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Aim: Multiple risk factors are involved in geriatric syndrome (GS) occurring in older adults. Although drug therapy often contributes to GS, the specific causes among older adults in Japan remain unclear. In this study, we examined the possible prescribing cascade rate among older outpatients eligible for Late‐stage Elderly Health Insurance and elucidated the differences between GS and GS associated with medication (GSAM) trends. Methods: This retrospective study enrolled patients from health insurance claims data in Japan between October 2018 and March 2019; hospitalized patients were excluded. Two groups were identified among the participants with GS: GS (no use of GS‐causing medications) and possible‐GSAM (p‐GSAM; use of GS‐causing medications). The collected data were analyzed using the Bell Curve for Excel, and statistical significance was set at P < 0.05. Results: In total, 137 781 outpatients were enrolled. Of the 32 259 outpatients who did not use GS‐causing medications, 7342 were classified into the GS group. Among 105 522 outpatients who used GS‐causing medications, 8347 were classified as having p‐GSAM. The mean number of prescriptions was significantly higher in the p‐GSAM group than in the GS group (P < 0.01). Furthermore, all GS symptoms showed significant differences, with impaired appetite being the most prevalent in the p‐GSAM group than in the GS group (P < 0.01). A possible prescribing cascade was suspected in 2826 (33.9%) of 8347 outpatients in the p‐GSAM group. Conclusion: Impaired appetite in patients taking GS‐causing medications might lead to prescribing cascades. Further studies are needed to prevent such prescribing cascades. Geriatr Gerontol Int 2024; 24: 61–67. [ABSTRACT FROM AUTHOR]

In current clinical practice, when a fall occurs in a long‐term care facility, it is often treated as an accident. Falls are classified as one of the most commonly prevalent geriatric syndromes. As their causes are extremely diverse and complex, their occurrence rate depends on individual susceptibility, even if appropriate fall prevention measures are taken. Falls are common among older adults, and fractures and intracranial hemorrhage resulting from falls can lead to the deterioration of activities of daily living and death. For this reason, it is recommended that the risk of falls is assessed in the general population of older adults, and that appropriate interventions are carried out for those at high risk. In response to this situation, the Japan Geriatrics Society and the Japan Association of Geriatric Health Services Facilities have issued the following statements on falls as a geriatric syndrome based on scientific evidence, especially considering the frequent occurrence of falls in long‐term care facilities. Geriatr Gerontol Int 2022; 22: 193–205. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether the frequency of eating together is associated with the incidence of functional disability in older adults who live alone., Methods: This 6-year observational prospective cohort study utilised self-reported questionnaires. Data were drawn from the participants of the Japan Gerontological Evaluation Study project between 2016 and 2022. The participants were independent older adults aged ≥65 years living alone in Japan. The primary outcome was the incidence of functional disability during the follow-up period, with the self-reported frequency of eating together serving as the explanatory variable. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models after adjusting for confounders associated with incident functional disability., Results: Among the 7167 participants, the mean age at baseline was 75.3 ± 6.5 years and 69.2% were female. About, 12.8% of participants (n = 917) developed functional disabilities during the observation period. The incidence rates were 11.7% for 'every day', 11.3% for 'several times a week', 11.5% for 'several times a month', 12.7% for 'several times a year' and 19.0% for 'seldom'. The frequency of eating together 'seldom' was significantly associated with an increased incidence of functional disability (HR: 1.55, 95% CI: 1.10-2.18)., Conclusion: Among older adults living alone, infrequent eating together ('seldom') was identified as a risk factor for developing functional disability., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: Although it is known that geriatric syndrome is associated with the development of frailty, it is not known whether an amelioration of geriatric syndrome also improves shared risk factors and frailty. Methods: In total, 67 community‐dwelling older people (79.6 ± 6.5 years, 49 women) participated in this study (41 were classified as pre‐frail and 26 as frail). We analyzed indices of physical frailty and cognitive depression, exercise tolerance and health‐related quality of life as frailty related indices, and the participants completed a questionnaire regarding common geriatric symptoms (cold extremities, leg edema, breathlessness, urinary incontinence, chronic headache, chronic pain, a sense of numbness, anorexia, constipation, insomnia and skin trouble) using numeric ratings. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study (J‐CHS) criteria. The participants then underwent a far‐infrared low‐temperature sauna (FILTS) program twice a week for 3 months and the above parameters were reassessed. Results: After the FILTS program, there were significant differences in usual walking speed, peak oxygen uptake, Geriatric Depression Scale‐15, health‐related quality of life and the severity of several geriatric symptoms. Of the 67 participants, 18 showed improvements in their J‐CHS frailty score, 47 showed no change and two showed reductions. Linear regression analysis showed that the change in the numeric rating of the coldness of extremities (B = −0.105, P = 0.013) and the cumulative numeric rating for geriatric syndromes (B = 0.044, P < 0.001) were independent determinants of the change in the J‐CHS score. Conclusions: A 3‐month FILTS program ameliorates geriatric syndrome, the severity of frailty and frailty related indices in older Japanese people. Geriatr Gerontol Int 2020; 20: 892–898. [ABSTRACT FROM AUTHOR]

• The link between physical activities and caregiving needs is studied. • The level and intensity of activities are focused in relation to social isolation. • This 5-year longitudinal observational study used a population-based study. • Regular daily steps, not intensity, were found to reduce incidence of disability. This study aimed to investigate association between objectively measured physical activities with incidence disability in older adults with and without social isolation. This 5-year longitudinal observational study used a population-based study from a sub-cohort of the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome. In Japan, Incident disability is defined as a new case of public insurance certification for long-term care. As participants, we enrolled 5,257 community-dwelling older adults aged ≥ 70 years. The Participants on whom incomplete baseline physical activity assessments were performed; who required long-term care; had a history of dementia, Parkinson's disease, stroke, or depression; who lacked independence in basic ADL; who had Mini-Mental State Examination scores; or who had missing measurements; were excluded. Thus, 2,071 participants were included. Of the participants, 1,183 non-socially isolated participants had 151 (4.3%) cases of disability, while socially isolated participants had 150 (13%) cases. Cox proportional-hazards regression analysis presented the adjusted hazard ratio (HR) and 95% confidence interval (95%CI) of daily steps and low-intensity and moderate-to-vigorous physical activities—0.62(0.43–0.89), 0.84(0.60–1.18), 0.62(0.43–0.89) in participants with social isolation, and 0.58(0.40–0.85), 0.86(0.60–1.24), 0.70(0.49–1.01) in those with social isolation. Daily steps were significantly associated with a decreased risk of incidence disability, regardless of social isolation. These results suggest the greater importance of daily physical activity than its specific intensity in socially isolated older adults. [ABSTRACT FROM AUTHOR]

Background: The symptoms of geriatric syndromes and the behavioural and psychological symptoms of dementia (BPSD), in addition to clinical conditions, are associated with hospital admission among dementia patients. However, the principal factors that necessitate hospital admission among dementia patients have not been fully elucidated. Methods: We retrospectively reviewed the data in the medical and autopsy reports of patients who had been treated at a hospital in Toyohashi, Japan. Each patient had been hospitalized sometime between 2012 and 2016 and underwent a brain autopsy. Dementia and the subtypes of dementia were diagnosed neuropathologically. Information about patients' general backgrounds, clinical conditions at the time of admission, and the geriatric syndrome symptoms and BPSD before admission was collected; comparisons were then made between patients with and without dementia and among those with the different major subtypes of dementia. Then, the factors relating to hospital admission of dementia patients were comprehensively evaluated by using principle component analysis. Results: Of the 128 eligible patients, 100 (78.1%) had dementia. In the comparison of patients with and without dementia, patients without dementia were younger at both admission (P = 0.034) and death (P = 0.003). Among the patients with dementia with Lewy bodies, delusions had a significantly high prevalence (P = 0.014). Principal component analysis identified nine components (disinhibition, irritability/lability, agitation/aggression, anxiety, delusions, sleep/night‐time behaviour disorders, hallucinations, aberrant motor behaviour, and speech impairment) as the principal factors related to hospital admission among dementia patients. Thus, BPSD were identified as principal factors. Conclusions: Compared to other factors, BPSD are more likely to cause dementia patients to be admitted to hospital. The present results indicate that measures should be taken to ameliorate the difficulties associated with caring for patients with BPSD at home. [ABSTRACT FROM AUTHOR]

Aim To identify whether individual physical performance measures or a combination of measures is a better indicator of multiple geriatric syndromes ( MGS) defined as the concomitant presence of more than one geriatric syndrome in an individual. Methods We carried out cross-sectional analyses on data from 340 community-dwelling women aged 75 years and older (mean 80.0 years). We examined the following geriatric syndromes: urinary incontinence, falls, underweight, depression and functional decline. Trained testers measured usual gait speed ( UGS), hand-grip strength and lower extremity performance ( LEP) score derived from four LEP measures: tandem stance, chair stand test, alternate step and timed up-and-go ( TUG). We categorized UGS to distinguish high- and low-performing participants using the established 1.0 m/s cut-off point. Applying the same population percentile (35.8%), we determined cut-off points for all individual measures and the LEP score. Results The UGS, TUG and LEP score had similar discriminating powers for MGS (each with area under receiver-operator curves [ AUC] of 0.80), which were more significant than the discriminating powers of other individual measures ( AUC = 0.69-0.76) when considered as continuous variables. A slow UGS, especially less than 1.0 m/s, was more strongly associated with MGS (odds ratio [ OR] = 7.6, 95% confidence interval [ CI] = 3.6-15.9) than the same percentiles for TUG ( OR = 3.9, 95% CI = 1.9-7.8) and LEP score ( OR = 5.2, 95% CI = 2.5-10.6). Conclusion The UGS test alone might be sufficient in detecting MGS in women aged 75 years and older compared with a more comprehensive test battery. Geriatr Gerontol Int 2013; 13: 901-910. [ABSTRACT FROM AUTHOR]

In Japan, the population aged 65 years and older exceeds 28% of the total population. Since the birth rate is also declining, aging of the population is likely to continue. According to a patient survey conducted by the Ministry of Health, Labour and Welfare in 2014, the number of outpatients aged ≥65 years was higher by approximately 1.8 million since the previous survey in 2011. Drug therapy for the elderly is, thus, a matter of rapidly growing importance. The older generation has poorer physiological functions than younger adults. Therefore they are more likely to experience variable efficacy of drugs administered. The incidence of adverse effects is known higher in elderly people, and multidrug regimens are often unavoidable, especially when patients have more than one disease. In elderly patients, chronic lifestyle-related diseases are usually associated with geriatric syndrome. Given these circumstances, the potential area to be covered by pharmacists is very broad, and they should be involved in drug treatment of elderly people from hospital to home. We therefore propose the establishment of a new scientific field of geriatric pharmacology. We will consider novel approaches to geriatric pharmacotherapy from the viewpoints of basic science and clinical practice, deliberating the role that pharmacists should play in the provision of polypharmacy in older patients.

Aim: To investigate factors associated with caregiver burden (CB) in persons caring for older adults with various cognitive stages of Alzheimer's disease (AD)., Methods: Participants were 1127 outpatients and their caregivers. Participants comprised 120 older adults with normal cognition (NC), 126 with amnestic mild cognitive impairment (aMCI) and 881 with AD. AD patients were subclassified into four groups by Mini-Mental State Examination (MMSE) score: AD29-24 (n = 117), AD23-18 (n = 423), AD17-12 (n = 254) and AD11-0 (n = 87). Participants and their caregivers underwent comprehensive geriatric assessment batteries including Zarit Burden Interview (ZBI) Barthel Index, Lawton Index, Dementia Behavior Disturbance Scale (DBD) to evaluate CB, Instrumental and Basic Activity of Daily Living (IADL/BADL), and Behavioral and Psychological Symptoms of Dementia (BPSD). The comorbidity of geriatric syndrome and the living situation of the patient/caregiver were also assessed., Results: ZBI score was higher in patients with lower MMSE score. Multivariate regression analysis identified that DBD was consistently associated with CB in all patients; symptoms related to memory deficit were related to CB in aMCI; differential IADL, such as inability to use a telephone, use transportation, manage finances, shop, cook and take responsibility for own medication, were related to CB in AD29-24, AD23-18 and AD17-12, and geriatric syndrome including falls and motor disturbance, sleep problems, urinary incontinence, and fatigue was related to CB in AD23-18 and AD17-12., Conclusions: Multiple factors including BPSD, impaired life function and geriatric syndrome were cognitive stage-dependently associated with CB. Preventive treatment of BPSD and comorbidity, and effective assistance for IADL deficits could contribute to alleviation of CB., (© 2014 Japan Geriatrics Society.)