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Aim: There are few studies concerning the classification of fall risk by nurses without established fall risk assessment tools. In the present study, clinical classification of fall risk using visually obtained information was compared with the assessment of fall risk in order to evaluate the rationale and validity of the clinical classification of fall risk by nurses., Methods: New patients who visited the center of comprehensive care and research for memory disorders at the National Center for Geriatrics and Gerontology were enrolled in the present study.Day-shift nurses separately recorded the clinical classification of fall risks through visually obtained information during the 10-minutes waiting time for outpatients.Fall risk assessments such as the Fall Risk Index and Timed Up & Go test, were performed by non-nurse medical staffs. Data were analyzed by an independent researcher who was not involved in obtaining clinical information., Results: Nurse's clinical classification of fall risk using visually obtained information correlated well with Fall Risk Index, Timed Up & Go test, One-leg Standing test and Dorsiflex meter. In addition, subjects classified as having high fall risk were more frequently judged to be frail than classes of moderate or little fall-risk., Conclusion: Nurse's clinical classification of fall risk using visually obtained information was judged on their integrated impression including their evaluation of the muscle strength, gait speed and balance.

Aim: In 2005, the Japan Geriatrics Society published a list of potentially inappropriate medication that was an extract from the "Guidelines for medical treatment and its safety in the elderly 2005." The 2005 guidelines are due for a revision, and a new comprehensive list of potentially inappropriate medications is required., Methods: A total of 15 diseases, conditions and special areas related to their clinical care were selected. We originated clinical questions and keywords for these 15 areas, carried out a systematic review using these search criteria, and formulated guidelines applying the Grading of Recommendations Assessment, Development and Evaluation system advocated by Minds2014. If we did not find good evidence despite the drug being clinically important, we looked for evidence of efficacy and for disease-specific guidelines, and incorporated them into our guidelines., Results: We selected 2098 articles (140 articles per area), and extracted another 186 articles through a manual search. We further added guidelines based on disease entity and made two lists, one of "drugs to be prescribed with special caution" and the other of "drugs to consider starting," primarily considering individuals aged 75 years or older or those who are frail or in need of special care., Conclusions: New lists of potentially inappropriate medications and potential prescribing omissions called "Screening Tool for Older Person's Appropriate Prescriptions for Japanese" were constructed. We anticipate that future studies will highlight more evidence regarding the safety of high-quality drugs, further improving the provision of appropriate medical care for the elderly. Geriatr Gerontol Int 2016: 16: 983-1001., (© 2016 Japan Geriatrics Society.)

Now that the number of elderly people has increased and the number of dementia patients is rapidly increasing, dementia might be regarded as a common disease. Under these circumstances, the establishment of systems to support the elderly with dementia from the early stages, and to provide primary care doctors and care workers with necessary education is an urgent issue. Up to the end of 2012, a total of 2680 doctors had been certified as Dementia Support Doctors (DSD). The DSD's function and roles are: (i) to support primary care doctors and care specialists involved in the medical care, and general care of dementia patients; (ii) to facilitate multidisciplinary cooperation led by a Community General Support Center; and (iii) to give lectures about dementia to primary care doctors and educate people in the community. DSD are more skilled than primary care doctors in the following functions: differential diagnosis; outpatient services to deal with behavioral and psychological symptoms of dementia; community liaison; and home care., (© 2014 Japan Geriatrics Society.)

Aim: The National Center for Geriatrics and Gerontology has begun to provide educational support for family caregivers through interdisciplinary programs focusing on patients in the early stage of dementia. These interdisciplinary programs have established two domains for the purpose of "educational support": cure domains (medical care, medication) and care domains (nursing care, welfare). In the present study, we examined the learning needs and post-learning attitude changes of patients and their families who participated in these programs in order to assess the effectiveness of an interdisciplinary program of educational support in each of these domains., Methods: A total of 170 participants (51 dementia patients, 119 family members) were included in the study. Data were obtained from electronic health records, and through a written survey administered before and immediately after each program., Results: A high percentage of patients and family members desired knowledge about the progression and symptoms of dementia, as well as measures to prevent progression, both of which fall under the medical care content. For patients, education in the medical care content increased their motivation to live. For families, education in the medical and nursing care contents promoted their understanding of dementia, while education in medication and welfare contents improved their skills for handling dementia patients and their symptoms., Conclusion: Both patients and family members expressed a need to learn medical care content, including the progression and disease symptoms of dementia, and methods to prevent the progression of dementia symptoms. Their responses showed that learning medical care was effective for understanding dementia. We suggested that medical care content was the core of interdisciplinary educational support for early-stage dementia patients and their family members., (© 2014 Japan Geriatrics Society.)

1., Background: Recent medical advancements, and improvements in hygiene and food supply have led to Japan having the longest life expectancy in the world. Over the past 50 years, the percentage of the elderly population has increased fourfold from 5.7% in 1960 to 23.1% in 2010. This change has occurred at the fastest rate in the world. Compared with France, where the percentage of the elderly population has increased just twofold in the past 100 years, Japanese society is aging at an unprecedented rate. In addition, the percentage of the very elderly (aged 75 years and over), comprising more frail people, exceeded 10% of the nation's population in 2008. In such a situation, many elderly Japanese wish to spend their later years healthy, and wish to achieve great accomplishments in their lives. To achieve that, rather than considering an aging population as a negative social phenomenon, we should create a society where elderly people can enjoy a healthy, prosperous life through social participation and contribution. Factors that hamper the elderly from leading a healthy life include various psychological and social problems occurring in older age, as well as a high incidence of diseases. Therefore, gerontology, which focuses on health promotion of the elderly by encompassing the study of social welfare, psychology, environment and social systems; and geriatrics, which focuses on health care of elderly people and carried out research, education and practices to promote health in the elderly, are becoming more important. Furthermore, along with a need for multidisciplinary care to support geriatric medicine, the development of a comprehensive education system for aged-care professionals is awaited. Thus, we should now recognize the importance of gerontology and geriatrics, and a reform of medical-care services should be made in order to cope with the coming aged society. Population aging is a global phenomenon. The actions being taken by Japan, the world's most aged society, have been closely watched by the rest of the world. Japan's aged society has been posing not only medical, nursing and welfare problems, but also complex problems closely associated with economy, industry and culture. Therefore, to solve these problems, a macroscopic integration and cooperation among industries, education institutions, administration and community through an interdisciplinary approach including medical science, nursing science, nursing care, study of social welfare, social science, engineering, psychology, economics, religion and ethics should be made. Regarding the promotion of gerontology, the "Committee for Establishing a Scientific Community for Sustainable Aged Society" of the Science Council of Japan also prepared a proposal and this was announced on 20 April 2011. 2., Current Situation and Problems: (1) Promotion of social participation and contribution of elderly people In Japan, the overall labor force rate is expected to decrease in the near future as a result of the low birth rate and high life expectancy. In contrast, many elderly people, particularly the young-old, have sufficient physical strength to fulfil their job duties and make a social contribution. For these people, a social structure where elderly people can work should be developed through re-educating the elderly and providing various job types. Promotion of social participation and contribution of the elderly is expected to cause a substantial increase in the labor force. Furthermore, it is also expected to contribute to not only the upturn of national economic activity through an increase in total consumption, but also a decrease in the number of elderly people who are likely to be in need of care. Therefore, in order for elderly people to be engaged in various social activities, strategies for developing a social structure for re-education, various employment statuses and employment opportunities should be prepared. However, as the total number of jobs is fixed, consideration should also be given to young workers. (2) Fostering medical specialists for aging Older people often suffer from many diseases, together with geriatric syndromes with multiple etiologies. Signs and symptoms vary according to each individual, and are often atypical; therefore, the patients visit different hospitals and receive many screening tests and prescriptions at the same time. To solve this problem, an effective screening system carried out by a primary-care doctor, and privacy-preserving medical data sharing among hospitals and clinics are needed. In a geriatric clinical setting, health-care professionals should be aware of the physical traits of older people who often develop not only dementia, but also geriatric syndromes, such as depression, falls and urinary incontinence, so that a holistic approach with consideration of nursing care is required. However, the existing Japanese medical education system is not prepared for medical professionals enabled to respond to the aforementioned requirements. Thus, the fostering of medical professionals who can provide comprehensive care - especially for the oldest-old - such as geriatric specialists and medical professionals who understand the principles of elderly care, is urgently needed. (3) Diagnosis of elderly-specific diseases and reform of medical-care services In Japan, the diagnostic system for elderly-specific diseases, including dementia, and reform of medical care services are markedly delayed. The current status concerning diagnosis, care and nursing should be investigated to collect academic data. In order to accumulate evidence for providing safe elderly care and nursing, the promotion of clinical research and a marked expansion of geriatric medical centers with high-level medical services are eagerly awaited. (4) Promotion of home-based care and multidisciplinary care To reduce the length of stay in acute hospitals, to reduce the physical burden of health-care professionals working at acute hospitals and to meet the demand of older people who prefer to remain in their own homes, further promotion of home-based care is needed. In addition, "multidisciplinary care" is increasingly needed to meet various demands in the medical care and welfare of the elderly. It is considered important to share countermeasures against the problems of disease prevention, medicine, care and welfare among health-care professionals in medicine, care and welfare, and cooperate by making the best use of health-care professionals' specialties. 3., Contents of the Proposal: The subcommittee for aging, thus, provided the following proposal: 1 Development and promotion of systems that enable elderly people to participate socially and make a contribution using an interdisciplinary approach among the various areas, including nursing science, nursing care, study of social welfare, social science, psychology, economics, religion and ethics, as well as medical sciences; 2 Promotion of gerontology, reform and enhancement of geriatrics in undergraduate, postgraduate and lifelong education; 3 Building geriatric medical centers in each area, and accumulating large-scale evidence of geriatric diseases and geriatrics; and 4 Structural development and promotion of home-based care and multidisciplinary care. Through implementation of the above measures, Japan is expected to function as a successful example for the rest of the world., (© 2011 Japan Geriatrics Society.)

Aim: The Japan Geriatrics Society (JGS) developed the guidelines for medical treatment and its safety in the elderly and the list of potentially inappropriate medication use, a Japanese version of the Beers list, in 2005. The JGS working group in collaboration with the Japan Broadcasting Corporation conducted the survey to geriatricians to investigate their experiences of adverse drug reactions (ADR) caused by potentially inappropriate medications., Methods: In September 2008, the survey mails were sent to all the JGS certified geriatricians (n=1492). The questionnaire consisted of 1 year of experiences of ADR of any type, past experiences of ADR by the use of antipsychotic benzamides, hypnotic benzodiazepines, digoxin (≥0.15 mg/day), vitamin D3 (alfacalcidol≥1.0 µg/day) and additional drugs, and their attitudes to reduce the dose/number of drugs for the prevention of ADR., Results: A total of 425 geriatricians responded (response rate 29%). Seventy-two percent experienced ADR within 1 year. Past experiences of ADR were reported by 79% for antipsychotic benzamides, 86% for hypnotic benzodiazepines, 70% for digoxin and 37% for vitamin D3. Free responses included frequent ADR by non-steroidal anti-inflammatory, antihypertensive, antiplatelet, anti-arrhythmic, antidiabetic and antidepressant drugs. Reduction of drugs for ADR prevention was attempted by 93%., Conclusion: This survey showed that most geriatricians experience ADR and take preventive measures for ADR. The results can be used for education and the development of new guidelines.

Adverse drug reactions (ADR) in elderly people, which have been shown to increase with age, are often attributed to functional decline and polypharmacy. A multi-institutional retrospective survey was undertaken to investigate the current status of ADR in geriatric wards of university hospitals. The inpatient database from 2000 to 2002 in 5 university hospitals was studied, and a total of 1,289 patients were analyzed. The incidence of ADR, as determined by attending physicians, was 9.2% on the whole but varied from 6.3% to 15.8% among the institutions. The factors significantly related to ADR were number of diagnoses, number of geriatric syndromes, number of prescribed drugs, increase of more than two drugs during admission, longer hospital stay, emergency admission, depression and apathy. These results are mostly consistent with previous reports and will provide important information on pharmacotherapy in elderly people.

Background: Instrumental activities of daily living (IADL) start to decline during the progression of amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD). Cognitive and physical decline are involved in the loss of functional independence. However, little is known about AD-related neural change that leads to IADL impairment. The purpose of this study was to clarify the effects of regional white matter hyperintensity (WMH) on IADL impairment in persons with AD and aMCI. Methods: The participants were 347 female subjects aged 65–85 years diagnosed with AD (n = 227), aMCI (n = 44) or normal cognition (n = 76). IADL was assessed by the Lawton Index. Cognition, mood and mobility function were evaluated by comprehensive geriatric assessment batteries. WMH and brain atrophy were analyzed with brain magnetic resonance imaging, using an automatic segmentation program. Regional WMH was measured in the frontal, temporal, occipital and parietal lobes. Results: Ability to carry out IADL of shopping, food preparation, mode of transportation, responsibility for own medication, and ability to handle finances was obviously impaired in the early stage of AD. Frontal WMH was specifically associated with disability to do shopping and food preparation even after adjusting for several confounders including brain atrophy. Conclusions: IADL subcategories were differentially impaired along with cognitive status in persons with AD and aMCI. Frontal WMH was an important predictor of impaired ability to do shopping and food preparation. A preventive strategy for WMH might lead to suppression of IADL disability and slow the progression of AD. [ABSTRACT FROM AUTHOR]

Aim: White matter lesions (WML) are common findings on magnetic resonance imaging (MRI) in elderly persons. In this study, we analyzed the relation of WML with global cognitive function, depression, vitality/volition, and 19 symptoms of geriatric syndrome in Japanese elderly patients who attended three university geriatric outpatient clinics. Methods: Two hundred and eighty-six subjects (103 men and 183 women; mean ± standard deviation age, 74.5 ± 7.8 years) were included in this study. MRI scans were performed for the diagnosis of WML, and the severity of periventricular and deep white matter hyperintensities (PVH and DWMH) was rated semiquantitatively. Concurrently, all subjects underwent tests of cognitive function, depressive state and vitality, and were examined for 19 symptoms of geriatric syndrome. Results: The study subjects showed cognitive decline, depression and low vitality, all to a mild extent. Univariate linear regression analysis showed a negative correlation between the severity of WML and cognitive function or vitality. Multiple logistic analysis revealed that the severity of WML was a significant determinant of cognitive impairment and low vitality, after adjustment for confounding factors such as age, sex and concomitant diseases. PVH and/or DWMH score was significantly greater in subjects who exhibited 13 out of 19 symptoms of geriatric syndrome. Logistic regression analysis indicated that WML were associated with psychological disorders, gait disturbance, urinary problems and parkinsonism. Conclusion: WML were associated with various symptoms of functional decline in older persons. Evaluating WML in relation to functional decline would be important for preventing disability in elderly people. [ABSTRACT FROM AUTHOR]

Background: Multiple consultations in older patients may increase the chance of overlapping prescriptions or inappropriate drug prescribing. Methods: We carried out a survey investigating the status of multiple consultations and the polypharmacy of patients attending geriatric outpatient units of five university hospitals. Results: The patients who received multiple consultations did not have a different number of diagnosed disorders and drugs prescribed by geriatricians compared with the patients who received a single consultation. Conclusions: No significant difference in diagnostic and prescribing profiles between the patients with referrals and those without, together with the relatively smaller incidence of inappropriate prescriptions by referrals to non-geriatric specialists, suggest that multiple consultations per se may not necessarily increase the risk for adverse drug events in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Adverse drug reactions (ADR) in elderly people are often attributed to functional decline and polypharmacy. Methods: In this study, a multi-institutional retrospective survey was undertaken to investigate the current status of ADR in geriatric units of university hospitals. The inpatient databases from 2000 to 2002 for five university hospitals were studied, and a total of 1289 patients were analyzed. Results: The incidence of ADR, as determined by attending physicians, was 9.2% on average, but varied from 6.3 to 15.8% among the institutions. Factors significantly related to ADR were the number of diagnoses, the number of geriatric syndromes, the number of prescribed drugs, an increase of two or more drugs during hospitalization, longer hospital stay, emergency admission, depression and apathy. Conclusion: These results are mostly consistent with previous reports and provide important information on drug treatment in elderly people. [ABSTRACT FROM AUTHOR]

Abstract: Background: Intima-media thickness (IMT) of the carotid artery, flow-mediated dilation (FMD) of the brachial artery, and pulse wave velocity of the central artery (PWV) have been widely used to evaluate progression of atherosclerosis. Our previous work has revealed that IMT, FMD and PWV are related to each other, and the combination of these measurements was useful in identifying patients with atherosclerotic disease. The aim of the present study was to investigate whether combination of these measurements would predict future cardiovascular events better than each test alone. Methods and results: From November 2000 to March 2008, 274 consecutive elderly subjects (men/women; 114/160, mean age; 71 ± 12 years) were enrolled in this study. We measured IMT, FMD, and PWV in all of these subjects and followed them for a mean of 41 ± 28 months. During the follow-up period, vascular events occurred in 42 patients (15.3%). IMT (hazard ratio = 1.28 [95%CI, 1.09–1.50], p = 0.002 per 0.1 mm increase in mean IMT) and brachial-ankle (ba) PWV (hazard ratio = 1.06 [95%CI, 1.01–1.10], p = 0.015 per 1 m/s increase in baPWV) were independent predictors of future vascular events by Cox proportional hazard analysis, although FMD did not reach statistical significance (hazard ratio = 0.85 [95%CI, 0.72–1.01], p = 0.062 per 1% increase in %FMD). Importantly, the number of tests showing results in the worst tertile was a more powerful predictor (hazard ratio = 2.21 [95%CI, 1.42–3.43], p = 0.0004 for number of tests showing worst tertile) of future vascular events than either IMT, baPWV, or FMD alone. When both IMT and baPWV (with respective cut-off values of 0.98 mm and 19.1 m/s) were taken into consideration, the efficacy increased as compared with each test alone (odds ratio 4.9). Conclusion: These results indicate that IMT and baPWV, especially when combined, are useful in predicting future vascular events in elderly subjects. [Copyright &y& Elsevier]

Abstract: Objectives: Physicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly. Design: Survey research. Setting: Four groups of health care providers and four groups of health care recipients. Participants: A total of 2512 health care providers and 4277 recipients. Measurements: Questionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes. Results: The mean response rate was 49%. All health care provider groups considered “improvement of quality of life” the most important. In contrast, in health care recipient groups, “effective treatment of illness,” “improvement of physical function,” and “reduction of carer burden” were given high priority, whereas “improvement of quality of life” was perceived as less important. All the groups, including health care providers and recipients, ranked “reduction of mortality” the least important, followed by “avoiding institutional care.” Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures. Conclusion: Priorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research. [Copyright &y& Elsevier]