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Objectives: This study explored collaboration models between primary care physicians (PCPs) and care managers (CMs) and assessed each model's potential in meeting the support needs of individuals with early-stage dementia. Methods: In 2022, a cross-sectional survey was conducted among the PCPs in Tokyo. The data regarding the participant and clinic characteristics and daily practices for individuals with early-stage dementia were collected. The clinical collaborative practice was classified using a latent class analysis; comparisons were made between the identified classes based on 14 items in seven domains of support. Results: Two collaborative and one stand-alone models were identified. The former varied in the professionals' roles, with one led by PCPs and the other by CMs. We named them PCP-led, CM-led, and stand-alone models, accounting for 46.4%, 32.8%, and 20.6% of the clinics, respectively. The PCP-led clinics were significantly more likely to provide support than the stand-alone ones across five domains: cognitive function, care planning, carers' support, information, and social health. The CM-led model clinics generally fell between those of the other two models. Conclusion: Different leadership styles exist in the PCP-CM collaborations in care delivery for people with early-stage dementia. This collaboration offers distinct advantages for clinics in addressing their needs. [ABSTRACT FROM AUTHOR]

This study examined the interaction of living alone and cognitive decline in relation to the well-being of older men and women. We analyzed the data from a cross-sectional, self-administered questionnaire survey of community-dwelling older adults in Tokyo, who were aged 65+ and not on long-term care. The questionnaire included the 10-item self-administered dementia checklist (SDC), the WHO-5 Well-Being Scale, a question on their living arrangement, and participants' baseline characteristics and social support and social contact. The analyses were stratified by sex and fitted with linear regression models with interaction. A total of 34,255 men and 41,056 women participated. Sample mean age was 73.5 (SD 6.1) for men and 73.6 (SD 6.0) for women, and 18.5% and 26.0% lived alone. The distribution of SDC scores indicated 95.9% and 97.0% had a cognitive status varying from intact to possible mild dementia. Cognitive decline showed a linear association with lower well-being in men (beta −0.53; 95% CI −0.58, −0.48; p < 0.001) and women (beta −0.38; 95% CI −0.42, −0.34; p < 0.001). Compared to men and women living with others, those living alone experienced lower well-being as their cognitive function declined, and the interactions (living arrangements ∗ SDC) were statistically significant. After controlling participants' characteristics and social support and social contact, the interaction was significant in men (p < 0.001) but not in women (p = 0.46). Our findings support that older men and women living alone experience a slightly steeper downward trajectory of cognitive decline and poor well-being than their counterparts living with others. The unequivocal effects of controlling confounding factors between men and women indicate the need for gendered countermeasures by welfare services. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to explore factors associated with (i) the inability to attend a follow‐up assessment in the community‐based participatory research (CBPR) framework; (ii) mortality; and (iii) institutionalization, across a 5‐year period among older people with cognitive impairment identified via an epidemiological survey. Methods: The participants were 198 older people whose score on the Mini‐Mental State Examination was below 24, and who were living in our CBPR region in the Tokyo metropolitan area. Baseline data included sociodemographic factors, health‐related factors, social factors, and assessments by healthcare professionals. Over the following 5 years we observed what happened to the subjects within the CBPR framework. Bivariate and stepwise multiple logistic regression analyses were performed to explore the factors associated with the inability to attend a follow‐up assessment, 5‐year mortality, and institutionalization. Results: Participants who did not attend a follow‐up assessment tended to live alone. Being older (>80), living with others, frailty, and the need for rights protection and daily living support were associated with increased mortality. Long‐term care insurance certification was strongly associated with institutionalization as a natural consequence of the health‐care system. Having dementia and low access to doctors were also positively associated with institutionalization. Conclusions: Older people with cognitive impairment who are living alone are at higher risk of being overlooked by society. To move toward more inclusive communities, the following are recommended: (i) more interventions focusing on older people living alone; (ii) social interventions to detect daily life collapse or rights violations; and (iii) more support to help people with dementia continue living in the community. [ABSTRACT FROM AUTHOR]

Objectives: Supporting people suffering from Diogenes Syndrome (DS) is a challenge for geriatric psychiatry. However, there is a lack of knowledge about DS in Japan. Therefore, a systematic longitudinal study to clarify the factors associated with DS and its prognosis was conducted. Methods/Design: A retrospective study using data from case records of a municipal psychogeriatric service was conducted. The study population was socially isolated older adults with complex mental health and social care needs who had been referred to the service over 10 years. The participants were stratified into DS and non‐DS groups, multivariate analysis was performed to identify factors associated with DS, and survival analysis was performed. Results: Of the 270 participants, 61 with Environmental Cleanliness and Clutter Scale (ECCS) scores >12 were assigned to the DS group, and 209 with ECCS scores ≤12 were assigned to the non‐DS group. On multiple logistic regression analysis, significantly more people in the DS group were living alone, had advanced dementia, and had reduced basic activities of daily living (BADL) compared to the non‐DS group. Furthermore, survival analysis showed that the DS group had a higher risk of early death than the non‐DS group. Conclusions: In the present study, social isolation, living alone, advanced dementia, and reduced BADL were found to be associated with DS. In addition, DS had a high risk of early death. Support for DS must take into account not only mental and social health, but also physical health from an early stage. Key points: This is the first systematic study of DS in JapanThe participants and their living environment were comprehensively assessed using standardized scales, and long‐term outcomes were followedPeople suffering from DS are socially isolated older adults living alone with advanced dementia, reduced BADL and a high risk of early deathPhysical health is an important consideration in supporting DS cases [ABSTRACT FROM AUTHOR]

Background: The study aim was to identify depressed mood and frailty and its related factors in older people during the coronavirus disease 19 pandemic. Methods: Since 2010, we have conducted questionnaire surveys on all older residents, who are not certified in the long‐term care insurance, living in one district of Tokyo municipality. These residents are divided into two groups by birth month, that is those born between April and September and those born between October and March, and each group completes the survey every 2 years (in April and May). Study participants were older residents who were born between April and September and who completed the survey in spring 2018 and in spring 2020, the pandemic period. Depressed mood and frailty were assessed using the Kihon Checklist, which is widely used by local governments in Japan. We had no control group in this study. Results: A total of 1736 residents responded to both surveys. From 2018 to 2020, the depressed mood rate increased from 29% to 38%, and frailty increased from 10% to 16%. The incidence of depressed mood and frailty was 25% and 11%, respectively. Incidence of depressed mood was related to subjective memory impairment and difficulty in device usage, and incidence of frailty was related to being older, subjective memory impairment, lack of emotional social support, poor subjective health, and social participation difficulties. Conclusions: Older people with subjective memory impairment may be a high‐risk group during the coronavirus pandemic. Telephone outreach for frail older people could be an effective solution. We recommend extending the scope of the 'reasonable accommodation' concept beyond disability and including older people to build an age‐friendly and crisis‐resistant community. [ABSTRACT FROM AUTHOR]

In the article, the authors present their study which assessed the relationship between the longitudinal changes in cognitive function and psychological well-being in older community-living persons with moderately impaired cognition. Also cited are the use of the Japanese versions of Mini-Mental State Examination (MMSE-J), Clinical Dementia Rating (CDR) scale and the World Health Organization-Five Well-Being Index (WHO-5-J) in the study.

Objective: To identify factors related to decisional conflict among surrogate decision makers for home medical care (HMC) patients. Design: Prospective Cohort Study. Setting/Subjects: For older patients receiving HMC from four different primary care clinics in Japan from January 2016 to June 2017, we studied the family member with the main potential for surrogate decision making. Measurements: At the baseline, surrogates filled out a baseline questionnaire on their characteristics and decision readiness, while the attending doctors provided information about the patients' characteristics. Patient-and-surrogate pairs were tracked for up to six months after the baseline or for three months in the case of death, hospitalization, or admittance to a nursing home. After this tracking, surrogates filled out a follow-up questionnaire on their decision-making experiences, including decisional conflict. Results: Of the original 159 patient-and-surrogate pairs, 121 (76.1%) responded to the follow-up questionnaire. During the follow-up period, 32 patients (26.4% of the patients followed up) died and 69 (57.0%) experienced decision making. Among surrogates who made decisions, the mean score of decisional conflict was 36.2 (standard deviation 14.7), and 43.5% were above the threshold relating to decision delay. Anticipatory guidance and discussion on the patient's care goals at the beginning of HMC were the two variables significantly associated with less decisional conflict of surrogates. Conclusions: Families felt less conflict with surrogate decision making if they had participated in previous discussions with doctors regarding the patients' care goals. Early-stage anticipatory guidance and discussion are a good opportunity for families to prepare for surrogate decision making. [ABSTRACT FROM AUTHOR]

Background: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. Objective: We investigated the decision readiness of HMC patients and their family surrogates. Design: Cross-sectional survey. Setting/Subjects: We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016. Measurements: Surrogates completed a questionnaire on their sociodemographic and health status and their decision readiness. Primary HMC physicians provided information on their patients. Results: A total of 337 dyads were screened and 159 were included. The mean age of patients and surrogates was 86 and 64 years, respectively and 29% of patients were cognitively impaired. Only 1.9% of the patients left written advance directives and 32% were entrusting all decision making to the doctor or their families. Regarding the surrogate's preferred decision-making role, 21.9% of the surrogates preferred doctors to assume decision-making responsibility. A multivariate analysis revealed that no discussion of care goals (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.17) and patients having expressed their wishes verbally, including entrusting decision making to others (OR 2.51, 95% CI 1.07-5.89), were associated with surrogate's preference for doctors to have decision-making responsibility. Conclusions: Many patients preferred to entrust the end-of-life decisions to others rather than utilizing advance directives, which made surrogates more dependent on doctors for decision making. Qualified advance care planning is required to promote familial discussion and surrogate's decision readiness. [ABSTRACT FROM AUTHOR]

We determined the genotoxicity of synthetic red tar dyes currently used as food color additives in many countries, including Japan. For the preliminary assessment, we treated groups of 4 pregnant mice (gestational day 11) once orally at the limit dose (2000 mg/kg) of amaranth (food red No. 2), allura red (food red No. 40), or acid red (food red No. 106), and we sampled brain, lung, liver, kidney, glandular stomach, colon, urinary bladder, and embryo 3, 6, and 24 h after treatment. We used the comet (alkaline single cell gel electrophoresis) assay to measure DNA damage. The assay was positive in the colon 3 h after the administration of amaranth and allura red and weakly positive in the lung 6 h after the administration of amaranth. Acid red did not induce DNA damage in any sample at any sampling time. None of the dyes damaged DNA in other organs or the embryo. We then tested male mice with amaranth, allura red, and a related color additive, new coccine (food red No. 18). The 3 dyes induced DNA damage in the colon starting at 10 mg/kg. Twenty ml/kg of soaking liquid from commercial red ginger pickles, which contained 6.5 mg/10 ml of new coccine, induced DNA damage in colon, glandular stomach, and bladder. The potencies were compared to those of other rodent carcinogens. The rodent hepatocarcinogen p-dimethylaminoazobenzene induced colon DNA damage at 1 mg/kg, whereas it damaged liver DNA only at 500 mg/kg. Although 1 mg/kg of N-nitrosodimethylamine induced DNA damage in liver and bladder, it did not induce colon DNA damage. N-nitrosodiethylamine at 14 mg/kg did not induce DNA damage in any organs examined. Because the 3 azo additives we examined induced colon DNA damage at a very low dose, more extensive assessment of azo additives is warranted. [ABSTRACT FROM PUBLISHER]

Background: Effective strategies to develop dementia-friendly communities (DFCs) are needed in aging societies. We aimed to propose a strategy to develop DFCs from a Japanese perspective and to evaluate an intervention program that adopted the strategy., Methods: This study implemented a multi-level intervention that emphasized nurturing community social capital in a large apartment complex in the Tokyo metropolitan area in 2017. We offered an inclusive café that was open for extended hours as a place to socialize and a center for activities that included monthly public lectures. Individual consultation on daily life issues was also available for free at the café. Postal surveys were sent out to all older residents aged 70 years and older in 2016 and 2019. With a one-group pre-test and post-test design, we assessed changes in the proportion of older residents who had social interaction with friends and those who were confident about living in the community, even if they were living with dementia., Results: Totals of 2633 and 2696 residents completed the pre and post-intervention surveys, respectively. The mean age of the pre-intervention respondents was 77.4 years; 45.7% lived alone and 7.7% reported living with impaired cognitive function. The proportion of men who had regular social interaction and were confident about living in their community with dementia increased significantly from 38.8 to 44.5% (p = 0.0080) and from 34.1 to 38.3% (p = 0.045), respectively. Similar significant increases were observed in the subgroup of men living with impaired cognitive function, but not in the same subgroup for women., Conclusions: The intervention benefitted male residents who were less likely to be involved in the community's web of social networks at baseline. A strategy to create DFCs that emphasizes nurturing community social capital can form a foundation for DFCs., Trial Registration: This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Clinical Trial Registry (registry number: UMIN000038193 , date of registration: Oct 3, 2019)., (© 2022. The Author(s).)

Japanese horse chestnut (Aesculus turbinata) seed extract inhibits the activity of cyclooxygenase (COX), but its active constituents have not been identified. In the present study, COX inhibitors were isolated from the hexane extract of this seed by means of 4 steps of liquid chromatography and were identified by gas chromatography/mass spectrometry and nuclear magnetic resonance. The COX inhibitors in the extract of Japanese horse chestnut seeds were identified as linoleic acid, linolenic acid, and oleic acid. Their efficacies were in the following order: linolenic acid = linoleic acid > oleic acid. These active constituents are C18 unsaturated fatty acids; stearic acid, a C18 saturated fatty acid, had no activity. Linolenic acid and linoleic acid had high selectivity toward COX-2 (selectivity index = 10), whereas oleic acid had no selectivity. Considering the efficacy and yield of each fatty acid, linoleic acid may be the principal COX inhibitor in this seed.

The positive list system became effective from May 29, 2006 to improve the regulation of residual agricultural chemicals (pesticides, feed additives and veterinary drugs) in foods. In accordance with the system, we investigated pesticide residues in 50 agricultural products purchased in Morioka city from March to November 2006. Analyses were performed according to the "Multiresidue Method for Agricultural Chemicals by GC/MS", the Notice of the Ministry of Health, Labour and Welfare. Five pesticides and two non-agricultural chemicals were detected from 16 samples. Ortho-phenylphenol (OPP) was detected from 8 samples: immature pea, snap bean, kiwi, plain-boiled bamboo shoot, mango, white asparagus, lemon and domestic shiitake mushroom. Maximum residue limits (MRLs) have not been established for these products, and they exceeded the uniform level of 0.01 ppm. DDT was detected from Philippines banana (0.30 ppm) and Korean paprika (0.45 ppm). The residual level in Philippines banana was lower than the MRL, but Korean paprika exceeded its MRL. Chlorpyrifos, Thiabendazole and Imazaril were detected from citrus imported from the U.S.A., but their residue levels were lower than the respective MRLs. Aniline and 2-pyrrolidone were detected from several imported products. These two may not be regulated by the positive list system because they are not agricultural chemicals, although their derivatives are used as pesticides or veterinary drugs. Three problems have been revealed from this survey: 1) application of the uniform level to minor agricultural products, 2) residues of non-agricultural chemicals whose toxicity is uncertain, 3) metabolites of agricultural chemicals, which are also regulated by the positive list system, have not been clearly defined.