Studies on the association between smoking and out-of-office blood pressure (BP) remain limited. This systematic review and meta-analysis was conducted to evaluate whether out-of-office BP differs between smoking and abstinence periods. We searched PubMed and IchuShi-Web through September 2025 and identified four non-randomized comparative studies (104 participants) that compared ambulatory BP (ABP) between smoking and abstinence periods among current smokers. The abstinence period ranged from 1 day to 1 week. Mean differences (MDs, smoking minus abstinence) and 95% confidence intervals (CIs) were estimated using a random-effects model. During the smoking period, 24-h systolic BP (SBP) (MD: 2.41 mmHg, 95% CI: -0.13 to 4.95), daytime SBP (MD: 3.47 mmHg, 95% CI: -0.41 to 7.36), and nighttime SBP (MD: 1.38 mmHg, 95% CI: -1.91 to 4.68) were not significantly different compared with those in the abstinence period. In contrast, 24-h diastolic BP (DBP) (MD: 2.67 mmHg, 95% CI: 0.72 to 4.62) and daytime DBP (MD: 3.17 mmHg, 95% CI: 1.15 to 5.18) were significantly higher, whereas nighttime DBP was not (MD: 1.00 mmHg, 95% CI: -1.17 to 3.17). Furthermore, 24-h heart rate (HR) (MD: 6.47 beats per minute [bpm], 95% CI: 3.98 to 8.96), daytime HR (MD: 7.19 bpm, 95% CI: 4.59 to 9.79), and nighttime HR (MD: 3.58 bpm, 95% CI: 0.69 to 6.47) were significantly higher. In conclusion, the ABP profile during the smoking period in current smokers is unfavorable compared with that during the abstinence period, providing further evidence to support smoking cessation.

This study aimed to examine the effect of the remote use of information and communications technology (ICT) to meet with families on the well-being of people with dementia living in a nursing home. The study was conducted during the coronavirus disease 2019 pandemic using a mixed-method approach. Six dyads of people with dementia and their families used ICT devices remotely. Quantitative and qualitative measures included the well-being of people with dementia and the experience of remote meetings using semi-structured interviews, respectively. In the linear mixed analysis, a difference in well-being was found between days when people with dementia in a nursing home met and did not meet their families remotely using ICT. The qualitative results showed that meeting families remotely using ICT was effective in supporting their well-being; however, barriers still exist for the introduction and use of this system. These findings could improve the well-being of people with dementia.

Introduction Although artificial intelligence (AI) has been widely applied to electronic health record (EHR) data in hospital environments, its use in long-term care (LTC) facilities remains unexplored. Limited information technology infrastructure and unique challenges in LTC settings require a comprehensive examination of AI’s potential to enhance care quality and operational efficiency. With the aim of examining the application of AI to EHR data in LTC facilities, this scoping review will identify current AI applications for EHR in LTC, informing future research and potential care improvements in LTC settings.Methods and analysis This review will follow the scoping review methodological guidelines. The protocol of this scoping review has been registered on the Open Science Framework. The inclusion criteria are EHR (participants), AI (concept) and LTC facilities (context), with no date restrictions, but limited to articles published in English. Studies of any design focusing on AI applications for EHR in LTC settings will be considered. A systematic search will be performed on MEDLINE (Ovid), CINAHL (EBSCOhost), the Cochrane Central Register of Controlled Trials (Ovid), the Cochrane Database of Systematic Reviews (Ovid) and SCOPUS (Elsevier) by an information specialist. Two reviewers will independently screen titles and abstracts for inclusion based on predefined criteria. The same process will be repeated for full-text screening. Discrepancies will be resolved through team meetings with the third, fourth and fifth reviewers. All reasons for exclusion at the full-text stage will be documented and reported, with any discrepancies resolved by a review team.Ethics and dissemination As the data will be collected from existing literature, ethical approval is not required. The findings will be disseminated through conference presentations and publication in a peer-reviewed journal. The results will map current knowledge on AI applications in LTC facilities, thereby providing a foundation for future research aimed at enhancing the implementation and effectiveness of AI technologies in such settings.

ABSTRACT Background While rapid population ageing is occurring worldwide, its speed is especially prominent in Asian countries. In Asia, cultural diversity might significantly affect care burden; however, few studies have investigated the differences in care burden, and mental, physical and social conditions among Asian countries. This study aimed to clarify the situations of and differences in family caregivers (FCs) of older persons in Japan and Thailand, and evaluate the factors associated with care burden in both countries. Methods A cross‐national survey of 217 in‐home FCs was conducted in Japan and Thailand and mainly included items regarding care burden and psychosocial conditions. Differences between the two countries were obtained, and the factors associated with care burden were analysed by multiple regression analyses. Results The FCs' and care receivers’ mean ages (64.8 ± 11.1 and 84.8 ± 8.6 years, respectively) in Japan were significantly higher than the mean ages (49.1 ± 13.3 and 77.1 ± 9.5 years) in Thailand. In Japan, FCs had more severe care burden, loneliness, and stress compared to those in Thailand. In Thailand, FCs had more social connections and informal support than those in Japan. The factors associated with care burden were different in each country; thus, severe stress, low emotional care preparation, and low willingness to continue care at home were significantly associated with severe care burden in Japan, whereas poor relationships with care receivers, few social connections, low confidence in providing care, low emotional care preparation, and lack of informal support were significantly associated with severe care burden in Thailand. Conclusions Despite there being a long‐term care insurance system in Japan, which is absent in Thailand, care burden and psychosocial conditions of FCs might be worse in Japan. There was a clear difference in the factors associated with care burden between Japan and Thailand.

Exercise is a promising nonpharmacological intervention to delay the progression of cognitive impairment and improve physical function and sleep quality in patients, but the evidence remains inconclusive. To compare the therapeutic efficacy of an exercise intervention on physical performance, sleep efficiency, and quality of life in older adults with cognitive impairment. A three-arm randomized controlled trial. This study recruited 81 older adults with mild to moderate cognitive impairment at a nursing home from December 2020 to July 2021. Participants were screened and randomized into three groups: a tai chi intervention group (n = 27), a conventional exercise intervention group (n = 27), and a waitlist control group with no intervention (n = 27). The intervention groups underwent 12 weeks of exercise intervention. Participants were assessed at weeks 0, 6, and 12. The primary outcome was the Short Physical Performance Battery score, and the secondary outcomes were sleep efficiency and quality of life. Statistical analysis was conducted with generalized estimating equations (GEEs). The mean age of the participants was 81.0 ± 7.4 years. The GEE analysis revealed that the Short Physical Performance Battery score, sleep efficiency, and quality of life were significantly higher in both intervention groups than in the control group at week 12, and physical performance improved significantly more in the tai chi group than in the conventional exercise group. Both exercise interventions improved physical performance, sleep efficiency, and quality of life in older adults with mild to moderate cognitive impairment. According to our results, tai chi may be a more effective therapeutic approach for cognitive impairment than conventional exercise. University Hospital Medical Information Network number UMIN000042051. Registered 01/12/2020.

Abstract Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and around two-thirds overall develop dementia over their lifetime. Previous studies have reported that family caregivers (FCs) caring for older people with MCI experience considerable burden, which tends to cause various neuropsychiatric symptoms, such as depression, apathy, and irritability. However, it is not clear how FCs’ stress, which leads to increased burden, fluctuates within a day through their daily activities. The aim of this study was to explore the characteristics of stress variability in FCs. We recruited one dyad of an older adult with MCI over the age of 65 and a FC. Data collection was performed continuously for 7 consecutive days. We adopted smart watches (GARMIN vívosmart 4) to measure Heart Rate Variability (HRV)-based stress. Moreover, we asked a FC to talk with a Virtual Agent (VA) on a laptop freely to understand when and what kind of daily activities were done and the FC’s feelings. Detecting change points in time series data was performed using Python 3.9. Results showed that change points in the FC’s daily stress appeared when the FC starts specific activities such as preparing meals and confirming some medicine that an older adult with MCI should take and daily schedules. The FC also expressed anticipatory grief at the prospect of future dementia through the VA. This finding is beneficial for considering how to reduce FCs’ stress during daily activities.

AIM:To understand whether the sleep quality of the caregivers of elderly inpatients is associated with their own characteristics and with the characteristics or sleep quality of the elderly inpatients. DESIGN:A cross-sectional study design that recruited participants from September to December 2020 was adopted, in which 106 pairs of elderly inpatients and caregivers were recruited. METHODS:Data collected from the elderly inpatients included demographic characteristics as well as the numerical rating scale (NRS) score, Charlson Comorbidity Index (CCI), Geriatric Depression Scale Short Form (GDS-SF) score, and Pittsburgh Sleep Quality Index (PSQI). Caregiver data included demographic characteristics and PSQI. RESULTS:In the regression analysis of caregiver characteristics and caregiver sleep quality, only caregiver age and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. In the regression analysis of elderly inpatient characteristics, caregiver characteristics, and caregiver sleep quality, only the PSQI of elderly inpatients and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. PATIENT OR PUBLIC CONTRIBUTION:Poor caregiver sleep quality was more likely to manifest when the elderly inpatients had poor sleep quality, when the caregivers themselves were older, and when the caregiver was the inpatient's spouse.

Abstract The rate of infection and magnitude of the effects of the coronavirus disease 2019 (COVID-19) pandemic has far exceeded the realm of what most people had previously experienced in their lives. There is an urgent need to ensure that strategies are in place to prevent and reduce anxiety in older adults. The present study aimed to assess anxiety in community-dwelling older adults and the related factors during the COVID-19 pandemic in Japan. A community-based cross-sectional study was completed in July 2021. The Japanese version of the Geriatric Anxiety Inventory was used to screen for anxiety symptoms. Demographical data and data for the following five other factors were collected: loneliness, mental well-being, perceived social support, coping behaviors to COVID-19, and fear of COVID-19. The association between anxiety and potential predictors was analyzed using binomial logistic regression. A total of 385 participants aged 65 to 86 years were included in the present study. 17% developed anxiety symptoms. Factors associated with anxiety were age, living alone, loneliness, significant people support, fear of COVID-19, and health monitoring as a COVID-19 coping behavior. Older age, living alone, and significant people support were associated with lower anxiety, and loneliness, fear of COVID-19, and health monitoring as a COVID-19 behavior were associated with higher anxiety in community-dwelling older adults during the COVID-19 pandemic. These findings can help to develop effective measures for reducing anxiety and will support the development of a psychological intervention for tackling the mental health of community-dwelling older adults during the COVID-19 pandemic.

Geriatrics & Gerontology InternationalVolume 22, Issue 9 p. 817-817 LETTER TO THE EDITOR Factors related to a sense of security with medical and long-term care services among community-dwelling middle-aged and older adults in Japan: Methodological issues to avoid misinterpretation Ryuno Hirochika, Corresponding Author Ryuno Hirochika ryuno@people.kobe-u.ac.jp orcid.org/0000-0001-5181-6710 Kobe University, Graduate School of Health Sciences, Kobe, Japan Correspondence Ryuno Hirochika, RN, PHN, PhD., Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma, Kobe Email: ryuno@people.kobe-u.ac.jpSearch for more papers by this author Ryuno Hirochika, Corresponding Author Ryuno Hirochika ryuno@people.kobe-u.ac.jp orcid.org/0000-0001-5181-6710 Kobe University, Graduate School of Health Sciences, Kobe, Japan Correspondence Ryuno Hirochika, RN, PHN, PhD., Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma, Kobe Email: ryuno@people.kobe-u.ac.jpSearch for more papers by this author First published: 28 July 2022 https://doi.org/10.1111/ggi.14441Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume22, Issue9September 2022Pages 817-817 RelatedInformation

Abstract Aims This study was to compare the therapeutic efficacy of Tai chi and conventional exercise on physical performance, sleep efficiency and quality of life among older people with dementia. Methods Eighty-one elderly mild to moderate older people with dementia living in a nursing home in China were screened and randomized to three groups. The intervention groups received a 12-week Tai chi or conventional exercise intervention. Participants were assessed at baseline, week 6, and week 12 between December 2020 and July 2021. The primary outcome was short physical performance battery, secondary outcomes including the sleep efficiency and quality of life. Generalized estimating equations and one-way analysis of variance were the main statistical tests. Results The mean age was 80.7 (SD 7.7) years and 74.1% of participants were women. Analysis indicated that there was a significant difference in both intervention groups in short physical performance battery, sleep efficiency and quality of life relative to control from 0-12 weeks, and the Tai chi group had a substantial advantage over the conventional exercise group. Conclusions Tai chi and conventional exercise could improve physical performance, sleep efficiency and quality of life in older people with dementia. Furthermore, Tai chi could be a more effective approach to improve physical performance.

BACKGROUND:Type 2 diabetes mellitus (T2DM), common in older people, is an important reason for muscle loss in Japanese and Taiwanese populations. However, little is known about the association between lifestyle behaviours and muscle quality. We aimed to compare the lifestyle behaviours of Japanese and Taiwanese older adults with T2DM and to the identify lifestyle factors associated with muscle quality.METHODS:This cross-sectional study was conducted among community-dwelling individuals with T2DM aged ≥65 years in Taiwan and Japan. Totally, 114 Japanese and 226 Taiwanese participants were enrolled in the study. Outcomes were measured by blood biochemical examinations, body composition analyses and structured self-reported questionnaires to assess lifestyle behaviours and muscle quality. Linear regression models were used to examine the relationship between lifestyle factors and muscle quality using SPSS version 27.0 with a statistical significance level of P < 0.05.RESULTS:Japanese subjects were more likely to be smokers and alcohol consumers, and they were less likely to have well-balanced diets and engage in more physical activity as compared to Taiwanese subjects. The muscle quality in the Japanese subjects was significantly poorer than that in the Taiwanese subjects. Physical activity, dietary habits and smoking were associated with muscle quality, after adjusting for age, gender and body mass index.CONCLUSIONS:Physical activity of insufficient intensity, unhealthy dietary habits and smoking could be risk factors for poor muscle quality. These findings can contribute to the development of effective strategies to improve muscle quality in community-dwelling older Asian people with T2DM.

The aim of this study was to clarify the association between dietary protein intake and decline in the estimated glomerular filtration rate (eGFR) among Japanese older adults.

This study aimed to evaluate the effects of a virtual reality intervention for dementia care education in Japa-nese acute care nurses. Non-randomised controlled trial was used to assess the effectiveness of the interven-tion pre-and post-intervention and at a 1-month follow-up. This study enrolled 20 and 19 nurses in the intervention and control groups, respectively. Generalized estimating equation analyses revealed significant differences in scores on the Dementia Nursing Competency Scale in Acute Hospitals and Staff Experiences of Working with Dementia Residents questionnaire in the intervention group. A post hoc test revealed signifi-cantly higher scores on the Dementia Nursing Competency Scale in Acute Hospitals at 1 month after com-pared with pre-intervention. Staff Experiences of Working with Dementia Residents questionnaire scores were significantly lower at pre-than that at post-intervention and 1 month after intervention. These findings could improve competency of dementia nursing care and attitudes toward people with dementia.(c) 2022 Elsevier Inc. All rights reserved.

AIM AND OBJECTIVESThe purpose of this study was to investigate which factors are associated with the quality of dementia care in acute care hospitals.BACKGROUNDThe number of people with dementia who are admitted to acute care hospitals is increasing. Improving the quality of dementia care in acute care hospitals is an important issue. Prior studies have demonstrated that not only knowledge and nursing experience, but also psychological factors and the nursing practice environment are related to high-quality care on general wards.DESIGNCross-sectional hypothesis-testing design.METHODSParticipants were nurses providing care to people with dementia at acute care hospitals. Questionnaires were distributed to 300 acute care hospitals in Japan, 10 copies each and 773 valid responses were received. Based on the hypothesis model, variables were tested using multiple regression analysis. The model described the relationship between quality of care, personal attributes and the nursing practice environment. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.RESULTSAlmost 90% of the study sample was female, the mean age was 37.4 ± 9.3 years, and the mean nursing experience was 14.0 ± 8.7 years. The results showed that nursing foundations for quality of care, staffing and resource adequacy, specialist consultation, promoting systematic recreation and exchange, knowledge, and feelings towards people with dementia were associated with the quality of dementia care in acute care hospitals. The adjusted coefficient of determination was 0.367.CONCLUSIONThis study identified factors associated with the quality of dementia care in acute care hospitals. Knowledge and feelings towards people with dementia are important, and the nursing practice environment plays an important role in improving the quality of dementia care.RELEVANCE TO CLINICAL PRACTICENot only improving nurse's practical ability but also a supportive nursing practice environment enhances the quality of dementia care in acute care hospitals.

Objective: To examine the effect of employment status on sleep, care burden, and negative affect among family caregivers (FCs) at home. Methods: An intensive longitudinal design was applied in which 25 FCs underwent in-home assessments for up to 56 days. At baseline, demographic data and employment status were collected. FCs wore a wrist-worn device with an accelerometer to assess objective total sleep time (TST) for consecutive 24-hour periods. FCs answered the Zarit Burden Interview (ZBI) and Positive and Negative Affect Schedule (PANAS) every night before sleep. Linear mixed model analysis was used to examine the effect of objective sleep status on ZBI and PANAS scores the following day. Results: Mean participant age was 66.3 ± 10.8 years (72.0% female), and mean survey period was 29.1 ± 9.6 days (866 observations). Mean TST of FCs was 5.7 ± 1.4 hours. In total, 32.0% of FCs were employed either full- or part-time. TST of employed FCs was significantly associated with care burden and negative affect (B = −0.4 and −1.3, respectively); however, positive affect was not associated with TST. FCs who were unemployed experienced less care burden and negative affect (rate of change: −7.7 and −8.0, respectively). Additionally, TST of unemployed FCs was associated with negative affect; thus, when they slept 1 hour longer than their mean TST, they experienced less negative affect the following day. Conclusion: A reduction in TST could lead to increased care burden and more severe negative affect the following day, which may be moderated by employment status.

We investigated the association of systolic blood pressure (SBP) level with physical frailty and cognitive function in community-dwelling older Japanese. Using the ‘Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians’ survey as the baseline, we performed a cross-sectional analysis of people aged 70 ± 1 (n = 1000), 80 ± 1 (n = 978), and 90 ± 1 (n = 272) years. Medical histories and medications were collected via interviews conducted by medical professionals. Blood pressure (BP), grip strength, gait speed, and cognitive function were examined on site. Trend analysis and multiple regression analysis were used to determine the association of the SBP level with physical frailty and cognitive function. The principal finding was that the association of SBP with physical frailty and cognitive function varied depending on characteristics such as age, physical and cognitive function, and antihypertensive medication use. A lower SBP level was associated with a higher prevalence of physical frailty only among 80-year-olds who were on antihypertensive medication. A significant association was found between higher SBP and lower cognitive function among 70-year-olds, while among 90-year-olds, the opposite was found. No association was found among participants who were 80 years old or among participants of all ages without antihypertensive medication. Our finding that an inverted association between SBP and geriatric syndrome exists suggests that the treatment of older patients must be individualized to prevent geriatric syndrome.

AimSeveral studies have reported a negative correlation between depressive symptoms and family caregivers' (FCs) subjective sleep status. However, there is a paucity of information on the association between objective/subjective sleep status, care burden, and related factors.MethodsParticipants were 23 pairs of care receivers (CRs; Mage = 82.7 ± 8.5 years; 69.6% women) receiving long‐term care at home and their FCs (Mage = 66.9 ± 11.0 years; 69.6% women). At baseline, demographic data, subjective sleep status (Pittsburgh Sleep Quality Index; PSQI), WHO‐5 well‐being, depressive mood, and frequency of going outdoors were collected. FCs wore a small, wrist‐worn device with an accelerometer to assess objective sleep status for a consecutive 24‐h 2‐week period, and they answered the Zarit Burden Interview short version (ZBI) every night before sleep. After 3 months, CR status was collected and analysed retrospectively.ResultsThe mean total sleep time over 2 weeks was 349.5 ± 69.6 min. The mean ZBI score over 2 weeks was 8.8 ± 6.8, which was significantly correlated with total sleep time (r = −0.42; P < 0.05), total time in bed (r = −0.44; P < 0.05), PSQI (r = 0.62; P < 0.01), frequency of going outdoors by CRs (r = −0.42; P < 0.05), and WHO‐5 well‐being among CRs (r = −0.50; P < 0.05). Multiple regression analyses revealed that total sleep time (β = −0.51; P < 0.05) was significantly associated with care burden (adjusted R2 = 0.45). At the 3‐month follow‐up, four CRs had been hospitalised or died, and their FCs displayed significantly severe care burden and slept less than at baseline.ConclusionsReduced objective total sleep time is significantly associated with the severity of care burden among FCs. Home‐based care is critical in Japan; therefore, it is meaningful to determine how to reduce care burden.

Purpose: This study aimed to elucidate nurses’ capacity to provide good dementia care in acute hospitals. Methods: A qualitative descriptive study, along with semi-structured interviews, was conducted with 15 nurses practicing dementia care at acute hospitals. Results: Nursing practice competencies included “Nurses’ basic attitudes toward dementia patients”, “Implementation of safety and comfort measures for dementia patients during hospital stays”, “Expansion of sustainable dementia care with consideration for patients’ lifestyle before and after hospitalization and environment around patients”, and “Behavior as a team member to provide appropriate care for dementia patients.” Conclusion: This study revealed not only the nurses’ basic attitudes towards dementia patients, but also their comprehensive competency in providing good dementia care in acute hospitals. Because the number of elderly people with dementia admitted to hospitals is expected to rise rapidly in the future, nurses should effectively improve their competency in providing dementia care from this perspective.