Background: Various functions are involved in prefrailty. However, no studies have examined more relevant functions. Therefore, this study examined the domains of the Kihon Checklist (KCL) associated with prefrailty by comparing them to robustness measures, using the KCL to comprehensively assess life-related functions in community-dwelling older adults.
Methods: The 194 (mean age, 75±6 years) participants were community-dwelling older adults. Their robustness and preferences were assessed using the Japanese Cardiovascular Health Study criteria. Comprehensive life-related functions were assessed using the KCL, and each physical function was measured.
Results: The main KCL characteristics associated with robustness and prefrailty were physical function (odds ratio [OR]=1.83; 95% confidence interval [CI], 1.17-2.88), nutritional status (OR=8.16; 95% CI, 2.96-22.48), and depressed mood (OR=3.46; 95% CI, 1.76-6.79). In particular, older adults had difficulty moving, including climbing stairs and getting up from a chair, which suggested a strong fear of falling. The participants also reported psychological characteristics such as low life fulfillment, a low sense of self-usefulness, and a strong sense of boredom.
Conclusions: Prefrail individuals were characterized by poor physical function and nutritional status, as well as depressive mood. Prefrailty may be prevented or improved by approaches to improve physical function and fear of falling in addition to psychological interventions that encourage activity and a sense of self-usefulness.
Background: No comprehensive assessment of the quality of medications used in older outpatients has been conducted in Thailand. This study aimed to ascertain the prevalence of and factors contributing to older outpatients' use of potentially inappropriate medications (PIMs).
Methods: This cross-sectional study retrospectively assessed the prescriptions of older (≥60 years) outpatients at a secondary-care hospital. For PIM identification, the 2019 American Geriatric Society (AGS) Beers criteria were applied, considering all five PIM categories: PIM category I (medications that are potentially inappropriate in most older adults), II (disease-/syndrome-exacerbating drugs), III (medications that should be used with caution), IV (clinically important drug-drug interactions), and V (medications that should be avoided or have their dosage reduced based on renal function).
Results: This study included 22,099 patients (mean age, 68.86±7.64 years). Nearly three-fourths of patients were prescribed PIMs, with 68.90%, 7.68%, 44.23%, 15.66%, and 3.05%, respectively, receiving category I-V medications. The positive factors associated with PIM use included female sex (odds ratio [OR]=1.08; 95% confidence interval [CI], 1.01-1.16), age ≥75 years (OR=1.10; 95% CI, 1.01-1.21), polypharmacy (OR=10.21; 95% CI, 9.31-11.21), ≥3 diagnostic categories (OR=2.31; 95% CI, 2.14-2.50), and ≥3 chronic morbidities (OR=1.46; 95% CI, 1.26-1.68). The negative factor associated with PIM use was a comorbidity score of ≥1 (OR=0.78; 95% CI, 0.71-0.86).
Conclusion: PIM use among older outpatients remains highly prevalent in clinical practice. The results of this study identified polypharmacy as the strongest factor affecting PIM use.
Background: Reducing the risk of falling by improving balance and leg strength may be a preventive strategy. This study evaluated the integrated effects of Thai essential oil and balance exercises on parameters associated with Falls in community-dwelling older adults at risk of falling.
Methods: Fifty-six participants were randomly allocated to either the intervention group (IG), which performed balance exercises while smelling Thai essential oil scents of Zanthoxylum limonella (Dennst.) Alston, or the control group (CG), which performed balance exercises while receiving a control patch. Balance exercises were practiced for 12, 30-minute sessions over 4 weeks. Static and dynamic balance with eyes open and eyes closed (EC), leg muscle strength, agility, and fear of falling were assessed at baseline, after the 4-week intervention, and at 1 month after the last intervention session.
Results: Both groups showed significant improvements in static and dynamic balance, ankle plantarflexor strength, and agility after the 4-week intervention (p<0.05), which persisted at the 1-month follow-up (p<0.05). Compared to the CG, the IG demonstrated significantly better static balance in terms of elliptical sway area (p=0.04) and center of pressure (CoP) velocity (p=0.001) during EC, as well as ankle plantarflexor strength (p=0.01). The IG also maintained a significantly greater improvement in CoP velocity during EC (p=0.01).
Conclusion: Integrated Thai essential oil and balance exercises improved static balance and ankle plantarflexor strength compared to the balance exercise with a control patch in older adults at risk of falling.
Background: Over half of the Japanese population hope to spend their last days at home; however, 73.0% die in hospitals. The proportion of deaths due to cancer in hospitals is even higher, at 82.4%, and is also high globally. Therefore, there is an urgent need to establish conditions that fulfill the hopes of patients, especially those with cancer, who hope to spend their last days at home. This study aimed to clarify medical resources and activities that are related to proportion of death at home among cancer patients.
Methods: We used data from the Japanese National Database and public data. Japan's Ministry of Health, Labour, and Welfare provides national data on medical services to applicants for research purposes. Using the data, we calculated the proportion of deaths at home in each prefecture. We also collected information on medical resources and activities from public data and conducted multiple regression analyses to investigate factors associated with the proportion of death at home.
Results: In total, 51,874 eligible patients were identified. The maximum and minimum proportions of death at home based on prefectures differed by approximately three-fold (14.8%-41.6%). We also identified scheduled home-visit medical care (coefficient=0.580) and acute and long-term care beds (coefficient=-0.317 and -0.245) as factors that increased and decreased the proportion of death at home, respectively.
Conclusion: To fulfill the hopes of cancer patients to spend their last days at home, we recommend that the government develop policies to increase home visits by physicians and optimize hospital acute and long-term care beds.
Background: With the rapid progression of population aging worldwide, the health management of older adults is emerging as an important topic. To help prevent declines in physical and cognitive function due to aging, older adults must maintain consistent physical activity. The development of digital technology has recently allowed the optimization of exercise programs for older adults using augmented reality (AR) game technology.
Methods: Fifteen older adult females were enrolled in an AR-based exercise program. The program was conducted for 30 minutes, three times weekly, for a total of 6 weeks. To verify the effectiveness of the program and assess physical function before and after exercise, the following tests were performed: timed up-and-go test, five times sit-to-stand test, 1-minute sit-to-stand test, lung capacity test, respiratory muscle strength test, and bioelectrical impedance analysis. The Trail Making Test was used to evaluate cognitive function. For statistical analysis, a paired t-test was used to verify the effects on physical and cognitive function before and after exercise.
Results: The study results confirmed improved overall physical and cognitive function. The timed up-and-go test, maximal inspiratory pressure, and Trail Making Test part B scores showed significant increases.
Conclusion: This study verified the effectiveness of AR exercise in community-dwelling older adult women. In the future, exercise programs with game elements that increase the interest and motivation of participants to engage in exercise routines should be developed and applied.
Background: This study evaluated the chronological changes in physical and cognitive functions in middle-aged and older adults with and without rheumatoid arthritis (RA).
Methods: This population-based case-control longitudinal study included individuals aged 40-79 years at baseline who agreed to participate. We identified 42 participants with RA and randomly selected 84 age- and sex-matched controls. Physical function was assessed according to gait speed, grip strength, and skeletal muscle mass. Cognitive function was assessed based on the information, similarities, picture completion, and digit symbol substitution test scores of the Wechsler Adult Intelligence Scale-Revised Short Form. The general linear mixed models comprised the fixed effects of the intercept, case, age, time in years since baseline, and case×time interaction, which were used to examine longitudinal changes in physical and cognitive functions.
Results: Regardless of RA status, grip strength decreased and the picture completion score increased in the group aged <65 years, while skeletal muscle mass index and gait speed decreased in the group aged ≥65 years. The interaction of case×follow-up years for grip strength in the group aged ≥65 years was significant (p=0.03). The decline in grip strength in the control group (slope=-0.45) was greater than that in the RA group (slope=-0.19).
Conclusion: Chronological changes in physical and cognitive functions were comparable between participants with and without RA; however, the decline in grip strength in the control group was greater among older adults with RA.
Background: This study developed a preliminary instrument to measure nurses' infection prevention compliance against emerging respiratory infectious diseases and to verify the reliability and validity of the developed instrument.
Method: The participants were 199 nurses working at a university hospital with more than 800 beds and two long-term care hospitals. Data were collected in May 2022.
Results: The final version of the developed instrument consisted of six factors and 34 items, with an explanatory power of 61.68%. The six factors were equipment and environment management and education, hand hygiene and respiratory etiquette, infection risk assessment and flow management, protection of employees in contact with infected patients, ward access management of patients with infectious diseases, and wearing and removing personal protective equipment. We verified the convergent and discriminant validities of these factors. The instrument's internal consistency was adequate (Cronbach's α=0.82), and the Cronbach's α of each factor ranged from 0.71 to 0.91.
Conclusion: This instrument can be utilized to determine the level of nurses' compliance with infection prevention activity against emerging respiratory infectious diseases and will contribute to measuring the effectiveness of future programs promoting infection-preventive activities.
The rivastigmine patch is the only existing transdermal delivery system used for the treatment of Alzheimer disease. Among the most common adverse events derived from its use are gastrointestinal events, particularly diarrhea. We report a clinical case of an 81-year-old patient admitted to our hospital under long-standing treatment with rivastigmine transdermal patch who presented with atypical watery diarrhea. Anamnesis showed that the patient presented with a likely infectious gastroenteric event, the diarrheal symptoms of which persisted upon resolution of the event and resolved only upon temporary discontinuation of acetylcholinesterase inhibitors. Failure to rapidly identify the causes of profuse diarrhea in older adults can have lethal consequences. When these symptoms occur, quickly recognizing the causes and providing proper management can be lifesaving.
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