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Background: The specific dimensions of learners that have been impacted by educational programs related to social determinants of health (SDoH) remain unknown. This study aims to elucidate how learners are affected by postgraduate education (a single 90‐min educational session) regarding tool‐guided clinical assessment of patients' social backgrounds. Methods: A pretest‐posttest design was utilized in which residents (postgraduate year (PGY) 1 or 2) and fellows in family medicine (PGY over 3) were recruited. Likert‐type questions were developed based on previous qualitative findings. Participants answered these questions before, immediately after, and 1.5 months after the educational session on tool‐guided clinical SDoH assessment. Paired‐sample t‐tests were used, and effect size was measured using Cohen's d. Results: A total of 114 residents and fellows participated. After the session, participants expressed more interest in knowing their patients' social backgrounds when considering how to address their patients and were more open to embracing a pre‐established assessment framework. Participants also considered clinical skills related to SDoH as learnable and improved their attitude toward patients. They reported that they did not perform specific interventions related to SDoH within 1.5 months after the session. Unlike previous qualitative findings, their concern about the implementation of SDoH‐related practices did not increase significantly. Conclusion: An educational session on tool‐guided SDoH assessment may have a positive impact on learners' attitudes related to addressing patients' social backgrounds without fostering concerns. [ABSTRACT FROM AUTHOR]

Background: Although nurses are expected to address the social determinants of health (SDH) in clinical settings, the perspectives of front‐line nurses on the integration of SDH into their clinical practice remain unclear. Understanding the dynamism of this integration and its outcomes can yield crucial insights into effective nursing care. This study aims to elucidate the integration and adoption of tool‐based SDH assessment nursing programs and their impacts on daily nursing care. Methods: We conducted qualitative research at a small community‐based hospital in Japan, where a tool‐based program characterized by social background interviews and documentation was implemented. Nurses at the hospital were recruited via purposive and snowball sampling. After hypothesis generation, semi‐constructed in‐depth online interviews were conducted. Each interview lasted between 30 and 50 min. The data were analyzed via thematic analysis using the framework approach. Results: A total of 16 nurses participated. Participants' incorporation of the novel SDH assessment program was bolstered by prior learning and their recognition of its practical value. Institutional support and collaborative teamwork further facilitated the adoption of this innovation. Enhanced knowledge about the social contexts of their patients contributed to increased respect, empathy, and self‐affirmation among participants, consequently enhancing the quality of nursing care. Conclusion: Through team‐based learning, reflection, and support, nurses can integrate a tool‐based SDH assessment program into their daily nursing practice. This program has the potential to empower nurses to deliver more holistic care and redefine their professional identity. Further research is warranted to assess patient‐reported outcomes. [ABSTRACT FROM AUTHOR]

Introduction: An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) Methods: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications. Results: Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient–physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care. Discussion: This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication–Practice–Maintenance–Advocacy framework could affect medical education, quality of patient care, and patient outcomes. This study illustrates a means of improving curricula by showing the Communication‐Practice‐Maintenance‐Advocacy (CPMA) framework to be useful for incorporating social determinants of health into healthcare to enhance education. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID‐19) has substantially affected the health and lives of medical professionals. However, the experiences of nurses engaged in primary care remain unclear. We explored how nurses working in primary care were psychologically and socially affected by the COVID‐19 disaster and how they overcame the difficulties experienced. Methods: We conducted a qualitative study of seven Japanese nurses working in primary care. Data collection was performed before, during, and after a workshop based on the Tojisha‐Kenkyu (user‐led research) framework to explore how the COVID‐19 disaster affected the nurses and how they coped. Data were analyzed using inductive thematic analysis. Results: Three themes emerged from the analysis: effects of the COVID‐19 disaster on nurses, nurses' newly found strength during the pandemic, and their changes and achievements through the Tojisha‐Kenkyu framework. The first theme comprised four subthemes: fear of the unknown; difficulty in adaptation; dysfunction in patient care; and defilement and oppression. The second theme involved feeling in control and professionalism. The third theme, which was based on participants' discovery of "same and different" fellowships, showed work reconstruction and self‐understanding, which alleviated their difficulties. Conclusions: The effect of the pandemic on nurses working in primary care ranges from work‐related frustration to daily life issues. The Tojisha‐Kenkyu method can help nurses to alleviate difficulties. Further research should be conducted to elucidate the constant burden on primary care professionals and establish appropriate occupational and daily life support during pandemics. [ABSTRACT FROM AUTHOR]

Background: Educating healthcare professionals about the social determinants of health is important in improving health outcomes of marginalized patients. Residents' experience of learning about the social determinants of health and a clinical assessment tool remains unclear. Methods: Residents participated in an online session about the social determinants of health and the assessment tool. Using the New World Kirkpatrick Model, we obtained data about participants' experience from various perspectives. The data were analyzed using a concurrent triangulation mixed‐methods design. Results: The study included 20 out of 30 residents. Their response was good, and self‐reported learning scores were increased by the session. They learned when to ask about patients' social conditions, what to ask, and how to coordinate medical care appropriately. Participants reported reflecting on their role as medical professionals and implementing new practices based on their learning, as well as concerns about addressing patients' social conditions. Conclusion: Through learning about the social determinants of health, and assessment tools, residents both acquired knowledge and skills, and reflected on their previous practice, accepted patients as they are, understood difficult patients better, and developed interprofessional collaboration. Medical education about the social determinants of health can trigger changes in residents' views. [ABSTRACT FROM AUTHOR]

Aim In 2005, the Japan Geriatrics Society published a list of potentially inappropriate medication that was an extract from the 'Guidelines for medical treatment and its safety in the elderly 2005.' The 2005 guidelines are due for a revision, and a new comprehensive list of potentially inappropriate medications is required. Methods A total of 15 diseases, conditions and special areas related to their clinical care were selected. We originated clinical questions and keywords for these 15 areas, carried out a systematic review using these search criteria, and formulated guidelines applying the Grading of Recommendations Assessment, Development and Evaluation system advocated by Minds2014. If we did not find good evidence despite the drug being clinically important, we looked for evidence of efficacy and for disease-specific guidelines, and incorporated them into our guidelines. Results We selected 2098 articles (140 articles per area), and extracted another 186 articles through a manual search. We further added guidelines based on disease entity and made two lists, one of 'drugs to be prescribed with special caution' and the other of 'drugs to consider starting,' primarily considering individuals aged 75 years or older or those who are frail or in need of special care. Conclusions New lists of potentially inappropriate medications and potential prescribing omissions called 'Screening Tool for Older Person's Appropriate Prescriptions for Japanese' were constructed. We anticipate that future studies will highlight more evidence regarding the safety of high-quality drugs, further improving the provision of appropriate medical care for the elderly. Geriatr Gerontol Int 2016: 16: 983-1001. [ABSTRACT FROM AUTHOR]

Aim To investigate the relationship between physical function, mortality and autonomic nervous activity measured by heart rate variability of elderly in long-term care. Methods Cross-sectional and longitudinal studies were carried out at hospitals and health service facilities for the elderly in Nagano prefecture, Japan, from July 2007 to March 2011. A total of 105 long-term care older adults and 17 control older adults with independent physical function were included. The Functional Independence Measure ( FIM) and Barthel Index were determined as indices of physical function. Twenty-four-hour Holter monitoring was carried out. From RR intervals in electrocardiograms, heart rate and standard deviations of all NN intervals in all 5-min segments of the entire recording, power spectral density, low frequency, high frequency and low frequency/high frequency ( LF/ HF) were calculated. Results FIM score and Barthel Index were 46 ± 26 and 30 ± 31, respectively, in long-term care elderly. FIM and Barthel index were significantly correlated with heart rate and the standard deviations of all NN intervals after adjustment for age, sex, cardiovascular risk factors and FIM. Furthermore, LF/ HF was significantly decreased in long-term care elderly compared with control elderly after adjustment for covariates. In addition, decrease in LF/ HF was an independent risk factor for mortality. Conclusion Low LF/ HF activity was observed in long-term care elderly and was related to an increase of overall mortality. Geriatr Gerontol Int 2014; 14: 159-166. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictors of falls, such as comorbidity and medication, in geriatric outpatients in a longitudinal observational study. Methods: A total of 172 outpatients (45 men and 126 women, mean age 76.9 ± 7.0 years) were evaluated. Physical examination, clinical history and medication profile were obtained from each patient at baseline. These patients were followed for up to 2 years and falls were self-reported to their physicians. The factors associated with falls were analyzed statistically. Results: A total of 32 patients experienced falls within 2 years. On univariate analysis, older age, osteoporosis, number of comorbid conditions and number of drugs were significantly associated with falls within 2 years. On multiple logistic regression analysis, the number of drugs was associated with falls, independent of age, sex, number of comorbid conditions and other factors that were significantly associated in univariate analysis. A receiver-operator curve evaluating the optimal cut-off value for the number of drugs showed that taking five or more drugs was a significant risk. Conclusion: In geriatric outpatients, polypharmacy is associated with falls. Intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidity and falls. Geriatr Gerontol Int 2012; 12: 425-430. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of fall risk with comorbidities and medications in geriatric outpatients in a cross-sectional design. Methods: A total of 262 outpatients (84 men and 178 women, mean age 76.2 ± 6.8 years) were evaluated. Physical examination, clinical histories and medication profile were obtained from each patient. History of falls in the past year, 22-item fall risk index, 13-point simple screening test for fall, and time interval of one-leg standing test were examined as markers of fall risk. Results: On univariate analysis, older age, female sex, hypertension, osteoporosis, history of stroke, number of comorbidities, use of antihypertensives, aspirin, bisphosphonates, hypnotics and number of prescribed drugs were significantly associated with either of four indices. On multiple regression analysis, the number of drugs was associated with all of the four indices, independent of other factors associated in the univariate analysis. The association of number of drugs with fall risk indices was stepwise. Conclusion: In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk. Prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. Geriatr Gerontol Int 2011; 11: 438-444. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the relationship between visceral fat area (VFA) evaluated using computed tomography (CT) scans and the number of metabolic risk factors in older adults. DESIGN: Cross-sectional study SETTING: A community clinic in Tokyo, Japan. PARTICIPANTS: Two hundred eighteen individuals aged 65 and older without impairments in activities of daily living who underwent geriatric health examination (63 men, mean age 74.5 ± 7.1; 155 women, mean age 75.3 ± 6.7). MEASUREMENTS: VFA was obtained from a cross-sectional image at umbilical level in the supine position using CT scanning. Metabolic syndrome components except waist circumference were measured using the criteria of the International Diabetes Federation. RESULTS: There was a positive correlation between VFA and number of metabolic risk factors in men and women. Multiple regression analysis demonstrated that only VFA was significantly correlated with number of risk factors in men, whereas age and VFA were significantly correlated in women; body mass index was not correlated with number of metabolic risk factors in men or women. Dyslipidemia and high blood glucose were associated with higher VFA, but high blood pressure was not. There was a negative correlation between VFA and serum adiponectin level and a positive correlation between VFA and homeostasis model assessment of insulin resistance. CONCLUSION: Visceral fat accumulation is associated with metabolic risk factor clustering even in the elderly population. These results have clinical implications for the management of obesity in older adults. [ABSTRACT FROM AUTHOR]

Aim: We aimed to determine whether plasma sex hormone levels are associated with activities of daily living (ADL), cognition, depression and vitality in elderly individuals with functional decline. Methods: Two hundred and eight consecutive persons 70 years or older (108 men and 100 women; mean ± standard deviation, 81 ± 7 years) with a chronic stable condition, receiving long-term care at a long-term care facilities located in Nagano Prefecture, Japan, were enrolled. Plasma total testosterone, free testosterone (only in men), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S) and estradiol levels were determined in the morning after an overnight fast. Comprehensive geriatric assessment was performed including basic ADL by Barthel Index, instrumental ADL, cognitive function by Hasegawa Dementia Scale – Revised, mood by Geriatric Depression Scale and ADL-related vitality by Vitality Index. Results: Simple regression analysis showed that, in men, plasma total and free testosterone levels were associated with basic ADL ( R = 0.292 and R = 0.282), instrumental ADL ( R = 0.261 and R = 0.408), cognitive function ( R = 0.393 and R = 0.553) and vitality ( R = 0.246 and R = 0.396), while DHEA(-S) was associated with cognitive function, and estradiol with cognitive function as well as vitality. In women, the only significant correlation was between DHEA(-S) and basic ADL. Adjustment for age and nutritional markers did not influence the associations of plasma sex hormone levels with functional scores except for that of free testosterone with Barthel Index. Conclusion: These results suggest that sex hormones have sex-specific associations with physical and neuropsychiatric functions in elderly individuals, and that endogenous testosterone is related to global function in elderly men. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with the pulmonary features of being underweight in older men.

The article presents a letter to the editor on a case of a transient heart failure that occurred in an elderly woman after a fall.

A letter to the editor is presented which is concerned with a case study of a patient with large B-cell lymphoma who had symptoms which resembled progressive dementia.

A letter to the editor is presented in which the authors discuss their study conducted to examine the association of admission due to gastrointestinal hemorrhage with the use of antithrombotic drugs or aspirin among older patients.

A letter to the editor is presented wherein the authors discuss a study which was conducted to study adverse drug reactions (ADR) in elderly patients taking six or more drugs by using the inpatient database of a geriatric department.

A letter to the editor is presented which is concerned with research which investigated the factors associated with prolonged hospital stays in a geriatric ward in a university hospital in Japan.

A letter to the editor is presented which is concerned with sleep apnea in patients with metabolic syndrome.

A letter to the editor regarding nocturia in older people with hypertension is presented.