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Aim Methods Results Conclusions As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors.We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long‐term‐care (LTC) resources, adjusted for the older adult population; proportion of single‐person households; and regional factors. We performed a multivariate negative binomial distribution analysis.A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home‐visit rates. Beds in LTC welfare facilities (coefficient, −0.10 [95% CI, −0.19 to −0.01]) and beds in LTC health facilities (coefficient, −0.09 [95% CI, −0.17 to 0.00]) were negatively associated.Policies to promote home health care have led to high home‐visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has markedly affected end‐of‐life care, notably increasing home deaths among cancer patients in Japan. This study investigated the characteristics of cancer patients who died at home during the pandemic and the associated factors before and during the pandemic. Methods: Vital statistics from January 2015 to December 2022 were analyzed to evaluate trends in home deaths among cancer patients aged 0 to 113 years, pre‐pandemic (January 2015 to March 2020) and during the pandemic (April 2020 to December 2022). Home deaths were assessed by demographics, including age, sex, marital status, and residential location. Multivariable modified Poisson regression analyses were performed to identify factors associated with home deaths in both periods. Results: Among 3,010,374 individuals, 11.6% (226,571/1,959,304) and 20.8% (218,429/1,051,070) died at home before and during the pandemic, respectively. In subgroup analysis depicting the trend of in‐home deaths by patient characteristics, only the age group showed a differential trend: the proportion of in‐home deaths was higher among older people before the pandemic, whereas it was higher among younger people during the pandemic. The multivariable analysis revealed the excess risk of in‐home deaths among people aged ≥65 years before the pandemic and among those aged <65 years during the pandemic. Conclusions: The pandemic has increased home‐based end‐of‐life care for terminal cancer patients, particularly younger individuals, possibly due to hospital visit restrictions. Ensuring sufficient resources for both home and hospital care is vital to allow individuals to receive end‐of‐life care in their preferred settings. [ABSTRACT FROM AUTHOR]

Aim: In Japan's public health system, dentists can assess and intervene in oral hypofunction cases. However, the associations between oral hypofunction and health outcomes and costs remain unclear. This study aimed to identify these associations. Methods: This retrospective cohort study using a Japanese health insurance claims database included 45 916 individuals aged ≥65 years who underwent dental examinations for oral hypofunction. The primary outcomes were incidence rates of aspiration pneumonia, femoral or vertebral fractures and all‐cause mortality. Secondary outcomes were annual medical and dental costs. We used competing risk regression and Cox models to estimate primary outcomes, and gamma regression models for secondary outcomes. Results: The adjusted hazard ratios were 0.84 (95% CI 0.74–0.96) for the incidence of aspiration pneumonia, 1.11 (1.02–1.21) for the incidence of femoral or vertebral fractures and 1.27 (1.07–1.50) for all‐cause mortality in individuals with oral hypofunction compared with those without. The adjusted relative risk was 1.05 (1.01–1.10) for annual medical costs and 0.94 (0.81–1.09) for annual dental costs in individuals with oral hypofunction compared with those without. Conclusions: Individuals with oral hypofunction were at increased risk of femoral or vertebral fractures and all‐cause mortality, and they incurred significantly higher annual medical costs, compared with those without this condition. Notably, they showed a lower risk of aspiration pneumonia, suggesting potential benefits of dental intervention. Integrating dental care into medical strategies might be necessary to improve health outcomes and reduce healthcare costs for those with oral hypofunction. Geriatr Gerontol Int 2024; 24: 1053–1059. [ABSTRACT FROM AUTHOR]

Background: To meet the increasing demand for home healthcare in Japan, as part of the national healthcare system, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012 respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24‐h home care services through the end of life. Methods: A retrospective cohort study was conducted using the national database in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, or enhanced HCSCs. Each patient was followed up for 6 months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end‐of‐life care defined as in‐home death. Multivariable logistic regression analyses were performed for statistical analysis. Results: The analysis included 160,674 patients, including 13,477, 64,616, and 82,581 patients receiving regular home visits by general clinics, conventional HCSCs, and enhanced HCSCs respectively. Compared to general clinics, the use of conventional and enhanced HCSCs was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56–1.69] and 1.86 [1.79–1.93], respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82–0.90] and 0.88 [0.84–0.92] respectively). Among 39,082 patients who died during the follow‐up period, conventional and enhanced HCSCs had more in‐home deaths (aOR [95% CIs] of 1.46 [1.33–1.59] and 1.60 [1.46–1.74], respectively) compared to general clinics. Conclusions: HCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting that further promotion of HCSCs (especially enhanced HSCSs) would be advantageous. [ABSTRACT FROM AUTHOR]

Aims/Introduction: We aimed to examine the proportion of subsequent clinic visits for persons screened as having hyperglycemia based on glycated hemoglobin (HbA1c) levels at screening and the presence/absence of hyperglycemia at health checkups before 1 year of the screening among those without previous diabetes‐related medical care and attending regular clinic visits. Materials and methods: This retrospective cohort study used the 2016–2020 data of Japanese health checkups and claims. The study analyzed 8,834 adult beneficiaries aged 20–59 years without regular clinic visits who had never received diabetes‐related medical care and whose recent health checkups showed hyperglycemia. The rates of 6‐month subsequent clinic visits after health checkups were evaluated according to HbA1c levels and the presence/absence of hyperglycemia at checkups a year before. Results: The overall clinic visit rate was 21.0%. The HbA1c‐specific rates were 17.0, 26.7, 25.4 and 28.4% for <7.0, 7.0–7.4, 7.5–7.9 and ≥8.0% (64 mmol/mol), respectively. Persons with hyperglycemia at a previous screening had lower clinic visit rates than those without hyperglycemia, particularly in the HbA1c category of <7.0% (14.4% vs 18.5%; P < 0.001) and 7.0–7.4% (23.6% vs 35.1%; P < 0.001). Conclusions: The overall rate of subsequent clinic visits among those without previous regular clinic visits was <30%, including for participants with HbA1c ≥8.0%. Persons with previously detected hyperglycemia had lower clinic visit rates, despite requiring more health counseling. Our findings might be useful for designing a tailored approach to encourage high‐risk individuals to seek diabetes care through clinic visits. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have shown temporal trends in the number of gastrostomies until 2016, but the recent trend is yet to be analyzed. This study aimed to evaluate temporal trends in gastrostomy (mostly percutaneous endoscopic gastrostomy) in older adults in Japan in more recent years. Methods: We extracted data on the numbers of gastrostomies and swallowing function assessment prior to gastrostomy, using the national aggregated open data (NDB Open Data) from 2014 to 2019. Results: Adults in their 80s accounted for the largest portion of gastrostomy during the study period. A decreasing trend in the total number of gastrostomy was observed in older adults from 2014 to 2016, but became almost stable thereafter (57 103 in 2014, 47 228 in 2016, and 47 944 in 2019). The age group‐stratified numbers of gastrostomy per 100 000 individuals decreased by −33.9% (≥90 years group) to −6.1% (65–69 years group) from 2014 to 2019. The implementation rate of the swallowing function assessment remained relatively low, despite a slight increase (21.4% in 2015 to 23.7% in 2019). Conclusion: We showed that the total number of gastrostomies remained almost stable after 2016 despite population aging. We considered that the avoidance of gastrostomy in frail or disabled older adults might explain the decrease, particularly for those aged over 80 years. Our findings would regain attention to appropriate decision‐making for gastrostomy. Geriatr Gerontol Int 2022; 22: 648–652. [ABSTRACT FROM AUTHOR]

The article investigate the prescription trends of Ninjin'yoeito (NYT), a traditional Japanese medicine, for older adults in Japan. It aims to analyze the growth rates of NYT prescriptions compared to other Kampo medicines (traditional herbal medicines). It further highlights that NYT has shown potential usefulness in treating muscle weakness, frailty, neuropsychiatric symptoms, and cognitive function in frail patients with Alzheimer's disease.

Aim: Obesity is reported to be a risk factor for Clostridioides difficile infection. However, obesity rarely occurs in older Asian patients, and the effects of obesity on health and disease are different in Asian and Western countries. This study aimed to assess the association between body mass index and C. difficile infection risk among older patients with pneumonia in Japan. Methods: This retrospective observational cohort study used data from the nationwide database of acute hospital inpatients' data in Japan between July 2014 and March 2016. All patients aged ≥65 years admitted with a primary diagnosis of pneumonia were enrolled. Risk factors for C. difficile infection were determined by logistic regression analysis, including known risks as covariates. Results: Among 221 242 pneumonia patients, 611 developed C. difficile infection. Underweight patients (body mass index <18.5 kg/m2) showed higher odds for C. difficile infection (odds ratio 1.38, 95% confidence interval 1.17–1.62, P < 0.001) than normal weight patients (body mass index 18.5–24.9 kg/m2), whereas overweight patients (body mass index ≥25 kg/m2) showed lower odds (odds ratio 0.63, 95% confidence interval 0.45–0.89, P < 0.01). Conclusions: Body mass index was associated with C. difficile infection in older pneumonia patients in Japan. Underweight was a risk factor, whereas overweight was a protective factor for C. difficile infection. Geriatr Gerontol Int 2022; 22: 63–67. [ABSTRACT FROM AUTHOR]

Aim: Family caregivers can experience psychological distress, resulting in physical and mental health problems, and discontinuation of caregiving. This study's objective was to examine factors associated with caregiver psychological distress. Methods: We analyzed data from the Comprehensive Survey of Living Conditions in 2007, 2010, 2013 and 2016, which included 12 504 pairs of caregivers and care recipients sharing a household in Japan. Kessler's Psychological Distress Scale (K6) was used to measure caregiver psychological distress. Multivariable logistic regression analyses identified factors associated with caregiver psychological distress (K6 score ≥5). Results: Caregivers' median K6 score was 3 (interquartile range 0–7), and 38.6% had a K6 score ≥5. K6 scores ≥5 were positively associated with female sex (adjusted odds ratio 1.35, 95% CI 1.21–1.51), poor caregiver health status (compared with "very good," 9.48, 95% CI 7.91–11.37 for "not very good/poor"), longer care time (compared with "help only when needed," 1.40, 95% CI 1.25–1.58 for "almost all day") and dementia (1.16, 95% CI 1.05–1.28), lower respiratory tract disease (1.25, 95% CI 1.06–1.49) and diabetes (1.16, 95% CI 1.00–1.33) in care recipients. K6 scores ≥5 were negatively associated with older caregiver age (compared with 20–54 years, 0.65, 95%CI 0.58–0.74 for 55–64 years, 0.54, 95%CI 0.46–0.63 for 65–74 years and 0.50, 95% CI 0.40–0.62 for ≥75 years), employment (0.88, 95% CI 0.80–0.97) and being a care recipient's child‐in‐law (compared with spouse 0.75, 95% CI 0.61–0.92). Conclusions: The findings identified several factors associated with caregiver psychological distress, showing that particular attention might need to be paid to caregivers with these risk factors. Geriatr Gerontol Int 2021; 21: 855–864. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate drug costs per resident at Japanese intermediate care facilities for older adults (called Roken) in relation to drug utilization after admission to these facilities. The payment, including coverage of drugs, is mainly determined by the resident's long‐term care needs. Methods: A nationwide drug utilization survey was carried out. The participants were 1324 residents of 350 Roken (up to five individuals per facility) who were admitted in 2015 and agreed to participate in this study. Drug costs per resident per month at admission and 2 months later were calculated for drugs prescribed for regular use. Associations between characteristics of the residents and drug costs were examined. Results: A wide variation in drug costs with a long right tail was observed. Median drug costs were $77 (interquartile range $34–147) at admission, and $46 (interquartile range $19–98) in month 2. There was no apparent association between the level of long‐term care needs and drug costs, adjusting for sex, age and main place of residence before admission. Anti‐dementia drugs accounted for the largest portion of total drug costs at admission (15.4%) and in month 2 (12.4%). The average drug cost per user was also the highest for anti‐dementia drugs ($90.2 per user per month), followed by drugs for Parkinson's disease ($70.3). The proportion of generic drugs across all drug classes examined increased after admission. Conclusions: These findings might suggest that implementation of the bundled payment scheme would be effective for the reduction of medication costs in institutional long‐term care. Geriatr Gerontol Int 2019; 19: 667–672. [ABSTRACT FROM AUTHOR]

Objectives: Antipsychotics are used to manage the behavioral and psychological symptoms of dementia (BPSD), despite their association with greater risks for mortality and cerebrovascular events. Previous studies in Japan have estimated the prevalence of antipsychotics among older adults who took antidementia drugs. Using long-term care (LTC) data, we aimed to obtain more accurate estimates of the prevalence of antipsychotics and to determine factors related to their use in older adults with dementia.Methods: Medical and LTC claims data and LTC certification data between April 2012 and September 2013 were obtained from a middle-sized suburban city. The 1-year prevalence of antipsychotic use was estimated among individuals with probable dementia aged greater than or equal to 75 years who were prescribed antidementia drugs and/or had dementia based on LTC needs certification data.Results: Of 25 919 participants, 4865 had probable dementia and 1506 were prescribed antidementia drugs. The prevalence of antipsychotics among participants with probable dementia was 10.7%, which was lower than that in those who were prescribed antidementia drugs (16.4%). Among participants with probable dementia with LTC certification data available (N = 4419), lower cognitive function (vs mild; adjusted odds ratio 2.16, 95% confidence interval 1.63-2.86), antidementia drug use (2.27, 1.84-2.81), and institutional LTC services use (2.34, 1.85-2.97) were associated with greater odds of antipsychotic use, whereas older age (greater than or equal to 92 years) was associated with lower odds (vs less than 77 years; 0.42, 0.27-0.65).Conclusions: These findings may be useful for estimating the burden of BPSD and for taking measures to reduce inappropriate antipsychotic prescription. [ABSTRACT FROM AUTHOR]

The article focuses on changes in use of high-priced new drugs and drug costs among residents of long-term care facilities under a bundled payment system. Topics include the Geriatric Health Services facilities in Japan follow has bundled payment system for most routine care services, the changes in medications and an associated reduction in drug costs after the admission of residents, resulting from the discontinuation of drugs and replacement of branded drugs with generic drugs.

Objectives: To assess the association between dementia and risk of hospital readmission and to evaluate whether the effect of dementia on hospital readmission varies according to primary diagnosis. Design: Retrospective cohort study. Setting: Nationwide discharge database of acute care hospitals in Japan. Participants: Individuals aged 65 and older diagnosed with one of the 30 most common diagnoses and discharged from 987 hospitals between April 2014 and September 2015 (N = 1,834,378). Measurements: The primary outcome was unplanned hospital readmission within 30 days. Poisson generalized estimating equation models were fitted to assess the risks of readmission for individuals with and without dementia, using primary diagnosis as a possible effect modifier and clinical factors as potential confounders. Results: The overall prevalence of dementia was 14.7% and varied according to primary diagnosis, ranging from 3.0% in individuals with prostate cancer to 69.4% in those with aspiration pneumonia. Overall, individuals with dementia had a higher risk of hospital readmission (8.3%) than those without (4.1%) (adjusted risk ratio (aRR])=1.46, 95% confidence interval (CI)=1.44–1.49), although diagnostic category substantially modified the relationship between dementia and hospital readmission. For hip fracture, dementia was associated with greater risk of hospital readmission (adjusted risk 11.5% vs 7.9%; aRR=1.46; 95% CI=1.28–1.68); this risk was attenuated for cholecystitis (adjusted risk 12.8% vs 12.4%; aRR=1.03; 95% CI=0.90–1.18). Conclusion: Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted by the author and colleagues on the effectiveness of using antidementia drugs. Topics discussed include calculation of the drug consumption along with the patient identification numbers, clinical trials of the population available, and its use in treating Alzheimer's disease as per the Japanese guideline.