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Aim: This preliminary study aimed to develop a care staff Final Life‐Stage Decision‐Making Support Scale (FS‐DM) for older adults with dementia (OwDs) in geriatric facilities. Methods: The FS‐DM items were developed from focus group interviews with care staff and reviewed through discussions with several experts in dementia care. A questionnaire survey was conducted among care staff in geriatric facilities from February to March 2021. Results: In total, 138 carers (110 [79.7%] women and 28 [20.3%] men, mean age: 41.5 ± 2.3 years) participated. Among them, 91 (65.9%) were professional caregivers, and 36 (26.1%) were nurses. The FS‐DM was developed using a factor analysis, which resulted in 11 items grouped into three factors', as it is the three factors: (1) support for the realization of the wills of OwDs in their final life‐stages through collaboration with families and multiple professionals; (2) consideration of communication regarding the formation and expression of the wills of OwDs in their final life‐stages; and (3) support for eliciting the wills of OwDs during their final life‐stages according to their decision‐making ability and values. The factor loadings ranged from 0.385 to 0.827, and the accumulated contribution ratio was 61.03%. The reliability analysis yielded a Cronbach's α of 0.740–0.855. The first and second factors of the FS‐DM were significantly correlated with the Approaches to Dementia Questionnaire item "Nurses' attitudes towards support for decision‐making." Conclusion: Our results suggest that the FS‐DM could provide supportive care for OwDs to formulate, express, and realize their will, and that it has a degree of reliability and validity. Geriatr Gerontol Int 2024; 24: 130–134. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the social factors affecting the frequency of going out, and social isolation related to the frequency of daily conversation, stratified by gender. Method: The participants comprised 1,016 community-dwelling older Japanese adults, who were categorized into four groups: those who are (1) not isolated socially and go out every day, (2) not isolated socially and do not go out every day, (3) socially isolated and go out every day, and (4) socially isolated and do not go out every day. We performed a logistic regression analysis to assess the relationship between the frequency of daily conversation and the four groups. Results: Our multivariable logistic regression analysis (reference, group 1) showed that the coexistence of poor social factors significantly affected men (group 2: odds ratio [OR] 2.13 [1.10 to 4.12]; group 3: OR 2.92 [1.70 to 5.00]; and group 4: OR 4.28 [2.43 to 7.54]). For women, the frequency of going out was related to daily conversation only with social isolation group (group 2: OR 1.51 [0.77 to 2.98]; group 3: OR 2.42 [1.25 to 4.68]; and group 4: OR 3.81 [2.08 to 7.00]). Conclusion: Our findings suggest that promoting daily conversations of community-dwelling older adults can help prevent related health adversities. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia has received much attention as a factor that affects caregiver burden. However, few studies have examined how its severity can affect caregiver burden. This study aimed to examine the effect of dysphagia severity on caregiver burden. Methods: A cross‐sectional online survey was carried out among family caregivers. We assessed caregiver burden using the Zarit Burden Interview. The dysphagia severity was assessed using the Functional Oral Intake Scale, and the caregivers were divided into three groups based on care receivers' oral intake status (levels 1–3: tube‐feeding group; levels 4–6: texture‐modified food group; level 7: normal group). To investigate the relationship between caregiver burden and dysphagia severity, univariable and multivariable logistic regression analyses were applied to caregiver burden. Results: The Zarit Burden Interview was significantly higher in the texture‐modified food group, and the proportions of high caregiver burden reached 25.2%, 39.5% and 23.4% in the normal group, texture‐modified food group and tube‐feeding group, respectively. The multivariable analyses applied to caregiver burden (reference, normal group) showed that the texture‐modified food group was significantly associated with caregiver burden (OR 1.55, 95% CI 1.04–2.32), whereas the tube‐feeding group had no relationship with caregiver burden (OR 0.68, 95% CI 0.31–1.49). Conclusions: Our study showed that the intake of texture‐modified food significantly affected caregiver burden even after adjusting for confounding factors, whereas the use of tube feeding did not increase caregiver burden. These results suggest that it is necessary to consider dysphagia severity to reduce dysphagia‐related caregiver burden. Geriatr Gerontol Int 2022; 22: 870–875. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the relationship between physical activity (PA) levels and short-term changes in skeletal muscle characteristics in patients with subacute hemiparetic stroke. Materials and Methods: This prospective observational study included 76 patients with stroke who received inpatient care in a convalescent rehabilitation ward. The PA level was measured as the duration of daily total PA (≥ 1.5 metabolic equivalents) using a triaxial accelerometer for 7 days after admission. The outcomes were changes in the quadriceps muscle quality and quantity on the affected and unaffected sides, as assessed by ultrasonography at admission and 1 month after admission. Results: Multiple regression analysis indicated that the duration of total PA was significantly associated with a percentage change in quadriceps muscle quality (p = 0.011) and quantity (p = 0.012) on the affected side. However, no significant relationship was observed between the muscle quality and quantity on the unaffected side. Conclusions: The results revealed that PA was associated with changes in the quadriceps muscle quality and quantity on the affected side in patients with subacute hemiparetic stroke. These findings highlight the importance of promoting PA in stroke rehabilitation to improve muscle properties and functional outcomes. IMPLICATIONS FOR REHABILITATION: Improving skeletal muscle quality and quantity is an important goal in post-stroke rehabilitation. We investigated physical activity and post-stroke changes in muscle properties. Physical activity is related to changes in muscle quantity and quality on the affected side. Promoting physical activity is essential for improving muscle quantity and quality on the affected side. [ABSTRACT FROM AUTHOR]

• We investigated the prevalence of postoperative dysphagia in older orthopedic patients. • The prevalence of dysphagia after orthopedic surgery was 16–32 %. • Factors related to postoperative dysphagia included being older, and sarcopenia. • Non-neurogenic dysphagia present in orthopedic patients, and sarcopenia may contribute. Oropharyngeal dysphagia is one of the most prevalent health complications in older adults. The prevalence of postoperative dysphagia is expected to rise with the increasing number of older patients undergoing orthopedic surgery; however, the specific prevalence and contributing factors remain unclear. This scoping review aimed to identify the prevalence and factors related to postoperative dysphagia in older orthopedic patients. This review included studies published up to September 2022 on postoperative patients aged ≥ 60 years who underwent orthopedic surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web. In total, 21 of the 2158 identified studies were reviewed. The studies were classified into the three categories according to the surgical site: cervical spine disease (n = 12), hip fracture (n = 7), and others (n = 2). The estimated dysphagia prevalence rates [95 % confidence interval] of cervical spine disease, hip fractures, and others were 16 % [8–27], 32 % [15–54], and 6 % [4–8], respectively. Factors related to postoperative dysphagia included cervical alignment in cervical spine disease, being older within the cohort, preoperative health status, malnutrition, and sarcopenia in hip fractures. The prevalence of postoperative dysphagia after orthopedic surgery was highest for hip fractures, followed by cervical spine and others. These results suggest non-neurogenic dysphagia in older patients undergoing orthopedic surgery and indicate that sarcopenia may contribute to postoperative dysphagia in this population. Therefore, further research should clarify the trajectory of postoperative dysphagia and the effectiveness of rehabilitation for postoperative dysphagia after orthopedic surgery. [ABSTRACT FROM AUTHOR]

Background: Swallowing disorders are a serious health concern among older adults. Previous studies reported that sarcopenia may affect swallowing disorders; however, whether sarcopenia is related to the capacity to swallow (measured according to swallowing speed) in community-dwelling older adults is unclear.Objectives: The aim of this study was to investigate the relationship between sarcopenia and swallowing capacity in community-dwelling older women.Methods: This cross-sectional observational study was conducted among community-dwelling older women in Japan. The inclusion criteria were as follows: women aged ≥65 years, with the ability to walk independently, and without dysphagia. The exclusion criterion was a history of stroke or Parkinson's disease that directly caused dysphagia. The participants were divided into a sarcopenia and a healthy group based on the criteria of the Asian Working Group for Sarcopenia 2019. We measured swallowing speed (mL/s) as the swallowing capacity by conducting a 100-mL water-swallowing test. To assess the relationship between sarcopenia and swallowing capacity, we performed a multiple regression analysis.Results: Two-hundred and sixty participants were enrolled in the study. Their mean age was 82.3 ± 6.9 years, and 61 (23.5%) of them displayed sarcopenia. The mean swallowing speed was 11.5 ± 4.9 mL/s, and 17 women (6.5%) exhibited choking or a wet-hoarse voice. Multiple regression analysis revealed that sarcopenia was related to the swallowing capacity after adjusting for age, the Mini-Mental State Examination, and the number of comorbidities (β = -0.20, 95% CI -3.78 to -0.86, p = 0.002).Conclusions: We found that sarcopenia was related to the swallowing capacity in older women in this study. Future research should clarify whether a similar relationship exists in older men as well as the effect of sarcopenia on the swallowing capacity in older adults over a period of time. [ABSTRACT FROM AUTHOR]

Highlights • We examined the relationship between oral function and sarcopenia staging. • The sarcopenia and dynapenia groups showed significantly lower oral function than the normal group. • Similar trends were indicated for oral function and skeletal muscle characteristics. • Interventions for sarcopenia and dynapenia are needed to improve oral function. Abstract Purpose To examine the relationship between oral function and sarcopenia staging, including dynapenia and presarcopenia, in community-dwelling older adults. Methods A cross-sectional study was performed in community-dwelling older women aged 65 years and above. We measured oral muscle strength using maximum tongue pressure, oral muscle performance using oral diadochokinesis, and subjective swallowing difficulties using the Eating Assessment Tool. We measured skeletal muscle mass and function and other variables. All participants were divided into 4 groups (normal, presarcopenia, dynapenia, and sarcopenia) using an algorithm that operationally defines sarcopenia staging by skeletal muscle characteristics. A general linear model was used to analyze differences in oral function among the 4 groups. Results A total of 245 participants were enrolled (median age [IQR], 81.0 [75.0–85.0]). The proportion of normal participants and those with presarcopenia, dynapenia, and sarcopenia was 48.6% (n = 119), 9.4% (n = 23), 30.2% (n = 74), and 11.8% (n = 29), respectively. The sarcopenia and dynapenia groups had significantly lower maximum tongue pressure and oral diadochokinesis than the normal group. In the multivariate analysis, after adjusting for age, maximum tongue pressure and oral diadochokinesis were found to be significantly lower in the sarcopenia and dynapenia groups than in the normal group. Conclusions In this study, participants with sarcopenia and dynapenia showed low oral function, and similar trends were indicated for oral function and skeletal muscle according to progression of sarcopenia staging. Future research should clarify the characteristics of swallowing-related muscles, including muscle mass, strength, and performance at each sarcopenia stage. [ABSTRACT FROM AUTHOR]

• The frequency of gratitude expressed by a home-based care receiver was higher in the mild caregiver burden group than in the severe group. • Even after adjusting for important variables, the frequency of gratitude was significantly associated with caregiver burden. • In middle-aged caregivers, there was no relationship between the frequency of gratitude and caregiver burden after adjusting for covariates. We focused on the frequency of "gratitude" expressed by home-based care receivers towards family caregivers before they were in the condition that needed care and investigated the relationship with caregiver burden. This cross-sectional online survey was completed by 700 family caregivers in Japan. Caregiver burden was assessed using the Zarit Burden Interview. Caregivers with a score of ≤ 19 were defined as having mild caregiver burden, those with a score of 20 to 38 as having moderate, and those with a score of > 38 as having severe. Additionally, caregivers were asked, "How often did you get a 'thank you' from your care receiver before they were in a condition that needed care?" Answers were scored using a 11-point Likert scale. Answers with scores 0-2 were defined as low frequency of gratitude, 3-6 as middle, and 7-10 as high. Among all caregivers, 233 (33.3%), 229 (32.7%) and 238 (34.0%) accounted for having mild, moderate and severe caregiver burden, respectively. High frequencies of gratitude of 48.9%, 43.7%, and 39.1%, respectively, were concluded with a significantly higher rate in the mild than in the severe caregiver burden group (p = 0.03). The results of multinominal logistic regression analysis, even after adjusting for several factors, show that high frequency of gratitude was significantly associated with caregiver burden (p < 0.01, OR: 0.48, 95%CI: 0.28-0.81). We found the frequency of gratitude from the care receiver before they were in the condition that needed care was substantially associated with caregiver burden. [ABSTRACT FROM AUTHOR]

Objective: To clarify music therapy-induced changes in behavioral evaluations, and saliva chromogranin A and immunoglobulin A concentrations in elderly patients with senile dementia. Methods: A music therapy group consisting of 8 elderly patients with dementia and a control group including eight similarly matched patients received a total of 25 1-h sessions of music therapy that were conducted twice weekly for 3 months. The Gottfries–Brane–Steen Scale, and the Behavioral Pathology in Alzheimer’s Disease Rating Scale were used to evaluate behavioral changes. Saliva chromogranin A and immunoglobulin A were used to assess changes in stress and immunological status, respectively. Results: On the Gottfries–Brane–Steen Scale, the mean score for “different symptoms common in dementia” improved significantly after music therapy. The mean Behavioral Pathology in Alzheimer’s Disease Rating Scale score for “paranoid and delusional ideation” also significantly improved ( P < 0.05) after the intervention. While immunoglobulin A was slightly increased prior to intervention, at the 25th session, mean chromogranin A was significantly decreased ( P < 0.05). Conclusion: In this study, the Gottfries–Brane–Steen Scale, the Behavior Pathology in Alzheimer’s Disease Rating Scale, and immunoglobulin A concentrations were shown to have been affected by music therapy. However, as the number of subjects was small, further research is required in order to fully clarify the effects of music therapy. [ABSTRACT FROM AUTHOR]

The present study investigated the effectiveness of music therapy for dementia patients using endocrinological and behavioral evaluations. The study comprised 10 patients with senile dementia who received music therapy; six had Alzheimer's dementia and four had vascular dementia. Music therapy was performed twice a week for 8 consecutive weeks (16 sessions). As a result, total scores on the Mini-Mental State Examination (MMSE) did not significantly change, but the scores of a subscale, ‘language’, improved significantly. According to the Multidimensional Observation Scale For Elderly Subjects (MOSES), scores for ‘irritability’ decreased significantly. Regarding changes in salivary chromogranin A (CgA) levels, the average was significantly decreased before session 16 compared to after this. These results suggest that the combination of endocrinological measurements, behavioral evaluations and functional assessment methods are useful in evaluating the effects of music therapy in persons with senile dementia. [ABSTRACT FROM AUTHOR]

Social inactivity after a stroke leads to adverse outcomes, making social activity after discharge important for chronic stroke survivors. This study aimed to investigate the effects of early rehabilitation services after discharge on social activity among chronic stroke survivors. The participants were prospectively recruited from 3 convalescent hospitals. Receipt of early rehabilitation services after discharge for chronic stroke survivors was defined as the utilization of day care or home-based rehabilitation services by the Japanese long-term care insurance system. Social activity was assessed using the Frenchay Activities Index (FAI) premorbid and at 3, 6, and 12 months after discharge. In this study, the outcome was defined as the change in the FAI score from 3 to 12 months after discharge. Multivariate regression analysis was performed to examine the effect of access to rehabilitation on changes in FAI. Ninety stroke survivors (age 67.2 ± 11.6 years, 52 male) were enrolled. The FAI showed improvements by 27.4% and 1.4% from 3 to 12 months after discharge in the rehabilitation and nonrehabilitation groups, respectively. Multivariate regression analysis showed that access to rehabilitation after discharge was positively associated with the FAI change from 3 to 12 months after discharge (B = 30.3, β = 0.38, 95% confidence interval = 11.13–49.47, P = 0.002). Early rehabilitation services after discharge were significantly associated with increased social activity. [ABSTRACT FROM AUTHOR]

Introduction: Skeletal muscle function is an important prognostically relevant indicator in patients with acute leukemia (AL), but skeletal dysfunction during chemotherapy is not well understood. This study aimed to investigate the factors that influence changes in skeletal muscle function from before the start of chemotherapy to before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: This was a retrospective cohort study that included 90 patients with AL who underwent chemotherapy before transplantation to perform allo-HSCT (men, 67.3%; median age, 53 years). The outcome measure was defined as changes in skeletal muscle function from before chemotherapy to before allo-HSCT, and was assessed by measuring the psoas muscle index (PMI) as skeletal muscle quantity and computed tomography values (CTV) as skeletal muscle quality using a computed tomography scanner. We examined the differences in PMI and CTV before chemotherapy and allo-HSCT, and the factors associated with changes in PMI. Result: The mean PMI for before chemotherapy and allo-HSCT were 4.6 ± 1.4 cm2/m2 and 4.0 ± 1.3 cm2/m2 and significant differences were observed (p < 0.001). However, the mean CTV before chemotherapy and allo-HSCT were 47.3 ± 4.5 HU and 47.4 ± 5.0 HU, respectively, and no significant differences were found (p = 0.798). In stepwise multiple regression analysis, age and sex were identified as factors related to changes in PMI (age, p = 0.019; sex, p = 0.001). Conclusion: We found that skeletal muscle quantity decreased during chemotherapy in patients with AL and was influenced by male sex and older age. Trial registration number: Trial registration number: 34–096(11,243). Date of registration: September 11, 2023. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with cases of shelter acquired pneumonia which were seen in citizens of Japan who were forced to live in shelters as a result of an earthquake and tsunami which hit the country in March of 2011.

Aim: To examine the relationship between the Kihon Checklist (KCL) and incidence of hospitalization among community‐dwelling older adults. Method: We analyzed the cohort data of 2920 community‐dwelling adults aged ≥65 years, who were living independently in a city in Shiga prefecture. We investigated the frailty status, instrumental activities of daily living, physical function, nutritional status, oral function, homebound status, cognitive function and mood using the KCL in the baseline survey. The outcome was incident all‐cause hospitalization in the 2‐year period. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the frailty status and each domain of the KCL as well as all‐cause hospitalization. Results: The prevalence of frailty, pre‐frailty and robustness were 29.7%, 34.5% and 35.8%, respectively. During the 2‐year follow‐up period, 417 participants (14.3%) underwent an incident of all‐cause hospitalization. The participants with frailty (adjusted OR 1.38, 95% CI 1.05–1.81) had a significantly elevated incidence of hospitalization according to the multivariate analysis compared with patients with robustness, but not in participants with pre‐frailty (adjusted OR 1.07, 95% CI 0.82–1.40). Participants with low physical function (adjusted OR 1.45, 95% CI 1.12–1.87) and depressed mood (adjusted OR 1.35, 95% CI 1.08–1.70) had a significantly elevated incidence of hospitalization according to multivariate analysis compared with non‐risk. Conclusion: These results suggest that older adults with frailty are more likely to be hospitalized and that the KCL may be the screening tool to estimate the hospitalization risk. Geriatr Gerontol Int 2022; 22: 132–137. [ABSTRACT FROM AUTHOR]

A review of the article "Effects of aging and sarcopenia on tongue pressure and jaw-opening force" by Machida N, Tohara H, Hara K et al, which appeared in the periodical "Geriatrics & Gerontology International" in 2016, is presented.

A letter to the editor is presented which is concerned with the case of an 81 year old patient with advanced Alzheimer's disease whose eating problems were solved with the use of a rivastigmine dermal patch.

Aim: We assessed care receivers' sharing ratios of household tasks before they required care and investigated their relationship with caregiver burden. Methods: A cross‐sectional, online survey was completed by 272 spousal caregivers in Japan. Caregiver burden was assessed using the Zarit Burden Interview. Low and moderate‐to‐high caregiver burdens were defined as those with scores ≤40 and ≥41, respectively. Additionally, caregiver responses to, "How much did your partner contribute to household tasks before the onset of their condition that needed care?" were scored on a 10‐point Likert scale ranging from 1 to 10. We defined answers that scored 1–4 as a low sharing ratio and those that scored 5–10 as a high sharing ratio of household tasks of care receivers before developing a condition that required care. Results: Among the husband and wife caregivers, moderate‐to‐high caregiver burden in 33 (25.0%) and 48 (34.3%) caregivers, respectively. Multivariate logistic regression analysis showed that among the husband caregivers, the high sharing ratio of household tasks of their wives before developing a condition that required care was significantly associated with their caregiver burden (OR 4.55, 95% CI 1.20–17.27); however, no such association was observed among the wife caregivers (OR 0.85, 95% CI 0.37–2.29). Conclusions: Among husband, but not wife caregivers, the high sharing ratio of household tasks of their wives before they required care was significantly associated with their caregiver burden. Geriatr Gerontol Int 2023; 23: 616–621. [ABSTRACT FROM AUTHOR]

The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08–0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization. [ABSTRACT FROM AUTHOR]

In Japan, where older people already make up more than 23% of the population and the proportion is still growing, the burden on those caring for people with dementia is an increasing problem. This burden is magnified by wandering behavior, a peripheral symptom. Thus, there is a need for an objective measure of wandering behavior to determine what constitutes effective care. In this study, we translated the Algase Wandering Scale - Version 2 into Japanese, and examined its reliability and validity. Ambulatory residents with dementia were selected from two nursing homes and two wards specializing in dementia care in hospitals in Japan. Nurses and care workers taking care of these residents answered questionnaires regarding the residents. From the results, the Algase Wandering Scale - Version 2, Japanese version, was examined for inter-rater reliability, stability, internal consistency, and concurrent validity. The results of the analysis in the present study demonstrated that the Algase Wandering Scale - Version 2, Japanese version, has reliability and validity, and that it can measure the presence or absence of wandering and its severity. Surveys of residents with various wandering patterns in many facilities and verification of construct validity are warranted in the future. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to develop a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment (PACSLAC-J) and evaluate the validity and reliability of the scale for use in older patients with dementia in Japan. All patients from 2 dementia wards at a geriatric hospital and 2 aged care facilities were asked to participate. Demographic data, medical prescriptions, Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) score, and PACSLAC-J score were obtained from the patients or their medical charts. Researchers used the PACSLAC-J to assess pain behaviors while the patients walked or were transferred between a bed and a wheelchair. Intra-class correlation coefficients (ICC) for inter-rater and test–retest reliability, Cronbach's alpha, and correlations between PACSLAC-J score and other variables were examined. A total of 117 older patients participated. Dementia, including Alzheimer's disease (n =54) and/or vascular dementia (n =35), had been diagnosed in almost all of them. The ICC for inter-rater and test–retest reliability were 0.917 and 0.600, respectively. Internal consistency of the entire sample was 0.782. Patients who stated they were experienced pain during movement had higher scores than did patients who stated they had no pain during movement. PACSLAC-J total score was not associated with BEHAVE-AD score. Multiple regression analysis showed that total dependence on assistance during transfer (β =0.32, p =0.001), and psychiatric medication prescription (β =0.26, p =0.003) were independently associated with PACSLAC-J score. We found sufficient evidence of the validity and reliability of the PACSLAC-J. [Copyright &y& Elsevier]

Neuropsychology and neuroimaging studies provide distinct views on the key neural underpinnings of social scene understanding (SSU): the amygdala and multimodal neocortical areas such as the posterior superior temporal sulcus (pSTS), respectively. This apparent incongruity may stem from the difference in the assumed cognitive processes of the situation-response association and the integrative or creative processing of social information. To examine the neural correlates of different SSU types using functional magnetic resonance imaging (fMRI), we devised a clothing recommendation task in three types of client's standpoint. Situation-response association was induced by a situation-congruent standpoint (ecological SSU), whereas the integrative and creative processing of social information was elicited by a lack and situation incongruence of the standpoint (perceptual and elaborative SSUs, respectively). Activation characteristic of the ecological SSU was identified in the right amygdala, while that of the perceptual SSU and elaborative SSU demand was identified in the right pSTS and left middle temporal gyrus (MTG), respectively. Thus, the current results provide evidence for the conceptual and neural distinction of the three types of SSU, with basic ecological SSU being supported by a limbic structure while sophisticated integrative or creative SSUs being developed in humans by multimodal association cortices. [ABSTRACT FROM AUTHOR]

Background: The aim of this cross‐sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long‐term care facilities in East Asia and to explore factors associated with these patterns. Methods: This study included elderly participants with cognitive impairments residing in long‐term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini‐Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. Results: In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti‐dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly‐pharmacy was identified as a common problem at all study sites. Conclusions: Our findings will be beneficial for health‐care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly‐pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence‐based practice. [ABSTRACT FROM AUTHOR]

Aim: The objective of this trial was to investigate the synergistic effects of bodyweight resistance exercise and a protein supplement with vitamin D on skeletal muscle in sarcopenic or dynapenic older adults. Methods: This was a four‐arm randomized controlled trial. Sarcopenic or dynapenic older adults were recruited for this trial. After screening, a total of 112 older adults were randomly allocated among four groups; 28 older adults each were enrolled in the combined resistance exercise and nutritional supplementation group, the exercise alone group, the nutritional supplementation alone group, and the control group. Participants in the combined group and exercise alone groups took part in a bodyweight resistance exercise program for 12 weeks. Protein and vitamin D supplements were provided every day for 12 weeks for the participants in the combined group and nutritional supplementation alone groups. We assessed the echo intensity of participants' thigh muscle using ultrasonography, measured their appendicular muscle mass using a bioelectrical impedance data acquisition system, and tested their knee extension strength and physical function. Results: Participants in the combined group had a significantly greater improvement in rectus femoris echo intensity and knee extension torque than those in the other groups (P < 0.05). Furthermore, the combined program increased appendicular muscle mass in sarcopenic older adults (P < 0.05), but not in older adults with low physical function with normal muscle mass. Conclusions: The present study confirmed the synergistic effect of bodyweight resistance exercise and protein supplement with vitamin D on muscle quality and muscle strength in sarcopenic or dynapenic older adults. Geriatr Gerontol Int 2019; 19: 429–437. [ABSTRACT FROM AUTHOR]

Aim: The current study was an international cross‐sectional study comparing the prevalence of incontinence among cognitively impaired older residents in long‐term care facilities in East Asia, including Japan, Korea, China, Taiwan and Thailand between 2015 and 2016. Methods: Participants were cognitively impaired older residents in long‐term care facilities. Demographic data were collected. The Clinical Dementia Rating scale was used to assess dementia severity, and the Barthel Index was used as a surrogate measure of incontinence and toilet use dependence. The prevalence of urinary incontinence and fecal incontinence were examined. Multiple logistic regression analysis was used to predict incontinence and toilet use dependence. Results: We analyzed data from 662 participants (age 82.6 ± 9.9 years, 57.6% women). The prevalence of urinary incontinence ranged from 10.1% in Taiwan to 71.0% in Korea. The prevalence of fecal incontinence varied from 4.0% in Taiwan to 57.0% in Korea. A higher Clinical Dementia Rating score was a significant predictor of urinary and fecal incontinence and toilet use dependence (P < 0.0001). Conclusions: The current survey showed a high prevalence of incontinence in long‐term care residents in East Asia, and identified challenges for future studies. Development of clinical guidelines for incontinence care in cognitively impaired older persons is urgently required. Geriatr Gerontol Int 2019; 19: 444–450. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long‐term care facilities in East Asia and to explore the factors associated with these patterns. Methods: This was a cross‐sectional survey of BPSD in cognitively impaired elderly residents of long‐term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini‐Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI‐NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI‐NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1– 3; clinically significant ≥4). Results: Data from 662 people were analyzed. Median age, median Mini‐Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI‐NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI‐NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI‐NH scores. Conclusions: Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries. [ABSTRACT FROM AUTHOR]

Aim: Frailty is a predictor of several adverse health outcomes in older adults. However, the relationship between preadmission frailty status and the incidence of dependency after discharge in hospitalized older patients remains unclear. The aim of the present study was to determine whether preadmission frailty status can predict dependency after discharge among hospitalized older patients. Methods: We analyzed the cohort data for hospitalized older patients (aged ≥65 years) with internal medical problems obtained from a prospective study. The main outcome was the incidence of dependency from admission to a month after discharge. The frailty status was assessed using the Kihon Checklist. We defined scores of ≥8 as frail, 4–7 as pre‐frail and 0–3 as robust. The Cox proportional hazards regression model was used to estimate the hazard ratios and confidence intervals of the relationships between preadmission frailty status and the incidence of dependency. Results: A total of 151 participants who completed follow ups were analyzed (mean age 77.2 years [SD 6.9 years]). The prevalence of frailty, pre‐frailty and robust was 22.5%, 37.8% and 39.7%, respectively. During the follow‐up period, 39 participants (25.8%) had an incidence of dependency. Participants with frailty (adjusted hazard ratio 4.29, 95% confidence interval 1.72–10.69) had a significantly elevated incidence of dependency compared with that of robust participants. Participants with pre‐frailty (adjusted hazard ratio 1.27, 95% confidence interval 0.51–10.69) had no significantly elevated incidence of dependency compared with robust participants. Conclusions: The preadmission frailty status using the Kihon Checklist can predict the incidence of dependency after discharge among hospitalized older patients. Geriatr Gerontol Int 2018; 18: 1609–1613. [ABSTRACT FROM AUTHOR]

Aim: Behavioral and psychological symptoms of dementia are an important source of distress for caregivers. The aim of the present study was to evaluate the effectiveness of educational intervention using printed educational material for reducing distress induced by behavioral and psychological symptoms of dementia among caregivers working at facilities without medical specialists and/or registered nurses. Methods: A cluster quasi‐randomized, controlled comparative trial was carried out at 17 facilities in Japan. Our intervention was an educational program administered at baseline using printed educational material for the care staff. The primary outcome was evaluated using the Japanese version of the Neuropsychiatric Inventory Questionnaire. The secondary outcome measures were caregiver burnout evaluated using the Japanese version of the Maslach Burnout Inventory and the care dependency of residents measured using the Japanese version of the Care Dependency Scale. Results: The total Neuropsychiatric Inventory Questionnaire score decreased significantly in the intervention group (F [1355] = 6.57, P = 0.01), and the difference between the intervention and control groups was also significant (F [1355] = 4.78, P = 0.03). There were no significant changes in the Maslach Burnout Inventory or Care Dependency Scale scores in the intervention group, while the Maslach Burnout Inventory subscale (personal accomplishment) score decreased significantly in the control group. Conclusions: Our intervention achieved a significant reduction of distress among caregivers working at care homes without medical specialists and/or registered nurses. The findings of this research show that educational intervention can make a valuable contribution to training programs for care staff. Geriatr Gerontol Int 2018; 18: 487–494. [ABSTRACT FROM AUTHOR]

Poor skeletal muscle function is relatively high in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), leading to various negative health outcomes. This study aimed to investigate the relationship between the quantity and quality of skeletal muscle before transplantation and the short-to long-term survival after transplantation in patients undergoing allo-HSCT. This retrospective cohort study included 156 patients undergoing allo-HSCT (men, 67.3 %; median age, 53 years; interquartile range, 42–61 years). The quantity and quality of the skeletal muscle were measured at the psoas major at the level of the third lumbar vertebrae using a computed tomography (CT) and were defined as psoas muscle index (PMI) and CT values (CTV), respectively. The outcome measure of this study was overall survival (OS) after allo-HSCT, and we examined the relationship between survival at three time points (6, 12, and 24 months) after transplantation, PMI, and CTV. PMI was significantly associated with survival at all time points in the crude model (P < 0.001), and a significant association was observed in the fully adjusted model (P < 0.01). CTV was significantly associated with survival at all time points in the crude model (P < 0.05), but not in the fully adjusted model (P > 0.05). We found that the quantity and quality of the skeletal muscle before transplantation were significantly associated with OS at 6, 12, and 24 months after transplantation, showing a particularly robust association with quantity. • We found that the quantity and quality of the skeletal muscle before allo-HSCT were significantly associated with OS. • These results suggest that maintaining muscle quantity and quality before transplantation is necessary to improve OS. • The present findings suggest that rehabilitation interventions before transplantation may improve OS. [ABSTRACT FROM AUTHOR]

Falls and fractures are serious geriatric adverse events worldwide, and skeletal muscle is considered to be a key factor in these incidents. The objective of this study was to investigate the combined effect of lower muscle quality and quantity on the incidence of falls and fall-related fractures in a 3-year follow-up period among community-dwelling older adults. We recruited community-dwelling adults aged 65 years and older who were living independently in 2018. A total of 773 older participants were analyzed in this study. The outcomes were incident falls and fall-related fractures during the 3-year follow-up period. At baseline, we assessed muscle quality and quantity using ultrasonography, and we categorized the participants into four groups based on their combination of poor/better muscle quality and poor/better muscle quantity. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the relationships among items in the four groups and the time to incident falls and fall-related fractures. During the 3-year follow-up period, 178 participants (23.0 %) had a fall incident and 51 participants (6.6 %) had fall-related fractures. Older adults with lower muscle quality and quantity had significantly elevated risks of incident falls according to multivariate analyses using older adults with better muscle quality and quantity as the reference (adjusted HR: 1.54 [95 % CI 1.06–2.23]). However, there were no significant differences in fall-related fractures among the four groups. We found that lower muscle quality and quantity led to higher incidents of falls; thus, identifying community-dwelling older adults with lower muscle quality and quantity is necessary to provide them fall preventive measures and maybe to reduce fall-related outcomes. • We conducted a prospective cohort study in community-dwelling older adults and found that 23.0% and 6.6% of participants had incidents of falls and fall-related fractures, respectively, during the 3-year follow-up period. • Older adults with poor muscle quality and quantity had an increased risk of incident falls, but not of fall-related fractures. • These findings suggest that managing muscle quality and quantity may be necessary for fall prevention in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

dijkstra a., yönt g.h., korhan e.a., muszalik m, kędziora-kornatowska k. & suzuki m. (2012) The Care Dependency Scale for measuring basic human needs: an international comparison. Journal of Advanced Nursing 68(10), 2341-2348. Abstract Aim. To report a study conducted to compare the utility of the Care Dependency Scale across four countries. Background. The Care Dependency Scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson's components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the Care Dependency Scale items. Design. The study used a cross-cultural survey design. Method. Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch Care Dependency Scale. Psychometric properties in terms of reliability and validity of the Care Dependency Scale have been assessed using Cronbach's alpha, Guttman's Lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. Results. High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. Conclusion. Outcomes confirm Henderson's idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patient's age, the type of care setting and/or cultural background. The psychometric characteristics of the Care Dependency Scale make this instrument very useful for comparative research across countries. [ABSTRACT FROM AUTHOR]

The article offers information on Factors associated with post-stroke apathy in subacute stroke patients. It mentions cross-sectional observational study included post-stroke patients admitted to Tokyo Bay Rehabilitation Hospital between January and October 2018; and inability to walk independently during hospitalization, even with a walking aid and/or brace.

• 12.9 % of hospitalized older patients were incidence of homebound status after discharge. • Locomotive functions were significantly associated with the incidence of homebound status. • Handgrip strength, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status. Physical and cognitive/psychological functions are risk factors for incident homebound status. However, there are only a few studies exploring the factors related to homebound status in hospitalized older patients. The aim of this study was to determine the relationship between physical, and cognitive/psychological function at discharge among hospitalized older patients and the risk of undergoing homebound status after discharge. We analyzed the cohort data of hospitalized older patients (age ≥65 years) with internal medical problems. The main outcome was the incidence of homebound status a month after discharge. Physical functions were measured by handgrip strength (HG), knee extension strength (KES), one-leg stance (OLS), and walking speed (WS). Cognitive and psychological functions were assessed using the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-5 (GDS-5), respectively. Poisson regression models were used to estimate the risk ratios (RR) and 95 % confidence intervals (CIs) of the relationships between physical, cognitive, and psychological functions as well as the homebound status. A total of 178 participants who completed the follow-up were analyzed mean age (standard deviation) 76.2 (6.9) years. A month after discharge, 23 participants were deemed homebound, for a cumulative incidence (95 %CI) of 12.9 % (8.0 %–17.8 %). The RR (95 %CI) estimated by Poisson regression were 3.51 (1.30–9.48), 0.15 (0.03-0.72) and 0.11 (0.01-0.92) for low KES, maximum WS and comfortable WS, respectively. However, HG, OLS, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status. Physical functions can predict the incidence of homebound status after discharge among hospitalized older patients. [ABSTRACT FROM AUTHOR]