Aim: The present study clarified the relationship between the temperature of bath water, the presence of systolic hypertension, the presence of antihypertensive medication, and the pulse rate during bathing, focusing on the variation of systolic blood pressure.

Methods: Twenty community-dwelling men 61 to 87 years old were included in the study. The subjects were randomly divided into 2 groups, based on bath temperature 39°C and 41°C. They were then given a full-body bath for 10 minutes.

Results: The variables significantly related to the change in systolic blood pressure from 2 to 8 minutes after bathing were the presence or absence of antihypertensive medication, and the interaction between the presence of antihypertensive medication and the change in pulse rate from 2 to 8 minutes after bathing.

Conclusions: Antihypertensive medication had a favorable effect on the reduction of systolic blood pressure during bathing.

Objective: To examine the relationship between the type, number, and frequency of social participation and higher life functions in elderly patients with diabetes.

Methods: The subjects were outpatients with diabetes ≥60 years old at Ise Red Cross Hospital. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a self-administered questionnaire, was used to assess the higher life function. The frequency and number of the six types of social participation activities were investigated. Standardized regression coefficients (β) for the higher life functions of social participation were calculated using a multiple regression analysis, with TMIG-IC scores as the dependent variable, social participation as the explanatory variable, and adjustment variables.

Results: A total of 447 patients were included in the analysis. Volunteer activities, sports/exercise clubs, and hobbies were significantly related to higher life functioning among men who participated in these activities several times a year, at least once a month, or at least once a week. For men, study circles (several times a year, β=0.184; p=0.003), activities to share skills and experiences (at least once a week, β=0.178; p=0.004), and work (at least once a month, β=0.144; p=0.022) were also significantly associated with higher life functioning. For women, only volunteer activities (at least once a week, β=0.164; p=0.017), sports/exercise clubs (at least once a week, β=0.149; p=0.032), and hobbies (at least once a week, β=0.147; p=0.036) were significantly related to higher life functions. Social participation was significantly associated with better life functioning. Social participation was significantly related to higher life functions.

Conclusion: The types and frequency of social participation related to higher life functions were clarified in elderly patients with diabetes.

Purpose: This study aimed to develop an educational program for doctors and nurses who treat and care for older adults with dementia and delirium, based on a person-centered care program, utilizing virtual reality (VR) and augmented reality (AR).

Methods: A VR/AR-based program was implemented from February 16 to June 10, 2023, and participants were asked to complete questionnaires before the intervention, immediately after, and three months later.

Results: This study included 74 participants, including 61 nurses (84.2%) and 13 doctors (17.6%). Confidence in delirium care significantly increased for both nurses and doctors immediately after the intervention and one month later relative to baseline. However, knowledge of delirium did not show significant improvement in either nurses or doctors. In the Approaches to Dementia Questionnaire, nurses showed significant improvement in the domain of "personhood" and their total score after one month relative to baseline. The total score of doctors only improved immediately after the intervention relative to the baseline score. In the Team Approach Assessment Scale-Revised, nurses showed significant improvement in the domain of "clarification of goals and roles" and the total score of nurses at one month relative to baseline, while physicians showed no significant improvement.

Conclusion: The program using VR/AR to experience the viewpoints of elderly individuals with dementia and the experiences of multiple professions in this study significantly improved nurses' practice and awareness of person-centered care for older adults with dementia, and nurses' and physicians' confidence in their treatment and care for delirium. Moreover, the study highlights the necessity of incorporating interventions that draw upon the expertise of various professions within dementia care programs to promote multidisciplinary collaboration.

Aim: The social isolation of older Japanese adults with infrequent contact with others diminishes appetite, reduces food intake, and worsens their nutritional status. However, there is insufficient evidence regarding the association between social isolation and nutritional status, with studies primarily confined to rural and suburban areas. This cross-sectional study aimed to investigate the association between social isolation and nutritional status among older adults residing in urban areas.

Methods: This cross-sectional analysis included 1,052 adults (mean age, 78 years). Nutritional status was assessed using the Mini Nutritional Assessment^® Short Form, with a score of 11 or below indicating malnutrition. Applying the abbreviated Lubben Social Network Scale, a score < 12 was considered indicative of social isolation. Logistic regression was applied to the entire population, then the population was separated by sex, with social isolation as the independent variable and malnutrition as the dependent variable. The covariates included age, living alone, economic status, health, daily activities, smoking habits, drinking habits, and years of education.

Results: Social isolation was observed in 41.7% (n = 439) of the total population, while malnutrition was observed in 27.4% (n = 288). Social isolation was significantly associated with malnutrition (odds ratio: 1.41, 95% confidence interval: 1.06-1.88). Sex subgroup analyses revealed that a significant association was retained only among female participants.

Conclusions: Social isolation has been associated with malnutrition among older urban adults in Japan. Future longitudinal studies of the nutritional status of socially isolated individuals are essential.

Objective: To examine the association between barriers to social participation and the risk of undernutrition in older adults with diabetes.

Methods: The subjects were outpatients with diabetes ≥60 years old at Ise Red Cross Hospital. The risk of undernutrition was measured using the Mini Nutritional Assessment Short Form, and a total score of ≤11 was defined as being at risk. The Social Participation Barriers in Patients with Diabetes (SPBD) questionnaire, which consists of 10 items, was used to measure social participation barriers. A logistic regression analysis was performed using the respective SPBD score quartiles (Q1-Q3) for men and women, with the risk of undernutrition as the dependent variable and SPBD score (based on the Q1 group) as the explanatory variable.

Results: In total, 310 patients (187 men and 123 women) were included in the analysis. In men, the adjusted odds ratios for the risk of undernutrition in Q2 and Q3 based on Q1 were 1.56 (95% confidence interval [CI], 0.63-3.83; p=0.328) and 4.52 (95% CI, 1.78-11.46; p=0.001), respectively. In women, the adjusted odds ratios for the risk of undernutrition of Q2 and Q3 based on Q1 were 2.87 (95% CI, 0.85-9.61; p=0.087) and 3.73 (95% CI, 0.88-15.82; p=0.073), respectively.

Conclusion: The results of this study in older people with diabetes showed that barriers to social participation were associated with a risk of undernutrition in men. In particular, hyperglycemia, diabetes treatment, and value-based barriers to social participation were associated with the risk of undernutrition. It is important to raise awareness of the barriers to social participation from the viewpoint of nutrition in older people with diabetes.

A 72-year-old woman with a history of hypertension who had already been taking calcium channel blockers and angiotensin II receptor blockers was prescribed additional indapamide (1 mg/day) due to inadequate blood pressure control. Two weeks later, she experienced loss of appetite and fatigue. Seeking medical attention, she was diagnosed with significant hyponatremia with a serum sodium level of 110 mEq/L at a local clinic, leading to her referral and subsequent admission to our department. Although her consciousness remained clear, laboratory findings revealed a serum sodium level of 116 mEq/L, blood urea nitrogen of 7 mg/dL, blood glucose of 96 mg/dL, and plasma osmolarity of 239.8 mOsm/kg·H₂O, consistent with hypotonic hyponatremia induced by indapamide. Indapamide was discontinued and normal saline was administered. By the 6th day of hospitalization, her serum sodium level had improved to 130 mEq/L, and her symptoms had resolved.

Thiazide-like diuretics can induce hyponatremia as a side effect with diverse symptoms and variable onset. However, in this case, hyponatremia was promptly detected shortly after the initiation of indapamide therapy, and no gastrointestinal symptoms other than anorexia were observed. When initiating thiazide-like diuretics, it is essential to be vigilant for hyponatremia and to provide appropriate medication guidance to patients in addition to monitoring their serum sodium levels.

In elderly diabetes patients with an impaired cognitive function and activities of daily living, multiple daily insulin injection (MDI) therapy is associated with poor injection rates. However, patients with insulin-dependent conditions, such as type 1 diabetes, need to continue insulin therapy. Intermittently scanned continuous glucose monitoring (isCGM) and smart insulin pens have recently emerged as devices for blood glucose management. Smart insulin pens are devices that automatically record the insulin injection time and injection units of insulin and wirelessly transfer the data to a smartphone application. We herein report an elderly patient with type 1 diabetes who was treated with a smart insulin pen.

An 84-year-old woman was diagnosed with type 1 diabetes at 45 years old and had been receiving MDI therapy. She had frequent unconscious hypoglycemia and thus had isCGM introduced at 80 years old. Her Mini-Mental State Examination score was 20 points, indicating mild cognitive decline, and isCGM revealed repeated hyperglycemia due to forgetting her insulin injection and hypoglycemia due to over-dose of insulin. When she was hospitalized for diabetic ketosis at 84 years old, a smart insulin pen was introduced. Following this introduction, her family and medical staff checked her insulin records and encouraged her to perform injections. She subsequently no longer experienced hyperglycemic crisis or severe hypoglycemia.

Elderly patients with type 1 diabetes often have difficulty with self-management of MDI therapy. Smart insulin pens are expected to reduce the rate of forgetting insulin injections and improve injection rates.