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Ito Y, Iwagami M, Komiyama J, Hamasaki Y, Kuroda N, Suzuki A, Ito T, Goto T, Wan EYF, Lai FTT, Tamiya N. Clinical subtypes of older adults starting long-term care in Japan and their association with prognoses: a data-driven cluster analysis. Sci Rep 2024; 14:14911. [PMID: 38942898 PMCID: PMC11213852 DOI: 10.1038/s41598-024-65699-6] [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: 03/08/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024] Open
Abstract
We aimed to identify the clinical subtypes in individuals starting long-term care in Japan and examined their association with prognoses. Using linked medical insurance claims data and survey data for care-need certification in a large city, we identified participants who started long-term care. Grouping them based on 22 diseases recorded in the past 6 months using fuzzy c-means clustering, we examined the longitudinal association between clusters and death or care-need level deterioration within 2 years. We analyzed 4,648 participants (median age 83 [interquartile range 78-88] years, female 60.4%) between October 2014 and March 2019 and categorized them into (i) musculoskeletal and sensory, (ii) cardiac, (iii) neurological, (iv) respiratory and cancer, (v) insulin-dependent diabetes, and (vi) unspecified subtypes. The results of clustering were replicated in another city. Compared with the musculoskeletal and sensory subtype, the adjusted hazard ratio (95% confidence interval) for death was 1.22 (1.05-1.42), 1.81 (1.54-2.13), and 1.21 (1.00-1.46) for the cardiac, respiratory and cancer, and insulin-dependent diabetes subtypes, respectively. The care-need levels more likely worsened in the cardiac, respiratory and cancer, and unspecified subtypes than in the musculoskeletal and sensory subtype. In conclusion, distinct clinical subtypes exist among individuals initiating long-term care.
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Affiliation(s)
- Yuji Ito
- Department of General Internal Medicine, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Jun Komiyama
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoko Hamasaki
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Naoaki Kuroda
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Health Department, Tsukuba City, Ibaraki, Japan
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ai Suzuki
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Health Department, Tsukuba City, Ibaraki, Japan
| | - Tomoko Ito
- Department of Nursing, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Eric Y F Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Sha Tin, Hong Kong
| | - Francisco T T Lai
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Sha Tin, Hong Kong
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kimura T, Nomura K, Hashimoto M, Shinmura K. Relationship between the characteristics of Japanese physicians involved in medical care for older adults and their approaches to treating older patients with multimorbidity. PLoS One 2024; 19:e0302532. [PMID: 38865339 PMCID: PMC11168666 DOI: 10.1371/journal.pone.0302532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
One countermeasure against the increasing prevalence of multimorbidity is the need to provide clinical education and training that considers the characteristics of physicians. We conducted a questionnaire survey to determine the relationship between physicians' characteristics and their approach to treating older patients with multimorbidity. A total of 3300 geriatric specialists and primary care specialists in Japan were enrolled. A 4-point Likert scale was used to score the following items: difficult diseases (43 items), difficult patient backgrounds (14 items), important clinical factors (32 items), and important clinical management (32 items). Exploratory factor analysis was performed to examine the constructs in each of the scales Diseases, Backgrounds, Clinical Factors, and Clinical Management, and group comparisons by physician characteristics were conducted. A total of 778 respondents were included in the analysis. Six factors for Diseases, two factors for Patient Background, four factors for Clinical Factors, and two factors for Clinical Management were explored as patterns. Group comparison between mean scores for each factor and the characteristics of responding physicians showed statistically significant differences in at least one factor for all patterns in terms of years of experience as a physician (26 years or less, 27 years or more), the clinical setting (providing or not providing home medical care), and sex (male or female). Our results suggest a need for clinical education and training that takes into account not only physicians' experience and clinical setting, but also their sex.
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Affiliation(s)
- Takuma Kimura
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Masayoshi Hashimoto
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan
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Abdulmelik A, Tila M, Tekilu T, Debalkie A, Habtu E, Sintayehu A, Dendir G, Gordie N, Daniel A, Suleiman Obsa M. Magnitude and associated factors of intraoperative cardiac complications among geriatric patients who undergo non-cardiac surgery at public hospitals in the southern region of Ethiopia: a multi-center cross-sectional study in 2022/2023. Front Med (Lausanne) 2024; 11:1325358. [PMID: 38695033 PMCID: PMC11061426 DOI: 10.3389/fmed.2024.1325358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Background Intraoperative cardiac complications are a common cause of morbidity and mortality in non-cardiac surgery. The risk of these complications increased with the average age increasing from 65. In a resource-limited setting, including our study area, the magnitude and associated factors of intraoperative cardiac complications have not been adequately investigated. The aim of this study was to assess the magnitude and associated factors of intraoperative cardiac complications among geriatric patients undergoing non-cardiac surgery. Methods An institutional-based multi-center cross-sectional study was conducted on 304 geriatric patients at governmental hospitals in the southern region of Ethiopia, from 20 March 2022 to 25 August 2022. Data were collected by chart review and patient interviews. Epi Data version 4.6 and SPSS version 25 were used for analysis. The variables that had association (p < 0.25) were considered for multivariable logistic regression. A p value < 0.05 was considered significant for association. Result The overall prevalence of intraoperative cardiac complications was 24.3%. Preoperative ST-segment elevation adjusted odds ratio (AOR = 2.43, CI =2.06-3.67), history of hypertension (AOR = 3.42, CI =2.02-6.08), intraoperative hypoxia (AOR = 3.5, CI = 2.07-6.23), intraoperative hypotension (AOR = 6.2 9, CI =3.51-10.94), age > 85 years (AOR = 6.01, CI = 5.12-12.21), and anesthesia time > 3 h (AOR =2.27, CI = 2.0.2-18.25) were factors significantly associated with intraoperative cardiac complications. Conclusion The magnitude of intraoperative cardiac complications was high among geriatric patients who had undergone non-cardiac surgery. The independent risk factors of intraoperative cardiac complications for this population included age > 85, ST-segment elevation, perioperative hypertension (stage 3 with regular treatment), duration of anesthesia >3 h, intraoperative hypoxia, and intraoperative hypotension. Holistic preoperative evaluation, optimization optimal and perioperative care for preventing perioperative risk factors listed above, and knowing all possible risk factors are suggested to reduce the occurrence of complications.
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Affiliation(s)
- Amina Abdulmelik
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Mebratu Tila
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Takele Tekilu
- School of Medical Laboratory, College of Medicine and Health Science, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Ashebir Debalkie
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Elias Habtu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Ashagrie Sintayehu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Getahun Dendir
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Naol Gordie
- School of Anesthesia, College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Abel Daniel
- School of Medicine, College of Medicine and Health Science, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Mohammed Suleiman Obsa
- Department of Anesthesia, College of Medicine and Health Science, Arsi University, Assela, Ethiopia
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Handa N, Ishizaki T, Mitsutake S, Ono K, Akishita M. Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study. Int J Geriatr Psychiatry 2024; 39:e6085. [PMID: 38622754 DOI: 10.1002/gps.6085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. METHOD AND PATIENTS Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n = 214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42 months. RESULTS During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all-cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. CONCLUSIONS Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. CLINICAL TRIAL REGISTRATION UMIN-CTR UMIN000048398.
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Affiliation(s)
- Nobuhiro Handa
- Department of Digital Therapeutics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Kino-Medic Clinic, Ichigao, Yokohama, Japan
- Medical Technology Innovation Center, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | | | | | - Koki Ono
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Department of Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Tanaka M, Ishii S, Matsuoka A, Tanabe S, Matsunaga S, Rahmani A, Dutt N, Rasouli M, Nyamathi A. Perspectives of Japanese elders and their healthcare providers on use of wearable technology to monitor their health at home: A qualitative exploration. Int J Nurs Stud 2024; 152:104691. [PMID: 38262231 DOI: 10.1016/j.ijnurstu.2024.104691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/20/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND With 24 million Japanese elderly aging at home, the challenges of managing chronic conditions are significant. As many Japanese elders manage multiple chronic conditions, investigating the usefulness of wearable health devices for this population is warranted. AIM The purpose of this qualitative study, using grounded theory, was to explore the perspectives of Japanese elders, their caretakers, and their healthcare providers on the use of technology and wearable devices to monitor health conditions and keep Japanese elders safe at home. METHODS In conducting this study, a community advisory board was first established to guide the research design; six focus groups and two one-on-one interviews were conducted, with a total of 21 participants. RESULTS Four major themes emerged from the analysis: 1) Current Status of Health Issues Experienced by Japanese Elders and Ways of Being Monitored; 2) Current Use of Monitoring Technology and Curiosity about Use of the Latest Digital Technology to Keep Elderly Healthy at Home; 3) Perceived Advantages of Wearing Sensor Technology; and 4) Perceived Disadvantages of Wearing Technology. Many of the elderly participants were interested in using monitoring devices at home, particularly if not complicated. Healthcare workers found monitoring technologies particularly useful during the isolation of the COVID-19 pandemic. Elderly participants felt cost and technical issues could be barriers to using monitoring devices. CONCLUSION While there are challenges to utilizing monitoring devices, the potential to aid the aging population of Japan justifies further investigation into the effectiveness of these devices. This study was not registered with a research trial registry.
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Affiliation(s)
- Mika Tanaka
- School of Nursing, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Shinobu Ishii
- School of Nursing, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Akiko Matsuoka
- School of Nursing, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Sachiko Tanabe
- School of Nursing, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Shota Matsunaga
- Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Amir Rahmani
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States of America
| | - Nikil Dutt
- Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States of America
| | - Mahkameh Rasouli
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States of America
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States of America.
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Kuwabara Y, Hamada T, Nakai T, Fujii M, Kinjo A, Osaki Y. Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan. J Rural Med 2024; 19:105-113. [PMID: 38655230 PMCID: PMC11033674 DOI: 10.2185/jrm.2023-049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 04/26/2024] Open
Abstract
Objective With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. Patients and Methods A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. Results A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Conclusion Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.
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Affiliation(s)
- Yuki Kuwabara
- Division of Environmental and Preventive Medicine, Faculty of
Medicine, Tottori University, Japan
| | - Toshihiro Hamada
- Department of Community-based Family Medicine, Faculty of
Medicine, Tottori University, Japan
| | - Tsubasa Nakai
- Department of Community-based Family Medicine, Faculty of
Medicine, Tottori University, Japan
| | - Maya Fujii
- Division of Environmental and Preventive Medicine, Faculty of
Medicine, Tottori University, Japan
| | - Aya Kinjo
- Division of Environmental and Preventive Medicine, Faculty of
Medicine, Tottori University, Japan
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Faculty of
Medicine, Tottori University, Japan
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Iwakiri R, Hamaya H, Nakayama T, Kataoka A, Murano Y, Okawa T, Araki A. Multimorbidity, consisting of a combination of chronic diseases and geriatric syndromes, predicts the risk of difficulty in discharge home in older patients admitted to acute care hospital. Geriatr Gerontol Int 2024; 24 Suppl 1:300-305. [PMID: 37983916 DOI: 10.1111/ggi.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
AIM To determine whether multimorbidity, consisting of chronic diseases and geriatric syndromes, is associated with home discharge difficulties in older patients. METHODS A total of 522 older adults (mean age: 85 ± 7 years) who were admitted to an acute care hospital were enrolled. Multimorbidity was assessed by calculating the number of 16 chronic conditions (CCs): 8 chronic diseases (cardiac diseases, diabetes mellitus, chronic kidney disease, respiratory diseases, gastrointestinal diseases, anemia, dementia, and Parkinson disease) and 8 geriatric syndromes (depression, constipation, chronic pain, polypharmacy, dysphagia, underweight, hypoalbuminemia, and functional limitations). The patients were divided into four groups based on the number of CCs. The outcome was difficulty in discharging home (transfer to other facilities or in-hospital death). Multivariate logistic regression analysis was performed to assess independent associations between four CC groups and failure to discharge home after adjusting for age, sex, living alone, and Barthel index and odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS Of the 522 patients, 18.8% were transferred to other facilities or died. The proportion of poor outcome in those with 0-2, 3-4, 5-6, and ≥7 CCs was 4.4%, 14.8%, 25.5%, and 37.5%, respectively. Logistic regression analysis after adjusting for covariates revealed that multimorbidity increased the risk of difficulty in discharging home (OR, 2.9 [95% CI, 1.1-8.0] for 3-4 CCs; OR, 4.9 [95% CI, 1.8-13.5] for 5-6 CCs; OR, 8.7 [95% CI, 3.1-24.6] for ≥7 CCs). CONCLUSION Multimorbidity, consisting of chronic diseases and geriatric syndromes, predicted difficulty in discharge home in older patients. Geriatr Gerontol Int 2024; 24: 300-305.
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Affiliation(s)
- Rika Iwakiri
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hironobu Hamaya
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tomohiro Nakayama
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Ai Kataoka
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoko Murano
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Teiki Okawa
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Kazawa K, Maeda-Sawada W, Shizukuishi E, Hamada S, Kobayashi M, Okochi J, Ishii S. Changing trends in health orientation among older adults: A scoping review. Geriatr Gerontol Int 2024; 24:5-17. [PMID: 38126143 DOI: 10.1111/ggi.14766] [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: 06/07/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
Older people's health condition is not uniform, and the components of their health are interrelated. Concepts regarding the health of older people have emerged and changed over time. However, the transition of concepts and influencing factors are not well examined through research. We have conducted a scoping review of the changes over time in the concept of health for older people and the factors influencing these changes. The public websites of international organizations and academic societies related to older people's health and research paper database were searched, and the extracted data were summarized in a chronological table. Consequently, this study revealed changing trends in health orientation after health had been defined by WHO, namely, successful aging, productive aging, active aging, and healthy aging, and their components, not the concept of health. The emergence and changes of health orientation among older people may have accompanied proposals and measures of international organizations and academic societies developed in response to changes in the demographic structure, and changes in how society perceives and supports older people. With the changing eras that bring about advances in health technology, prolongation of life expectancy, and changes in lifestyles, the needs of older people, society's perceptions of aging and older people, and how to support them will also change. Our findings may provide a valuable basis for understanding aging and older people, reconsidering their health orientation based on the health issues of older people and their significance, and formulating policies for older people in the future. Geriatr Gerontol Int 2024; 24: 5-17.
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Affiliation(s)
- Kana Kazawa
- Department of Nursing, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | | | | | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mia Kobayashi
- Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Jiro Okochi
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Wakakoukai Health Care Corporation, Geriatric Health Services Facility Tatsumanosato, Osaka, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Peng X, Nakatani H, Chen H, Inoue Y, Song F, Yoshihara M, Lei R. Developing a scale for examining the perspective of university students on parental care. Front Psychol 2023; 14:1256110. [PMID: 38023053 PMCID: PMC10657846 DOI: 10.3389/fpsyg.2023.1256110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction With the declining birth rate and increasingly aging population in Japan, an increased care burden may be placed on the family and the younger generation will address challenging circumstances when they can care for their parents. This study aimed to develop a scale for examining the perspectives of Japanese university students on parental care and determines its reliability and validity. Methods A web-based survey on a total of 408 Japanese students was adopted. This study performed exploratory and confirmatory factor analyses to obtain the underlying factors of the scale. Reliability was verified using Cronbach's α coefficient and Spearman-Brown's split-half reliability α coefficient. Validity was verified through sample, criterion-related, and convergent and discriminant validity. Results In total, the study identified a three-factor 11 item-scale. Cronbach's α for the scale was 0.901, and the Cronbach's α and split-half reliability α coefficients of each factor were greater than 0.7. Three factors explained 64.6% of the total variance. The model indicators were χ2/df = 2.241, comparative fit index (CFI) = 0.951, incremental fit index (IFI) = 0.951, TLI = 0.942, root mean square error of approximation (RMSEA) = 0.078 (p < 0.001). Thus, the study confirmed that the convergent and discriminant validity is acceptable. Correlations were noted for criterion-related validity (r = 0.675, p < 0.001). Discussion The results show that the scale for examining the perspective of Japanese university students on parental care was confirmed with good reliability and validity.
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Affiliation(s)
- Xuxin Peng
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisae Nakatani
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Huifang Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuriko Inoue
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fang Song
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mikako Yoshihara
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ruxin Lei
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Tarukado K, Ono T, Doi T, Harimaya K, Nakashima Y. Safety and Clinical Results of Continuous Low-Dose Aspirin in Microendoscopic Laminectomy. Spine Surg Relat Res 2023; 7:350-355. [PMID: 37636142 PMCID: PMC10447200 DOI: 10.22603/ssrr.2022-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction It remains controversial whether it is better to continue oral low-dose aspirin (LDA) during the perioperative period in spinal surgery. This study aims to evaluate the safety of continued LDA administration in the perioperative periods of microendoscopic laminectomy (MEL) by assessing perioperative complications and clinical outcomes. Methods We ultimately included 88 patients (35 males, 53 females) who underwent one level of MEL for lumbar spinal canal stenosis from April 2016 to March 2022. Patients who did not undergo anticoagulation therapy were classified into Group A (65 patients), those who stopped anticoagulation therapy at the perioperative periods were classified into Group B (9 patients), and those who continued oral administration of LDA throughout the perioperative periods were classified into Group C (14 patients). Surgery time, intraoperative estimate blood loss (EBL), differences between hemoglobin (Hb) and platelet (Plt) before and after surgery, perioperative complications, and cross-sectional area of hematoma and dural sac on MRI taken within 1 week and at 6 months or more after surgery were assessed between three groups. The EuroQol-5 dimensions (EQ-5D), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were also evaluated as the clinical outcomes. Results There was no statistically significant difference between the three groups in operation time, intraoperative EBL, differences between Hb and Plt before and after surgery, and cross-sectional area of hematoma and dural sac on MRI. A case of hematoma removal was confirmed in Group A. There was also no statistically significant difference between the three groups in EQ-5D, ODI, and each domain of JOABPEQ. Conclusions The continuation of LDA throughout the perioperative periods did not affect perioperative complications and clinical outcomes of one-level MEL. In MEL, it might be possible to continue oral administration of LDA throughout the perioperative periods.
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Affiliation(s)
- Kiyoshi Tarukado
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Teruaki Ono
- Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Oita, Japan
| | - Toshio Doi
- Department of Orthopedic Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Oita, Japan
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11
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Kimura T, Shinmura K. Questionnaire survey of geriatricians and primary care physicians' approaches to treating older patients with multimorbidity. Geriatr Gerontol Int 2023. [PMID: 37433747 DOI: 10.1111/ggi.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
AIM Geriatricians and primary care physicians in Japan are expected to provide care to older patients with multimorbidity. METHODS A questionnaire survey was carried out to understand the current approaches to older patients with multimorbidity. A total of 3300 participants, including 1650 geriatric specialists (G) and 1650 primary care specialists (PC) were enrolled. A 4-point Likert scale was used to score the following items: diseases that cause difficulty in treatment (diseases), patient backgrounds that cause difficulty in treatment (backgrounds), important clinical factors and important clinical strategies. Statistical comparisons were made between the groups. In the Likert scale, higher scores show a greater degree of difficulty. RESULTS We obtained responses from 439 and 397 specialists in the G and PC, respectively (response rates 26.6 and 24.1%). The overall scores for "diseases" and "backgrounds" were significantly higher in the G than those in the PC (P < 0.001 and P = 0.018). The top 10 items in the "backgrounds" and in the "important clinical strategies" were all matched between the groups. The overall score of the "important clinical factors" was not statistically different between the groups; however, "low nutrition," "bedridden activities of daily living," "living alone" and "frailty" were found only in the top 10 items of the G, and "financial problems" was found in those of the PC. CONCLUSIONS Geriatricians and primary care physicians have many similarities and differences in their approaches to multimorbidity management. Therefore, there is an urgent need to establish a system in which they can share a common understanding to manage older patients with multimorbidity. Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Takuma Kimura
- Department of R&D Innovation for Home Care Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University, School of Medicine, Nishinomiya, Japan
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12
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Fujita T, Babazono A, Li Y, Jamal A, Kim SA. Hypnotics and injuries among older adults with Parkinson's disease: a nested case-control design. BMC Geriatr 2023; 23:259. [PMID: 37127561 PMCID: PMC10152606 DOI: 10.1186/s12877-023-03944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Patients with Parkinson's disease often experience sleep disorders. Hypnotics increase the risk of adverse events, such as injuries due to falls. In this study, we evaluated the association between hypnotics and injuries among older adults with Parkinson's disease. METHODS The study used a nested case-control design. The participants were 5009 patients with Parkinson's disease aged ≥ 75 years based on claims data between April 2016 and March 2019 without prescription hypnotics 1 year before the study started. Hypnotics prescribed as oral medications included benzodiazepines, non-benzodiazepines, orexin receptor antagonists, and melatonin receptor agonists. The incidences of outcomes, including injuries, fractures, and femoral fractures, were determined. Each case had four matched controls. Conditional logistic regression analyses were performed to calculate the odds ratios and 95% confidence intervals for the number of hypnotics taken per day for each type of hypnotic. RESULTS The proportion of participants taking at least one type of hypnotic was 18.6%, with benzodiazepines being the most common. The incidence of injuries, fractures, and femoral fractures was 66.7%, 37.8%, and 10.2%, respectively. Benzodiazepines significantly increased the risk of injuries (odds ratio: 1.12; 95% confidence interval: 1.03-1.22), and melatonin receptor agonists significantly increased the risk of femoral fractures (odds ratio: 2.84; 95% confidence interval: 1.19-6.77). CONCLUSIONS Benzodiazepines and non-benzodiazepines, which are not recommended according to current guidelines, were the most prevalent among older adults with Parkinson's disease. Benzodiazepines significantly increased the risk of injuries, and melatonin receptor agonists significantly increased the risk of femoral fractures.
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Affiliation(s)
- Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aziz Jamal
- Health Administration Program, Department of International Business and Management, Faculty of Business and Management, Universiti Teknologi MARA, Selangor Campus, Shah Alam, Malaysia
| | - Sung-A Kim
- St. Mary's Research Center, Kurume, Japan
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Kitayama T, Tsuji T, Mikami K, Usui N, Emori R, Maruyama Y, Harada T. Characteristics and Related Factors of One-year Transition in Exercise Tolerance Following an Emergency Declaration due to the Coronavirus Disease 2019 Pandemic in Patients on Phase III Cardiac Rehabilitation. Phys Ther Res 2023; 26:50-57. [PMID: 37621572 PMCID: PMC10445121 DOI: 10.1298/ptr.e10232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/21/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to understand the long-term transition of exercise tolerance in patients on phase III cardiac rehabilitation (CR) and clarify the characteristics of patients with a high risk of declined exercise tolerance during the first emergency declaration. METHODS Patients who participated in phase III outpatient CR before the first emergency declaration and those who performed cardiopulmonary exercise testing were at ≥2-time points: before and at 3 or 12 months post-emergency declaration. Exercise tolerance transition at 3-time points was analyzed, and whether different social background factors affected the peak oxygen uptake (V̇O2) transition method remains to be examined. RESULTS A total of 101 (median age 74.0 years, 69% men), and both peak V̇O2 and anaerobic threshold (AT) significantly declined from pre-declaration to 3 months post-declaration but recovered to levels likely similar from pre-declaration at 12 months (peak V̇O2: from 17.3 to 16.7 to 18.7 mL/min/kg; AT: from 11.8 to 11.2 to 11.6 mL/min/kg). Further, patients with multiple comorbidities at pre-declaration had a significantly lower peak V̇O2 at 3 months (-1.0 mL/min/kg, p = 0.025) and it remained significantly low in those with a slower gait speed at 12 months after lifting the emergency declaration (-2.5 mL/min/kg, p = 0.009). CONCLUSION The emergency declaration declined the exercise tolerance in patients on phase III CR but improved to pre- declaration levels over time, but more likely declined in patients with multiple comorbidities during pre-declaration and those with low-gait speeds were less likely to improve their declined exercise tolerance.
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Affiliation(s)
| | - Taishi Tsuji
- Faculty of Health and Sport Sciences, University of Tsukuba, Japan
| | - Kenta Mikami
- Department of Rehabilitation, Iwatsuki Minami Hospital, Japan
| | - Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Japan
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Japan
| | - Ryo Emori
- Department of Rehabilitation, Sonoda Third Hospital, Japan
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Mitsutake S, Ishizaki T, Edahiro A, Kitamura A, Hirata T, Saito A. The effects of dental visits on the occurrence of acute hospitalization for systemic diseases among patients aged 75 years or older: A propensity score-matched study. Arch Gerontol Geriatr 2023; 107:104876. [PMID: 36516734 DOI: 10.1016/j.archger.2022.104876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although several studies examined the association between oral status and the risk of systemic diseases, few have examined whether dental visits affect the occurrence of acute hospitalization due to systemic diseases. This study examined the effects of dental visits on preventing the occurrence of acute hospitalization due to systemic diseases in adults aged ≥ 75 years, in order to optimize the healthcare system for older adults. METHODS This propensity-score-matched retrospective cohort study was conducted using medical insurance claims data from Hokkaido, Japan. We analyzed 432,292 adult outpatients aged ≥ 75 years between September 2016 and February 2017 (baseline period). The exposure variable was visits to the dental office during the baseline period. The primary outcome variable was the occurrence of acute hospitalization due to pneumonia, urinary tract infections, cerebrovascular diseases, or coronary heart diseases between March 2017 and March 2019. RESULTS Among the 432,292 patients before propensity score matching, 149,639 (34.6%) had visited the dental office. One-to-one propensity score matching produced 149,289 matched pairs adjusted for the differences in all covariables (age, sex, copayment rate, annual health checkup, chronic diseases, and residential area). In these matched pairs, the risk ratio of the occurrence of acute hospitalization due to pneumonia, urinary tract infections, and cerebrovascular diseases was lower among patients who had visited dental office than among those who did not. CONCLUSIONS Dental visits appeared to be effective in preventing acute hospitalization due to systemic diseases, thus, dental care services would be an important component of healthcare for older adults.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University, Nara, Japan
| | - Atsushi Saito
- Department of Peridontology, Tokyo Dental College, Tokyo, Japan
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15
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Mitsutake S, Takahashi Y, Otsuki A, Umezawa J, Yaguchi-Saito A, Saito J, Fujimori M, Shimazu T. Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan. J Med Internet Res 2023; 25:e44741. [PMID: 36862482 PMCID: PMC10020913 DOI: 10.2196/44741] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users. OBJECTIVE This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs. METHODS This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use. RESULTS The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use. CONCLUSIONS For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.,Division of Prevention, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Jun Umezawa
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.,Faculty of Human Sciences, Tokiwa University, Ibaraki, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
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Kato T, Tohi Y, Honda T, Matsuda I, Osaki Y, Naito H, Matsuoka Y, Okazoe H, Taoka R, Tsunemori H, Ueda N, Sugimoto M. A national questionnaire survey of Japanese urologists on active surveillance for low- and intermediate-risk prostate cancer. Int J Urol 2023; 30:289-297. [PMID: 36415128 DOI: 10.1111/iju.15102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a national questionnaire survey of Japanese urologists on active surveillance (AS) for low- and intermediate-risk prostate cancer (PCa). METHODS A questionnaire was sent to 922 Japanese Urological Association Teaching Base Hospitals. The items included were years of experience as a urologist, sex, workplace, treatment equipment owned, specialty area of daily practice, specialty area of urological cancer, and six hypothetical cases of AS. The cases were categorized by the following Gleason scores: 3 + 3 low risk of PCa, 3 + 4 intermediate risk, and 4 + 3 intermediate risk, with or without comorbidities for each case. Comorbidities were defined as cardiovascular diseases or illnesses warranting anticoagulant therapy. RESULTS Altogether, 1962 questionnaires were analyzed. Responses were almost equally distributed among all age groups. Workplaces included general hospitals (49.4%), university hospitals (40.3%), and cancer centers (4.2%). Percentages of proposed AS for low risk/no comorbidity, low risk/with comorbidity, intermediate-risk 3 + 4/no comorbidity, intermediate risk 3 + 4/with comorbidity, intermediate risk 4 + 3/no comorbidity, and intermediate risk 4 + 3/with comorbidity were 90.5%, 90%, 39.5%, 48.7%, 15%, and 22%, respectively. Analysis of the correspondents' backgrounds showed that the more the urologists' years of experience, the less they were to advise AS of low-risk patients. In the presence of comorbidities, urologists across all age groups tended to propose AS, even in the same Gleason grade group. Cancer center urologists recommended AS more often than their counterparts at general and university hospitals. CONCLUSIONS Approximately 40% of urologists proposed AS for intermediate-risk cases, confirming that AS for intermediate-risk patients is being considered in Japan.
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Affiliation(s)
- Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Tomoko Honda
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Iori Matsuda
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yu Osaki
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Hirohito Naito
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Homare Okazoe
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
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Saijo T, Yasumoto K, Ryomoto K, Momoki C, Habu D. Effect of protein underdosing on the prognosis of patients with severe acute heart failure in the early acute phase: A single-institutional retrospective cohort study. Clin Nutr ESPEN 2023; 53:260-267. [PMID: 36657922 DOI: 10.1016/j.clnesp.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/26/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The appropriate protein dose during the early acute phase of severe acute heart failure (AHF) remains unknown. We hypothesized that protein underdosing during this period may lead to a poor prognosis. Thus, we investigated the relationship between protein sufficiency rate and prognosis during the early acute phase in patients with severe AHF. METHODS This retrospective observational study investigated patients with AHF requiring invasive mechanical ventilation who were admitted in the intensive care and cardiac care units between January 2015 and August 2021. These patients were ranked according to the tertile of protein sufficiency rate on intubation day 2. Univariate and multivariate logistic regression analyses were performed to determine whether a low protein sufficiency rate on intubation day 2 was an independent factor for in-hospital mortality. Patients were weighted using the inverse probability of treatment weighting (IPTW) method to determine the differences in baseline characteristics. RESULTS A total of 118 patients were included in the study and divided into low-protein (n = 40) and non-low-protein (n = 78) groups with protein sufficiency rates of ≤10% and >10%, respectively.In the multivariate analysis of in-hospital mortality, low protein sufficiency on day 2 was identified as an independent factor (odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.05-7.27, P = 0.039). After adjusting for baseline characteristics using the IPTW method, multiple logistic regression analysis of in-hospital mortality revealed low protein sufficiency on day 2 as an independent factor (OR = 3.32, 95% CI = 1.18-9.32, P = 0.023). CONCLUSION Protein underdosing in the early acute phase of severe AHF may be associated with increased in-hospital mortality.
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Affiliation(s)
- Takeshi Saijo
- Department of Nutrition Management, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan; Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138, Sugimoto, Sumiyoshi-ku, Osaka, Osaka 558-8585, Japan.
| | - Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan.
| | - Kayoko Ryomoto
- Department of Nutrition Management, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan; Department of Diabetes, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan.
| | - Chika Momoki
- Department of Food Science and Human Nutrition, Faculty of Agriculture, Setsunan University, 45-1, Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan.
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138, Sugimoto, Sumiyoshi-ku, Osaka, Osaka 558-8585, Japan.
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Hirano Y, Fujikura T, Kono K, Ohashi N, Yamaguchi T, Hanajima W, Yasuda H, Yamauchi K. Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study. J Clin Med 2022; 11:6589. [PMID: 36362821 PMCID: PMC9659087 DOI: 10.3390/jcm11216589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 10/29/2023] Open
Abstract
Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence during the induction phase of dialysis and the factors that influence this decline, and to provide information on prevention and treatment during this period. Of the 354 patients who were newly initiated on hemodialysis between April 2018 and January 2022, 285 were included in the analysis. The functional independence measure-walking score was used to sort patients into decreased walking independence (DWI; n = 46) and maintained walking independence (no DWI; n = 239) groups, and patient characteristics were compared. After adjusting for various factors by logistic regression analysis, we observed that age, high Charlson comorbidity index (CCI), C-reactive protein, and emergency dialysis start (EDS) were significant predictors of DWI. Even during the very short period of dialysis induction, as many as 16.1% of patients had DWI, which was associated with older age, higher CCI, higher inflammation, and EDS. Therefore, we recommend the early identification of patients with these characteristics and early rehabilitation.
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Affiliation(s)
- Yuma Hirano
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, 4-3, Kozunomori, Narita City 286-8686, Japan
| | - Naro Ohashi
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Wataru Hanajima
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
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Chen Y, Pan M, He Y, Dong X, Hu Z, Hou J, Bao Y, Yang J, Yuchi Y, Li R, Zhu L, Kang N, Liao W, Li S, Wang C, Zhang L. Disease Burden and Accumulation of Multimorbidity of Non-communicable Diseases in Henan Rural Population: A Cross-Sectional Study (Preprint). JMIR Public Health Surveill 2022; 9:e43381. [DOI: 10.2196/43381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 03/19/2023] Open
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Sugiyama Y, Mutai R, Aoki T, Matsushima M. Multimorbidity and complex multimorbidity, their prevalence, and associated factors on a remote island in Japan: a cross-sectional study. BMC PRIMARY CARE 2022; 23:258. [PMID: 36192706 PMCID: PMC9531464 DOI: 10.1186/s12875-022-01860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence is still limited on the prevalence of multimorbidity and complex multimorbidity in Japan, as well as their associated factors. Additionally, no studies regarding multimorbidity and complex multimorbidity in Japan have used patient data obtained directly from medical records. The primary objective was to clarify the prevalence of multimorbidity and complex multimorbidity using patient data obtained directly from medical records. The secondary objective was to elucidate factors associated with multimorbidity and complex multimorbidity. METHODS We conducted a cross-sectional study at Tarama Clinic on Tarama Island, a remote island in Okinawa, Japan. Among patients who visited Tarama Clinic from April 1 to June 30, 2018, those who were ≥ 20 years of age, lived on Tarama Island, and had capacity to give consent were eligible for study inclusion. We collected the following data using medical records, medical expense receipts, and self-administered questionnaires: multimorbidity and complex multimorbidity, participants' characteristics, and potentially associated factors. Multimorbidity was defined as having ≥ 2 among 17 chronic health conditions, in accordance with previous studies conducted in Japan, and having ≥ 2 among 16 chapters of the International Classification of Primary Care, 2nd edition (ICPC-2). Complex multimorbidity was defined as having ≥ 3 among 16 chapters of the ICPC-2. RESULTS We included 355 study participants. Descriptive analysis showed multimorbidity prevalence measured using the 17 chronic health conditions in this area was 30.0% (age ≥ 20 years) and 57.5% (age ≥ 65 years). Multimorbidity prevalence measured using the ICPC-2 was 32.9% (age ≥ 20 years) and 60.3% (age ≥ 65 years). We also found a 20.9% (age ≥ 20 years) and 45.1% (age ≥ 65 years) prevalence of complex multimorbidity, respectively. Poisson regression with robust error variance showed that age ≥ 60 years was associated with multimorbidity. Age ≥ 60 years (adjusted prevalence ratio [aPR] 1.887 and 1.831 for ages 60-79 and ≥ 80 years, respectively) and being unemployed (aPR 1.251) were associated with complex multimorbidity. However, having hazardous drinking or more was inversely associated with complex multimorbidity (aPR 0.745). CONCLUSIONS The population-based prevalence of multimorbidity and its upward trend with increasing age on a remote island in Japan was consistent with previous reports in the country. Multimorbidity was associated with age 60 years or older, and complex multimorbidity was associated with age 60 years or older, being unemployed, and not having hazardous drinking or more. Our study findings indicated a possible association between the coexistence of diseases and social determinants of health (SDH) in Japan. To improve care for patients with multimorbidity and complex multimorbidity, more research that takes SDH into account is warranted, and evidence-based policymaking is essential for Japan. The present study can provide a foundation for accumulating such evidence.
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Affiliation(s)
- Yoshifumi Sugiyama
- grid.411898.d0000 0001 0661 2073Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461 Japan ,Tarama Clinic, Okinawa Miyako Hospital, 162-3, Shiokawa, Tarama, Miyako-gun, Okinawa, 906-0601 Japan ,grid.411898.d0000 0001 0661 2073Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461 Japan
| | - Rieko Mutai
- grid.411898.d0000 0001 0661 2073Department of Adult Nursing, The Jikei University School of Nursing, 8-3-1, Kokuryocho, Chofu, Tokyo 182-8570 Japan
| | - Takuya Aoki
- grid.411898.d0000 0001 0661 2073Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461 Japan
| | - Masato Matsushima
- grid.411898.d0000 0001 0661 2073Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-8461 Japan
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21
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Ishizaki T, Masui Y, Nakagawa T, Yoshida Y, Ishioka YL, Hori N, Inagaki H, Ito K, Ogawa M, Kabayama M, Kamide K, Ikebe K, Arai Y, Gondo Y. Construct Validity of a New Health Assessment Questionnaire for the National Screening Program of Older Adults in Japan: The SONIC Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610330. [PMID: 36011962 PMCID: PMC9407940 DOI: 10.3390/ijerph191610330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 05/10/2023]
Abstract
The Japanese government has implemented a new screening program to promote measures to avoid worsening lifestyle-related diseases and frailty among the older population. In this effort, the government formulated a new health assessment questionnaire for the screening program of old-old adults aged ≥75 years. The questionnaire comprises 15 items, of which 12 address frailty, two address general health status, and one addresses smoking habits. This study examined the construct validity of this questionnaire, using the explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The data used in this study were drawn from a mail-in survey conducted in 2020 as part of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A total of 1576 respondents (range, 78-99 years of age) were included in the study. Although the EFA did not show an interpretable factor structure of the questionnaire with 15 items, the CFA using only 12 frailty-related items showed the goodness of fit for a higher-order factor "frailty", and the five frailty-related sub-factors model was acceptable. These results suggest that the total score of the 12 frailty-related items in the questionnaire can be used as an indicator of the degree of "frailty".
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Affiliation(s)
- Tatsuro Ishizaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
- Correspondence:
| | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Takeshi Nakagawa
- National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Yoshiko L. Ishioka
- Jindal School of Liberal Arts and Humanities, O.P. Jindal Global University, Sonipat 131001, Haryana, India
| | - Noriko Hori
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Kae Ito
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Madoka Ogawa
- Clinical Thanatology and Geriatric Behavioral Science, Graduate School of Human Sciences, Osaka University, Osaka 565-0871, Japan
| | - Mai Kabayama
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kei Kamide
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yasuyuki Gondo
- Clinical Thanatology and Geriatric Behavioral Science, Graduate School of Human Sciences, Osaka University, Osaka 565-0871, Japan
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22
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Nakane A, Nakagawa K, Yamaguchi K, Yoshimi K, Hara Y, Tohara H. Cough Test Results during Screening for Silent Aspiration Are Affected by Risk Factors for Silent Cerebral Infarct in Older Adults with Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10202. [PMID: 36011839 PMCID: PMC9408609 DOI: 10.3390/ijerph191610202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
The cough reflex does not change with age. However, older adults with chronic diseases often have a reduced cough reflex. The effects of several risk factors on reduced cough sensitivity in older adults remain unclear. This study aims to clarify the risk factors for reduced cough sensitivity in older adults with chronic diseases. This cross-sectional study included participants aged <65 years (young group; n = 21), those aged ≥65 years (older adults with chronic disease group; n = 18), and those with dysphagia (dysphagia group; n = 16). A cough test was performed on all participants using an ultrasonic nebulizer with a mist of 1% w/v citric acid physiologic saline. Cough response was observed in the young (21/21), older adult (9/18), and dysphagia (13/16) groups. The difference between the young and older adult groups was significant (p < 0.01). The older adult and dysphagia groups had decreased cough sensitivity compared to the younger group. Cough sensitivity was affected by risk factors for silent cerebral infarct and age. Our findings show that cough test results might be affected by risk factors for silent cerebral infarction in older adults with chronic diseases.
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23
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Rodrigues LP, de Oliveira Rezende AT, Delpino FM, Mendonça CR, Noll M, Nunes BP, de Oliviera C, Silveira EA. Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis. Age Ageing 2022; 51:6649133. [PMID: 35871422 PMCID: PMC9308991 DOI: 10.1093/ageing/afac155] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes. Methods We systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission. Results Of the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay. Conclusions Multimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).
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Affiliation(s)
- Luciana Pereira Rodrigues
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Felipe Mendes Delpino
- Department of Nursing in Public Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Matias Noll
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cesar de Oliviera
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil
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24
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Ishikawa T, Sato J, Hattori J, Goda K, Kitsuregawa M, Mitsutake N. Association between COVID-19 and Policy Responses on Telehealth Utilization in Japan: Interrupted Time-Series Analysis. Interact J Med Res 2022; 11:e39181. [PMID: 35752952 PMCID: PMC9278403 DOI: 10.2196/39181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/05/2022] [Accepted: 06/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background Telehealth using telephones or online communication is being promoted as a policy initiative in several countries. However, there is a lack of research on telehealth utilization in a country such as Japan that offers free access to medical care and regulates telehealth provision—particularly with respect to COVID-19. Objective The present study aimed to clarify telehealth utilization, the characteristics of patients and medical institutions using telehealth, and the changes to telehealth in Japan in order to support the formulation of policy strategies for telehealth provision. Methods Using a medical administrative claim database of the National Health Insurance and Advanced Elderly Medical Service System in Mie Prefecture, we investigated patients who used telehealth from January 2017 to September 2021. We examined telehealth utilization with respect to both patients and medical institutions, and we determined their characteristics. Using April 2020 as the reference time point for COVID-19, we conducted an interrupted time-series analysis (ITSA) to assess changes in the monthly proportion of telehealth users to beneficiaries. Results The number of telehealth users before the reference time point was 13,618, and after the reference time point, it was 28,853. Several diseases and conditions were associated with an increase in telehealth utilization. Telehealth consultations were mostly conducted by telephone and for prescriptions. The ITSA results showed a sharp increase in the proportion of telehealth use to beneficiaries after the reference time point (rate ratio 2.97; 95% CI 2.14-2.31). However, no apparent change in the trend of increasing or decreasing telehealth use was evident after the reference time point (rate ratio 1.00; 95% CI 1.00-1.01). Conclusions We observed a sharp increase in telehealth utilization after April 2020, but no change in the trend of telehealth use was evident. We identified changes in the characteristics of patients and providers using telehealth.
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Affiliation(s)
- Tomoki Ishikawa
- Institute for Health Economics and Policy, No.11 Toyo-kaiji Bldg,1-5-11Nishi-Shimbashi, Minato-ku, Tokyo, JP.,Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, JP
| | - Jumpei Sato
- Institute of Industrial Science, The University of Tokyo, Meguro, Tokyo, JP
| | - Junko Hattori
- Institute of Industrial Science, The University of Tokyo, Meguro, Tokyo, JP
| | - Kazuo Goda
- Institute of Industrial Science, The University of Tokyo, Meguro, Tokyo, JP
| | - Masaru Kitsuregawa
- Institute of Industrial Science, The University of Tokyo, Meguro, Tokyo, JP
| | - Naohiro Mitsutake
- Institute for Health Economics and Policy, No.11 Toyo-kaiji Bldg,1-5-11Nishi-Shimbashi, Minato-ku, Tokyo, JP
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25
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Takagi M, Nakano S, Otsuka H. [Differences in perceptions between healthcare professionals and caregivers when accepting patients on insulin therapy to elderly care facilities]. Nihon Ronen Igakkai Zasshi 2022; 59:190-199. [PMID: 35650052 DOI: 10.3143/geriatrics.59.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To clarify the problems with accepting patients on insulin therapy at elderly care facilities. METHODS We conducted a questionnaire on staff awareness of diabetes before accepting the first diabetic patient on insulin therapy at our elderly care facility. Once the patient was admitted, we held diabetes classes for staff based on their needs. Six months later, we conducted a questionnaire again to confirm the staff's awareness concerning patients on insulin therapy. RESULTS In the initial questionnaire, nurses were negative about acceptance while caregivers were positive. Once the patient was admitted, staff struggled to deal with his frequent symptoms. A diabetes specialist held diabetes classes for staff to ensure the patient could enjoy a stable life. Gradually, the staff developed a better collaborative system and performed appropriate care. In the second questionnaire conducted six months later, there was a decrease in excessive optimistic opinions among caregivers. However, nurses still tended to be reluctant about acceptance while caregivers were positive, a trend similar to the initial evaluation. CONCLUSION In this study, we noted differences in the perceptions of nurses and caregivers regarding the acceptance of patients on insulin therapy. Mitigating this difference is necessary to ensure the safety of patients. It is essential to institutionalize diabetes education in long-term care facilities, allow educated caregivers to measure blood glucose levels, select patients with treatment policies suitable for a given facility, ensure that doctors deliver accurate instructions, and maintain close communication to build a better medical care cooperation system.
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Affiliation(s)
- Miki Takagi
- Osaka Social Welfare Corporation Houjuso Clinic Yutaka
| | - Susumu Nakano
- Osaka Social Welfare Corporation Houjuso Clinic Yutaka
| | - Hisako Otsuka
- Osaka Social Welfare Corporation OSJ Training and Research Center
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26
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Haruta J, Goto R, Sachiko O, Kimura S, Teruyama J, Hama Y, Maeno T. How do general practitioners handle complexities? A team ethnographic study in Japan. BMC PRIMARY CARE 2022; 23:133. [PMID: 35624417 PMCID: PMC9137137 DOI: 10.1186/s12875-022-01741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND General practitioners (GPs) are often faced with complex problems, including patients with socio-economic and medical problems. However, the methods they use to approach these complexities are still not understood. We speculated that elucidating these methods using complex adaptive systems (CAS) methodology to comprehensively assess GPs' daily activities would contribute to improving the professional development of GPs. This study aimed to clarify how expert GPs handle complex problems and adapt to their community context through the ethnography of GPs and other healthcare professionals in terms of CAS. METHODS We adopted the interdisciplinary team-ethnographic research approach. Five hospitals and four clinics in Japan which were considered to employ expert GPs were selected by purposive sampling. 62 individuals of various backgrounds working in these nine facilities were interviewed. Using field notes and interview data, the researchers iteratively discussed the adequacy of our interpretations. The first author (JH) prepared a draft report, which was reviewed by the GPs at the participating facilities. Through critical and iterative consideration of the different insights obtained, the final findings emerged together with representative data. RESULTS We identified four approaches used by GPs to deal with complexities. First, GPs treat patients with complex problems as a whole being and address their problems multi-directionally. Second, GPs build horizontal, trusting relationships with other healthcare professionals and stakeholders, and thereby reduce the degree of complexity of problems. Third, GPs change the learning climate while committing to their own growth based on societal needs and by acting as role models for other professionals through daily interpersonal facilitation. Fourth, GPs share community vision with multi-professionals and thereby act as a driving force for organizational change. These various interactions among GPs, healthcare professionals, organizations and communities resulted in systematization of the healthcare and welfare network in their community. CONCLUSIONS Expert GPs developed interconnected multidimensional systems in their community health and welfare networks to adapt to fluctuating social realities using four approaches. GPs' work environment may be considered as a complex adaptive system (CAS) and the approach of GPs to complexities is CAS-based. Our findings are expected to have practical applications for GPs.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Ryohei Goto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ozone Sachiko
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shuhei Kimura
- Faculty of Humanities and Social Sciences, University of Tsukuba, Tsukuba, Japan
| | - Junko Teruyama
- Faculty of Library, Information and Media Science, University of Tsukuba, Tsukuba, Japan
| | - Yusuke Hama
- Tokyo Junior College of Transportation, Tokyo, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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27
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Krishnan AM, Bouazizi M, Ohtsuki T. An Infrared Array Sensor-Based Approach for Activity Detection, Combining Low-Cost Technology with Advanced Deep Learning Techniques. SENSORS 2022; 22:s22103898. [PMID: 35632305 PMCID: PMC9145665 DOI: 10.3390/s22103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
In this paper, we propose an activity detection system using a 24 × 32 resolution infrared array sensor placed on the ceiling. We first collect the data at different resolutions (i.e., 24 × 32, 12 × 16, and 6 × 8) and apply the advanced deep learning (DL) techniques of Super-Resolution (SR) and denoising to enhance the quality of the images. We then classify the images/sequences of images depending on the activities the subject is performing using a hybrid deep learning model combining a Convolutional Neural Network (CNN) and a Long Short-Term Memory (LSTM). We use data augmentation to improve the training of the neural networks by incorporating a wider variety of samples. The process of data augmentation is performed by a Conditional Generative Adversarial Network (CGAN). By enhancing the images using SR, removing the noise, and adding more training samples via data augmentation, our target is to improve the classification accuracy of the neural network. Through experiments, we show that employing these deep learning techniques to low-resolution noisy infrared images leads to a noticeable improvement in performance. The classification accuracy improved from 78.32% to 84.43% (for images with 6 × 8 resolution), and from 90.11% to 94.54% (for images with 12 × 16 resolution) when we used the CNN and CNN + LSTM networks, respectively.
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Affiliation(s)
| | - Mondher Bouazizi
- Faculty of Science and Technology, Keio University, Yokohama 223-8522, Japan;
| | - Tomoaki Ohtsuki
- Faculty of Science and Technology, Keio University, Yokohama 223-8522, Japan;
- Correspondence:
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28
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Sriram V, Shivakumar M, Jung SH, Nam Y, Bang L, Verma A, Lee S, Choe EK, Kim D. NETMAGE: A human disease phenotype map generator for the network-based visualization of phenome-wide association study results. Gigascience 2022; 11:6528770. [PMID: 35166337 PMCID: PMC8848314 DOI: 10.1093/gigascience/giac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/29/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Disease complications, the onset of secondary phenotypes given a primary condition, can exacerbate the long-term severity of outcomes. However, the exact cause of many of these cross-phenotype associations is still unknown. One potential reason is shared genetic etiology-common genetic drivers may lead to the onset of multiple phenotypes. Disease-disease networks (DDNs), where nodes represent diseases and edges represent associations between diseases, can provide an intuitive way of understanding the relationships between phenotypes. Using summary statistics from a phenome-wide association study (PheWAS), we can generate a corresponding DDN where edges represent shared genetic variants between diseases. Such a network can help us analyze genetic associations across the diseasome, the landscape of all human diseases, and identify potential genetic influences for disease complications. RESULTS To improve the ease of network-based analysis of shared genetic components across phenotypes, we developed the humaN disEase phenoType MAp GEnerator (NETMAGE), a web-based tool that produces interactive DDN visualizations from PheWAS summary statistics. Users can search the map by various attributes and select nodes to view related phenotypes, associated variants, and various network statistics. As a test case, we used NETMAGE to construct a network from UK BioBank (UKBB) PheWAS summary statistic data. Our map correctly displayed previously identified disease comorbidities from the UKBB and identified concentrations of hub diseases in the endocrine/metabolic and circulatory disease categories. By examining the associations between phenotypes in our map, we can identify potential genetic explanations for the relationships between diseases and better understand the underlying architecture of the human diseasome. Our tool thus provides researchers with a means to identify prospective genetic targets for drug design, using network medicine to contribute to the exploration of personalized medicine.
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Affiliation(s)
- Vivek Sriram
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
| | - Manu Shivakumar
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
| | - Sang-Hyuk Jung
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA.,Department of Digital Health, SAIHST, Sungkyunkwan University, Samsung Medical Center, 06355 Seoul, Republic of Korea
| | - Yonghyun Nam
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
| | - Lisa Bang
- Ultragenyx Pharmaceutical, 94949 Novato, California, USA
| | - Anurag Verma
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
| | - Seunggeun Lee
- Graduate School of Data Science, Seoul National University, 08826 Seoul, Republic of Korea
| | - Eun Kyung Choe
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
| | - Dokyoon Kim
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA.,Institute for Biomedical Informatics, University of Pennsylvania, 19104 Philadelphia, Pennsylvania, USA
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29
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Kazawa K, Kodama A, Sugawara K, Hayashi M, Ota H, Son D, Ishii S. Person-centered dementia care during COVID-19: a qualitative case study of impact on and collaborations between caregivers. BMC Geriatr 2022; 22:107. [PMID: 35130868 PMCID: PMC8821828 DOI: 10.1186/s12877-022-02794-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/27/2022] [Indexed: 12/23/2022] Open
Abstract
Background Little is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care. Methods This is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis. Results The interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were “re-acknowledgement of care priorities” and “rebuilding of relationships.” When caregivers’ perceptions were aligned in the decision-making processes regarding care priorities, “reaffirmation of trust” and “strengthening of intimate relationships” emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to “anxiety during COVID-19 pandemic” and caused a “gap in perception” regarding infection control. Conclusions The present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.
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Affiliation(s)
- Kana Kazawa
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Ayuto Kodama
- Advanced Research Center for Geriatric and Gerontology, Akita University, 1-1 Tegatagakuen-machi, Akita, 010-8502, Japan
| | - Kaoru Sugawara
- Advanced Research Center for Geriatric and Gerontology, Akita University, 1-1 Tegatagakuen-machi, Akita, 010-8502, Japan
| | - Mikio Hayashi
- Center for Medical Education, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hidetaka Ota
- Advanced Research Center for Geriatric and Gerontology, Akita University, 1-1 Tegatagakuen-machi, Akita, 010-8502, Japan
| | - Daisuke Son
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, 86 Nishi machi, Yonago, Tottori, 683-8503, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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The effects of early post-discharge rehabilitation services on care-needs level deterioration in older adults with functional impairment: A propensity score–matched study. Arch Phys Med Rehabil 2022; 103:1715-1722.e1. [DOI: 10.1016/j.apmr.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
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Shiba T, Sato M, Akisawa N, Sawaya Y, Murai H, Kiryu S, Otsuka M, Urano T. [A patient with mesenteric lymphoma who developed amyotrophic lateral sclerosis and sepsis]. Nihon Ronen Igakkai Zasshi 2021; 58:476-481. [PMID: 34483176 DOI: 10.3143/geriatrics.58.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We treated a patient with mesenteric lymphoma who concomitantly developed amyotrophic lateral sclerosis (ALS). The patient died of urinary tract infection nine months after the onset of ALS. We herein report the changes in the patient's condition and the sequence of events until death from the viewpoint of a physiotherapist. The patient was a 69-year-old woman who developed mesenteric lymphoma in September of X year and perceived weakness in the toes in November of X year. She showed signs of upper and lower motor neuron disorders, and electrophysiologic testing revealed denervation in three areas of the spinal cord. In March of X+1 year, she was diagnosed with definite ALS based on the Awaji criteria. In April of X+1 year, she began to receive continuous home healthcare, specifically outpatient rehabilitation. No remarkable bulbar palsy was observed soon after the initiation of rehabilitation; however, manual muscle testing revealed strengths in the lower and upper limbs of 1 and 3-5, respectively, indicating muscle weakness and muscle atrophy. She developed exacerbation of neurological symptoms in the upper limbs, bulbar palsy, and respiratory muscle paralysis during rehabilitation. The ALS Functional Rating Scale-Revised indicated a decreased tendency to X [please define X]. In July of X+1 year, the mesenteric lymphoma had enlarged, resulting in the development of ureteric obstruction and ultimately causing hydronephrosis. Urinary tract infection and sepsis were diagnosed, and she was hospitalized. Although her fever temporarily subsided following ceftriaxone administration, she ultimately died due to a systemic inflammatory response syndrome three days after hospitalization. The mean period between the ALS onset and death is reportedly 40.6±33.1 months. The rate of ALS progression differs among individuals. Malignant tumors and paraneoplastic neurological syndrome may be involved in rapidly worsening neurological symptoms. Patients who concomitantly develop motor neuron disorders and malignant tumors are likely to have a higher risk of developing serious conditions associated with the exacerbation of neurological symptoms and complications. Our patient had several diseases that affected her survival prognosis; however, the sharing of information regarding her condition among healthcare professionals may have been insufficient. The primary physician responsible for treating each disease should cooperate with physiotherapists and other paramedical staff who have frequent opportunities to talk to patients in daily clinical practice. In geriatric patients in particular, such an environment is essential.
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Affiliation(s)
- Takahiro Shiba
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en"
| | - Miho Sato
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en"
| | - Naomi Akisawa
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en"
| | - Yohei Sawaya
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en".,Department of Physical Therapy, School of Health Science, International University of Health and Welfare
| | - Hiroyuki Murai
- Department of Neurology, School of Medicine, International University of Health and Welfare
| | - Shigeru Kiryu
- Department of Radiology, School of Medicine, International University of Health and Welfare
| | - Mieko Otsuka
- Department of Neurology, International University of Health and Welfare Hospital
| | - Tomohiko Urano
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en".,Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare
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Handa N, Mitsutake S, Ishizaki T, Nakabayashi T, Akishita M, Tamiya N, Yoshie S, Iijima K. Associations of coprescribed medications for chronic comorbid conditions in very old adults with clinical dementia: a retrospective cohort study using insurance claims data. BMJ Open 2021; 11:e043768. [PMID: 34266835 PMCID: PMC8286766 DOI: 10.1136/bmjopen-2020-043768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the association of coprescribed medications for chronic comorbid conditions with clinical dementia in older adults, as indicated by the initiation of a new prescription of antidementia medication (NPADM). DESIGN Retrospective enumeration cohort study. SETTING A Japanese city in Tokyo Metropolitan Area. PARTICIPANTS A total of 42 024 adults aged ≥77 years residing in Kashiwa City, a suburban city of Tokyo Metropolitan Area, who did not have any prscription of antidementia medication from 1 April to 30 June 2012. MAIN OUTCOME MEASURE The primary outcome was NPADM during follow-up period until 31 March 2015 (35 months). Subjects were categorised into four age groups: group 1 (77-81 years), group 2 (82-86 years), group 3 (87-91 years) and group 4 (≥92 years). In addition to age and sex, 14 sets of medications prescribed during the initial background period (from 1 April 2012 and 31 June 2012) were used as covariates in a Cox proportional hazard model. RESULTS In a follow-up period of 1 345 457 person-months (mean=32.0±7.5 months, median 35 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9%±0.1% (group 1: 0.9%±0.1%, group 2: 2.1%±0.1%, group 3: 3.2%±0.2% and group 4: 3.6%±0.3%; p<0.0001). In addition to older age and female sex, use of the following medications was significantly associated with NPADM: statins (HR: 0.82, 95% CI 0.73 to 0.92; p=0.001), antihypertensives (HR: 0.80, 95% CI 0.71 to 0.85; p<0.0001), non-steroidal bronchodilators (HR: 0.72, 95% CI 0.58 to 0.88; p=0.002), antidepressants (HR: 1.79, 95% CI 1.47 to 2.18; p<0.0001), poststroke medications (HR: 1.45, 95% CI 1.16 to 1.82; p=0.002), insulin (HR: 1.34, 95% CI 1.01 to 1.78; p=0.046) and antineoplastics (HR: 1.12, 95% CI 1.01 to 1.24; p=0.035). CONCLUSIONS This retrospective cohort study identified the associations of coprescribed medications for chronic comorbid conditions with NPADM in older adults. These findings would be helpful in understanding the current clinical practice for dementia in real-world setting and potentially contribute to healthcare policymaking. TRIAL REGISTRATION NUMBER UMIN000039040.
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Affiliation(s)
- Nobuhiro Handa
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Medical Technology Innovation Centre, Juntnndo University, Tokyo, Japan
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
- Department of Geriatric Medicine, Clinic Ian South Center, Yokohama, Kanagawa, Japan
| | - Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nanako Tamiya
- Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Satoru Yoshie
- Institute of Gerontology, University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, University of Tokyo, Tokyo, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
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Ujiie N, Sato C, Taniyama Y, Koseki K, Takaya K, Okamoto H, Fukutomi T, Unno M, Kamei T. Characteristics of esophageal achalasia in geriatric patients over 75 years of age and outcomes after peroral endoscopic myotomy. Geriatr Gerontol Int 2021; 21:788-793. [PMID: 34250704 DOI: 10.1111/ggi.14235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 01/11/2023]
Abstract
AIM As the population ages, the proportion aged ≥75 years is expected to increase. Many studies on peroral endoscopic myotomy (POEM) as treatment for esophageal achalasia have already been reported; however, few studies have been designed on patients aged ≥75 years. The purpose of this study is to describe the characteristics of esophageal achalasia in patients >75 years and to evaluate the outcomes of POEM. METHODS This study included 121 patients who underwent POEM for esophageal achalasia, which was divided into the geriatric (n = 18) group aged ≥75 and the young (n = 103) group ≤74 years. The characteristics of esophageal achalasia and the short-term outcomes after POEM in the geriatric group compared with the young group were retrospectively investigated. RESULTS The median age of the geriatric group was 78 years, and two patients were initially diagnosed with refractory pneumonia, and esophageal achalasia was initially overlooked. The preoperative Eckardt score of the geriatric group was significantly lower than that of the young group (4 vs. 6, P = 0.007), particularly in the regurgitation score. The Eckardt score and integrated relaxation pressure of both groups were significantly improved after POEM (P < 0.001). There were no cases of perioperative complications in the geriatric group. CONCLUSIONS POEM for esophageal achalasia is a safe and effective treatment even in geriatric patients >75 years of age. In geriatric patients with recurrent or intractable pneumonia, it is important to rule out esophageal achalasia. Geriatr Gerontol Int 2021; 21: 788-793.
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Affiliation(s)
- Naoto Ujiie
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Koseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kai Takaya
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Okamoto
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiaki Fukutomi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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[Utilization of health information for health guidance focusing on multimorbidity and polypharmacy among older adults]. Nihon Ronen Igakkai Zasshi 2021; 58:214-218. [PMID: 34039797 DOI: 10.3143/geriatrics.58.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hirata K, Suzuki M, Iso N, Okabe T, Goto H, Cho K, Shimizu J. Using machine learning to investigate the relationship between domains of functioning and functional mobility in older adults. PLoS One 2021; 16:e0246397. [PMID: 33571239 PMCID: PMC7877571 DOI: 10.1371/journal.pone.0246397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Previous studies have shown that functional mobility, along with other physical functions, decreases with advanced age. However, it is still unclear which domains of functioning (body structures, body functions, and activities) are most closely related to functional mobility. This study used machine learning classification to predict the rankings of Timed Up and Go tests based on the results of four assessments (soft lean mass, FEV1/FVC, knee extension torque, and one-leg standing time). We tested whether assessment results for each level could predict functional mobility assessments in older adults. Using support vector machines for machine learning classification, we verified that the four assessments of each level could classify functional mobility. Knee extension torque (from the body function domain) was the most closely related assessment. Naturally, the classification accuracy rate increased with a larger number of assessments as explanatory variables. However, knee extension torque remained the highest of all assessments. This extended to all combinations (of 2-3 assessments) that included knee extension torque. This suggests that resistance training may help protect individuals suffering from age-related declines in functional mobility.
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Affiliation(s)
- Keisuke Hirata
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
- * E-mail:
| | - Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Naoki Iso
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Takuhiro Okabe
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Hiroshi Goto
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Kilchoon Cho
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Junichi Shimizu
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
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Chua YP, Xie Y, Lee PSS, Lee ES. Definitions and Prevalence of Multimorbidity in Large Database Studies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041673. [PMID: 33572441 PMCID: PMC7916224 DOI: 10.3390/ijerph18041673] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
Background: Multimorbidity presents a key challenge to healthcare systems globally. However, heterogeneity in the definition of multimorbidity and design of epidemiological studies results in difficulty in comparing multimorbidity studies. This scoping review aimed to describe multimorbidity prevalence in studies using large datasets and report the differences in multimorbidity definition and study design. Methods: We conducted a systematic search of MEDLINE, EMBASE, and CINAHL databases to identify large epidemiological studies on multimorbidity. We used the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) protocol for reporting the results. Results: Twenty articles were identified. We found two key definitions of multimorbidity: at least two (MM2+) or at least three (MM3+) chronic conditions. The prevalence of multimorbidity MM2+ ranged from 15.3% to 93.1%, and 11.8% to 89.7% in MM3+. The number of chronic conditions used by the articles ranged from 15 to 147, which were organized into 21 body system categories. There were seventeen cross-sectional studies and three retrospective cohort studies, and four diagnosis coding systems were used. Conclusions: We found a wide range in reported prevalence, definition, and conduct of multimorbidity studies. Obtaining consensus in these areas will facilitate better understanding of the magnitude and epidemiology of multimorbidity.
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Affiliation(s)
- Ying Pin Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
| | - Ying Xie
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
| | - Poay Sian Sabrina Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
- Correspondence:
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Multimorbidity Patterns of Chronic Diseases among Indonesians: Insights from Indonesian National Health Insurance (INHI) Sample Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238900. [PMID: 33266273 PMCID: PMC7731032 DOI: 10.3390/ijerph17238900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
Given the increasing burden of chronic diseases in Indonesia, characteristics of chronic multimorbidities have not been comprehensively explored. Therefore, this research evaluated chronic multimorbidity patterns among Indonesians using Indonesian National Health Insurance (INHI) sample data. We included 46 chronic diseases and analyzed their distributions using population-weighted variables provided in the datasets. Results showed that chronic disease patients accounted for 39.7% of total patients who attended secondary health care in 2015–2016. In addition, 43.1% of those were identified as having chronic multimorbidities. Findings also showed that multimorbidities were strongly correlated with an advanced age, with large numbers of patients and visits in all provinces, beyond those on Java island. Furthermore, hypertension was the leading disease, and the most common comorbidities were diabetes mellitus, cerebral ischemia/chronic stroke, and chronic ischemic heart disease. In addition, disease proportions for certain disease dyads differed according to age group and gender. Compared to survey methods, claims data are more economically efficient and are not influenced by recall bias. Claims data can be a promising data source in the next few years as increasing percentages of Indonesians utilize health insurance coverage. Nevertheless, some adjustments in the data structure are accordingly needed to utilize claims data for disease control and surveillance purposes.
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Mutai R, Sugiyama Y, Yoshida S, Horiguchi R, Watanabe T, Kaneko M, Tominaga T, Hayashi D, Matsushima M. Development and validation of a Japanese version of the Patient Centred Assessment Method and its user guide: a cross-sectional study. BMJ Open 2020; 10:e037282. [PMID: 33234616 PMCID: PMC7689105 DOI: 10.1136/bmjopen-2020-037282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the validity and reliability in the primary care setting. DESIGN Cross-sectional study. SETTING Three family physician teaching clinics located in urban residential areas in Tokyo, Japan. PARTICIPANTS Patients who were aged 20 years or older, and who had an appointment with physicians at the three participating clinics. MAIN OUTCOME MEASURES Patient complexity measured by PCAM and complexity/burden level measured by a Visual Analogue Scale (VAS). RESULTS Although confirmatory factor analysis using a model described in a previous study revealed that the indices did not meet the criteria for good fit, exploratory factor analysis revealed a new three-factor structure of 'Personal well-being,' 'Social interaction' and 'Needs for care/service.' Cronbach's alpha of PCAM was 0.86. Spearman's rank correlation coefficients between PCAM scores and VAS scores were 0.51 for complexity (p<0.001) and 0.41 for burden (p<0.001). There were 42 patients (14.3% of total patients) with PCAM scores greater than its mean of 16.5 but with complexity VAS scores less than its mean of 20.8. CONCLUSIONS The Japanese version of PCAM and its user guide were developed through Japanese translation and cultural adaptation by cognitive debriefing. PCAM is a valid and reliable tool to assess patient complexity in the primary care settings in Japan. Additionally, although the correlation between total PCAM scores and complexity/burden as assessed by VAS was moderate, PCAM can more precisely identify patient complexity than skilled physician's intuition.
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Affiliation(s)
- Rieko Mutai
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Department of Adult Nursing, The Jikei University School of Nursing, Chofu, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Shuhei Yoshida
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Kitaadachi-seikyo Clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryoko Horiguchi
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Watanabe
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Kitaadachi-seikyo Clinic, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Makoto Kaneko
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Musashikoganei Clinic, Japanese Health and Welfare Co-operative Federation, Koganei, Japan
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomokazu Tominaga
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
- Musashikoganei Clinic, Japanese Health and Welfare Co-operative Federation, Koganei, Japan
- Koganei Family Clinic, Koganei, Japan
| | - Daichi Hayashi
- Department of Radiology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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Jiao D, Watanabe K, Sawada Y, Tanaka E, Watanabe T, Tomisaki E, Ito S, Okumura R, Kawasaki Y, Anme T. Multimorbidity and functional limitation: the role of social relationships. Arch Gerontol Geriatr 2020; 92:104249. [PMID: 32980575 DOI: 10.1016/j.archger.2020.104249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To examine the relationship between multimorbidity and functional limitation, and how social relationships alter that association. METHODS This cross-sectional study used data collected by self-reported questionnaires from adults aged 65 years and older living in a rural area in Japan in 2017. This analysis included complete data from 570 residents. Multimorbidity status was defined as having two chronic diseases exist simultaneously in one individual, and the function status was measured by their long-term care needs. Social relationships were assessed by the Index of Social Interaction and divided into high and low levels. Multiple logistic regression analysis was used to examine the association between social relationships and functional limitation and to assess the role of social relationships in this association. RESULTS The logistic regression model indicated that the risk of functional limitation was higher in multimorbidity participants than free-of-multimorbidity participants (OR = 2.55, 95% CI = 1.56-4.16). Compared with participants with no multimorbidity and a high level of social relationships, low level of social relationships increased the risk of functional limitation among participants both with and without multimorbidity, with the OR = 7.71, 95% CI = 3.03-19.69 and OR = 3.28, 95% CI = 1.30-8.27, respectively. However, no significant result was found in participants with multimorbidity and a high level of social relationships (P = 0.365). CONCLUSIONS Multimorbidity was associated with functional limitations. However, this association could be increased by a low level of social relationships and decreased by a high level of social relationships.
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Affiliation(s)
- Dandan Jiao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Kumi Watanabe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Yuko Sawada
- Medical Sciences, Morinomiya University of Medical Sciences, Osaka, 559-8611, Japan
| | - Emiko Tanaka
- Community Nursing, Musashino University, Tokyo, 202-8585, Japan
| | - Taeko Watanabe
- College of Nursing and Nutrition, Shukutoku University, Chiba, 260-8703, Japan
| | - Etsuko Tomisaki
- Faculty of Nursing and Medical Care, Keio University, Tokyo, 160-0016, Japan
| | - Sumio Ito
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Rika Okumura
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Yuriko Kawasaki
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
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Tsuchiya-Ito R, Ishizaki T, Mitsutake S, Hamada S, Yoshie S, Iijima K, Tamiya N. Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users. BMC Geriatr 2020; 20:314. [PMID: 32859158 PMCID: PMC7456048 DOI: 10.1186/s12877-020-01704-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures. METHODS A secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function. RESULTS Among 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670-0.987) and spend on (RR: 0.910; 95%CI: 0.829-0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232-1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799-0.986) home help services than middle/high-income subjects. CONCLUSION Household income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.
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Affiliation(s)
- Rumiko Tsuchiya-Ito
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan. .,Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
| | - Satoru Yoshie
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Institute of Gerontology, University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Ibaraki, Japan
| | - Katsuya Iijima
- Institute of Gerontology, University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Ibaraki, Japan
| | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Liu Z, Xu G, Xu L, Zhang Y, Huang Y. Perioperative Cardiac Complications in Patients Over 80 Years of Age with Coronary Artery Disease Undergoing Noncardiac Surgery: The Incidence and Risk Factors. Clin Interv Aging 2020; 15:1181-1191. [PMID: 32801670 PMCID: PMC7398882 DOI: 10.2147/cia.s252160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Ever-increasing noncardiac surgeries are performed in patients aged 80 years or over with coronary artery disease (CAD). The objective of the study was to explore the incidence and risk factors of perioperative cardiac complications (PCCs) for the oldest-old patients with CAD undergoing noncardiac surgery, which have not been evaluated previously. Patients and Methods A total of 547 patients, aged over 80 years, with a history of CAD who underwent noncardiac surgery were enrolled in this retrospective study. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCCs intraoperatively or within 30 days postoperatively, defined as any of the following complications: acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Multivariate logistic regression analysis and multivariate Cox regression model were both performed to estimate the risk factors of PCCs. The incidence of PCCs overtime was illustrated by the Kaplan-Meier curve with a stratified Log-rank test. Results One hundred six (19.4%) patients developed at least one PCC, and 15 (2.7%) patients developed cardiac death. The independent risk factors contributing to PCCs were age ≧85 years; body mass index ≧30 kg/m2; the history of angina within 6 months; metabolic equivalents <4; hypertension without regular treatment; preoperative ST-T segment abnormality; anesthesia time >3 h and drainage ≧200 mL within 24 h postoperatively. Conclusion The incidence of PCCs in elderly patients over 80 years with CAD who underwent noncardiac surgery was high. Comprehensive preoperative evaluation, skilled surgical technique, and regular postoperative monitoring may help to reduce the occurrence of PCCs in this high-risk population.
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Affiliation(s)
- Zijia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Guangyan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
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Miyazaki M, Uchiyama M, Nakamura Y, Matsuo K, Ono C, Goto M, Unoki A, Nakashima A, Imakyure O. Association of Self-Reported Medication Adherence with Potentially Inappropriate Medications in Elderly Patients: A Cross-Sectional Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165940. [PMID: 32824284 PMCID: PMC7460224 DOI: 10.3390/ijerph17165940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Polypharmacy (PP) and potentially inappropriate medications (PIMs) cause problematic drug-related issues in elderly patients; however, little is known about the association between medication adherence and PP and PIMs. This study evaluated the association of self-reported medication adherence with PP and PIMs in elderly patients. METHODS A cross-sectional pilot study was conducted using data collected from electronic medical records of 142 self-administering patients aged ≥65 years, excluding emergency hospitalization cases. Self-reported medication adherence was assessed using the visual analogue scale (VAS). RESULTS Of the 142 patients, 91 (64.1%) had PP and 80 (56.3%) used at least one PIM. In univariate analysis, patients with a VAS score of 100% had a significantly higher number of female patients and ≥1 PIM use compared to other patients. We found no association between the VAS score and PP. In multivariable analysis, the use of PIMs was significantly associated with a VAS score of 100% (odds ratio = 2.32; 95% confidence interval = 1.16-4.72; p = 0.017). CONCLUSIONS Use of PIMs by elderly patients is significantly associated with self-reported medication adherence. Pharmacists should pay more attention to prescribed medications of self-administering elderly patients in order to improve their prescribing quality.
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Affiliation(s)
- Motoyasu Miyazaki
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (K.M.); (A.N.)
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
- Correspondence: (M.M.); (O.I.); Tel.: +81-92-921-1011 (M.M.); +81-921-1011 (O.I.)
| | - Masanobu Uchiyama
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan;
| | - Koichi Matsuo
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (K.M.); (A.N.)
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
| | - Chika Ono
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
- Department of Pharmacy, Oita Nakamura Hospital, Oita 870-0022, Japan
| | - Miwa Goto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
| | - Ayako Unoki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
| | - Akio Nakashima
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (K.M.); (A.N.)
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
| | - Osamu Imakyure
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (K.M.); (A.N.)
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan; (M.U.); (C.O.); (M.G.); (A.U.)
- Correspondence: (M.M.); (O.I.); Tel.: +81-92-921-1011 (M.M.); +81-921-1011 (O.I.)
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43
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Sum G, Ishida M, Koh GCH, Singh A, Oldenburg B, Lee JT. Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan. PLoS One 2020; 15:e0232281. [PMID: 32343739 PMCID: PMC7188213 DOI: 10.1371/journal.pone.0232281] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups. METHODS Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models. RESULTS Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only. CONCLUSION Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Marie Ishida
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ankur Singh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
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Lee Y, Kim H, Jeong H, Noh Y. Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082618. [PMID: 32290367 PMCID: PMC7215522 DOI: 10.3390/ijerph17082618] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/24/2022]
Abstract
This study aimed to identify the prevalence and patterns of multimorbidity among Korean adults. A descriptive study design was used. Of 11,232 adults aged 18 and older extracted from the 2014 Korean Health Panel Survey, 7118 had one or more chronic conditions. The chronic conditions code uses the Korean Standard Classification of Diseases. Association rule analysis and network analysis were conducted to identify patterns of multimorbidity among 4922 participants with multimorbidity. The prevalence of multimorbidity in the overall population was 34.8%, with a higher prevalence among women (40.8%) than men (28.6%). Hypertension had the highest prevalence in both men and women. In men, diabetes mellitus and hypertension yielded the highest probability of comorbidity (10.04%). In women, polyarthrosis and hypertension yielded the highest probability of comorbidity (12.51%). The results of the network analysis in four groups divided according to gender and age showed different characteristics for each group. Public health practitioners should adopt an integrated approach to manage multimorbidity rather than an individual disease-specific approach, along with different strategies according to age and gender groups.
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Affiliation(s)
- Yoonju Lee
- College of Nursing, Pusan National University, Yangsan 50612, Korea;
| | - Heejin Kim
- Department of Nursing, The Graduate School, Pusan National University, Yangsan 50612, Korea;
- Correspondence: ; Tel.: +82-51-510-8367
| | - Hyesun Jeong
- Department of Nursing, The Graduate School, Pusan National University, Yangsan 50612, Korea;
| | - Yunhwan Noh
- Department of Statistics, The Graduate School, Pusan National University, Busan 46241, Korea;
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Mitsutake S, Ishizaki T, Tsuchiya-Ito R, Teramoto C, Shimizu S, Yamaoka T, Kitamura A, Ito H. Association of pharmacological treatments for hypertension, diabetes, and dyslipidemia with health checkup participation and identification of disease control factors among older adults in Tokyo, Japan. Prev Med Rep 2020; 17:101033. [PMID: 32140383 PMCID: PMC7044507 DOI: 10.1016/j.pmedr.2019.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 10/29/2022] Open
Abstract
The Japanese government encourages older adults to participate in annual health checkups designed to detect lifestyle diseases such as hypertension, diabetes, and dyslipidemia. However, individuals who are already being treated for these diseases are unlikely to benefit from health checkup participation. This retrospective cohort study of older adults evaluated the associations of pharmacological treatments for these diseases with health checkup participation and identified the disease control factors among patients receiving treatments. Using medical claims data and health checkup data between September 2013 and August 2014 from 820,215 older adults aged ≥ 75 years residing in Tokyo, Japan, we examined the associations between pharmacological treatments and health checkup participation using binary logistic regression analysis. Next, patients receiving pharmacological treatments were categorized into intensive, moderate, or limited disease control based on their blood pressure, hemoglobin A1c levels, and lipid levels; multinomial logistic regression analyses were used to identify the disease control factors. The results showed that patients receiving pharmacological treatments were more likely (odds ratio: 1.374; P < 0.001) to participate in health checkups than patients not receiving treatments. Patients with intensive disease control were more likely to be aged ≥ 90 years and use home medical care than patients with moderate control. Our findings suggest that it may be beneficial to shift the focus of health checkups from simply identifying at-risk patients to also supporting disease management. Information obtained from databases that link medical claims and health checkup data may improve evaluations of disease control in older adults and help to streamline healthcare systems.
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Affiliation(s)
| | | | - Rumiko Tsuchiya-Ito
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Chie Teramoto
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takuya Yamaoka
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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46
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Mitsutake S, Ishizaki T, Tsuchiya-Ito R, Uda K, Teramoto C, Shimizu S, Ito H. Associations of Hospital Discharge Services With Potentially Avoidable Readmissions Within 30 Days Among Older Adults After Rehabilitation in Acute Care Hospitals in Tokyo, Japan. Arch Phys Med Rehabil 2020; 101:832-840. [PMID: 31917197 DOI: 10.1016/j.apmr.2019.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. DESIGN Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. SETTING Acute care hospitals. PARTICIPANTS Patients who underwent rehabilitation and were discharged to home (N=31,247; mean age in years ± SD, 84.1±5.7) between October 2013 and July 2014. INTERVENTIONS None. MAIN OUTCOME MEASURE 30-day PAR. RESULTS Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<.001), and the odds of 30-day PAR among patients with a higher number (median or higher) of rehabilitation units were 2.031 times higher than those of patients with a lower number (below median) (P<.001). Also, the odds of 30-day PAR among patients with a higher Hospital Frailty Risk Score (median or higher) were 1.252 times higher than those of patients with a lower score (below median) (P=.001). CONCLUSIONS The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Rumiko Tsuchiya-Ito
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Dia Foundation for Research on Aging Societies, Tokyo, Japan
| | - Kazuaki Uda
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chie Teramoto
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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Zhang L, Ma L, Sun F, Tang Z, Chan P. A Multicenter Study of Multimorbidity in Older Adult Inpatients in China. J Nutr Health Aging 2020; 24:269-276. [PMID: 32115607 PMCID: PMC7026204 DOI: 10.1007/s12603-020-1311-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Multimorbidity is common in older hospitalized adults. To date, however, few studies have addressed multimorbidity in the older population of Chinese inpatients. We aimed to investigate the multimorbidity rate and associated risk factors in older adult inpatients in China. DESIGN, SETTING, PARTICIPANTS This study was conducted in the medical wards of a tertiary-care hospital from. The patients were recruited aged between 60 to 101 (74.14±8.46) years. MEASUREMENTS Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011-2012 in China. A total of 4,633 inpatients older than 60 years was recruited from 12 hospitals in 7 cities throughout China. The prevalence of comorbidity, distribution of common chronic diseases, and the associated risk factors were studied. RESULTS A total of 4,348 people aged 60 to 101 (74.14±8.46) years completed questionnaires. The average frequency of multimorbidity was 69.3% (95% CI, 67.9% to 70.6%). The prevalence of multimorbidity increased with age and was higher in men (71.6%; 95% CI, 69.9% to 73.3%) than in women (65.3%, 95% CI 63.0% to 67.6%), and higher in the northern region (71.7%, 95% CI 69.9% to 73.5%) than in the southern region (66.0%; 95% CI, 63.8% to 68.1%). The most frequent chronic diseases were hypertension, coronary heart disease, diabetes, cataract, and stroke. Area (OR=0.556; 95% CI, 0.465 to 0.666), region (OR=0.834; 95% CI, 0.723 to 0.962), body mass index (BMI) (OR=1.124; 95% CI, 1.017 to 1.242), and impairment of activities of daily living (OR=0.911; 95% CI, 0.855 to 0.970) were independent factors associated with multimorbidity. CONCLUSIONS Multimorbidity is common in older Chinese inpatients with a national prevalence of 69.3% that increases in line with age. Age, region, area, BMI, and daily activities were independent factors significantly associated with multimorbidity in older inpatients. Clinicians should therefore focus more attention on multimorbidity.
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Affiliation(s)
- L Zhang
- Piu Chan, MD, Department of Neurobiology, Xuanwu Hospital of Capital MedicalUniversity, Beijing 100053, China. . Zhe Tang, MD, Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Li H, Yu G, Dong C, Jia Z, An J, Duan H, Shu Q. PedMap: a pediatric diseases map generated from clinical big data from Hangzhou, China. Sci Rep 2019; 9:17867. [PMID: 31780760 PMCID: PMC6883068 DOI: 10.1038/s41598-019-54439-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Epidemiological knowledge of pediatric diseases may improve professionals' understanding of the pathophysiology of and risk factors for diseases and is also crucial for decision making related to workforce and resource planning in pediatric departments. In this study, a pediatric disease epidemiology knowledgebase called PedMap (http://pedmap.nbscn.org) was constructed from the clinical data from 5 447 202 outpatient visits of 2 189 868 unique patients at a children's hospital (Hangzhou, China) from 2013 to 2016. The top 100 most-reported pediatric diseases were identified and visualized. These common pediatric diseases were clustered into 4 age groups and 4 seasons. The prevalence, age distribution and co-occurrence diseases for each disease were also visualized. Furthermore, an online prediction tool based on Gaussian regression models was developed to predict pediatric disease incidence based on weather information. PedMap is the first comprehensive epidemiological resource to show the full view of age-related, seasonal, climate-related variations in and co-occurrence patterns of pediatric diseases.
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Affiliation(s)
- Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
| | - Gang Yu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Cong Dong
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Zheng Jia
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jiye An
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
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Xu SN, Chen X, Sun YT, Li GX. Peptic ulcer complicated with hypertension: Diagnosis, treatment, and changes in immunologic function. Shijie Huaren Xiaohua Zazhi 2019; 27:1095-1099. [DOI: 10.11569/wcjd.v27.i17.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Peptic ulcer (PU) and hypertension, known as two clinically common diseases, often develop simultaneously. This paper introduces the status quo of the diagnosis and treatment of hypertensive patients with PU, and also expounds the progress in the understanding of the changes in the mucosal immune function and cellular immune function, with an aim to shed some light on the clinical diagnosis and treatment of PU with hypertension.
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Affiliation(s)
- Si-Nan Xu
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Xin Chen
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Yi-Tian Sun
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Guo-Xiong Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
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50
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Association of physical performance and self-rated health with multimorbidity among older adults: Results from a nationwide survey in Japan. Arch Gerontol Geriatr 2019; 84:103904. [PMID: 31302504 DOI: 10.1016/j.archger.2019.103904] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine the association of physical performance measures and self-rated health with multimorbidity among older Japanese adults aged ≥60 years using cross-sectional data from a nationwide longitudinal survey. METHODS Using respondents' self-reported data from the 2012 National Survey of the Japanese Elderly, we analyzed multimorbidity involving nine major chronic diseases (heart disease, arthralgia, hypertension, diabetes, stroke, cataract, cancer, respiratory disease, and low back pain). Respondents who reported having two or more of these diseases were identified as having multimorbidity. Multivariate logistic regression analysis was used to examine if physical performance (grip strength and walking speed) and self-rated health were independently associated with multimorbidity after adjusting for potential confounders (e.g., demographic, physiological, and lifestyle-related variables). RESULTS The responses of 2525 participants who responded to the survey by themselves (i.e., without proxies) were analyzed (response rate: 57.9%). Among the chronic diseases examined, hypertension had the highest prevalence (44.1%), followed by low back pain (25.7%) and cataract (24.7%). Approximately 44.4% of the respondents had multimorbidity. The regression analysis revealed that multimorbidity was significantly associated with both poor grip strength (P = 0.006) and self-rated health (P < 0.001), but not with walking speed (P = 0.479). CONCLUSIONS Multimorbidity is prevalent in older Japanese adults, and poor grip strength and self-rated health were independently and significantly associated with multimorbidity. Health assessments that include these indicators may provide insight into the health status patterns of older adults with multimorbidity and inform the development of health management strategies.
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