The care for the homebound older adults, the most vulnerable group of patients and with many problems and needs, needs to be provided by a multidisciplinary team. This is because the assessment becomes more comprehensive and leads to subsequent effective management (from planning to providing care services). Comprehensive geriatric assessment is a multidisciplinary team approach. The author defines the purpose of care for the elderly as “maximizing the product of life expectancy and QOL”, and aims to create a care team that can provide the best “support for the older adults” through various initiatives. Beyond that gaze is “communities excelling in the care for the elderly.”

This article explains the differential diagnosis, characteristics, environmental and psychological factors, and treatment of senile depression. In case of senile depressive state, it is important to distinguish depression from delirium and dementia. Frequent physical complaints as well as notable anxiety and restlessness are described as the characteristics of senile depression. As pathogenic factors, environmental factors such as retirement and children’s independence as well as psychological factors such as age-related decrease in mental and physical strength are mentioned. The treatment of senile depression is explained from the perspective of yojo (cure), based on the concepts of Morita Therapy, and it was suggested that appropriate advices should take into account the degree of recovery. It is also important that even after the diagnosis of depression is given, one should bear in mind that it may shift to dementia over time or may present delirium temporarily.

Hallucination or delusion in the old age is an important topic as same as dementia and cognitive decline. Because a variety of diseases can cause hallucination and delusion, we should make an appropriate diagnosis for useful treatment. At first, we should consider the presentation of organic diseases, such as malignant tumor and so on. Delirium often occurs based on malignant tumors, which is the major factors of hallucination and delusion. If the patient only have delusion without any organic diseases, we should consider delusional disorder or paranoia. Elderly patients with hallucination or delusion can have many factors, such as intracranial diseases, other physical diseases, psychiatric diseases, psychological factors, or environmental stress in their background. So we should consider an appropriate differential diagnosis. When we use antipsychotic drugs, we should be careful to try them from a small dose for fear of extrapyramidal symptoms.

Parkinson’s disease (PD), PD with dementia (PDD), and dementia with Lewy bodies (DLB) can all be seen as falling within the spectrum of diseases known as Lewy body disease, which is characterized by the presence of Lewy bodies. Parkinsonism in DLB shows less resting tremor and fewer bilateral differences than that in PDD. On the other hand, cognitive dysfunction, such as in processing speed, visuospatial cognition, executive function, and attention are more pronounced in DLB than in PD. Dementia with Lewy bodies is also characterized by more Alzheimer pathology than PDD. Neuronal loss of the substantia nigra is greater in PDD than in DLB. In general, the term DLB is used when dementia precedes Parkinsonism, while PDD is used when Parkinsonism precedes dementia by more than one year. There is no evidence, however, to support a fundamental difference between the two.

In this paper, at first, we described the characteristics of somatoform disorder or medically unexplained symptoms in the old age (Senile MUS) at first. Then we showed a classification of Senile MUS. Senile MUS can be classified into 1. Transient somatization, 2. Hypochondriac anxiety type, 3. Obsessive type, 4. Symptoms fixed type in view of their clinical course. Finally, we proposed a recommended approach to Senile MUS. That is to say, 1. To ask the patient’s understanding model (What is she worried about?), 2. To assure the patient status based on physical or other examination, 3. To follow up her with a symptomatic treatment, 4. To regulate the patient’s autonomic nervous function through good daily life rhythm, 5. To guide the patient can shift her daily life from symptoms-centered one to her original one, 6. To be always conscious that the patient should take the leading role in her therapy.

Through examples of old-age clients in my private counseling room, I discussed their psychological traits, understandings and responses.

What’s characteristic about them is, that their problems are not single. In addition to practical problems, many of them are suffering from neurotic and somatic symptoms. They have the problems of loss in body, mind and environment which are universal in the old age.

For the solution of these problems, the clients had a tendency not only to accept the loss but also to actively reconstruct it.

In addition, for understanding today’s elderly population, it is important to respect their individuality and diversity.

One of the health problems in the aged is sarcopenia, and rehabilitation is considered as one of its effective remedies. It is important to have an appropriate dietary protein intake and increase the amount of exercise with the program including repeated resistance training in spite of the low-load treatment of sarcopenia. Specifically with inpatients, it is important in sarcopenia to support them to be able to exercise voluntarily as well as to provide appropriate combined rehabilitation programs. Encouraging patients’ independence in rehabilitation would increase the amount of exercise, resulting in preferable health outcome. In this article, we introduce current perspectives about sarcopenia, and the approaches to increase the amount of exercise and encourage patients’ independence in rehabilitation in our hospital.

Background and Objective : Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that causes abdominal pain and bloating with bowel movement changes, despite no organic diseases. The results of the Japanese health checkup showed that the ratio of women among patients with IBS was 1.56 times higher than that among patients without IBS. The acceptance and commitment therapy (ACT) has been acknowledged as effective to alleviate symptoms and improve the psychological component of anxiety in patients with IBS. Patients with IBS tend to avoid gastrointestinal-specific anxiety, such as thinking, emotion, and feeling, associated with abdominal pain and bloating. Hence, this study aimed to investigate the influence of experiential avoidance, which is the therapeutic target of ACT, on gastrointestinal-specific anxiety and frequency of abdominal pain and abdominal bloating.

Methods : The study was initiated by the chair of the Waseda University after the approval was obtained from the review board of ethics committee. Informed consents were obtained from all participants. The study conducted from August 2016 to October 2016. The survey comprised abdominal pain and bloating caused by functional constipation Rome Ⅲ Diagnostic Criteria for IBS, Acceptance and Action Questionnaire-Ⅱ (AAQ-Ⅱ), Visceral Sensitivity Index Japanese Version (VSI-J), and Depression and Anxiety Mood Scale distributed among 253 women with constipation (age : 20-59 years). We surveyed 244 women who were aware of constipation ; and 128 of them met the criteria of IBS with Rome Ⅲ, with an average age of 36.3±9.3 years.

Results : The structural equation modeling analysis revealed a positive association between experiential avoidance and gastrointestinal-specific anxiety (.30) and between gastrointestinal-specific anxiety and abdominal pain with bloating (.55). As a result of conducting the structural equation modeling and examining the validity, the evaluation of the whole model and its fitness index obtained high flexibility (Χ²=1.129, df=2, p=.569, GFI=.998, AGFI=.988, RMSEA=.000).

Conclusions : Gastrointestinal-specific anxiety mediated the relationship between frequency of abdominal pain/bloating and experiential avoidance. These findings suggest that the experiential avoidance, through gastrointestinal-specific anxiety, influences the frequency of abdominal pain and abdominal bloating.