Background:Japan faces a shortage of care workers due to its rapidly aging population. Although nursing care technologies can reduce caregiver burden and improve care quality, their long-term feasibility remains unclear. We investigated the implementation of these technologies and associated challenges in long-term care facilities. Methods:A cross-sectional questionnaire survey of all long-term care facilities in Aichi Prefecture, Japan (total population, approximately 7.5 million), was conducted between February and March 2024. Results:Of 2,514 eligible facilities, 497 participated (a 19.8% response rate), and 477 were included in the final analysis. The overall implementation rate was 22.0%. Implementing facilities reported a lack of information on available devices (55.2%) and challenges with subsidy application processes (52.4%). Among non-implementing facilities, 63.2% expressed a willingness to adopt devices, primarily to reduce staff workload (95.7%). Key barriers included financial constraints (91.1%), cost-effectiveness concerns (62.1%), and limited information (55.7%). The results indicate significant interest in nursing-care technologies and identify key implementation difficulties and adoption barriers. Conclusion:Improving information accessibility and simplifying subsidy-application procedures could facilitate the adoption of nursing care technologies. These results may also benefit countries facing similar demographic challenges.
Background:Frailty is a geriatric syndrome characterized by increased vulnerability to stressors. Evidence on sex-specific determinants of frailty in cognitively intact nursing home residents remains limited. This study aimed to identify health dimensions associated with frailty in older women and men in nursing homes. Methods:A cross-sectional study was conducted in 11 nursing homes in Bilbao, Spain. 147 residents aged ≥ 60 years without cognitive impairment were assessed using the Tilburg Frailty Indicator, together with validated measures of functional status, physical performance, emotional status (anxiety and depression), and loneliness. Sex-stratified analyses were performed using Spearman correlations and multivariable linear regressions. Results:In women, total frailty was positively correlated with depressive symptoms, anxiety, and loneliness, and inversely correlated with functional status and physical performance (all p ≤ 0.012). In multivariable models, only depressive symptoms (B = 0.306; p = 0.011) and loneliness (B = 0.215; p = 0.002) remained independently associated with frailty. In men, total frailty was positively correlated with depressive symptoms and anxiety and inversely correlated with handgrip strength, functional status, and physical performance (all p < 0.001). After adjustment, depressive symptoms (B = 0.442; p = 0.004), lower handgrip strength (B = -0.066; p = 0.041), and poorer physical performance (B = -0.194; p = 0.022) remained independently associated. Conclusions:Frailty among nursing home residents is a multidimensional condition. The findings suggest potential sex-related differences in the factors associated with frailty, with psychosocial variables showing stronger associations in women and physical performance-related variables showing stronger associations in men.
Background:Falls in older adults are a major public health concern. Chronic pain and slower processing speed are risk factors for falls; however, their combined effect on falls remains unclear. In this study, we aimed to assess whether the coexistence of chronic pain and slower processing speed was associated with falls in community-dwelling older adults. Methods:This cross-sectional study included 320 older adults who participated in a community-based health survey. Chronic pain was defined as pain persisting or recurring for more than 3 months. Processing speed was assessed by the Digit Symbol Substitution Test; slower processing speed was defined as an age-adjusted Z-score ≤ -1.0. The participants were categorized into four groups based on the presence of chronic pain and slower processing speed. Logistic regression analysis was performed to evaluate the association between group status and falls in the past year. Results:Of the 320 participants, 60 (18.8%) reported at least one fall in the previous year. After adjustment for age, sex, body mass index, the Timed Up and Go test, and the Falls Efficacy Scale-International, the coexistence of chronic pain and slower processing speed was significantly associated with falls compared to that with neither condition (odds ratio [OR]=3.203, 95% confidence interval [CI]=1.036-9.901, p=0.043). Conclusion:The coexistence of chronic pain and slower processing speed was associated with an increased risk of falls in community-dwelling older adults. These findings may help refine fall risk stratification and inform fall prevention strategies considering chronic pain and processing speed.
Background:Psychotropic medications may impair recovery in older inpatients, but their effect on previously independent patients is unknown. We examined whether admission psychotropic medication use is associated with activities of daily living (ADL) decline at discharge. Methods:This multicenter prospective cohort study used data from a nine-center hospital-associated disability database collected from February 1, 2023, to March 31, 2025. Patients aged ≥70 years admitted to general medical wards who underwent rehabilitation and were independent of ADL before admission (Katz Index=6) were enrolled. The primary and secondary outcomes were the Katz Index and Food Intake Level Scale (FILS) score at discharge, respectively. One primary multivariable analysis and two sensitivity analyses were performed. Pharmacist-led instruction sessions were also evaluated, and FILS scores were compared by session status. Results:Among 202 patients (mean age, 80.3 years; 39.6% female), 32 (15.8%) used psychotropic medications at admission. In the primary analysis, psychotropic use was independently associated with a lower discharge Katz Index (B = -0.333, p = 0.046). The association was consistent in both sensitivity analyses (Model 1: B = -0.386, p = 0.019; Model 2: B = -0.345, p = 0.020), but not FILS score at discharge (p = 0.970). Any pharmacist-led session was linked to higher FILS scores, without a dose-response pattern. Conclusion:Use of psychotropic medications at admission may be a risk factor for ADL decline at discharge in previously independent older inpatients. The patients receiving any instruction session had higher FILS scores than those receiving none.
Background:The global demographic shift toward an aging population necessitates a critical transformation in healthcare, particularly within Physical and Rehabilitation Medicine (PRM). Older adults frequently present with complex geriatric syndromes, such as frailty, sarcopenia, and cognitive impairment, that demand specialized, multidisciplinary rehabilitation strategies. Methods:The present global survey conducted by the International Society of Physical and Rehabilitation Medicine (ISPRM) Special Interest Group (SIG) in Geriatric Rehabilitation identifies systemic and educational gaps in the current PRM landscape. Results:Despite a high clinical caseload of older adults, the majority of PRM practitioners report inadequate residency training in geriatric competencies and cite workforce shortages as primary barriers to care. Conclusions:This article discusses the perspectives and future steps required to elevate geriatric rehabilitation, emphasizing the urgent need for structured academic programs.
Background:Despite the importance of early cognitive impairment detection, standard screening tools have limitations. Motor-cognitive dual tasks such as the Digital Trail Making Peg Test (DTMP) are feasible objective alternatives. Nonetheless, most studies have focused on older adults, and whether these tasks are associated with cognitive performance in midlife remains unclear. This study investigated associations between DTMP performance and neuropsychological test performance in middle-aged and older adults. Methods:We analyzed 171 middle-aged (54.5 years; female, 61.4%) and 173 older (73.7 years; female, 41.6%) adults from the Tsukuba Happiness Life Study. Finger-dexterity dual-task performance was assessed using DTMP-A, requiring peg insertion in ascending numerical order, and DTMP-B, requiring alternating peg insertion between numbers and hiragana characters. Neuropsychological test performance was assessed using standardized measures of attention, executive function, memory, and language. Associations were examined using age-stratified multiple linear regression models after adjusting for covariates, with supportive domain-level models additionally adjusted for the Digit Symbol Substitution Test (DSST). Results:In age-stratified models, faster DTMP-B performance was significantly associated with better performance across attention, executive, memory, and language measures in both age groups, with standardized β coefficients ranging in absolute value from 0.22 to 0.64. Compared with DTMP-A, DTMP-B showed a broader and more consistent pattern of associations. In supportive DSST-adjusted models, DTMP-B remained associated with executive, memory, and language domains. Conclusion:The finger-dexterity dual task, particularly DTMP-B, showed consistent associations with neuropsychological test performance across cognitive domains, suggesting its potential as a practical performance-based indicator in middle-aged and older adults.
Background:Sedentary behavior (SB), physical activity, and sleep duration are 24-hour movement behaviors and key indicators of healthy aging. This study examined the association between daily mean ambient temperature and 24-hour movement behaviors among community-dwelling older adults. Methods:Data were obtained from 769 participants aged ≥ 65 years (mean age 73.5 ± 5.5 years; 59.0% female) in the Kyotango Longevity Cohort Study conducted in Kyotango City, Japan. SB and physical activity were objectively assessed in each participant using a triaxial accelerometer over 7 consecutive days (4,344 valid person-days in total). Associations between daily mean ambient temperature and 24-hour movement behaviors were evaluated using linear mixed-effects models with natural cubic splines. The association between ambient temperature and sleep duration, estimated from sleep diaries or standardized sleep windows when diary data were unavailable, was also examined. Results:Significant non-linear associations were observed between daily mean ambient temperature and all 24-hour movement behaviors (all p < 0.05). SB exhibited a U-shaped pattern, with the predicted minimum at approximately 20.8 °C. By contrast, light-intensity and moderate-to-vigorous-intensity physical activity showed inverted U-shaped associations, peaking at approximately 20.7 °C and 21.1 °C, respectively. Sleep duration remained relatively stable at low-to-moderate ambient temperatures but tended to decline above approximately 22 °C. Conclusions:Ambient temperature is an important environmental factor associated with 24-hour movement behaviors in older adults. These findings underscore the importance of considering thermal conditions when developing strategies to reduce SB, increase physical activity, and maintain appropriate sleep durations in older adults.
Background: Although frailty is associated with disability, its long-term persistence and changes over time remain unclear. This study aimed to investigate the long-term association between frailty and the incidence of disability over a 10-year follow-up period, evaluating how this association changed over time.Methods: This cohort study was conducted in Okayama City, Japan. Community-dwelling older adults aged ≥65 years were included. Frailty was assessed using the Kihon Checklist, and disability was defined as a new certification for long-term care insurance. The association between frailty and disability was examined across five time periods (years 1–2, 3–4, 5–6, 7–8, and 9–10) using a marginal structural model with inverse probability of treatment weighting and inverse probability of censoring weighting.Results: The final analysis included 45,291 participants, with 17.3% classified as frail. The adjusted odds ratios (ORs) for the association between frailty and the incidence of disability gradually decreased over time but remained throughout the 10-year follow-up period. The adjusted ORs and 95% confidence intervals were 2.90 (2.55–3.29) for years 1–2, 2.40 (2.09–2.75) for years 3–4, 2.03 (1.76–2.34) for years 5–6, 1.75 (1.52–2.01) for years 7–8, and 1.58 (1.38–1.82) for years 9–10.Conclusion: Frailty was consistently associated with the incidence of disability over a 10-year follow-up period, with a stronger association in the earlier years and a gradual decline over time.
Background: Population aging is increasing the prevalence of type 2 diabetes mellitus (T2DM) and hip fractures, which are major contributors to morbidity, mortality, and healthcare costs among older adults. The coexistence of both conditions further worsens clinical outcomes and quality of life. This study analyzes the association between T2DM and 30-day outcomes after hip fracture.Methods: Observational, longitudinal study with a 1-month follow-up after hospital discharge, including a total of 1,164 patients aged ≥65 years with hip fracture treated at a public university hospital between 2017 and 2022. The main variable was the presence of T2DM. Sociodemographic, clinical, and surgical variables, along with 30-day outcomes (mortality, readmission, reoperation, functional change, and change of residence), were collected.Results: Patients with insulin-treated diabetes showed a higher percentage of 30-day hospital readmission (11.4%) compared with patients without diabetes (3.3%) and those with non–insulin-treated diabetes (2.9%). Insulin-treated diabetes was associated with an increased risk of 30-day hospital readmission (hazard ratio=3.36; 95% confidence interval 1.59–7.08). No statistically significant differences were observed in the remaining outcomes analyzed.Conclusion: Individuals with insulin-treated diabetes exhibit an increased risk of hospital readmission following hip fracture. These findings highlight the need for targeted perioperative management, closer post-discharge monitoring, and diabetes-specific care pathways for this high-risk subgroup. Implementing individualized follow-up and optimizing glycemic control may help reduce early readmissions and improve short-term clinical outcomes in patients with type 2 diabetes, particularly those treated with insulin.
Background: Promoting physical activity among older adults is essential for extending healthy life expectancy. Municipality-led walking programs have been introduced in Japan; however, evidence of their effectiveness in promoting readiness for lifestyle improvement among older adults remains limited. We examined the association between participation in a municipality-led walking promotion program and readiness for lifestyle improvement among community-dwelling older adults.Methods: Data of community-dwelling adults aged ≥65 years who participated in a municipality-led walking promotion program implemented in Zushi City, Japan, in 2021, were compared with those of non-participants selected from the National Health Insurance database. Behavioral readiness was evaluated using the five-stage classification of the transtheoretical model. Pre- and post-intervention stages were assessed in both groups. Associations between participation and behavioral stage were examined using ordinal logistic regression with unadjusted, basic-adjusted, and fully adjusted models, controlling for baseline stage and habitual exercise.Results: Participants in the walking event had higher odds of being at a higher readiness stage than non-participants (unadjusted odds ratio [OR]=2.91; basic-adjusted OR=2.99; fully adjusted OR=2.98). Analyses using a dichotomized transtheoretical model variable also indicated consistently higher odds of being in the action or maintenance stages among participants.Conclusion: Our findings suggest that short-term, municipality-led walking initiatives contribute to early-stage behavioral readiness for lifestyle improvement in older adults. They provide a valuable foundation for planning community-based health promotion and long-term care prevention strategies. Further studies are needed to evaluate similar programs across different settings and over more extended periods.
Background: Self-perceived voice disorders (PVD) are common in later life and may affect psychological, social, and physical well-being. However, longitudinal evidence in community settings remains limited. This study sought to examine whether PVD predicted changes in well-being among community-dwelling older adults.Methods: Data were obtained from a community cohort in Kasama City, Japan. Older adults (n=273; aged 76.5 years; 57.1% female) were classified based on baseline Voice Handicap Index-10 scores (0, no; 1–4, mild; and ≥5, PVD). Outcomes were assessed annually through 2025 using the Geriatric Depression Scale (GDS), Lubben Social Network Scale (LSNS), Physical Activity Scale for the Elderly, and physical performance measures (handgrip strength, single-leg balance with eyes open, sit-and-reach, and 5-m habitual walk). Linear mixed models analyzed the fixed effects of group, time, and their interaction while adjusting for selected covariates.Results: Significant group effects were observed for the GDS, total LSNS scores, and the LSNS family scale, indicating that participants with PVD had weakened psychological and social well-being and smaller family networks. Additionally, a notable group effect was observed in sit-and-reach, with PVD participants showing less flexibility than those without it in the physical performance measures.Conclusion: Among community-dwelling older adults, PVD was prospectively associated with increased depressive symptoms, diminished social networks, particularly smaller family networks, and reduced physical flexibility. These findings suggest that PVD preceding medical diagnosis may signal broader declines in psychological, social, and physical well-being, highlighting the importance of early identification and support.
Background: Alzheimer’s disease is more prevalent among females. Estrogens influence brain metabolism and function, and low blood levels before, during, and after menopause may be associated with cognitive decline in later years. Here, we investigate the association between hormone therapy and reproductive lifespan with cognitive performance using a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) database.Methods: This cross-sectional study included 1,374 eligible women aged 60 years or older from the NHANES database. Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word learning subtest, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Univariate analysis and multivariate logistic regression were employed to evaluate the association between hormone therapy, reproductive span, and cognitive performance. Restricted cubic spline curves were used to assess the relationship between age as a continuous variable and cognitive performance.Results: After adjusting for age, race, and educational level, hormone therapy was significantly associated with word recall, digit symbol, and animal fluency cognitive performance (p < 0.05). The reproductive span was associated with word recall performance (p = 0.027) but not with digit symbol or animal fluency. The age-related cognitive decline is attenuated by hormone therapy with maximum effect between 65 and 70 years for all dimensions.Conclusion: There is a positive association between hormone therapy and cognitive performance in postmenopausal women, particularly in age groups with the steeper decline. In addition, there is no significant association between reproductive span and cognitive function.
Decision-making about systemic therapy in older adults with cancer is complex due to frailty, clinical uncertainty, and competing treatment goals. Limited evidence exists synthesizing how healthcare professionals support decision-making in geriatric oncology. This qualitative systematic review searched four databases through November 2025 and conducted citation tracking. Thematic synthesis was performed, and confidence in findings was assessed using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). Twelve studies involving 212 healthcare professionals were included. Two analytical and six descriptive themes were identified. Healthcare professionals sought to minimize treatment-related harm while respecting patients' values and life perspectives. Decision-making was shaped by clinical judgment integrating geriatric assessment findings, healthcare professionals' perspectives, ethical considerations regarding beneficence and autonomy, and structural factors such as resource limitations and interprofessional collaboration. These findings highlight the need for clinical expertise, collaboration across oncology, primary care, and geriatric care providers, and system-level support for geriatric-informed care.
Background:In 2019, the European Working Group of Sarcopenia in Older People indicated the importance of assessing muscle mass and quality in diagnosing sarcopenia. The extracellular water-to-total body water ratio (ECW/TBW) has recently been noticed as muscle quality. This study aimed to clarify the associations of ECW/TBW and grip strength and gait speed in community-dwelling individuals in their 20s to 90s. Methods:This study employed a cross-sectional design. We enrolled 661 community-dwelling individuals (aged ≥ 20). The ECW/TBW was measured using multifrequency bioelectrical impedance analysis. Associations between grip strength, gait speed, and ECW/TBW were analyzed separately for males and females using Spearman's correlation coefficient. Multiple linear regression analyses were conducted to examine factors associated with grip strength and gait speed. Results:Correlation analyses revealed significant negative correlations between ECW/TBW and grip strength (males; ρ = -0.413, p < 0.001, females; ρ = -0.384, p < 0.001) and gait speed (males; ρ = -0.122, p = 0.037, females; ρ = -0.206, p < 0.001). In the multiple linear regression analysis, ECW/TBW was significantly and independently associated with grip strength (males; β = -0.207, p = 0.006, females; β = -0.215, p = 0.001) and gait speed (males; β = -0.213, p = 0.013, females; β = -0.305, p < 0.001). Conclusions:The present study identified negative associations between ECW/TBW and both grip strength and gait speed among community-dwelling individuals aged in their 20s to 90s. Additionally, these associations were confirmed in males and females.
Background:Cardiovascular disease (CVD) in older adults is compounded by malnutrition and chronic inflammation. We compared the long-term prognostic performance of three categories of routinely available indices: nutritional (Prognostic Nutritional Index [PNI], Geriatric Nutritional Risk Index [GNRI], Controlling Nutritional Status [CONUT]); immune-inflammatory (Systemic Immune-Inflammation Index [SII]); and anthropometric (Weight-Adjusted Waist Index [WWI]). Methods:We analyzed 1,804 NHANES 2009-2018 participants aged ≥60 years with established CVD, linked to the National Death Index. Survey-weighted Cox models with restricted cubic splines estimated associations with cardiovascular and all-cause mortality, adjusted for demographic, socioeconomic, behavioral, and comorbid covariates. Sensitivity analyses included landmark exclusion of early deaths (6, 12, 24 months), a complete-case analysis, and additional adjustment for total energy and protein intake. Results:The nutritional indices (PNI, GNRI, CONUT) showed L-shaped associations with cardiovascular mortality that persisted after sequential exclusion of early deaths and after additional adjustment for total energy and protein intake. Each 1-point increase in PNI corresponded to an adjusted hazard ratio (aHR) of 0.91 (95% CI 0.87-0.95) for cardiovascular mortality; moderate-to-severe malnutrition by PNI carried a 4.61-fold higher hazard. PNI yielded the best model fit (lowest AIC/BIC); CONUT had the highest discrimination. The SII association attenuated when deaths within 24 months were excluded. The WWI predicted all-cause but not cardiovascular mortality. Conclusions:The nutritional indices (PNI, GNRI, CONUT) showed durable associations with cardiovascular mortality, whereas the SII signal was acute and the WWI predicted only all-cause mortality. These findings are hypothesis-generating; prospective external validation is required before routine clinical use.
Background:In this study, we aimed to investigate the association between the presence of pressure ulcers and body composition parameters in older residents of long-term care facilities and identified the most relevant indicators. Methods:This cross-sectional observational study assessed 156 residents. Body composition was measured, including body mass index (BMI) and phase angle (PhA). Functional assessments included the Barthel index (BI), and Clinical Frailty Scale. The participants were classified into two groups based on the presence or absence of pressure ulcers. Group comparisons and receiver operating characteristic analyses were used to determine the area under the curve (AUC) and cutoff values. The diagnostic performance of the combined cutoff values was also examined. Binary logistic regression was used to evaluate the association between PhA and the presence of pressure ulcers. Results:Twenty (12.8%) participants had pressure ulcers, 90% of which were mild-stage. PhA was lower in the pressure ulcer group (p < 0.001), with an optimal cutoff value of 3.1° (AUC 0.72). Using the cutoff values derived from each assessment, the combination of PhA with BI or BMI improved the AUC to a maximum of 0.78. Logistic regression demonstrated a significant association between PhA and the presence of pressure ulcers (p < 0.05). Conclusion:Phase angle may serve as a complementary biomarker for pressure ulcer risk assessment and may be more useful when combined with functional and nutritional indicators. The use of body composition parameters for noninvasive risk assessment could play an important role in future pressure ulcer prevention strategies.
