Fracture prevention in the elderly is an urgent issue at all levels: individual, family, and societal. Osteoporosis is the underlying cause of fractures in the elderly, and it is important to understand its pathogenesis and treatment. Diet, exercise, and pharmacotherapy are all important for fracture prevention. Particularly with regard to pharmacotherapy, it is important to understand the mechanism of action of each drug and its characteristics and problems from a clinical point of view. Appropriate treatment of osteoporosis has been proven to reduce fractures in the elderly, and its widespread implementation is desirable.

Objective: To examine the relationship between difficulties experienced by family in supporting elderly patients with diabetes and these patients' higher-level functions.

Methods: The subjects were outpatients with diabetes ≥65 years old at Ise Red Cross Hospital and their family members. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to assess patients' higher-level functions. The Japanese version of the Diabetes Caregiver Activity and Support Scale (D-CASS-J) was used to measure difficulties experienced by family in supporting elderly patients with diabetes. Using a multiple regression analysis with TMIG-IC scores (instrumental ADL, intellectual activity, and social participation) as the dependent variable and D-CASS-J scores (based on the highest scoring Q1 group among the three quartiles of D-CASS-J scores) as the explanatory variables, standardized regression coefficients (β) for higher-level functions on the family's perceived support difficulties were calculated.

Results: In total, 429 patients (254 male patients and 175 female patients) were included in the analysis. For male patients, the adjusted beta values for TMIG-IC scores in Q2 and Q3 were −0.039 (P=0.649) and −0.352 (P<0.001), respectively, and the adjusted beta values for the instrumental ADL scores were −0.064 (P=0.455), −0.192 (P=0.047), −0.090 (P=0.375), and −0.360 (P=0.002) for the Intellectually Active scores, respectively, and the adjusted beta for social role scores were 0.054 (P=0.581) and −0.261 (P=0.019), respectively. However, there was no association between the patients' higher-level functions and family support difficulties among female patients.

Conclusions: Difficulty experienced by the family in supporting elderly male patients with diabetes is associated with reduced higher-level functioning.

Aim: The coronavirus disease (COVID-19) pandemic has caused significant disruptions in various aspects of daily life. The Japanese Government declared a state of emergency in April 2020, which resulted in reduced physical activity. This study investigated the impact of these lifestyle changes by generation among outpatients with cardiovascular disease (CVD).

Methods: In autumn 2020, we conducted a questionnaire survey of 1,156 CVD outpatients who visited the Department of Cardiology at our institution. The survey collected data on physical activities and changes in daily behaviors over the course of the COVID-19 pandemic. Participants were classified into 3 age groups: middle-aged (n=114, ≤64 years old), semi-old (n=330, aged 65-74 years old), and old (n=712, ≥75 years old). The number of steps per day and sedentary time per day were compared between autumn 2019 and 2020, over the course of the pandemic.

Results: In autumn 2020, the number of steps per day was significantly decreased and sedentary time significantly increased in all age groups compared to the pre-pandemic levels. However, there were no significant differences in the extent of changes in steps per day or sedentary time over the study period across all age groups. Regarding changes in daily behaviors, only the old-age group reported a decline in volunteering and reduced utilization of daycare services.

Conclusions: The COVID-19 pandemic has resulted in changes in daily activities and lifestyles across all age groups. Because lifestyle patterns differ across generations, it may be necessary to implement age-specific interventions and procedures.

Objective: To examine the relationship between decreased appetite and the cognitive function in elderly diabetic patients.

Methods: The study subjects were outpatients with diabetes who were 60 years of age or older, and who were managed at Ise Red Cross Hospital. The cognitive function was assessed using a self-administered Dementia Checklist. The Japanese version of the Simplified Nutritional Appetite Questionnaire (SNAQ) was used to measure decreased appetite. A logistic regression analysis, in which the dependent variable was cognitive decline and the explanatory variables were appetite loss and adjustment variables, was used to calculate the odds ratio for cognitive decline according to the presence of appetite loss.

Results: Four hundred eighty patients were included in the analysis. Seventeen percent of the patients had decreased appetite and 21% had a decreased cognitive function. The unadjusted and adjusted odds ratios of cognitive decline for those with decreased appetite were 2.78 (95% confidence interval (CI), 1.66-4.65; P<0.001) and 2.26 (95% CI, 1.16-4.37; P=0.015), respectively, based on the absence of decreased appetite.

Conclusion: Decreased appetite in elderly patients with diabetes was associated with a decreased cognitive function.

Aim: This study clarified the association between the amount of physical activity and apathy after one year among community-dwelling older adults.

Methods: Two hundred community-dwelling older adults (mean age: 74.3±5.0 years old, female: 52.5%) who participated in the 2018 and 2019 "Kasama Longevity Health Examination" were included. Apathy was assessed using the Apathy Scale (0-42 points; the higher the score, the lower the motivation), physical activity by Physical Activity Scale for the Elderly (PASE), and Geriatric Depression Scale-15 (GDS). The 2018 PASE data were grouped into tertiles. A multiple regression analysis was performed with the 2019 Apathy Scale as the dependent variable and the 2018 PASE as the independent variable, and the sex, age, years of education, economic situation, body mass index, chronic illness, smoking history, alcohol drinking habits, physical function, cognitive function, GDS, and the 2018 Apathy Scale as adjustment variables. The PASE subcategories (leisure-time, household, and work-related activities) were examined using a similar method.

Results: The mean Apathy Scale in 2019 was 14.0±6.2 for the low physical activity group, 12.8±6.0 for the medium physical activity group, and 10.1±5.9 for the high physical activity group. The high physical activity group showed a significant negative association with the Apathy Scale (B=−1.56, 95% confidence interval=−2.91 to −0.21, p=0.023). No association was found for any activity of the PASE sub-items.

Conclusions: A high level of physical activity may protect against apathy among community-dwelling older adults.

Objective: To examine the relationship between the type and number of social participation events and the cognitive function in elderly patients with diabetes.

Methods: The subjects were diabetic outpatients of ≥60 years of age who were managed at Ise Red Cross Hospital. Mild cognitive impairment (MCI) and dementia were assessed using a self-administered dementia checklist. Six types of social participation activities and the number of participants were investigated. A logistic regression analysis with MCI and dementia as dependent variables, social participation as an explanatory variable, and adjustment variables was used to calculate the odds ratios for social participation according to the presence of MCI and dementia.

Results: In total, 352 patients were included in the analysis. Volunteer activities (P=0.012), hobbies (P=0.006), activities to share skills and experiences (P=0.026), and work (P=0.003) were significantly associated with dementia. Regarding the association between the amount of social participation and dementia, there was a decrease in the risk of dementia when the number of social participation was 2. However, social participation was not significantly associated with MCI in this study.

Conclusion: The type and number of social participation events were found to be associated with the risk of dementia in elderly patients with diabetes.

Objective: To examine the relationship between vegetable-first eating habits and the cognitive function in elderly patients with diabetes.

Methods: The subjects were outpatients with diabetes ≥60 years old at Ise Red Cross Hospital. A self-administered dementia checklist was used to assess mild cognitive impairment and dementia. The participants were asked to fill out a questionnaire on their vegetable-first eating habits and were classified into 4 groups: 0, 1, 2, and 3 times a day. The dependent variables were mild cognitive impairment and dementia, and the explanatory variable was vegetable-first eating habits (0 as a reference).

Results: In total, 358 patients were included in the analysis. The number of vegetable-first meals was 0 in 153 (42.7%), 1 in 48 (13.4%), 2 in 46 (12.8%), and 3 in 111 (31.1%) patients. The adjusted odds ratios for 1, 2, and 3 times of mild cognitive impairment were 0.83 (95% confidence interval [CI], 0.35-1.94; P=0.680), 0.81 (95% CI, 0.32-2.00; P=0.653), and 0.37 (95% CI, 0.17-0.81; P=0.014), respectively. However, there was no significant association between vegetable-first eating habits and dementia.

Conclusion: In elderly patients with diabetes, a vegetable-first eating habit at each meal was associated with a decreased risk of mild cognitive impairment.

Aim: This study aimed to investigate the relationship between depressive tendencies and oral diadochokinesis (ODK) in 24 older adults living in a private residential nursing home. ODK is an indicator of the oral function.

Methods: Depressive tendencies were assessed using the Geriatric Depression Scale 5, with scores of two or higher indicating probable depression. ODK was measured across four syllable tasks (/pa/, /ta/, /ka/, and /pataka/), which were evaluated using coefficient of variation (CV) values. Low CV values indicate superior performance. Potential confounders, including the cognitive function, sleep status, body mass index, instrumental activities of daily living, and physical function, were controlled.

Results: Five participants (20.8%) experienced depression. Individuals with depressive tendencies demonstrated significantly poor ODK performance (higher CV) in the /ta/ task and a marginally significant difference in the /ka/ task. No significant differences were observed between /pa/ and /pataka/.

Conclusions: These findings suggest a link between depressive tendencies and reduced proficiency in specific ODK tasks among older nursing home residents. This finding implies that a decline in the oral function in articulating /ta/ and /ka/ syllables may precede other common depressive symptoms. Furthermore, depression monitoring could be a valuable tool for early detection of the oral function in this population, enabling timely interventions.

Purpose: The present multicenter randomized controlled trial explored the effectiveness of a person-centered care program (intervention group) and a dementia-type-specific program (control group) for nurses in acute-care hospitals.

Methods: Seven hospitals in Prefecture A were randomly allocated to two groups (an intervention group and a control group), and a study of these groups was conducted from July 2021 to January 2022.

Results: A total of 158 participants were included in the study: 58 in the control group and 100 in the intervention group. In a comparison of assessment values immediately after the course, three months later, and six months later for both the intervention and control groups, "expertise in dementia nursing," "medical expertise in dementia, " and "confidence in nursing older people with dementia" were all significantly higher than before the course. Significant improvements in the intervention group's "knowledge of dementia" and "sense of dignity" on the ethical sensitivity scale were found immediately after the course compared to baseline, three months later, and six months later and were also significantly greater than the control group in terms of the amount of change. In the control group's "unique care tailored to cognitive function and the person," there were significant improvements in the ratings immediately after the course and three and six months after the course compared to baseline, with significantly greater amounts of change than in the intervention group.

Conclusion: The person-centered care program for nurses led to improvements in the knowledge about dementia and awareness of the dignity of ethical sensitivity. In addition, the type of dementia program had a significant influence on medical knowledge and unique care tailored to the cognitive function and the individual patient. Further outcome evaluations of physical restraint rates as a quality of care in nursing practice are needed.

Aim: Some studies have reported a higher incidence of falls during winter with similar proportions of indoor and outdoor falls. We investigated the relationship between indoor temperature during winter and falls at home in the past year among community-dwelling older adults.

Methods: This cross-sectional study enrolled 964 individuals of ≥65 years of age in Japan. Participants answered questions about falls (including trips) at home within the past year, and the living room temperature was measured for 2 weeks during winter. Participants were divided into those living in cold (mean temperature near the floor <12°C), slightly cold (12-17.9°C), and warm (≥18°C) houses. The association between indoor temperature (cold vs. slightly cold vs. warm houses) and falls at home in the past year was examined using a logistic regression analysis adjusted for potential confounding factors.

Results: Valid data were obtained from 907 participants (mean age: 72.0±6.3 years), of whom 265,553, and 89 lived in cold, slightly cold, and warm houses, respectively. In the past year, falls occurred once in 325 (35.8%) participants and multiple times in 148 (16.3%) participants. In warm houses, the odds ratio of falling once and multiple times in the past year was 0.49 (p=0.032) and 0.34 (p=0.035), respectively, in comparison to cold houses.

Conclusions: Living in cold houses may be associated with an increased risk of falling at home among older adults. Maintaining an appropriate indoor thermal environment during winter may reduce the risk of falling among individuals who spend most of their time at home.

Aim: This study aimed to elucidate the barriers perceived by Advance Care Planning (ACP) facilitators in nursing and welfare professions when implementing ACP in practice.

Methods: An online survey using Google Forms was conducted between December 2021 and January 2022. The survey targeted 220 individuals, including 82 who completed the Hiroshima Prefecture ACP Promotion Training in 2020 and 138 ACP Promotion Collaborators in Fukuyama City, Hiroshima Prefecture. In addition to the respondents' attributes, the survey asked about the importance of 37 items related to barriers to ACP implementation, using a 7-point scale. We compared two groups: nurses and physicians ("nurses/physicians") and other medical and nursing care professionals ("nursing care professionals, etc.").

Results: Responses were obtained from 67 participants (response rate: 34.4%). The barriers to ACP perceived by nursing care professionals were as follows: 1) lack of knowledge about ACP, 2) belief that other professions are more suitable for implementing ACP than themselves, and 3) difficulty in realizing intentions due to institutional and environmental factors. Nurses and physicians perceived lack of time as an important barrier. Measures such as 1) clarifying how different professions should be involved in ACP, 2) expanding educational opportunities tailored to each profession, 3) utilizing tools to support the decision-making process in ACP, and 4) establishing an information-sharing system infrastructure are considered to be effective in promoting the implementation of ACP by facilitators in the nursing and welfare professions.

Conclusions: By implementing measures to address the barriers identified in this study, it is expected that the practice of ACP by facilitators in nursing and welfare professions will be promoted, and ACP will become more widespread in the community.

An 87-year-old woman was admitted to our hospital with general fatigue, anorexia, nausea, and chest pain, and was diagnosed with Takotsubo cardiomyopathy and a stomal ulcer. Pseudohyperchloremia and a negative anion gap were detected in laboratory tests. She was continuously taking commercially available analgesics, including bromvalerylurea. On the 11th day of hospitalization, her bromide concentration was high (331.2 mg/L). She was readmitted with fatigue and anorexia one and a half years after her last hospitalization. On admission, her serum chloride and bromide levels were also high. Despite being instructed to stop taking analgesics after the first hospitalization, she was unable to stop taking the medication. It took more than two years for her blood bromide concentration to decrease and the withdrawal of the medication to be confirmed. Clinicians should consider bromide intoxication in patients with unclear neuropsychiatric symptoms and high chloride levels.