Geriatrics & Gerontology International最新文献

Unno et al. [1] recently highlighted the importance of preoperative intramuscular adipose tissue content (IMAC) in early functional recovery after hip fracture.

In daily rehabilitation practice, we frequently encounter patients who demonstrate preserved systemic stability—adequate nutritional indices and stable vital parameters—yet remain unable to initiate effective gait despite intensive therapy. The findings by Unno et al. provide a compelling physiological explanation for this clinical discrepancy: a dissociation between “systemic metabolic reserve” (reflected by PhA) [2] and “locomotor mechanical integrity” (reflected by IMAC) [1].

The authors' observation that IMAC independently predicts walking recovery, while PhA does not, raises a critical question regarding our current therapeutic strategies: Are conventional resistance-based rehabilitation paradigms sufficient for patients with high IMAC? [3] The presence of myosteatosis implies a qualitative deficit in motor unit recruitment and force transmission. Consequently, we propose that patients identified with high preoperative IMAC might require distinct interventions, such as targeted neuromuscular re-education or high-velocity power training, rather than standard strengthening protocols alone.

Finally, while the authors acknowledge the 2-week follow-up limitation, this early period is often just the beginning of the functional journey. In models like Taiwan's nationwide Post-Acute Care (PAC) program, patients undergo high-intensity rehabilitation for several weeks to months [4]. Whether IMAC retains its strong predictive value for ambulatory recovery during such prolonged, high-intensity rehabilitation remains an important and clinically actionable question that warrants further investigation.

The authors have nothing to report.

The authors have nothing to report.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Incorporating tongue pressure as an indicator of oral frailty allows for a comprehensive approach to frailty management in older adults.

Background: Aspiration pneumonia (AP) is a leading cause of morbidity and mortality in older adults. Facility-level determinants of AP in long-term care settings remain poorly understood. In Japan's long-term care insurance system, geriatric health service facilities differ in their staff composition, care processes, and swallowing support systems, which may influence AP incidence.

Methods: We conducted a nationwide, facility-level cross-sectional study using data from the 2024 Survey on Eating and Swallowing Support conducted by the Japan Association of Geriatric Health Service Facilities. Of the 454 respondents, 445 facilities were included. The facilities were categorized as super-enhanced, enhanced, add-on, or basic. Facility characteristics, staffing composition, nutritional and swallowing management practices, and reimbursement-based care add-ons were compared across facility types. Multivariate logistic regression was used to identify the risk factors associated with AP occurrence.

Results: Facility type, staff composition, and care resources varied significantly. The multivariable model revealed that a history of AP (OR = 45.138, 95% CI 16.937-120.292; p < 0.001) and aspiration events (OR = 9.280, 95% CI 4.215-20.116; p < 0.001) were strongly associated with AP. Facilities lacking occupational therapists had a higher risk of AP (OR = 4.875, 95% CI 1.708-13.909; p = 0.003).

Conclusions: Facilities characterized by frequent aspiration events or a history of AP tended to have a higher incidence of AP. The absence of occupational therapists was associated with an increased facility-level risk of AP, suggesting that organizational differences in care management may influence AP in long-term care settings.