Geriatrics & Gerontology International最新文献

Japan's rapidly aging population has heightened the need for high-quality home medical care based on patient-centered care (PCC). Shared decision making (SDM) and advance care planning (ACP) are essential processes for achieving PCC; however, their implementation in Japan remains limited. This narrative review summarizes theoretical foundations, international evidence, and current challenges in SDM and ACP, and discusses future directions for their integration into Japanese home medical care. Globally, SDM has been promoted through decision aids and policy initiatives, yet barriers such as limited consultation time, insufficient provider support, and variability in outcome measurement persist. In Japan, although professional societies have issued guidelines to promote SDM and ACP, awareness and adoption remain inadequate, partly due to entrenched informed consent practices, provider knowledge gaps, and limited patient involvement. ACP in home care has demonstrated benefits-including enhanced caregiver security, improved patient-provider communication, and greater support for home-based end-of-life care-yet real-world implementation is inconsistent. Cultural factors, such as family-centered decision making and reluctance to discuss death, further constrain uptake. Evidence increasingly emphasizes the need for integrating SDM and ACP as a continuous, iterative process, enabling both advance preparation and real-time decision making. Training programs incorporating SDM skills have shown potential to shift provider behavior toward PCC. Emerging digital and AI-based tools may expand opportunities for structured conversations and preference documentation. Advancing SDM and ACP in Japanese home medical care will require system-level reforms, workforce training, and ICT-supported care models. Japan's experience may also provide insights for other rapidly aging societies.

Background: Sarcopenia and dyslipidemia are established as independent risk factors for cardiovascular disease (CVD).

Aims: The study aims to investigate the joint effect of sarcopenia and lipid parameters on the risk of self-reported cardiovascular disease in individuals with different stages of glucose metabolism.

Methods: This study included 9053 China Health and Retirement Longitudinal Study (CHARLS) 2015 participants aged ≥ 45 years without baseline CVD. Using multivariable logistic regression, it assessed sarcopenia-lipid-CVD event links, stratified by glucose metabolism. Risk reclassification used combined sarcopenia-lipid status. Restricted cubic splines detected non-linear lipid-CVD relationships. Receiver operating characteristic curves (ROC) evaluated lipid metric accuracy.

Results: A total of 1074 participants (11.9%) reported new-onset CVD. Joint exposure analysis identified synergistic effects: sarcopenia combined with elevated lipid parameters (except HDL-C) conferred the highest CVD risk, particularly in normoglycemic (NGR) and prediabetic (Pre-DM) subgroups (p < 0.001), but not in Type 2 diabetics (p > 0.05). ROC analysis revealed modest discriminative ability of non-traditional indices compared with conventional parameters across glycometabolic strata. Atherogenic Coefficient demonstrated relatively consistent, yet limited, predictive capability across glycometabolic states and may warrant consideration as a potential lipid biomarker for CVD risk assessment.

Conclusions: The findings highlight the coexposure effects between sarcopenia and lipid parameters on cardiovascular diseases, especially for individuals with normal glucose regulation and prediabetes.

Aim: Beyond structured physical activity, emerging evidence suggests the potential health benefits of incidental lifestyle physical activity (ILPA). However, the relationship between ILPA and frailty or frailty domains in older populations remains unclear.

Methods: A total of 15 302 community-dwelling adults aged 65 years and older in Osaka, Japan, were invited to participate in a mailed survey. The survey included a single-item question asking about participants' ILPA: "Are you trying to be physically active in your daily life, for example, through housework or transportation?" Frailty outcomes, including overall frailty and frailty domains (physical, nutritional, oral, social, cognitive, and mental), were assessed using the validated Kihon Checklist based on its scoring manual. Logistic regressions were used to investigate associations between ILPA and overall frailty and each frailty domain. Age and sex differences were determined using subgroup analysis and interaction analysis.

Results: The response rate was 49.03%. Logistic regression analyses revealed ILPA is negatively associated with overall frailty and domains including physical, nutritional, oral, social, cognitive, and mental domains of frailty. Most associations were evident regardless of age and sex, while the association between ILPA and the physical domain of frailty was stronger in males (p for interaction = 0.01), while the association with the mental domain of frailty was stronger in females (p for interaction = 0.007).

Conclusions: In community-dwelling older Japanese adults, ILPA was negatively associated with overall frailty and multiple domains of frailty. While structured physical activity remains critical, the findings underscore the importance of promoting increased ILPA in daily experience.

Aim: To investigate the associations between participation in cognitive/physical activities (CAs/PAs) and life satisfaction among older adults with mild cognitive impairment (MCI).

Methods: This cross-sectional study surveyed 1760 older adults with MCI in Japan regarding their engagement in six cognitive and 11 physical activities. MCI was evaluated using a cognitive function test assessing memory, attention, executive function, and processing speed. CA/PA scores were based on participation frequency, and the participants were categorized into tertile groups (high/moderate/low). Life satisfaction was assessed using the Life Satisfaction Scale and dichotomized into high and low categories. A logistic regression model was used to examine the relationship between CAs/PAs and life satisfaction. We also examined the association between life satisfaction and the interaction term between activity participation and MCI subtype (amnestic vs. non-amnestic).

Results: The odds ratios (95% confidence intervals) for high life satisfaction (using the low score group as the reference) were as follows: CA score (moderate: 1.235 [0.966-1.579]; high: 1.339 [1.051-1.708]) and PA score (moderate: 1.341 [1.051-1.710]; high: 1.369 [1.061-1.769]). Six activities were associated with high life satisfaction: writing for pleasure, participating in organized group discussions, playing tennis, participating in group exercise, climbing stairs, and babysitting. No significant associations between the interaction terms of activity participation and MCI subtype and life satisfaction were observed.

Conclusions: Among older adults with MCI, frequent and diverse engagement in CAs and PAs is associated with high life satisfaction, especially writing, participating in organized group discussions, playing tennis, participating in group exercise, climbing stairs, and babysitting.

Aim: To identify risk factors for pneumonia among institutionalized older adults with severe functional dependency, using routinely available clinical information from the standardized "Doctor's Written Opinion" for long-term care insurance.

Methods: This retrospective observational study included 257 institutionalized older adults with severe functional dependency (median age, 88 years; 55 men and 202 women) residing in a Japanese nursing home between January 2014 and May 2020. Risk factors for pneumonia were analyzed using medical records and data from the standardized "Doctor's Written Opinion" for long-term care insurance.

Results: During a median follow-up of 2.1 years, 51 residents (19.8%) developed pneumonia, which was associated with lower overall survival (log-rank test, p = 0.001). Among the 102 residents who died during this period, pneumonia was the most common cause of death (37% of deaths). Multivariate Cox regression analysis revealed male sex (hazard ratio [HR] 4.692, 95% confidence interval [CI] 2.352-9.357), serum albumin level (HR 0.368, 95% CI 0.151-0.898), cognitive ability for daily decision-making (HR 1.626 per one-point worsening on a four-point scale, 95% CI 1.082-2.444), and recent weight loss (≥ 3% over the past 6 months) (HR 2.645, 95% CI 1.195-5.858) as significant risk factors.

Conclusions: Male sex, lower serum albumin level, impaired cognitive ability for daily decision-making, and recent weight loss were associated with an increased risk of pneumonia. Information routinely available in standardized long-term care assessments may support the identification of individuals at increased risk of pneumonia in resource-limited long-term care settings where comprehensive geriatric assessments are not feasible.

Aim: Intermittent hydrogen gas inhalation has the potential to prevent UVA-induced photoaging by reducing oxidative stress, although the underlying molecular mechanisms remain unclear. Additionally, alternatives to animal experiments are recommended for studies not primarily focused on pathogenesis. This study aimed to evaluate the preventive effects of hydrogen gas on UVA-induced photoaging using a short-term in vitro system with artificial skin.

Methods: Artificial skin was irradiated with UVA at 0, 7, or 10.5 J/cm²/day and incubated for 1 day in a CO₂ incubator with or without 1.3% hydrogen gas. This cycle was repeated three times, followed by one-day incubation. Transcriptomic and histological analyses were then performed.

Results: UVA at 7 J/cm²/day induced minimal epidermal morphological changes but marked photoaging-related transcriptomic alterations, whereas 10.5 J/cm²/day caused epidermal hypoplasia with excessive apoptosis and only limited transcriptomic changes. In comparisons between the 7 J/cm²/day groups with and without hydrogen, hydrogen modulated UVA-induced biological processes and signaling pathways, including the NRF2-mediated and the NFκB1-RelA-mediated responses, and suppressed the p53-mediated senescence pathway.

Conclusions: This study demonstrated that photoaging-related transcriptomic changes were detectable in artificial skin under a relatively low UVA dose (7 J/cm²/day; total 21 J/cm²) with minimal histological alterations. Furthermore, hydrogen may have a protective effect against UVA-induced cellular stress and senescence, via diffusion through the skin surface, suggesting its potential effectiveness in preventing photoaging. This study provides preliminary evidence that may contribute to the development of future translational research on the utility of molecular hydrogen in UVA-induced photoaging.

Objective: Frailty is a recognized syndrome in aging populations, predicting adverse outcomes. The link between its evaluation and adverse effects, particularly under Gobben's framework, is unclear. This study reviews how multidimensional frailty affects older adults' health risks.

Methods: We searched the PubMed, EMBASE, Web of Science, Cochrane Library, CIHNAL, and Chinese databases (WANFANG, CNKI, VIP, and CBM) for relevant studies published from the establishment of the library to January 9, 2026. Statistical synthesis was performed using R software. Employing either fixed-effects or random-effects models based on heterogeneity assessments to evaluate the association between multidimensionally frail older adults and adverse outcomes. Methodological quality, sensitivity analyses, and publication bias were systematically conducted.

Results: A review of 26 studies with 11 186 older adults found that 20.5%-80% exhibited multidimensional frailty, which was associated with increased risks of adverse outcomes, including mortality (HR = 1.61, 95% CI: 1.37-1.89, OR = 2.40, 95% CI: 1.82-3.17), falls (OR = 2.45, 95% CI: 1.29-4.64), and hospitalization (OR = 1.80, 95% CI: 1.29-2.52). However, significant small-study effects were detected for mortality (Egger's test p < 0.001). After trim-and-fill adjustment, the HR attenuated to 1.27 (95% CI: 1.02-1.59), indicating a weaker but still statistically significant association. The association with readmission was of borderline significance (HR = 1.40, 95% CI: 1.00-1.96, p = 0.05).

Conclusion: The research indicates that multidimensional frailty affects older adults, increasing their risk of mortality, falls, hospitalization, and readmission. These results underscore the crucial need for early screening and preventative measures.