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Background: This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity., Design: Retrospective, observational, longitudinal study., Setting: Acute phase hospitals., Participants: From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0-3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8-60 days., Main Outcome Measures: The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation., Results: Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke., Conclusions: These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

Aims: This study aimed to investigate the differences in the prognosis of older patients who received home care or hospitalized care to treat acute fever in Japan. Methods: This prospective case–control study screened 192 registered acutely pyrexic older patients who received home care at 10 medical institutions in Japan, and enrolled 15 and 30 patients who were treated in the hospital (hospitalized group) and at home (home‐care group), respectively, matched for fever and the physical conditions before fever onset. Intergroup differences in the 90‐day mortality from fever onset and changes in patients' disability and dementia from the pre‐fever to 90 days post‐fever onset were determined. Results: No significant intergroup difference in the 90‐day mortality rate was detected (26.7% vs 13.3% for hospitalized and home‐care groups, respectively, P = 0.41). Disability tended to worsen in the hospitalized group compared with the home‐care group (54.5% vs 23.1%, respectively, P = 0.06), whereas dementia significantly worsened in the hospitalized group compared with the home‐care group (45.5% vs 3.8%, respectively, P = 0.02). Conclusions: Home care confers a better prognosis for treating acute fever in older people whose daily functions have deteriorated enough to necessitate regular home care. This study assists those people in making informed choices about where to receive treatment for acute fever. Geriatr Gerontol Int 2023; 23: 355–361. [ABSTRACT FROM AUTHOR]

Aim: To examine whether the outcomes of fever treatment through home care differ from those through hospitalized care for older people who regularly receive home care in Japan. Methods: A retrospective survey of medical record‐based data for 679 older people who regularly received home care provided by a clinic in Japan. From these data, 61 fever cases (21 cases treated in the hospital and 40 treated at home and assigned to the hospitalized and home‐care groups, respectively) were selected for analysis through a matching process. We compared the two groups in terms of mortality rate at 90 days after fever onset, and concerning changes in respective ranks for "Degree of Independent Living for the Elderly with Disability" and "Degree of Independent Living for the Elderly with Dementia" from immediately before fever onset to 90 days after fever onset. Results: The mortality rate tended to be higher in the hospitalized group than in the home‐care group (33% vs. 13%, respectively, P = 0.05). The hospitalized group also had a higher proportion of patients whose disability had worsened (43% vs. 23%, respectively, P = 0.16) and a significantly higher proportion of patients whose dementia had worsened (29% vs. 6%, respectively, P = 0.03). Conclusions: Our findings suggest that home care is more effective than hospitalized care for treating fever in older people who regularly receive home care in Japan, as it leads to lower mortality and better maintenance of activities of daily living capabilities. Geriatr Gerontol Int 2020; 20: 482–487. [ABSTRACT FROM AUTHOR]

Objective To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. Design Retrospective, observational, propensity score (PS)–matched case-control study. Setting General hospitals. Participants Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no–self-exercise program groups. Intervention Self-exercise program participation. Main Outcome Measures At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value − admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no–high efficiency), and mRS score. Results Patients were classified into a self-exercise program (n=780) or a no–self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no–high efficiency) of 2.2 (95% confidence ratio, 1.75–2.70). Conclusions SEPs may contribute to improving ADL. [ABSTRACT FROM AUTHOR]

During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population 65 years of age and above to ∼28%. This study aimed to examine the changes in major health-related measures, including a physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, this study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, body mass index, walking speed, grip strength, and instrumental activity of daily living, between 2007 (±2 years) and 2017 (±2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of this study indicate that the phenomenon of "rejuvenation" is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be reacknowledged. [ABSTRACT FROM AUTHOR]