Multi-omics approaches to human biological age estimation.

Multi-omics approach nowadays increasingly applied to molecular research in many fields of life sciences. Biogerontology is not an exception; multi-omics gives possibility to evaluate complex biomarkers (or panels) which consist of quantitative as well as phenotypic ones. It is especially important because of weak understanding of the nature of aging. The difficulty now is distinguishing between causes and effects of aging. The application of the whole set of metabolome, methylome, transcriptome, proteome or metagenome data in aging biomarker design becomes the only way to create a holistic view of aging landscape without missing undiscovered mechanisms and levels of organization. We found patents, up-to-date multi-omics datasets and studies, which include bioinformatics innovations to predict biological age in humans. We hope that the review will be also useful for clinicians, because it follows majorly translational purposes.

Naive extrapolations, overhyped claims and empty promises in ageing research and interventions need avoidance.

Most proclamations about another wonder breakthrough and another imminent miracle treatment of ageing are usually overhyped claims and empty promises. It is not that the experimental science behind those claims is totally wrong or fake. But it is often a case of being ahistorical and ignoring the cumulated knowledge and understanding of the evolutionary and biological principles of ageing and longevity. Furthermore, remaining stuck to the body-as-a-machine viewpoint reduces ageing and its associated health challenges to a mere problem of engineering and design. However, highly dynamic nature of the living systems with properties of interaction, interdependence, tolerance, adaptation and constant remodelling requires wholistic and interactive modes of understanding and maintaining health. The physiological relevance and significance of progressively accumulating molecular damage remains to be fully understood. As for ageing interventions, the three pillars of health-food, physical activity, and social and mental engagement-which actually show health-promoting effect, cannot simply be reduced to a single or a limited number of molecular targets with hopes of creating an exercise pill, a fasting pill, a happiness pill and so on. If we want to increase the credibility and socio-political-economic support of ageing research and interventions, we need to resist the temptation to overhype the claims or to make far-fetched promises, which undermine the theoretical and practical significance of new discoveries in biogerontology.

Engaging older people as university-based instructors: A model to improve the empathy and attitudes of pharmacists in training.

BACKGROUND AND PURPOSE: Clinical guidelines increasingly emphasise the importance of comprehensive and holistic care for older people. The objective of this education brief is to describe a workshop designed to improve first year pharmacy students' empathy and attitudes towards older people. EDUCATIONAL ACTIVITY AND SETTING: A two-hour, interactive, university-based workshop was developed and evaluated. Small groups of first year pharmacy students (approximately five per group) worked with an older person to complete a number of scaffolded activities focused on the older person's life experiences with pharmacy and medication usage. The effectiveness of this intervention was measured using an eight-item, pre- and post-workshop survey adapted from published scales. FINDINGS: Engaging older people as university-based instructors for first year pharmacy students was associated with significant improvements in three of the eight attitudinal items. Following the workshop, students were more likely to report that older people are: pleasant to be with (p < 0.001), more likely to understand what it feels like to have problems with aging (p < 0.005) and less likely to believe older people become less organised and more confused as they age (p < 0.001). SUMMARY: Engaging older people as university-based instructors for first year pharmacy students may be a useful strategy to develop empathy and positive attitudes towards older people. Further research is needed to determine if the attitudinal improvements are sustained over time.

[Survey on psychosomatic treatment options in geriatric clinical routine: state of the art]. / Umfrage zur Psychosomatik im geriatrischen Klinikalltag: eine Bestandsaufnahme.

BACKGROUND: Mental and physical disorders form a common body of experience and suffering in old age that can negatively influence aging. Experience and handling of age-associated functional impairments are challenging for multimorbid patients, their relatives and the healthcare providers involved. Among patients aged 70 years or older more than 50% suffer from psychopathological symptoms and 30-40% of geriatric inpatients have a psychosomatic or psychiatric comorbidity; however, despite this high prevalence of mental problems in older patients they are hardly ever treated and if treatment is offered it is carried out by specialists for somatic medicine. The aim of the present study of the working group on gerontopsychosomatics of the German Geriatric Society (DGG) was the evaluation of interdisciplinary co-management opportunities for geriatricians who treat inpatients with gerontopsychosomatic needs. METHOD: Online survey among members of the DGG regarding experiences with interdisciplinary co-management of inpatients with gerontopsychosomatic needs. RESULTS: The majority of the respondents were senior physicians in a department for geriatrics. While every second institution had access to a psychiatric consultation service, psychosomatic cooperation was only offered in every fifth department. Psychosomatic co-management was particularly required in connection with neurogeriatric problems. CONCLUSION: There is need of gerontopsychosomatic co-management among geriatric inpatients; however, in comparison to gerontopsychiatric co-management the options are deficient and need to be strengthened.

Geriatric Trends Facing Nursing with the Growing Aging.

This article expands on the Gerontological Society of America leaders' work to explore challenges facing healthcare providers in preparing for an aging population. Traditional medicine and models of care may no longer meet complex patient needs. Older patients present with multifaceted issues while living longer with chronic health conditions. The changing environment requires a cross-disciplinary perspective. Changes in reimbursement are in the early stages of implementation and will be used to evaluate measurable outcomes. Preparing to care for this population can only occur with enough health professionals and expanded use of advance practice nurses. Health improvement is economically advantageous.

Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors.

OBJECTIVE: To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. METHODS: A national cross-sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. RESULTS: In total, 73.5% of participants report "often" treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72-2.94), working in a non-urban area (OR 1.85; 95% CI 1.35-2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26-2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15-1.96). CONCLUSIONS: The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.

[Year in review : geriatrics]. / Gériatrie.

In 2018, new recommendations about the prevention of falls and fractures emphasized the benefits from exercise and from multimodal prevention programs but did not endorse any more vitamin D supplementation for falls prevention. Results were contrasted for several studies testing exercise (negative) and cognitive training (mixed results) in the management of older patients suffering from neurocognitive disorders. The new direct oral anticoagulants are increasingly prescribed in older patients despite the paucity of data. New information has been released in 2018 from « real-world ¼ data that seem reassuring about their risk/benefit ratio in old-old patients, provided a careful prescription. Finally, the Mediterranean diet is still gaining credit with a new study showing its benefits in preventing frailty in community-dwelling older persons.

En 2018, l'intérêt de l'activité physique et des programmes de prévention multimodaux est confirmé pour la prévention des chutes, mais l'utilisation de la vitamine D dans cette indication est remise en question. Pour les pathologies neurocognitives, les résultats sont contrastés concernant l'activité physique, alors qu'une revue systématique confirme les bénéfices, certes modestes, de l'entraînement cognitif sur les performances cognitives et la qualité de vie des patients et de leurs proches. Les nouveaux anticoagulants sont de plus en plus largement utilisés chez les patients âgés malgré des données encore limitées, mais plusieurs études du « monde réel ¼ semblent confirmer leur bon rapport risques/bénéfices aussi chez ces patients. Le régime méditerranéen a le vent en poupe, une étude rapporte un bénéfice sur l'incidence de la fragilité.

Empathy in the nurse-patient relationship in geriatric care: An integrative review.

INTRODUCTION: Empathy is a complex human experience that involves the subjective intersection of different individuals. In the context of nursing care in the geriatric setting, the benefits of empathetic relationships are directly related to the quality of the practice of nursing. OBJECTIVE: Analyze scientific production on the benefits of empathy in the nurse-patient relationship in the geriatric care setting. METHODS: An integrative review of the literature was performed using the PubMed, Cochrane, CINAHL, Scopus, PsycINFO, and Web of Science databases. The articles retrieved were organized, evaluated, and classified based on the level of scientific evidence. RESULTS: Relationships of empathy between nurses and older people were analyzed in quasi-experimental studies using different assessment tools, the majority of which had moderate levels of validity and reliability. Studies with a qualitative approach discussed the meaning of empathy in terms of the quality of care offered, compassion, and vulnerability. DISCUSSION: Levels of empathy increase when activities are developed with the aim of teaching, sensitization, and training for relational care between nursing staff and older people. The analysis of empathetic relationships is important to the evaluation of the quality of care provided to older people. CONCLUSION: Empathy in the nurse-patient relationship in the geriatric care setting is an important ethical aspect that contributes to the quality of the practice of nursing. The present findings indicate the need for more robust assessment tools with adequate psychometric properties and the descriptive analysis of empathy.

[Geriatric medicine]. / Gériatrie.

2017 highlights benefits of prevention. Better control of cardiovascular risk reduces the incidence of dementia and monthly high-dose vitamin D the incidence of respiratory infections in nursing home. Pre-operative geriatric assessment lowers by 20% the rate of delirium after hip-fracture surgery and complications in vascular surgery. Deleterious effects are also reported. High-dose vitamin D triples the rate of falls in supplemented residents and doesn't improve gait speed in sedentary men. Widely used in cardiovascular prevention, antithrombotic therapy is associated with an astonishing risk of subdural bleeding that further increases with the number of drugs combined together. Finally, the non-pharmacological management of behavioral and psychotic symptoms in advanced dementia, although effective, doesn't reduce the associated burden for proxies.

2017, année de la prévention. Un meilleur contrôle des facteurs de risque cardiovasculaires réduit l'incidence de la démence et des fortes doses mensuelles de vitamine D diminuent l'incidence des infections respiratoires en EMS. L'évaluation gériatrique préopératoire diminue de 20% le taux de confusion postopératoire après chirurgie d'une fracture du col fémoral et de complications précoces en chirurgie vasculaire. De hautes doses de vitamine D multiplient par 3 le risque de chutes chez des résidents vivant en institution et n'améliorent pas la vitesse de marche chez des hommes sédentaires. Très utilisés en prévention cardiovasculaire les médicaments antithrombotiques sont associés à un risque élevé d'hématomes sous-duraux. Ce risque augmente avec le nombre de médicaments prescrits. Enfin, le traitement non pharmacologique des troubles psycho-comportementaux dans les démences avancées réduit l'intensité des troubles et aussi le fardeau des aidants.

Developing the Transdisciplinary Aging Research Agenda: New Developments in Big Data.

BACKGROUND: Advances in big data analytics can enable more effective and efficient research processes, with important implications for aging research. Translating these new potentialities to research outcomes, however, remains a challenge, as exponentially increasing big data availability is yet to translate into a commensurate era of 'big knowledge,' or exponential increases in biomedical breakthroughs. Some argue that big data analytics heralds a new era associated with the 'end of theory.' According to this perspective, correlation supersedes causation, and science will ultimately advance without theory and hypotheses testing. On the other hand, others argue that theory cannot be subordinate to data, no matter how comprehensive data coverage may ultimately become. OBJECTIVE: Given these two tensions, namely (i) between exponential increases in data that have not translated into exponential increases in biomedical research outputs; and (ii) between the promise of comprehensive data coverage and inductive data-driven modes of enquiry versus theory-driven deductive modes, this critical review seeks to offer useful perspectives of big data analytics and to derive certain theoretical implications for aging research. METHOD: This work offers a critical review of theory and literature relating big data to aging research. RESULT: The rise of big data provides important insights into the theory development process itself, highlighting potential for holistic theoretical assemblage to ultimately enable near real time research capability. CONCLUSION: Big data may represent a new paradigm of aging research that can dramatically increase the rate of scientific breakthroughs, but innovative theory development remains key to this potential.

New horizons in comprehensive geriatric assessment.

In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.

[Geriatrics or geriatricization of medicine : Quo vadis geriatrics?] / Geriatrie oder Geriatrisierung der Medizin : Quo vadis Geriatrie?

This article examines the question whether and how geriatrics will change in the future and whether in view of the demographic changes the trend will go more in the direction of a further expansion of geriatrics or more towards a geriatricization of individual specialist medical fields. The different development of geriatrics in the individual Federal States can only be understood historically and is absolutely problematic against the background of the new hospital remuneration system. Geriatrics is a typical cross-sectional faculty and still has demarcation problems with other faculties but has also not yet clearly defined the core competence. This certainly includes the increasing acquisition of decentralized joint treatment concepts and geriatric counselling services in the future, in addition to the classical assessment instruments. Keywords in association with this are: traumatology and othopedics of the elderly, geriatric neurology and geriatric oncology. Interdisciplinary geriatric expertise is increasingly being requested. Outpatient structures have so far not been prioritized in geriatrics. An independent research is under construction and it is gratifying that academic interest in geriatrics seems to be increasing and new professorial chairs have been established. It is not possible to imagine our hospital without geriatrics; however, there is still a certain imbalance between the clearly increased number of geriatric hospital beds, the representation of geriatrics in large hospitals (e.g. specialized and maximum care hospitals and university clinics), the secure establishment in further education regulations and the lack of a uniform nationwide concept of geriatrics.

Global geriatric oncology: Achievements and challenges.

The aging of the population is a global challenge. The number of older adults is rapidly growing, leading to an increase in the prevalence of noncommunicable diseases associated with aging, such as cancer. Worldwide, older adults account for approximately half of all cancer cases, and this proportion is projected to increase globally. Furthermore, the majority of older adults live in less developed regions, where health systems are generally ill-equipped to provide care for complex chronic conditions. Worldwide, there is paucity of geriatric training, and most of the oncology workforce lacks the skills and knowledge to provide comprehensive care for older patients. Various initiatives aimed at providing adequate clinical care for older adults, increasing the geriatric skills and knowledge of healthcare professionals, and developing geriatric oncology research, have been successfully implemented. However, most developments in geriatric oncology have taken place in high-income countries, and there are still large inequalities in the availability of clinical, educational, and research initiatives across different regions of the world. This article provides an overview of geriatric oncology initiatives in Asia, Europe, Australia and New Zealand, Latin America, and the United States and Canada. Understanding the achievements and challenges of geriatric oncology around the world, and fostering international collaboration in research and training are essential for improving the care of all older adults with cancer.

The Relationship of Physiopsychosocial Factors and Spiritual Well-Being in Elderly Residents: Implications for Evidence-Based Practice.

BACKGROUND: Older adults in residential settings frequently suffer from functional decline, mental illness, and social isolation, which make them more vulnerable to spiritual distress. However, empirical evidence of the interrelationships between physiopsychosocial variables and spiritual well-being are still lacking, limiting the application of the biopsychosocial-spiritual model in institutional healthcare practice. AIMS: To explain the mechanisms by which these variables are linked, this cross-sectional study tested a causal model of predictors of spiritual well-being among 377 institutionalized older adults with disability using a structural equation modeling approach. METHODS: The primary variables in the hypothesized model were measured using the Barthel Index for functional ability, the Geriatric Depression Scale-short form for depression, the Personal Resources Questionnaire 85-Part 2 for perceived social support, and the Spiritual Well-Being Scale for spiritual well-being. RESULTS: The model fit indices suggest that the hypothesized model had a reasonably adequate model fit (χ2 = 12.18, df = 6, p = .07, goodness-of-fitness index [GFI] = 0.99, adjusted GIF index [AGFI] = 0.93, nonnormed fit index [NFI] = 0.99, comparative fit index [CFI] = 0.99). In this study, perceived social support and depression directly affected spiritual well-being, and functional ability indirectly affected spiritual well-being via perceived social support or depression. In addition, functional ability influenced perceived social support directly, which in turn influenced depression and ultimately influenced spiritual well-being. DISCUSSION: This study results confirm the effect of physiopsychosocial factors on institutionalized older adults' spiritual well-being. However, the presence and level of functional disability do not necessarily influence spiritual well-being in late life unless it is disruptive to social relationships and is thus bound to lead to low perceived social support and the onset of depression. LINKING EVIDENCE TO ACTION: The findings address the fact that the practice of spirituality is multidimensional and multileveled. Psychosocial interventions for institutionalized elders with disabilities should focus on increasing nurse-patient interaction and providing access to meaningful social activities to improve mental health and spiritual well-being.

New horizons in design for autonomous ageing.

The world is ageing rapidly. Between 2000 and 2050, the number of people aged ≥65 will double as a proportion of the global population, from 7% to 16%, respectively. By 2050, for the first time in human history, there will be more older people than children (aged 0­14 years) in the population. More distinctive is the tremendous increase in the oldest old aged ≥85. This challenges society to adapt, in order to maximise the health and functional capacity of older people as well as their social participation and security. Ageing is a multidimensional process of change in the physical, mental and social domain, leading to functional decline. Design thinking has embraced ageing as a topic where it can add to public health interventions. Applications of design and technology can contribute to 'autonomous ageing', for example, independent living and life style support, and can compensate for functional deficits associated with ageing. The focus is on supporting and reinforcing the reduced physical, mental, social and functional capacities of older people by applying groundbreaking, innovative design inclusive engineering methods, always starting with a human-centered integrated approach. Examples of design for geriatric giants include design for falls prevention, dementia care and integrated care. The establishment of collaborative networks between clinicians and designers, academia and industry is required to advance design for autonomous ageing.

Barriers to the Preclinical Development of Therapeutics that Target Aging Mechanisms.

Through the progress of basic science research, fundamental mechanisms that contribute to age-related decline are being described with increasing depth and detail. Although these efforts have identified new drug targets and compounds that extend life span in model organisms, clinical trials of therapeutics that target aging processes remain scarce. Progress in aging research is hindered by barriers associated with the translation of basic science discoveries into the clinic. This report summarizes discussions held at a 2014 Geroscience Network retreat focused on identifying hurdles that currently impede the preclinical development of drugs targeting fundamental aging processes. From these discussions, it was evident that aging researchers have varied perceptions of the ideal preclinical pipeline. To forge a clear and cohesive path forward, several areas of controversy must first be resolved and new tools developed. Here, we focus on five key issues in preclinical drug development (drug discovery, lead compound development, translational preclinical biomarkers, funding, and integration between researchers and clinicians), expanding upon discussions held at the Geroscience Retreat and suggesting areas for further research. By bringing these findings to the attention of the aging research community, we hope to lay the foundation for a concerted preclinical drug development pipeline.

[Geriatrics - an interdisciplinary challenge]. / Geriatrie - eine interdisziplinäre Herausforderung.

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units.

Perceptions of music therapy for older people among healthcare professionals.

PURPOSE OF STUDY: To investigate the perceptions of healthcare providers on music therapy and their recommendations on wider adoption in a hospital setting. DESIGN AND METHODS: A qualitative exploratory study employing short semistructured interviews using a thematic analysis method of data analysis. INTERVENTION: A qualitative exploratory study, employing short semistructured interviews was conducted in March 2015 in an urban teaching hospital to explore healthcare providers' attitudes towards and recommendations on music therapy. Convenience sampling was used for recruitment of hospital staff from a multidisciplinary geriatric unit. Only staff who had exposure, awareness, or participated in the hospital music therapy programme were asked to partake in an in-depth qualitative interview. MAIN FINDINGS: Themes emerging reflected a belief among hospital staff that music therapy was of benefit to patients and staff; perceptions of how a hospital music therapy programme should be implemented and a desire for expansion of the music therapy programme throughout the hospital setting. PRINCIPAL CONCLUSIONS: Music therapy is of great importance to patients and healthcare professionals, and thus more attention is warranted to better integrate and advance this programme. This study is important because although numerous studies have examined music therapy from a patient health perspective, no report has analysed the perceptions of healthcare providers on this intervention and their recommendations on further development of music therapy services.

Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.

BACKGROUND: The demographic structure of a country changes dramatically with increasing trends toward general population aging and declining birth rates. In Japan, the percentage of the elderly population (aged ≥65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. The national total population has been decreasing steadily since its peak reached in 2008, and it is expected to fall to the order of 80 million in 2060. Of the total population, those aged ≥75 years accounted for 12.3% as of 2013, and this is expected to reach 26.9% in 2060. As the demographic structure changes, the disease structure changes, and therefore the medical care demand changes. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. Japan has thus far attained remarkable achievements in medical care, seeking a better prognosis for survival; however, its medical care demand is anticipated to change both qualitatively and quantitatively. As diseases in the elderly, particularly in the old-old population, are often intractable, conventional medical care must be upgraded to one suitable for an aged society. What is required to this end is a shift from "cure-seeking medical care" focusing on disease treatment on an organ-specific basis to "cure and support-seeking medical care" with treatments reprioritized to maximize the quality of life (QOL) for the patient, or a change from "hospital-centered medical care" to "community-oriented medical care" in correlation with nursing care and welfare. CURRENT SITUATION AND PROBLEMS: (1) Necessity for a paradigm shift to "cure-and-support seeking medical care" In addition to the process of aging with functional deterioration of multiple organs, the elderly often suffer from systemically disordering diseases, such as lifestyle-related diseases, as well as geriatric syndrome and daily activity dysfunction; therefore, integrated and comprehensive medical care is required. In addition, with regard to diseases in the elderly, not only their acute stage, but also their chronic and intermediate stages must be emphasized in their treatment. Aiming to achieve a complete cure of disease by exploring the cause and implementing radical treatment, the conventional medical care model is difficult to apply to the medical care of the elderly; medical care suitable for the elderly is required. (2) Spread of home-based care and the necessity for human resources development Many elderly people want to continue to live in their house and their community where they have been living for a long time, even with disease. There are increasing needs for QOL-emphasizing home-based care for patients in the intermediate stage after completion of acute stage treatment, or for end-of-life care. Hence, there is a demand for a shift to "community-oriented medical care" for providing comprehensive care supported with medical and nursing resources available in the community. As the percentage of the elderly population (aged ≥65 years) and the availability of medical care resources vary considerably among different regions, it is important that specialists in the fields of public health, medical care, nursing care, and welfare work on establishing a collaborative system suitable for the local characteristics of each region by making the best use of their own specialties. (3) Necessity for establishing a department of gerontology or geriatric medicine at each medical school In line with the increasing number of elderly people, it is necessary to upgrade the systems for educating and nurturing physicians engaged in healthcare and nursing care for the elderly. It is also necessary to develop the organic cooperation with other medical and nursing care professionals, such as registered nurses and care workers. At present, just approximately 30% of medical schools in Japan have a department specializing in medical care for the elderly and relevant medical education; there is an urgent need to improve the situation, as the majority of universities do not provide any such education. (4) Necessity for establishing a medical center for promoting medical care provider collaboration, multidisciplinary training and a means to increase public awareness In the medical care for the elderly, comprehensive care must be provided from the viewpoints of both healthcare and nursing care; to improve the quality of such care services, multidisciplinary collaboration and team-based medicine are indispensable. Therefore, physicians, nurses, therapists, pharmacists, dieticians, care managers, and other health care professionals who have thorough knowledge about medical care for the elderly are of utmost necessity. In reality, however, the collaboration of these health care professionals is unsatisfactory, and the degree of understanding of team-based medicine by each medical professional is low. Therefore, as in the case of the establishment of cancer centers within individual regions to promote medical care for cancer, there is a demand to nurture professionals engaged in medical care for the elderly, and to establish a core facility for the promotion of multidisciplinary collaboration and team-based medicine for each region. (5) Do the people understand the paradigm shift? Currently, not only healthcare professionals, but also many citizens seek "cure-seeking medical care" aiming at a restoration of organ function; however, surveys of the elderly often show that they want to restore independent daily activity, rather than to achieve a "cure." In contrast, in the actual medical care setting, contradictory situations prevail in which the public awareness of the shift to "cure-and-support seeking medical care" is unsatisfactory, including the fact that the majority of recipients of tertiary emergency care are elderly patients. CONTENTS OF THE PROPOSAL: The Science Council of Japan has the task to propose future visions for the Japanese aging society not only from the viewpoint of the health of each individual, but also from a broader perspective, taking into account the relationship between humans and society. Various issues related to general population aging are posing serious problems, which require prompt resolution. Although we made a number of proposals at the 21st Subcommittee for Aging, the situation has not changed satisfactorily. Accordingly, the present proposals on specific solutions were designed. (1) In a super-aged society, a paradigm shift to "cure-and-support seeking medical care" should be implemented A super-aged society will consist of an unprecedented demographic structure in which the percentage of only those people aged ≥75 years will increase in the entire population. Therefore, there is an urgent need to prepare for increasing populations of persons in need of long-term care and those who are likely to become in need of long-term care. Given the consideration that "patients are not merely sick persons, but rather living persons," a paradigm shift from conventional "cure-seeking medical care" to "cure and support-seeking medical care" must be implemented. (2) Facilitate a paradigm shift to community-oriented medical care, and promote the activity of female physicians in the medical care for the elderly A paradigm shift should be promptly facilitated by reorganizing hospital functions and establishing a community comprehensive care system for home-based care to promote the participation of the elderly by themselves in care-supporting society. To further promote the collaboration of medical care and welfare, not only persons in charge of actual regional settings, but also university schools of medicine and regional core medical institutions experienced in medical care for the elderly should take the initiative to promote home-based care and facilitate a paradigm shift to community-oriented medical care. In addition, programs should also be developed to re-educate female physicians who became housewives in order to nurture them to become facilitators of geriatric medicine. (3) Physicians who are required at local medical facilities must be nurtured through the establishment of a department of gerontology or geriatric medicine at each medical school To facilitate efficient medical care services, medical education and research, and human resources development in support of expected paradigm shifts, it is considered that a department of gerontology or geriatric medicine should be established at each medical school. Furthermore, it is necessary to allocate dedicated teachers of medical care for the elderly to all medical schools, as well as to upgrade practice-participatory drills and to collaborate with a broad range of entities, including local medical institutions, and welfare and nursing care facilities. Efforts must be made to nurture locally wanted physicians through specific efforts concerning team-based medicine. (4) Promote the establishment of centers for geriatrics and gerontology (provisional name) for medical care collaboration, multidisciplinary training, and a means to increase public awareness To promote the uniform accessibility of expertise on efficient medical care that is best suited for a super-aged society, it is necessary to build a post-graduation educational system under the initiatives of the Japan Geriatrics Society and the National Center for Geriatrics and Gerontology across the nation in cooperation with regional medical schools and the Japan Medical Association. Furthermore, at least one hospital serving as a center for geriatrics and gerontology should be established in each regional block (Hokkaido, Tohoku, Koshinetsu, Hokuriku/Tokai, Kinki, Chushikoku and Kyushu/Okinawa) by making the best use of existing hospitals. Byestablishing these centers, uniform accessibility for the quality of medical care for the elderly in each region is expected. (ABSTRACT TRUNCATED).