearman's rank correlation coefficients between the QUALID-J scores and each data point were calculated. In addition, a multiple regression analysis was conducted using the QUALID-J score as the dependent variable, and variables identified as significant in the correlation analysis as independent variables. The following factors were identified as being significantly correlated with the QUALID-J: the number of comorbidities, BMI, grip strength, calf circumference, eating pattern, Barthel Index (BI), Clinical Dementia Rating (CDR) scale, Neuropsychiatric Inventory-Nursing Home result, communication level on the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, the number of days in the facility, the frequency of visitors, the number of times in which the subject positively participated in leisure activities, and the total number of times the subject participated in leisure activities. BI, the total number of times the subject participated in leisure activities, grip strength, and CDR were included in the multiple regression analysis model as independent variables. Higher BI values (ADL), stronger grip strength (muscle force), greater participation in leisure activities, and lower CDR scores (severity of dementia) were associated with a higher QOL.
This study investigated the issues experienced by home care workers in providing home care support for older adults on insulin therapy. Semi-structured interviews were conducted with six home care workers, and the resulting data were coded. Data with approximate semantic content were aggregated, organized, and divided into categories and subcategories. The participants were asked about the nature of the support they provided to older adults with diabetes requiring insulin therapy, the difficulties they experienced in doing so, and their thoughts on solutions. A total of 290 codes were extracted from the narratives of home care workers. The codes were then aggregated and categorized. Support provided to diabetic older adults requiring insulin therapy was organized into seven categories, such as "substitution of family care"; problems in providing this support were organized into eight categories, such as "substitution of medical care" and "gap between the system and needs"; and ideas on solutions for the future were organized into five categories, such as "improvement of expertise in home care," "creation of an organization and system for providing support to diabetic older adults requiring insulin therapy," and "information sharing and establishment of a cooperative system with medical personnel." Home care workers provide support to older adults with diabetes who require insulin therapy in place of medical personnel and family caregivers. Furthermore, home care workers cannot cooperate with medical personnel. These findings suggest that the system for training home care workers to provide support to older adults with diabetes requiring insulin therapy and the scope of their duties should be reviewed. In addition, information on insulin therapy should be shared among professionals related to home care, and a system of cooperation and collaboration should be established to ensure that home care workers do not need to replace medical care workers.
The combination of sarcopenia and osteoporosis is a risk factor for frailty and fractures, which are the main causes of conditions that require long-term care. The objective of this study was to clarify the association between frailty, as measured using the Kihon Checklist (KCL), sarcopenia, and low bone mass. A total of 521 community-dwelling older adults were recruited and frailty was assessed using the KCL. A binomial logistic regression analysis was performed to determine the association between frailty and the presence or absence of sarcopenia and low bone mass, with the presence or absence of frailty as the dependent variable. In addition, the sub-items of the KCL were compared to examine the characteristics of the four groups based on the presence or absence of sarcopenia and low bone mass. Of the participants, 17.7% were frail. Only osteosarcopenia was associated with frailty (odds ratio 3.324, 95% confidence interval 1.308-8.448). Osteosarcopenia was also associated with a poor motor function, poor nutritional status, social isolation, and depressed mood. The results suggest that older people with a combination of sarcopenia and low bone mass are at a high risk for frailty, as measured by the KCL, and that a comprehensive approach to their care is required that includes not only physical, but also mental, psychological, and social aspects.
We have developed a quality indicator for long-term care (LTC) that can be applied across various care settings, advancing the "Visualizing Effectiveness of Nursing & Long-term Care (VENUS) indicators." This study assessed the feasibility and reliability of the VENUS indicators in LTC hospitals and revised the evaluation forms and guides based on these findings. This study included 24 nurses and 12 care workers employed in two LTC hospitals in the Tokyo metropolitan area. Each group, consisting of two nurses and one care worker, was asked to evaluate VENUS indicators for the same patient. The missing data rate and inter-rater reliability between the two nurses and between the nurses and care workers were calculated. Interviews were conducted to gather feedback on the use of VENUS indicators, followed by revisions to the evaluation forms and guides. The revised forms were re-evaluated, and opinions on re-evaluation were collected. The average missing data rate for evaluations was 20.0%, with particularly high missing rates for the following indicators: "Poor family wellbeing," "Neglecting the client's desired way of life," "Lack of social interaction," and "Social isolation." On the other hand, the inter-rater reliability was high, with an average of 89.4% between nurses and 92.0% between nurses and care workers. After the revision of the evaluation forms and guides, it was reported that the criteria for evaluating patients with communication difficulties and their families were clarified, making it easier for them to evaluate. In LTC hospitals, the VENUS indicators showed high overall feasibility and reliability, although there were challenges in the feasibility of some items. The revision of the evaluation forms and guides allowed for clearer criteria based on which patients' conditions could be assessed. This research has the potential to contribute to maintaining consistency in quality evaluation across various LTC settings and to improve the quality of LTC.
The increased number of older workers correlates with an increased incidence of industrial accidents, particularly falls. This study investigated falls among workers in nursing care facilities that have already implemented resident fall prevention measures. From December 2, 2024, to January 23, 2025, a web-based survey was conducted targeting 3,547 member facilities of the Japan Association of Geriatric Health Services Facilities. The survey covered the number of facility staff, the number of fall accidents in the past year, and the age, gender, and occupation of individuals who suffered industrial fall accidents, as well as their return to work status after the accident. Of the 844 responding facilities, 91 reported 110 fall-related industrial accidents in the past year (1.63 per 1,000 people). The incidence rate increased with facility size and was unrelated to the proportion of full-time staff. The most affected age group was those in their 60s. After adjusting for age stratification within facilities, the accident rate was higher for those in their 50s (3.8 times higher), 60s (9.1 times higher), and 70s and over (8.8 times higher) than for those under 50 years old. Care workers (47%) and nurses (31%) were most frequently affected. Approximately 80% returned to the same occupation, whereas 5% retired. Falls among workers in nursing care facilities increased from 50 years old, with varying incidence by occupation. To prevent fall-related industrial accidents among workers in nursing care facilities, the early detection of age-related physical and mental decline should be considered for each job type.
We examined patients with nasogastric tube who were hospitalized in a long-term care hospital from 2018-2023 to analyze the current situation and role of nasogastric tube placement. Patients with nasogastric tube were divided into three groups; cured (n=75), transferred (n=61) and deceased (n=168).Sex, average age, length of stay, and history of aspiration pneumonia were compared between the transferred and deceased groups. Younger patients were easier to treat and their length of hospital stay became shorter. In the cured and deceased groups, 8% and 50.6% of patients, respectively, had aspiration pneumonia, which amounted to a statistically significant difference.In the deceased group, aspiration pneumonia was the direct cause of death in 41.7% of cases. Although nasogastric tube placement does not involve surgery and is easy to interrupt and resume, it has many disadvantages.The enteral nutrition guidelines state that, "If tube feeding is short-term, nasal access is chosen. If it is long-term for > 4 weeks, gastrostomy is the first choice, if possible." When there is a low risk of aspiration pneumonia, short-term nasogastric tube feeding must be attempted before proceeding to gastrostomy.
This study aimed to identify the characteristics of elderly individuals in need of nursing care who would require a walking aid after two years and to examine the factors that make it challenging for them to walk alone. This study involved 179 elderly individuals in need of care, whose grip strength, balance, lower limb muscle strength, and walking ability were assessed. Participants were divided into two groups based on whether they were using walking aids after two years, and their physical function was compared.A logistic regression analysis was conducted with the use of a walking aid as the dependent variable and the items showing significant differences between the two groups as independent variables. Knee extension muscle strength was a significant factor. Furthermore, the incidence curves of walking aid use were compared between the two groups based on the presence or absence of knee extensor muscle weakness.The findings indicated that individuals who required a walking aid after two years had reduced knee extensor muscle strength, highlighting the importance of using a walking aid at an earlier stage.
This study examined the effect of five months of interval walking training (IWT) on knee extensor and flexor muscle strength and blood pressure in older people based on monthly changes over time. Forty-eight elderly subjects (14 men, 34 women; mean age, 70±5 years old) practiced IWT for 5 months. The peak oxygen intake (VO2peak) was measured before and after the intervention, and knee extension, flexion muscle strength, and blood pressure were measured monthly from the start of the intervention. A significant increase in the VO2peak (pre: 20.0±3.2 ml/min/kg, post: 21.3±3.9 ml/min/kg) was observed after 5 months of IWT, along with significant increases in knee extensor (pre: 20.6±6.4 kgf, post: 27.2±9.3 kgf) and flexor (pre: 12.7±4.5 kgf, post: 14.7±5.2 kgf) muscle strength, with knee extensor strength increasing significantly until the third month and knee flexor strength until the second month, after which these values plateaued. Regarding resting blood pressure, a significant decrease in systolic blood pressure was observed after the second month of intervention and a significant decrease in diastolic blood pressure was observed after the fifth month of intervention. Five months of IWT resulted in an increase in physical fitness due to an increase in the VO2peak, an increase in lower limb muscle strength, and an improvement in resting blood pressure. However, significant increases in knee extensor and flexor muscle strength plateaued after four months. These results suggest that VO2peak should be measured every three months and adjusted to an appropriate exercise program to more effectively maintain and improve physical fitness.
In recent years, the impact of walkability, a measure of the residential environment, on public health has gained importance. However, few studies have examined the relationship between walkability and the cognitive function in older people. This study examined the cross-sectional and longitudinal associations between neighborhood walkability and the cognitive function among community-dwelling older adults, stratified by age group and gender. This study analyzed data from the SONIC study, involving 1,675 participants 70±1 and 80±1 years old. A cross-sectional analysis assessed the relationship between walkability and cognitive impairment, while a longitudinal analysis focused on 268 participants with a normal cognitive function at baseline. Cognitive decline was defined as a MoCA-J score of <25. Walkability was evaluated using the Walk Score®, categorized into three groups: Car-dependent (0-49), Walkable (50-89), and Walker's Paradise (90-100). In the cross-sectional analysis, the adjusted odds ratio for cognitive decline was significantly lower in the Walkable group than in the Car-dependent group for both sexes and those in their 70s. In the longitudinal analysis, the odds ratio for new-onset cognitive decline was significantly lower in men in the Walker's Paradise group than the Car-dependent group, at 0.146 (95% confidence interval: 0.025-0.855). Higher neighborhood walkability is associated with a lower prevalence of cognitive decline and a lower incidence of new-onset cognitive decline in men in community-dwelling older adults. Creating walkable environments may be effective in the primary prevention of cognitive decline.
Myocarditis is a group of inflammatory diseases that primarily affect the myocardium. It includes various pathological conditions. In addition to viruses, which are the main etiological agents, other causal agents, including bacteria, toxic substances, autoimmunity, and drugs, including vaccines, can also induce the disease.In Japan, an outbreak of coronavirus disease 2019 (COVID-19) began in January 2020, and COVID-19 messenger RNA (mRNA) vaccinations have been widely used since February 2021.Myocarditis after vaccination is reported to be more common in young males, particularly after the second vaccination. We report the case of an 80-year-old woman with no history of cardiovascular disease who was hospitalized with acute pulmonary edema one week after receiving her third dose of mRNA vaccine. She had elevated myocardial markers, new complete left bundle branch block, and a decreased left ventricular ejection fraction relative to before the onset; however, there was no stenosis or coronary artery occlusion that could have caused the disease. Although a myocardial biopsy could not be performed, myocarditis after vaccination was diagnosed based on detailed clinical findings. With noninvasive positive pressure ventilation and diuretics without steroids, the patient improved and was discharged on the 11th day. However, 1.5 years later, she developed a complete atrioventricular block and a permanent pacemaker was implanted. This case suggests that even older women can develop myocarditis after the third vaccination dose. We should carefully consider whether vaccination should be administered, even in older patients.
This study investigated the association between frailty awareness-defined as understanding the term "frailty" and its meaning-and actual frailty status as well as oral frailty among community-dwelling older adults. This cross-sectional study was conducted among adults ≥65 years old residing in the community. Data were collected via a postal survey assessing frailty awareness, status (using a health assessment questionnaire for the national screening program for older adults in Japan), and oral frailty (using the Oral Frail Index-8). Frailty awareness was divided into three categories: Awareness I (aware of both the term and its meaning), Awareness II (aware of the term only), and Awareness III (unaware of both). Associations between frailty awareness and frailty outcomes were analyzed using the chi-square test and multivariate logistic regression. A total of 1,758 respondents (age 77.0±6.9 years old) were included. The prevalence of frailty was 32.6%, while that of oral frailty was 55.5%. Among the participants, 38.4% were classified as Awareness I, 18.3% as Awareness II, and 43.3% as Awareness III, respectively. Lower frailty awareness was significantly associated with higher rates of frailty and oral frailty (p < 0.001). In logistic regression analyses, compared with Awareness I, the odds ratios (ORs) for frailty were 1.57 (95% confidence interval [CI], 1.16-2.13, p = 0.004) for Awareness II and 2.06 (95% CI, 1.60-2.64, p < 0.001) for Awareness III. Compared with Awareness I, the ORs for oral frailty were 1.58 (95% CI, 1.20-2.08, p = 0.001) for Awareness II and 1.91 (95% CI, 1.53-2.40, p < 0.001) for Awareness III. Lower frailty awareness was associated with an increased likelihood of both frailty and oral frailty among community-dwelling older adults, suggesting that improving frailty knowledge may contribute to effective frailty prevention and management.
This study examined the impact of the residential environment on the health-related quality of life (HRQOL) and other health-related factors among older women in urban and rural areas. This study included 423 older adults living in urban and rural areas, of whom 236 older women met the inclusion criteria. The HRQOL, physical function, body composition, pain, mental and sleep status, and cognitive function were measured and compared between the two groups by region. Correlation and multiple regression analyses were used to investigate the factors influencing HRQOL. Older rural women had a significantly worse educational history, grip strength, knee extension strength, sit-and-reach distance, one-leg standing, gait speed, and muscle mass as well as significantly better results for the Timed Up and Go tests and fat mass than older urban women. However, no significant differences in the HRQOL were found between regions. Pain intensity and central sensitization-related symptom (CSS) severity were identified as the key factors influencing the HRQOL across both regions. Despite a poorer physical function in older rural women, pain intensity and CSS severity were the main factors influencing the HRQOL in both urban and rural areas. Thus, approaches targeting pain and CSS could be beneficial for improving the HRQOL in community-dwelling older women. Improving the physical function is particularly important for older rural women.
An 88-year-old woman was referred to our hospital due to body weight loss (9 kg) over one year. Bronchoscopy revealed Mycobacterium avium, and antimicrobial treatment was initiated. Three months later, a chest CT scan revealed a mass shadow in the left lingular segment. After a second bronchoscopic examination, a pathological diagnosis of diffuse large B-cell lymphoma was made. After one course of chemotherapy, the mass in the left middle lobar significantly decreased in size. We report a case of malignant lymphoma with NTM in an elderly patient. Impaired immunity may have played a role in the development of both diseases. In an aging society, complications associated with both diseases may increase. Careful and detailed examination is essential.
This study aimed to examine the relationship between decreased appetite and the higher life function in elderly patients with diabetes. The subjects were outpatients with diabetes of ≥ 60 years of age at Ise Red Cross Hospital. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a self-administered questionnaire, was used to assess the higher life function. The Japanese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) was used to measure decreased appetite. A multiple regression analysis with TMIG-IC score as the dependent variable and decreased appetite and adjustment variables as explanatory variables was used to calculate the standardized regression coefficient (β) of decreased appetite for higher life functions. A total of 492 patients were included in this study. Seventeen percent of the patients had decreased appetite, and the mean TMIG-IC score was 10.6. The adjusted beta for decreased appetite for the TMIG-IC score based on no decreased appetite was -0.141 (P=0.004). Decreased appetite in elderly patients with diabetes is associated with impaired higher life functions.
This study investigated the relationships between loneliness, health status (including frailty), sense of purpose in life, and lifestyle behaviors among individuals with disabilities living in officially designated depopulated areas. Participants held either a disability certificate or a medical certificate for intractable diseases. Self-administered questionnaires were distributed via mail or employment support facilities. Based on the median score on the UCLA Loneliness Scale ("UCLA score"), participants were divided into high- and low-loneliness groups. The Mann-Whitney U test was used for continuous variables (age, age at onset, and BMI), while chi-square or Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis identified the factors associated with high loneliness. In total, 173 valid responses were obtained (response rate: 100%). The Hosmer-Lemeshow test showed a good model fit (p = 0.94). Two significant factors associated with higher UCLA scores were as follows: (1) a strong feeling of not living an enjoyable or purposeful life (odds ratio = 2.169, 95% confidence interval = 1.371-3.431, p = 0.001) and (2) frailty status (odds ratio = 5.528, 95% confidence interval = 2.497-12.240, p < 0.001). Individuals with disabilities living in depopulated areas may face increased frailty as they transition to long-term care. Integrating social prescribing, an approach expected to reduce loneliness, into existing disability welfare programs may help prevent further health deterioration.