In Japan, the proportion of older adults with obesity is rising, highlighting the need for specialized medical care for older adults with obesity. The Japan Society for the Study of Obesity (JASSO) defines 'obesity' as excessive fat storage in adipose tissue with body mass index (BMI) ≥ 25 kg/m², and "Obesity Disease" as a condition with health disorders associated with obesity and/or visceral fat accumulation.

The term 'high-degree obesity' applies to those with BMI≥ 35 kg/m², and "Obesity Disease" with high-degree obesity is defined as "high-degree Obesity Disease".

While the diagnostic criteria for "Obesity Disease" are same regardless of age group, older adults have unique problems. For example, BMI may not accurately reflect fat mass due to age-related height changes and other factors like edema. There's also an 'obesity paradox' in the older adults, where higher BMI may correlate with reduced mortality, though visceral fat is a risk factor.

Weight reduction goal is 3% or more of body weight in 3-6 months for "Obesity Disease" and 5-10% or more for "high-degree Obesity Disease" . Management may include calorie-controlled diets and resistance exercises to prevent bone and muscle loss. Advanced treatment options like bariatric/metabolic surgery are also available for "high-degree Obesity Disease" .

Recent guidelines from the Japan Geriatrics Society and JASSO provide insights into managing "Obesity Disease" among older adults, considering specific issues like dementia and functional decline. Future therapy need to evolve and provide individualized approaches to manage obesity for older adults.

Aim: To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups.

Methods: Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed.

Results: A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference.

Conclusions: We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Aim: To determine the relationship between the subjective age, higher-life function, and new certification for the need for long-term care among older adults in the community.

Methods: A mail survey was conducted in 2016 among community-dwelling older adults, and the 2,323 participants who were available for follow-up in 2019 were included in the analysis. Subjective age was evaluated using the following three items in response to the question "Please answer how old you feel you are": "Same as actual age," "Feel younger," and "Feel older." Other assessments included an evaluation of the higher-life function, Geriatric Depression Scale scores, general self-efficacy, and exercise adherence. In addition, at follow-up, we investigated whether or not participants required new certification for the need for long-term care.

Results: At baseline, participants who felt "older than their actual age" had a significantly lower life function and general self-efficacy and were less likely to exercise at least once a week than the other groups. Furthermore, those who felt "older than their actual age" was more likely than the other groups to be newly certified as needing long-term care, while those who felt "younger than their actual age" were less likely to receive new certification. A logistic regression analysis revealed that "feeling older" was a risk factor for being certified as needing long-term care, even after adjusting for other factors (odds ratio= 3.33, 95% confidence interval: 1.02-10.94, p=0.047).

Conclusions: Among community-dwelling older adults, those with a subjective age exceeding their chronological age were expected to show a decreased life function in the future and an increased risk of needing long-term care.

Aim: This study aimed to evaluate the use of potentially inappropriate medications (PIMs) and to examine the number of oral medicines based on the swallowing function and activities of daily living (ADL) categories in a geriatric medical care ward.

Methods: A prospective investigation of oral medication use of 124 consecutive patients (male, n=58; female, n=66) admitted to a geriatric medical care ward was conducted from November 2019 to October 2020. Nutritional routes and ADL categories were quantitatively assessed, and the respective medication quantities were subjected to a statistical analysis.

Results: The average number of oral medications was 5.8 at acute care admission, 4.4 upon transfer to the geriatric medical care ward and 4.8 at discharge. Approximately 30% of oral medications were classified as PIMs, including antithrombotic agents, diuretics, antidiabetic drugs, magnesium oxide, sleep and anxiolytic medications, and antipsychotic drugs. Magnesium oxide, antipsychotic drugs, sleep and anxiolytic medications were frequently discontinued during the patient's stay at the geriatric medical care ward. The proportion of PIMs significantly decreased from 35.1% at admission, to 28.8% at ward transfer, and 24.3% at discharge (P<0.01). The number of oral medicines at discharge varied based on the nutritional route, with averages of 5.5 for oral intake, 3.6 for enteral nutrition, and 0.7 for venous nutrition. It also varied based on ADL categories, with averages of 6.0 for ADL 1, 5.8 for ADL 2, and 3.8 for ADL 3.

Conclusion: The use of PIMs decreased in the geriatric medical care ward. A reduced swallowing function and lower ADL were associated with a decrease in the quantity of oral medicines.

Aim: Morning-off is a symptom experienced by patients with Parkinson's disease (PD), which markedly reduces patients' quality of life. The present study evaluated the effect of safinamide on morning-off in elderly PD patients.

Methods: This observational study included 30 PD patients treated with 50 or 100 mg/day of safinamide in the evening. Using patient-reported outcomes, we evaluated the effect of safinamide on daily/morning ON-time, daily/morning OFF-time, Unified Parkinson's Disease Rating Scale (UPDRS) Part III score, and non-motor symptoms. Data at baseline (treatment start) and at 4, 8, 12, and 16 weeks after baseline were recorded.

Results: The PD patients (75.8±7.5 years old) in this study, who tended to be older than in previous phase 2/3 or 3 studies, may represent real-world Japanese PD patients. Compared with baseline, safinamide significantly increased the daily ON-time at eight weeks and morning ON-time at four weeks. Safinamide significantly reduced the daily OFF-time and morning OFF-time at four weeks. The UPDRS Part III score was significantly reduced by 1 point at 12 weeks. Safinamide showed a tendency to reduce non-motor symptoms, such as anxiety, pain, and depressive feelings. There was no marked difference in these parameters between patients treated with 50 and 100 mg of safinamide.

Conclusions: Our results suggest that safinamide administered in the evening can benefit elderly patients who experience wearing off, especially morning off, and non-motor symptoms.

Aim: This study clarified the relationship between aspiration pneumonia and the oral health status.

Methods: A total of 809 users from Kounankai were targeted. The Oral Health Assessment Tool (OHAT) includes eight items: lip, tongue, gingiva/mucosa, saliva, remaining teeth, dentures, oral cleaning, and toothache. Information on aspiration pneumonia was collected from each facility. A binomial logistic regression analysis was performed, with aspiration pneumonia as the objective variable and the OHAT items as explanatory variables. The analysis was performed using the R software program, version 4.0. 2, with a significance level of < 5%.

Results: No significant association was found between the development of aspiration pneumonia and the OHAT score. The proportion of males was significantly higher in the aspiration pneumonia group than in the group without pneumonia.

Conclusion: No association was found between the development of aspiration pneumonia and the OHAT score.

Aim: Since the declaration of an emergency following the spread of COVID-19, the number of elderly patients complaining of delusions has increased. Therefore, we investigated the characteristics of patients diagnosed with delusional disorders in our clinic.

Methods: A total of 1,884 patients ≥ 65 years old who visited the Center for Comprehensive Care on Memory Disorders at Kyorin University Hospital from January 2017 to December 2021 were included in the study. The 17 patients diagnosed with delusional disorders were divided into 2 groups based on the timing of the first declaration of emergency, and the characteristics of each group were investigated.

Results: Seven patients were diagnosed with delusional disorder before the first declaration of emergency and 10 after the declaration. The proportion of patients increased by approximately three-fold after the declaration. Post-emergency patients were less motivated to be active than those encountered before the declaration, and many had no history of mental illness. Seven of the 10 post-emergency patients visited the Memory Clinic within 1 year of the onset of delusions.

Conclusions: After the first declaration of an emergency, elderly patients with no history of psychiatric disorders acutely developed delusional disorders.

The physical and psychological effects of COVID-19 on the elderly should be considered.

Purpose: This study investigated the subjective effects and safety of using a twiddle muff to reduce the wearing of mittens by care staff for older patients with dementia.

Methods: A survey was conducted among hospital staff using muffs since January 2022. In addition to the use of questionnaires, the staff were interviewed via the Zoom platform.

Results: A total of 18 participants were surveyed, including 15 nurses (83.3%) and 3 physical and occupational therapists (16.8%). Based on the responses to the questionnaire, all participants indicated that the muffs were effective in "removing or reducing physical restraints," and 11 participants (61.1%) pointed out that the muffs were effective in "alleviating behavioral and psychological symptoms" of dementia. The effects of the twiddle muff, as perceived by the staff, were as follows: 1) provides relief from physical and mental tension by reducing mitten restraints and inducing relaxation by pleasant sensory stimulation; 2) improves understanding and allows gentle communication with older patients with dementia; 3) promotes assistance and rehabilitation, enabling transfers and moving operations by reducing the act of clutching bed fences and lines; and 4) is useful as a rehabilitation method for preventing disuse syndrome.

Conclusion: According to the staff surveyed, the use of the twiddle muff not only eased the distress of older patients with dementia but also helped the respondents understand dementia and promoted communication among themselves. However, it is necessary to objectively demonstrate the effectiveness of a twiddle muff in the future.

Aim: This study aimed to examine the effect of intervention using the Himotoki Sheet versus conventional care on behavioral and psychological symptoms of dementia (BPSD) in residents of care facilities.

Methods: This non-randomized controlled trial included 37 institutionalized individuals with dementia. During the four-week intervention period, the care workers in the intervention group, which consisted of 17 participants, were asked to 1) select one BPSD item for intervention from the items of the Behavioral and Psychological Symptoms of Dementia Plus Questionnaire (BPSD+Q), 2) complete the Himotoki Sheet and share information about the BPSD focused on by the team led by the Himotoki Sheet manager, and 3) provide care according to the contents of the Himotoki Sheet. The 18 patients in the control group received conventional care for four weeks. A two-way analysis of variance was used to compare changes in scores between groups and the BPSD+Q.

Results: A total of 32 participants (intervention group, n=16; control group, n=16) were analyzed. There were no significant differences in basic attributes between the groups. There was a significant interaction between the group and the BPSD+Q distress score (F=4.704, p=0.038) and Hyperactive domain distress score (F=4.946, p=0.034). The BPSD+Q (p=0.002) and Hyperactive domain (p=0.001) distress scores were significantly reduced in the intervention group but not the control group.

Conclusions: In comparison to conventional care, care using the Himotoki Sheet was associated with a significant reduction in the BPSD+Q and Hyperactive domain distress scores.

Introduction: Although the number of deaths in bathtubs in homes and residential facilities for the elderly has been decreasing slightly since 2017, it is still 4,900 (2019), which is almost twice the number of traffic accident deaths.

Purpose: The purpose of this study was to investigate blood pressure and pulse fluctuations in community-dwelling elderly people during bathing, and to examine the alert range to determine when heat shock occurs.

Methods: Ten elderly men (72.6±3.4/67-78) living in the community were subjected to a 6-minute full-body bath in a bath with a temperature of 41°C, and their blood pressure (SBP, DBP) and pulse (PR) were measured.

Results: The SBP of the group whose PR increased by 15/min or more from before bathing to 30 seconds after bathing increased by about 30 mmHg. In the group where PR increased by 15/min or more, the pulse pressure (PP) increased by about 30 mmHg, and in the double product (DP), the abnormal increase of 5,000 DP or more was observed from before bathing to 30 seconds after bathing.

Discussion: In the group where PR increased by 15/min or more from before bathing to 30 seconds after bathing, there is a possibility of cerebral hemorrhage immediately after bathing, dizziness, and falls. Analysis of pulse pressure (PP) and double product (DP) also suggests that the burden on the heart is applied 30 seconds after bathing, and sufficient attention is required.

Giant cell arteritis (GCA) is closely associated with polymyalgia rheumatica (PMR). We herein report an 82-year-old woman who developed GCA during PMR treatment. She initially presented with shoulder pain and was diagnosed with PMR based on elevated serum C-reactive protein (CRP) levels and bursitis detected in both shoulders on ultrasonography (US). Treatment was initiated with a daily dose of 15 mg prednisolone (PSL), which led to rapid symptom alleviation, and the dosage was tapered to 1 mg/day. One month later, she developed myalgia extending from the lumbar region to the thigh and tenderness in the left temporal region. However, no abnormalities in the temporal artery were observed on US. Although the PSL dose was increased to 2 mg for relapse of PMR, the symptoms did not improve. One week later, she developed occipital pain with an increased CRP level of 9 mg/dL. She was diagnosed with GCA based on the 1990 ACR Classification Criteria. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) detected anomalous accumulations in the bilateral superficial temporal and vertebral arteries, but not in the larger vessels. We therefore diagnosed her with cranial-type GCA. At this time point, we repeated US and found a halo sign in the temporal artery. Although epithelioid and giant cells were not observed in the temporal artery biopsy, vascular inflammatory findings such as disruption of the internal elastic lamina and chronic inflammatory cell infiltration were noted. Symptoms improved immediately and CRP levels decreased after the PSL dose was increased to 30 mg daily. To mitigate the risk of steroid-induced diabetes, tocilizumab was introduced, and gradual tapering of PSL was implemented. In conclusion, we encountered a case of GCA that developed after PSL reduction during the course of PMR. PET/CT confirmed intracranial artery inflammation and facilitated a definitive diagnosis. Although PET/CT cannot be routinely performed for diagnose in Japan, we consider it useful as an adjunctive diagnostic tool.