The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected older populations globally. However, limited data are available on the long-term survival and evolving care needs of older patients with COVID-19 in Japan. We evaluated 1-year survival rates and long-term care needs in this vulnerable population.
Methods
This population-based cohort study analyzed 2175 hospitalized patients with COVID-19 aged ≥ 65 years using data from the Nara Kokuho Database between February 2020 and August 2022. The database contains administrative claims data from the National Health Insurance and Late Elders' Health Insurance systems, incorporating information on care needs levels. We examined 1-year survival and changes in care needs levels.
Results
The overall 1-year survival rate was 80.9%. Age significantly influenced survival, with rates of 93.6% for patients aged 65–69 years and 56.6% for those ≥ 90 years. Disease severity had a substantial impact: patients not requiring oxygen therapy had a survival rate of 87.5%, compared to 74.0% for those with supplemental oxygen and 49.9% for those receiving invasive mechanical ventilation. Despite a decline in severe cases following the Delta and Omicron-predominant waves, survival among severely ill patients remained lower. While most patients without prior care needs retained independence, approximately 23% developed new care requirements after COVID-19. Higher care needs levels were associated with significantly higher mortality, with patients at care needs level ≥ 2 experiencing mortality rates exceeding 35%.
Conclusion
This study highlights the importance of comprehensive management of the long-term survival and care needs of older patients with COVID-19.
{"title":"One-Year Survival and Changes in Care Needs Among Hospitalized Older Patients With Coronavirus Disease 2019 in Japan: A Nara Kokuho Database Analysis","authors":"Kiyoshi Takemoto, Tomoya Myojin, Yuichi Nishioka, Ikko Yamazaki, Tatsuya Noda, Tomoaki Imamura","doi":"10.1111/ggi.70353","DOIUrl":"10.1111/ggi.70353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected older populations globally. However, limited data are available on the long-term survival and evolving care needs of older patients with COVID-19 in Japan. We evaluated 1-year survival rates and long-term care needs in this vulnerable population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This population-based cohort study analyzed 2175 hospitalized patients with COVID-19 aged ≥ 65 years using data from the Nara Kokuho Database between February 2020 and August 2022. The database contains administrative claims data from the National Health Insurance and Late Elders' Health Insurance systems, incorporating information on care needs levels. We examined 1-year survival and changes in care needs levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall 1-year survival rate was 80.9%. Age significantly influenced survival, with rates of 93.6% for patients aged 65–69 years and 56.6% for those ≥ 90 years. Disease severity had a substantial impact: patients not requiring oxygen therapy had a survival rate of 87.5%, compared to 74.0% for those with supplemental oxygen and 49.9% for those receiving invasive mechanical ventilation. Despite a decline in severe cases following the Delta and Omicron-predominant waves, survival among severely ill patients remained lower. While most patients without prior care needs retained independence, approximately 23% developed new care requirements after COVID-19. Higher care needs levels were associated with significantly higher mortality, with patients at care needs level ≥ 2 experiencing mortality rates exceeding 35%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the importance of comprehensive management of the long-term survival and care needs of older patients with COVID-19.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the impact of the medical fee revisions related to polypharmacy in Japan on the long-term hypnotic prescriptions in older patients.
Methods
We utilized the JMDC medical institution database. Outpatients and inpatients aged ≥ 50 years were included. The target hypnotics included benzodiazepines (BZDs), z-drugs, and ramelteon and orexin receptor antagonists (ramelteon/ORAs). The incidence rates of the newly initiated ≥ 4 weeks of prescriptions per 10 000 outpatients and inpatients (LP-rate) in each month from 2015 to 2022 were calculated. An interrupted time-series analysis was conducted with the intervention point of April 2020 when the medical fees were revised.
Results
The average number of outpatients and inpatients in the database from 2015 to 2022 was 828,510/month. The LP-rates of BZDs and z-drugs gradually decreased from 210 to 125 and 111 to 78.6, respectively, from January 2015 to December 2022, whereas that of ramelteon/ORAs increased from 7.41 to 54.4. In the LP-rate of BZDs and z-drugs, although the level significantly increased by factors of 1.08 [95% confidence interval (CI): 1.02–1.13] and 1.12 [95% CI: 1.08–1.16], respectively, at the intervention time, the slope change significantly decreased after the intervention (0.990 [95% CI: 0.988–0.992] and 0.994 [95% CI: 0.993–0.996]). In ramelteon/ORAs, the slope change with the increasing trend was significantly attenuated after the intervention (0.991 [95% CI: 0.986–0.995]).
Conclusions
The medical fee revisions related to polypharmacy significantly redirected the long-term prescription trends of BZDs, z-drugs, and ramelteon/ORAs toward a decline.
{"title":"Impact of the Medical Policy Intervention for Polypharmacy on Long-Term Prescriptions of Hypnotic Medications in Older Patients: An Interrupted Time-Series Analysis Using a Nationwide Claims Database in Japan","authors":"Takeshi Kimura, Kazuhiro Yamamoto, Ryunosuke Saeki, Tomohiro Omura, Ikuko Yano","doi":"10.1111/ggi.70376","DOIUrl":"10.1111/ggi.70376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the impact of the medical fee revisions related to polypharmacy in Japan on the long-term hypnotic prescriptions in older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We utilized the JMDC medical institution database. Outpatients and inpatients aged ≥ 50 years were included. The target hypnotics included benzodiazepines (BZDs), z-drugs, and ramelteon and orexin receptor antagonists (ramelteon/ORAs). The incidence rates of the newly initiated ≥ 4 weeks of prescriptions per 10 000 outpatients and inpatients (LP-rate) in each month from 2015 to 2022 were calculated. An interrupted time-series analysis was conducted with the intervention point of April 2020 when the medical fees were revised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average number of outpatients and inpatients in the database from 2015 to 2022 was 828,510/month. The LP-rates of BZDs and z-drugs gradually decreased from 210 to 125 and 111 to 78.6, respectively, from January 2015 to December 2022, whereas that of ramelteon/ORAs increased from 7.41 to 54.4. In the LP-rate of BZDs and z-drugs, although the level significantly increased by factors of 1.08 [95% confidence interval (CI): 1.02–1.13] and 1.12 [95% CI: 1.08–1.16], respectively, at the intervention time, the slope change significantly decreased after the intervention (0.990 [95% CI: 0.988–0.992] and 0.994 [95% CI: 0.993–0.996]). In ramelteon/ORAs, the slope change with the increasing trend was significantly attenuated after the intervention (0.991 [95% CI: 0.986–0.995]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The medical fee revisions related to polypharmacy significantly redirected the long-term prescription trends of BZDs, z-drugs, and ramelteon/ORAs toward a decline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to assess the validity of the criteria for determination of the daily life independence level of older adults with dementia (CDED) in the diagnosis procedure combination (DPC) database, compared with the dementia assessment sheet for community-based integrated care system (DASC-21), to promote the use of CDED in DPC data for clinical and policy research on in-patients.
Methods
A validation study was conducted using a DPC database and medical records. Data from patients aged ≥ 65 years hospitalized at Tokyo Metropolitan Geriatric Hospital and the Institute of Gerontology were extracted. The CDED scores range across five levels of dementia severity, and their validity was confirmed using the DASC-21 as a reference standard. The association between both scales was assessed using descriptive statistics and a generalized linear model.
Results
Data from 9401 patients were analyzed. As CDED scores increased, age, Charlson Comorbidity Index, and frailty risk increased, while activities of daily living scores decreased. Additionally, higher CDED scores were associated with higher mean DASC-21 scores, indicating worsening cognitive and functional status. A generalized linear regression model with a Gaussian link function showed that DASC-21 scores significantly increased with higher CDED scores (CDED 1: 1.19, CDED 2: 1.48, CDED 3: 1.64, CDED 4: 1.84, and CDED M: 1.80; p < 0.001).
Conclusions
The CDED reliably assessed dementia severity and showed a strong association with the DASC-21, reflecting dementia progression. It is useful for patient assessment and policy research on dementia.
{"title":"Correlation Between the Dementia Assessment Sheet for Community-Based Integrated Care System-21 Scores and Criteria for Determination of the Daily Life Independence Level of Older Adults With Dementia Using the Diagnosis Procedure Combination Database","authors":"Takuaki Tani, Yoshitomo Shimazaki, Shinobu Imai","doi":"10.1111/ggi.70375","DOIUrl":"10.1111/ggi.70375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to assess the validity of the criteria for determination of the daily life independence level of older adults with dementia (CDED) in the diagnosis procedure combination (DPC) database, compared with the dementia assessment sheet for community-based integrated care system (DASC-21), to promote the use of CDED in DPC data for clinical and policy research on in-patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A validation study was conducted using a DPC database and medical records. Data from patients aged ≥ 65 years hospitalized at Tokyo Metropolitan Geriatric Hospital and the Institute of Gerontology were extracted. The CDED scores range across five levels of dementia severity, and their validity was confirmed using the DASC-21 as a reference standard. The association between both scales was assessed using descriptive statistics and a generalized linear model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 9401 patients were analyzed. As CDED scores increased, age, Charlson Comorbidity Index, and frailty risk increased, while activities of daily living scores decreased. Additionally, higher CDED scores were associated with higher mean DASC-21 scores, indicating worsening cognitive and functional status. A generalized linear regression model with a Gaussian link function showed that DASC-21 scores significantly increased with higher CDED scores (CDED 1: 1.19, CDED 2: 1.48, CDED 3: 1.64, CDED 4: 1.84, and CDED M: 1.80; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CDED reliably assessed dementia severity and showed a strong association with the DASC-21, reflecting dementia progression. It is useful for patient assessment and policy research on dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Calf circumference (CC) is a simple surrogate marker of muscle mass. Body mass index (BMI) adjustment and age-specific cutoffs for low CC have been proposed to optimize its use in clinical practice. This study aimed to clarify the association of BMI-adjusted CC and age-specific cutoffs with in-hospital falls among older adults.
Methods
This study was conducted using data from the Japan Hospital Acquired Complications (J-HAC) project, a multicenter cohort study. In this analysis, we included adults aged ≥ 65 years. CC was measured on admission, and the occurrence of falls was assessed and recorded by medical personnel throughout the hospitalization. BMI adjustment and age-specific cutoffs for low CC were applied based on previous studies. Multivariable logistic regression models were developed to examine the association between in-hospital falls and BMI-adjusted CC and age-specific low CC cutoffs, adjusting for age and comorbidities.
Results
A total of 808 patients (mean age 83.7 ± 6.6 years, 57.2% females) were analyzed. In females, higher BMI-adjusted CC was significantly associated with a lower risk of in-hospital falls after adjusting for age and comorbidities (adjusted OR = 0.88, 95% CI: 0.77–0.998). Furthermore, low BMI-adjusted CC, as defined by age-specific cutoff values, was independently associated with an increased fall risk in the multivariable model (adjusted OR = 2.39, 95% CI: 1.03–5.54). In contrast, no significant associations were observed in males regardless of CC adjustment or cutoff criteria.
Conclusions
BMI-adjusted CC and age-specific cutoffs showed a stronger association with in-hospital falls among older females than unadjusted CC. Further validation in diverse populations and outcomes is required to confirm their usefulness.
{"title":"Association of BMI-Adjusted Calf Circumference and Age-Specific Cutoff Values With In-Hospital Falls Among Older Adults: A Multicenter Prospective Study","authors":"Shuzo Miyahara, Keisuke Maeda, Shosuke Satake, Masaaki Nagae, Hirotaka Nakashima, Yasushi Takeya, Yumi Umeda-Kameyama, Hiroyuki Umegaki","doi":"10.1111/ggi.70354","DOIUrl":"10.1111/ggi.70354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Calf circumference (CC) is a simple surrogate marker of muscle mass. Body mass index (BMI) adjustment and age-specific cutoffs for low CC have been proposed to optimize its use in clinical practice. This study aimed to clarify the association of BMI-adjusted CC and age-specific cutoffs with in-hospital falls among older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted using data from the Japan Hospital Acquired Complications (J-HAC) project, a multicenter cohort study. In this analysis, we included adults aged ≥ 65 years. CC was measured on admission, and the occurrence of falls was assessed and recorded by medical personnel throughout the hospitalization. BMI adjustment and age-specific cutoffs for low CC were applied based on previous studies. Multivariable logistic regression models were developed to examine the association between in-hospital falls and BMI-adjusted CC and age-specific low CC cutoffs, adjusting for age and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 808 patients (mean age 83.7 ± 6.6 years, 57.2% females) were analyzed. In females, higher BMI-adjusted CC was significantly associated with a lower risk of in-hospital falls after adjusting for age and comorbidities (adjusted OR = 0.88, 95% CI: 0.77–0.998). Furthermore, low BMI-adjusted CC, as defined by age-specific cutoff values, was independently associated with an increased fall risk in the multivariable model (adjusted OR = 2.39, 95% CI: 1.03–5.54). In contrast, no significant associations were observed in males regardless of CC adjustment or cutoff criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BMI-adjusted CC and age-specific cutoffs showed a stronger association with in-hospital falls among older females than unadjusted CC. Further validation in diverse populations and outcomes is required to confirm their usefulness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supplementary Suggestions on Subtype-Specific Interventions for KOA Surgical Patients Based on Chinese Social Reality","authors":"Menghan Zhu, Jiayuan Song","doi":"10.1111/ggi.70360","DOIUrl":"10.1111/ggi.70360","url":null,"abstract":"","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We examined the association of deviation from the glycated hemoglobin (HbA1c) target proposed in the Guidelines for the Treatment of Diabetes in Older Patients in Japan 2016 with the place of care and interval between HbA1c tests among older patients with diabetes.
Methods
We included patients aged > 65 years receiving biweekly home medical care by physicians from four clinics in Tokyo and Kanagawa Prefecture for > 2 months with ≥ 2 HbA1c tests between November 14, 2016 and November 13, 2021. Among patients meeting the glycemic target according to the above guidelines at the beginning of the study period, we defined those who met the final glycemic target as the “non-deviating group” and those who missed this target as the “deviating group.” Data were collected on place of care (home or nursing facility), intervals between HbA1c tests, number of oral medications, comorbidities, and activities of daily living (ADL). Multivariate logistic regression analysis was performed using deviation from the HbA1c target (=1) as the outcome.
Results
Among 1120 patients, we analyzed 834 whose first HbA1c value met the target. The non-deviating group comprised 763 patients (91.5%), and the deviating group comprised 71 (8.5%). Deviations from the HbA1c target were more frequent among patients who received home care (adjusted odds ratio [aOR] = 2.06, 95% confidence interval [CI]: 1.18–3.61). For each day added to the interval between HbA1c tests, the aOR decreased by approximately 2% (aOR = 0.98, 95% CI: 0.98–0.99).
Conclusions
The place of care should be considered for older patients with diabetes receiving home medical care.
{"title":"Association of Deviation From Glycated Hemoglobin (HbA1c) Target in the Guidelines for the Treatment of Diabetes in Older Patients With Place of Care and Interval Between HbA1c Tests Among Older Patients Receiving Home Medical Care","authors":"Mari Fukuhara, Takuma Kimura, Yoshiyuki Sasaki, Satoshi Fukuhara, Suguru Mabuchi, Kazue Ota, Masanaga Yamawaki, Masayoshi Hashimoto","doi":"10.1111/ggi.70338","DOIUrl":"10.1111/ggi.70338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We examined the association of deviation from the glycated hemoglobin (HbA1c) target proposed in the Guidelines for the Treatment of Diabetes in Older Patients in Japan 2016 with the place of care and interval between HbA1c tests among older patients with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients aged > 65 years receiving biweekly home medical care by physicians from four clinics in Tokyo and Kanagawa Prefecture for > 2 months with ≥ 2 HbA1c tests between November 14, 2016 and November 13, 2021. Among patients meeting the glycemic target according to the above guidelines at the beginning of the study period, we defined those who met the final glycemic target as the “non-deviating group” and those who missed this target as the “deviating group.” Data were collected on place of care (home or nursing facility), intervals between HbA1c tests, number of oral medications, comorbidities, and activities of daily living (ADL). Multivariate logistic regression analysis was performed using deviation from the HbA1c target (=1) as the outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1120 patients, we analyzed 834 whose first HbA1c value met the target. The non-deviating group comprised 763 patients (91.5%), and the deviating group comprised 71 (8.5%). Deviations from the HbA1c target were more frequent among patients who received home care (adjusted odds ratio [aOR] = 2.06, 95% confidence interval [CI]: 1.18–3.61). For each day added to the interval between HbA1c tests, the aOR decreased by approximately 2% (aOR = 0.98, 95% CI: 0.98–0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The place of care should be considered for older patients with diabetes receiving home medical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In advanced nations experiencing rapid population aging, such as Japan, maintaining supportive community environments and sustainable living conditions for older adults are urgent priorities [<span>1</span>]. Frailty, characterized by the accumulation of physical, psychological, and social function decline, is a reversible condition and an important target for preventing adverse health outcomes [<span>2</span>]. Previous practices have primarily focused on individual-level risk factors; the role of community-level environments in shaping trajectories remains underexplored [<span>3</span>]. The Community Well-Being Index (CWBI), developed by the Digital Agency of Japan, is an objective, multidimensional measure of municipal livability [<span>4</span>]. However, few studies have empirically linked community-level well-being to frailty-related risk among older adults at a national scale. We aimed to examine the association between community well-being and the frailty checkup risk score (FCRS), a composite indicator of functional disability reflecting physical and social domains derived from the frailty checkup (FC) program [<span>5</span>].</p><p>Data were obtained from 91 municipalities participating in the FC program between 2018 and 2024. The study included 37 208 community-dwelling adults aged ≥ 65 years (mean age 76.6 ± 7.2 years; 77% female) with complete demographic data. The outcome variable was the FCRS, which represents the degree of frailty progression encompassing physical and social domains [<span>5</span>]. The primary exposure of interest was community-level well-being, operationalized using domain-specific scores from the 2024 CWBI, derived from objective administrative indicators [<span>4</span>]. Individual-level covariates (Level 1) included age, sex, and self-efficacy for health management, which measures confidence in performing multiple health-related behaviors [<span>6</span>]. Community-level covariates (Level 2) were incorporated as contextual predictors in the multilevel model. A generalized linear mixed model with municipalities as random intercepts was employed, specifying a normal distribution and identity link. Analyses were performed using SPSS version 29.0 (IBM Japan, Tokyo).</p><p>At the individual level, older age was associated with higher FCRS, whereas male sex and higher self-efficacy for health management were associated with lower FCRS (<i>p</i> < 0.001 for all; Table 1). At the community level, several CWBI domains demonstrated significant associations. Municipalities with higher shopping and dining convenience, digital life and childcare environments, and environmental symbiosis showed significantly lower FCRS. Municipalities with higher public space, diversity and tolerance, employment and income, business creation, and educational environment scores showed higher FCRS. Sixteen other indicators were non-significant. Between municipality variance was significant (variance = 0.284, <i>p</i> < 0.001),
{"title":"Community Well-Being and Functional Disability Risk Among Older Adults: A Multilevel Analysis of 91 Municipalities in Japan","authors":"Tomoki Tanaka, Weida Lyu, Katsuya Iijima","doi":"10.1111/ggi.70337","DOIUrl":"10.1111/ggi.70337","url":null,"abstract":"<p>In advanced nations experiencing rapid population aging, such as Japan, maintaining supportive community environments and sustainable living conditions for older adults are urgent priorities [<span>1</span>]. Frailty, characterized by the accumulation of physical, psychological, and social function decline, is a reversible condition and an important target for preventing adverse health outcomes [<span>2</span>]. Previous practices have primarily focused on individual-level risk factors; the role of community-level environments in shaping trajectories remains underexplored [<span>3</span>]. The Community Well-Being Index (CWBI), developed by the Digital Agency of Japan, is an objective, multidimensional measure of municipal livability [<span>4</span>]. However, few studies have empirically linked community-level well-being to frailty-related risk among older adults at a national scale. We aimed to examine the association between community well-being and the frailty checkup risk score (FCRS), a composite indicator of functional disability reflecting physical and social domains derived from the frailty checkup (FC) program [<span>5</span>].</p><p>Data were obtained from 91 municipalities participating in the FC program between 2018 and 2024. The study included 37 208 community-dwelling adults aged ≥ 65 years (mean age 76.6 ± 7.2 years; 77% female) with complete demographic data. The outcome variable was the FCRS, which represents the degree of frailty progression encompassing physical and social domains [<span>5</span>]. The primary exposure of interest was community-level well-being, operationalized using domain-specific scores from the 2024 CWBI, derived from objective administrative indicators [<span>4</span>]. Individual-level covariates (Level 1) included age, sex, and self-efficacy for health management, which measures confidence in performing multiple health-related behaviors [<span>6</span>]. Community-level covariates (Level 2) were incorporated as contextual predictors in the multilevel model. A generalized linear mixed model with municipalities as random intercepts was employed, specifying a normal distribution and identity link. Analyses were performed using SPSS version 29.0 (IBM Japan, Tokyo).</p><p>At the individual level, older age was associated with higher FCRS, whereas male sex and higher self-efficacy for health management were associated with lower FCRS (<i>p</i> < 0.001 for all; Table 1). At the community level, several CWBI domains demonstrated significant associations. Municipalities with higher shopping and dining convenience, digital life and childcare environments, and environmental symbiosis showed significantly lower FCRS. Municipalities with higher public space, diversity and tolerance, employment and income, business creation, and educational environment scores showed higher FCRS. Sixteen other indicators were non-significant. Between municipality variance was significant (variance = 0.284, <i>p</i> < 0.001), ","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the long-term prognostic impact of delayed recovery of independent ambulation and post-operative sarcopenia progression in patients undergoing endovascular aortic aneurysm repair (EVAR).
Methods
In this multicenter retrospective cohort study, 228 patients (mean age 78.1 ± 6.5 years; 82.5% male) who underwent EVAR for abdominal aortic aneurysm between January 2015 and December 2020 were included. Independent ambulation was defined as walking ≥ 15 m. Sarcopenia was assessed using the psoas muscle index (PMI) at L3 on CT, normalized by height squared. Baseline PMI was measured within 3 months preoperatively; post-operative sarcopenia progression was calculated as ΔPMI/baseline (% change from baseline to 6 months). The primary outcome was all-cause mortality, analyzed using multivariate Cox proportional hazards models.
Results
Over a mean follow-up of 4.6 ± 2.2 years, 52 patients (22.8%) died. Mean time to independent ambulation was 1.4 ± 1.2 days, and mean ΔPMI/baseline decreased by 4.5% ± 8.9%. After adjusting for age, sex, nutritional status, and pre-operative sarcopenia, time to independent ambulation (HR 1.25; 95% CI 1.07–1.46; p = 0.004) and ΔPMI/baseline (HR 1.13; 95% CI 1.09–1.17; p < 0.001) were independent predictors of mortality. ROC analysis identified cut-offs of ≥ 2 days for ambulation and a decrease of ≥ 6.09% in ΔPMI/baseline. Patients meeting both criteria exhibited the poorest survival, representing delayed ambulation and marked sarcopenia progression.
Conclusions
Delayed recovery of independent ambulation and post-operative sarcopenia progression independently predict all-cause mortality after EVAR and may serve as clinically useful indicators for risk stratification and targeted rehabilitation.
目的：评价血管内动脉瘤修复术（EVAR）患者独立活动恢复延迟和术后肌肉减少症进展的长期预后影响。方法：在这项多中心回顾性队列研究中，纳入了2015年1月至2020年12月期间因腹主动脉瘤接受EVAR治疗的228例患者（平均年龄78.1±6.5岁，男性82.5%）。独立行走定义为步行≥15 m。骨骼肌减少症的评估采用腰大肌指数（PMI）在CT上的L3，通过高度的平方归一化。术前3个月内测量基线PMI；术后肌肉减少症进展计算为ΔPMI/基线（从基线到6个月的变化百分比）。主要结局是全因死亡率，使用多变量Cox比例风险模型进行分析。结果：平均随访4.6±2.2年，52例（22.8%）患者死亡。平均独立行走时间为1.4±1.2天，平均ΔPMI/基线下降4.5%±8.9%。在调整了年龄、性别、营养状况和术前肌肉减少后，独立行走时间（HR 1.25; 95% CI 1.07-1.46; p = 0.004）和ΔPMI/基线（HR 1.13; 95% CI 1.09-1.17; p）得出结论：独立行走延迟恢复和术后肌肉减少进展独立预测EVAR后全因死亡率，并可作为临床有用的风险分层和针对性康复指标。
{"title":"Impact of Delayed Recovery of Independent Ambulation and Sarcopenia Progression on Long-Term Outcomes Following Endovascular Aortic Aneurysm Repair","authors":"Hirokazu Sugiura, Tsuyoshi Shibata, Yutaka Iba, Shingo Tsushima, Kenta Yoshikawa, Shun Hayasaka, Tomohiro Nakajima, Junji Nakazawa, Ayaka Arihara, Kenichi Kato, Shigeki Komatsu, Masato Yonemori, Hajime Maeda, Masanori Nakamura, Yuki Sugawara, Nobuyoshi Kawaharada","doi":"10.1111/ggi.70355","DOIUrl":"10.1111/ggi.70355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the long-term prognostic impact of delayed recovery of independent ambulation and post-operative sarcopenia progression in patients undergoing endovascular aortic aneurysm repair (EVAR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multicenter retrospective cohort study, 228 patients (mean age 78.1 ± 6.5 years; 82.5% male) who underwent EVAR for abdominal aortic aneurysm between January 2015 and December 2020 were included. Independent ambulation was defined as walking ≥ 15 m. Sarcopenia was assessed using the psoas muscle index (PMI) at L3 on CT, normalized by height squared. Baseline PMI was measured within 3 months preoperatively; post-operative sarcopenia progression was calculated as ΔPMI/baseline (% change from baseline to 6 months). The primary outcome was all-cause mortality, analyzed using multivariate Cox proportional hazards models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a mean follow-up of 4.6 ± 2.2 years, 52 patients (22.8%) died. Mean time to independent ambulation was 1.4 ± 1.2 days, and mean ΔPMI/baseline decreased by 4.5% ± 8.9%. After adjusting for age, sex, nutritional status, and pre-operative sarcopenia, time to independent ambulation (HR 1.25; 95% CI 1.07–1.46; <i>p</i> = 0.004) and ΔPMI/baseline (HR 1.13; 95% CI 1.09–1.17; <i>p</i> < 0.001) were independent predictors of mortality. ROC analysis identified cut-offs of ≥ 2 days for ambulation and a decrease of ≥ 6.09% in ΔPMI/baseline. Patients meeting both criteria exhibited the poorest survival, representing delayed ambulation and marked sarcopenia progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Delayed recovery of independent ambulation and post-operative sarcopenia progression independently predict all-cause mortality after EVAR and may serve as clinically useful indicators for risk stratification and targeted rehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital-associated sarcopenia (HAS) is a preventable and reversible condition characterized by rapid muscle loss during hospitalization. Although its prevalence is higher than that of age-related sarcopenia, the clinical recognition and structured management of this condition remain limited. In this narrative review, the pathophysiology of HAS is synthesized, the effectiveness of acute-phase interventions is evaluated, and the implementation challenges are examined to propose multifaceted strategies for optimizing treatment outcomes. The development of HAS involves a vicious cycle of activity limitation, inflammation, malnutrition, and iatrogenic stress. Initiating interventions within 48 h may aid in preserving muscle function and improving the patients' quality of life. However, protocol variability, inadequate patient stratification, fragile transitional care systems, and other challenges persist. The proposed solutions include modular protocols, electronic medical record-integrated adaptive algorithms, and strengthened team coordination. To prevent HAS progression and improve patient-centered outcomes, timely, structured multidisciplinary interventions in the acute phase are imperative. Standardized evaluations, scalable protocols, and sustainable post-discharge systems are key to advancing the clinical implementation of HAS management strategies.
{"title":"Acute-Phase Interventions and Clinical Implementation Challenges for Hospital-Associated Sarcopenia: A Narrative Review of a Multifaceted Approach to a Preventable Condition","authors":"Yoshinori Yamamoto, Masato Ogawa, Takayuki Okamoto, Marika Tsuboi, Ryo Momosaki","doi":"10.1111/ggi.70330","DOIUrl":"10.1111/ggi.70330","url":null,"abstract":"<p>Hospital-associated sarcopenia (HAS) is a preventable and reversible condition characterized by rapid muscle loss during hospitalization. Although its prevalence is higher than that of age-related sarcopenia, the clinical recognition and structured management of this condition remain limited. In this narrative review, the pathophysiology of HAS is synthesized, the effectiveness of acute-phase interventions is evaluated, and the implementation challenges are examined to propose multifaceted strategies for optimizing treatment outcomes. The development of HAS involves a vicious cycle of activity limitation, inflammation, malnutrition, and iatrogenic stress. Initiating interventions within 48 h may aid in preserving muscle function and improving the patients' quality of life. However, protocol variability, inadequate patient stratification, fragile transitional care systems, and other challenges persist. The proposed solutions include modular protocols, electronic medical record-integrated adaptive algorithms, and strengthened team coordination. To prevent HAS progression and improve patient-centered outcomes, timely, structured multidisciplinary interventions in the acute phase are imperative. Standardized evaluations, scalable protocols, and sustainable post-discharge systems are key to advancing the clinical implementation of HAS management strategies.</p>","PeriodicalId":12546,"journal":{"name":"Geriatrics & Gerontology International","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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