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Seong H, Resnick B, Holmes S, Galik E, Breman RB, Fortinsky RH, Zhu S. Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture. J Appl Gerontol 2024; 43:627-637. [PMID: 38105620 DOI: 10.1177/07334648231221640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
This study aimed to test a model of factors associated with resilience and physical activity post-hip fracture and compare model fit between men and women. We used data from the seventh Baltimore Hip Study that included 339 participants. Model testing indicated that health status (men: β = .237, p = .002; women: β = .265, p = <.001), depression (men: β = -.245, p = .001; women: β = -.241, p = <.001), and optimism (men: β = .320, p = <.001; women: β = .282, p = <.001) were associated with resilience in men and women, but resilience was only associated with physical activity in men (β = .203, p = .038) and not in women. Social interaction was related to physical activity only among women (β = .206, p = .044). This study provides support for the relationship between resilience and physical activity at least among men.
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Affiliation(s)
| | | | | | | | | | | | - Shijun Zhu
- University of Maryland, Baltimore, MD, USA
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Ando T, Sasaki T, Abe Y, Nishimoto Y, Hirata T, Haruta J, Arai Y. Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan. J Gen Fam Med 2023; 24:343-349. [PMID: 38025930 PMCID: PMC10646296 DOI: 10.1002/jgf2.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
| | - Takashi Sasaki
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yukiko Abe
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yoshinori Nishimoto
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Department of NeurologyKeio University School of MedicineTokyoJapan
| | - Takumi Hirata
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Institute for Clinical and Translational ScienceNara Medical UniversityKashiharaJapan
| | - Junji Haruta
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
- Medical Education CenterKeio University School of MedicineTokyoJapan
| | - Yasumichi Arai
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
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Kurata H, Meguro S, Abe Y, Sasaki T, Asakura K, Arai Y, Itoh H. Dietary protein intake and all-cause mortality: results from The Kawasaki Aging and Wellbeing Project. BMC Geriatr 2023; 23:479. [PMID: 37558986 PMCID: PMC10413626 DOI: 10.1186/s12877-023-04173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Increased protein intake has been recommended to prevent sarcopenia/frailty, reports on the quantity and quality of protein intake needed and the associated prognosis, particularly in the aging population of Asia, are limited. In this study, we aimed to investigate the relationship between protein intake and mortality in Japanese individuals, aged 85 years and older. METHODS The data were obtained from The Kawasaki Aging and Wellbeing Project, which is a prospective cohort study of older adults aged between 85 and 89 years with no physical disability at baseline. Of the 1,026 adults in the cohort, 833 were included in the analysis, after excluding those who had not completed a brief, self-administered diet history questionnaire or those who scored less than 24 on the Mini-Mental State Examination. The participants were grouped into quartiles based on protein intake: Q1 (protein < 14.7, %Energy), Q2 (14.7 ≤ protein < 16.7, %Energy), Q3 (16.7 ≤ protein < 19.1, %Energy), and Q4 (≥ 19.1, %Energy). Multivariate Cox proportional hazards models were utilized to evaluate the association between protein intake and all-cause mortality. Kaplan-Meier survival curves were employed to investigate the relationship between protein intake and all-cause mortality. RESULTS The mean protein intake of our study population was 17.0% of total energy. Animal protein intake, particularly fish intake, increased significantly along with total protein intake. The study had an average observation period of 1,218 days and recorded 89 deaths. After adjusting for age, sex, skeletal muscle mass index, cardiovascular disease, cancer, education, and serum albumin levels, a lower risk of all-cause mortality was observed in the highest protein intake (Q4) group than in the lowest protein intake (Q1) group (hazard ratio: 0.44, 95% confidence interval: 0.22-0.90, p-value: 0.020). CONCLUSION Protein intake is associated with a reduced risk of all-cause mortality in older adults (aged ≥ 85 years) who engage in independent activities of daily living. This association may impact all-cause mortality independent of muscle mass.
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Affiliation(s)
- Hideaki Kurata
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University, School of Medicine, Shinjuku-ku, Tokyo, 160-0016, Japan.
| | - Shu Meguro
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University, School of Medicine, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Yukiko Abe
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku- ku, Tokyo, 160-0016, Japan
| | - Takashi Sasaki
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku- ku, Tokyo, 160-0016, Japan
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Ohta-ku, Tokyo, 143-8540, Japan
| | - Yasumichi Arai
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku- ku, Tokyo, 160-0016, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University, School of Medicine, Shinjuku-ku, Tokyo, 160-0016, Japan
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Tsunawaki S, Abe M, DeJonckheere M, Cigolle CT, Philips KK, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Primary care physicians' perspectives and challenges on managing multimorbidity for patients with dementia: a Japan-Michigan qualitative comparative study. BMC PRIMARY CARE 2023; 24:132. [PMID: 37370035 DOI: 10.1186/s12875-023-02088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Multimorbidity management can be extremely challenging in patients with dementia. This study aimed to elucidate the approaches of primary care physicians in Japan and the United States (US) in managing multimorbidity for patients with dementia and discuss the challenges involved. METHODS This qualitative study was conducted through one-on-one semi-structured interviews among primary care physicians, 24 each from Japan and Michigan, US. Thematic and content analyses were performed to explore similarities and differences among each country's data. RESULTS Primary care physicians in Japan and Michigan applied a relaxed adherence to the guidelines for patients' chronic conditions. Common challenges were the suboptimal consultation time, the insufficient number or ability of care-coordinating professionals, patients' conditions such as difficulties with self-management, living alone, behavioral issues, and refusal of care support. Unique challenges in Japan were free-access medical systems and not being sure about the patients' will in end-of-life care. In Michigan, physicians faced challenges in distance and lack of transportation between clinics and patients' homes and in cases where patients lacked the financial ability to acquire good care. CONCLUSIONS To improve the quality of care for patients with multimorbidity and dementia, physicians would benefit from optimal time and compensation allocated for this patient group, guidelines for chronic conditions to include information regarding changing priority for older adults with dementia, and the close collaboration of medical and social care and community resources with support of skilled care-coordinating professionals.
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Affiliation(s)
- Shinji Tsunawaki
- Omaezaki Family Medicine Center, Omaezaki, Shizuoka, Japan
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | | | - Christine T Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Kristin K Philips
- Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System (VAAAHS) Geriatric Research, Ann Arbor, MI, USA
| | - Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Masakazu Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Kikugawa, Shizuoka, Japan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
- The School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Machiko Inoue
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan.
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
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Lalani N, Dongjuan X, Cai Y, Arling GW. Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic. J Patient Rep Outcomes 2023; 7:46. [PMID: 37195441 DOI: 10.1186/s41687-023-00583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND COVID-19 put older individuals at high risk for morbidity and mortality, isolation, reduced coping, and lower satisfaction with life. Many older adults experienced social isolation, fear, and anxiety. We hypothesized that successful coping with these stressors would maintain or improve satisfaction with life, a crucial psychological outcome during the pandemic. Our study investigated relationships between older people's coping and life satisfaction during the pandemic and their optimism, sense of mastery, closeness with spouse, family, and friends, and vulnerabilities from frailty, comorbid diseases, memory problems, and dependencies in instrumental activities of daily living (IADL). METHODS The study was based on a special COVID-19 sample of 1351 community-dwelling older adults who participated in the 2020 Health and Retirement Survey. A comprehensive structural equation modeling was used to test direct and indirect effects, with life satisfaction as the main outcome and coping as a mediator between the other variables and coping. RESULTS Most survey respondents were female and between the ages of 65-74 years. They averaged 1.7 chronic conditions, one in seven was frail, about one-third rated their memory as fair or poor, and about one in seven reported one or more difficulties in IADL. As hypothesized-older people with increased sense of mastery and optimism were better able to cope and had greater life satisfaction. In addition, close relationships with friends and with other family members besides the spouse/partner or children contributed to more successful coping, while the interpersonal closeness of all types contributed directly to greater life satisfaction. Finally, older people with more IADL limitations reported greater difficulty coping and lower life satisfaction, and those older people who were frail or had multiple comorbid diseases reported lower life satisfaction. CONCLUSIONS Optimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction, whereas frailty and comorbidities make coping more challenging and lead to lower life satisfaction particularly during a pandemic. Our study improves on prior research because of its nationally representative sample and formal specification and testing of a comprehensive theoretical framework.
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Affiliation(s)
- Nasreen Lalani
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
- Center of Aging and Life Course, Purdue University, West Lafayette, IN, USA.
| | - Xu Dongjuan
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
- Center of Aging and Life Course, Purdue University, West Lafayette, IN, USA
| | - Yun Cai
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
- Center of Aging and Life Course, Purdue University, West Lafayette, IN, USA
| | - Greg W Arling
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
- Center of Aging and Life Course, Purdue University, West Lafayette, IN, USA
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Evaluation of Satisfaction with Healthcare Services in Multimorbid Patients Using PACIC+ Questionnaire: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020276. [PMID: 36837477 PMCID: PMC9959355 DOI: 10.3390/medicina59020276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Although multimorbidity poses many challenges for both individuals and healthcare systems, information on how these patients assess the quality of their healthcare is lacking. This study assessed the multimorbid patients' satisfaction with their healthcare. Materials and Methods: This cross-sectional study was a part of a project Joint Action-Chronic Diseases and Promoting Healthy Ageing across the Life Cycle and its implementation. The study included 400 patients with arterial hypertension and at least one concomitant chronic disease. Patients completed The Patient Assessment of Care for Chronic Conditions Plus (PACIC+) questionnaire, EuroQol Five-Dimensions-Three-Level Quality of Life questionnaire, and Hospital Anxiety and Depression scale. Results: The mean age of the participants was 65.38 years; there were 52.5% women. The mean PACIC+ 5As summary score was 3.60. With increasing age, participants rated worse on most PACIC+ subscales. Participants who assessed their quality of life as worse were also less satisfied with their healthcare. The presence of three or more concomitant diseases negatively affected PACIC+ scores. Patients with ischemic heart disease and heart failure had lower PACIC+ scores on most subscales, whereas patients with atrial fibrillation had lower scores only on the Agree subscale. The presence of diabetes was not associated with worse PACIC+ scores; moreover, the scores in Assist and Arrange subscales were even better in diabetic patients (3.36 vs. 2.80, p = 0.000 and 3.69 vs. 3.13, p = 0.008, respectively). Patients with chronic obstructive pulmonary disease, asthma, and musculoskeletal disorders showed lower PACIC+ scores. Conclusions: Older age, worse self-assessed health state, presence of three or more diseases, and certain chronic diseases were associated with lower patients' satisfaction with their healthcare. Personalized healthcare, increasing competencies of primary healthcare teams, healthcare services accessibility, and financial motivation of healthcare providers may increase multimorbid patients' satisfaction with their healthcare.
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Hata R, Miyamoto K, Abe Y, Sasaki T, Oguma Y, Tajima T, Arai Y, Matsumoto M, Nakamura M, Kanaji A, Miyamoto T. Osteoporosis and sarcopenia are associated with each other and reduced IGF1 levels are a risk for both diseases in the very old elderly. Bone 2023; 166:116570. [PMID: 36182103 DOI: 10.1016/j.bone.2022.116570] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
It is mandatory to manage musculoskeletal disorders in the elderly to prevent their becoming bed-ridden or requiring long-term care. However, the prevalence of musculoskeletal disorders such as osteoporosis and sarcopenia in otherwise healthy people over 85 years old is not completely known. Here we enrolled 1026 healthy subjects between 85 and 89 years old and evaluated them for the presence of osteoporosis, sarcopenia and fragility fracture(s), and how those conditions were related. We also evaluated biomarkers such as serum levels of insulin-like growth factor 1 (IGF1) and vitamin D status. The prevalence of osteoporosis, sarcopenia or fragility fracture(s) in these subjects was 22.4, 10.2 or 15.0 %, respectively. Serum IGF1 and 25(OH)D were significantly and negatively correlated with osteoporosis or sarcopenia. Osteoporosis and either sarcopenia or fragility fracture(s) were significantly related and shown to be risk factors for each other, even after adjustment for gender and BMI, while sarcopenia and fragility fracture(s) were not associated. Our data may provide a health platform for the very elderly and suggest strategies to prevent musculoskeletal disorders in this population.
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Affiliation(s)
- Ryosuke Hata
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yukiko Abe
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takashi Sasaki
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuko Oguma
- Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan; Graduate School of Health Management, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan
| | - Takayuki Tajima
- Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan; Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Yasumichi Arai
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Faculty of Nursing and Medical Care, Keio University, 5322 Endo, Fujisawa, Kanagawa 252-0882, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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