Amputation-free Home Management of Infected Lower Extremity Pressure Ulcer through Shared Decision-making: Enhancing the Quality of Life and Highlighting Societal Significance in Home Care.

Home healthcare is important for allowing patients to live their lives. However, home-care bedridden patients often experience pressure ulcers in the lower extremities, which can lead to life-threatening infections requiring decisions on the need for amputation. We herein report a patient with an infected lower-limb pressure ulcer with a history of spinal injury. The patient, his family, and the home-care physician repeatedly shared decision-making to deliver home-based treatment instead of amputation. Administration of wound dressing, AQUACEL® Ag, led to complete epithelialization. Such shared decision-making and dressing were feasible in a home-care setting and broadened its scope.

Association between sodium and potassium excretion estimated from spot urine and socioeconomic status among primary school children and their mothers in Okinawa, Japan.

Hypertension is the greatest and the most preventable risk factor for cardiovascular disease. Excessive sodium (Na) intake and insufficient potassium (K) intake have been identified as risk factors for hypertension. Socioeconomic status (SES) may be related to diet quality. In Japan, few studies have examined the relationship between urinary Na and K excretion and SES in adults, and there are no studies in children. In 2014, 1944 children (1382 households) in all public elementary schools in Yaese town, Okinawa, Japan were recruited to participate in a study. Casual urine specimens were collected to estimate 24-h urinary Na and K excretion and urinary Na/K ratio. Mother's educational background and household incomes were assessed and used as indicators of SES. A total of 236 pairs of children and their mothers were analyzed in this study. Urinary Na and K excretion were not significantly related to educational levels of mothers and household incomes in children. On the other hand, in mothers, lower household income group had higher 24-h estimated urinary Na excretion and urinary Na/K ratio than other groups. There was no significant difference between urinary excretion and educational levels in mothers. Household income disparities in urinary levels seen in mothers were not seen in children. There may be some factors that moderate the dietary inequalities in children.

Association between having a primary care physician and health behavioral intention in Japan: results from a nationwide survey.

INTRODUCTION: Introducing a primary care physician (Kakaritsuke-I: KI) system to improve the efficiency of the health care system has been controversial in Japan. This study aimed to determine the relevance of KI to an individual's health behavioral intentions. METHODS: We used data from a nationwide, population-based internet survey (N = 5,234) to conduct a cross-sectional regression analysis. Additionally, we used a propensity score matching method to mitigate the potential endogenous biases inherent in the decision to have a KI. RESULTS: KI was positively associated with various behavioral intentions. For example, the probabilities of intending to eat a well-balanced diet and engaging in moderate exercise were 12.8 (95% confidence interval [CI]:9.5-16.1) percentage points and 7.2 (95% CI: 3.9-10.4) percentage points higher, respectively, among those with a KI than among those without a KI. A KI equally increased the likelihood of getting vaccinated against coronavirus (in November 2021) by 7.5 (95% CI: 5.2-9.8) percentage points. CONCLUSIONS: Although further analysis is needed to examine the effect of KI on health, the results of this study suggest the potential benefits of policy measures to promote the KI system.

Development and validation of a rurality index for healthcare research in Japan: a modified Delphi study.

OBJECTIVES: Rural-urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research. DESIGN: We employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare. SETTING: The panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise. PARTICIPANTS: The initial survey recruited 100 people, including rural healthcare providers, local government staff and residents. PRIMARY OUTCOME MEASURES: Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy. RESULTS: The response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was -0.45 (p<0.001), and the correlation coefficients with the life expectancies of men and women were -0.35 (p<0.001) and -0.12 (p<0.001), respectively. CONCLUSION: This study developed the RIJ using a modified Delphi method. The index showed good validity.

Effect of social activities on health checkups and recommended doctor visits: a fixed-effects analysis in Japan.

Health checkups are considered to promote occupational and public health. This study aimed to investigate the extent to which participation in social activities encourages middle-aged people to participate in health checkups and adhere to doctor-visit recommendations. We analyzed 337,024 longitudinal observational studies involving 33,420 individuals aged 50-59 yr in the baseline year (2005) derived from a nationwide, population-based, 14-wave survey. We estimated fixed-effects logistic models to elucidate how people's participation in health checkups and recommended doctor visits are affected by participation in social activities. Attending health checkups was positively associated with participation in social activities, with an odds ratio (OR) of 1.19 (95% confidence interval [CI]: 1.15-1.22) and a marginal effect of 3.3% (95% CI: 2.7%-3.9%). Adherence to doctor-visit recommendations was also positively associated with participation in social activities, with an OR of 1.15 (95% CI: 1.08-1.23) and a marginal effect of 3.3% (95% CI: 1.8%-4.8%), although the association was observed only among regular employees. These results provide new insights into the effectiveness of health checkups.

Impact of residing in neighborhoods of high social participation on health of retired workers: A multilevel analysis using nationwide longitudinal data in Japan.

Retirement is a key determinant of health among middle-aged and older adults. Social participation (SP) has a favorable impact on health outcomes. Combining these two issues, we examined how neighborhood-level SP may affect the health outcomes of retired workers. We used 94,661 longitudinal observations of 13,185 full-time workers aged 50-59 years in 2005 from a nationwide 14-wave survey conducted in Japan from 2005 to 2018. First, we computed neighborhood SP using an econometric method. We then conducted multilevel analysis to examine how neighborhood SP, retirement, and their interaction affected the probabilities of SP, poor self-rated health (SRH), problems in activities of daily living (ADL), and psychological distress (SD). The estimation results showed that retirement in a high-SP neighborhood reduced the probabilities of poor SRH, ADL problems, and SD by 1.1 (95% confidence interval [CI]:0.5-1.7), 0.9 (95% CI:0.0-1.8), and 2.1 (95% CI:0.6-3.7) percentage points, respectively. These effects were substantial in magnitude, considering that the prevalence of poor SRH, ADL problems, and SD were 3.7%, 7.4%, and 18.5%, respectively, among retired men. In contrast, such interaction effects between retirement and neighborhood SP were not observed among the women. The results suggest that policy measures to encourage SP at the neighborhood level should be developed to help individuals enjoy a healthier life in retirement.

Does Residing in a Neighborhood of High Social Participation Postpone Deterioration in Health among Middle-Aged Adults? A Multilevel Survival Analysis in Japan.

Social participation (SP) is known to have a favorable impact on an individual's health. This study examined whether residing in a neighborhood with a high SP level would be predictive of delayed deterioration in health outcomes, even after controlling for individual SP. With the 14-wave longitudinal data of 32,388 individuals (15,749 men and 16,639 women) aged 50-59 years residing in 2,477 neighborhoods in 2005, we used multilevel Cox proportional hazards models to examine the impact of neighborhood SP on the onset of problems in activities of daily living (ADL), poor self-rated health, and psychological distress. Residing in a neighborhood with high SP levels modestly postponed the onset of health problems in individuals. The hazard ratio (HR) of ADL problems in response to residing in a neighborhood with above-average SP levels was 0.92 (95% confidence interval [CI]: 0.85-0.99) and 0.93 (95% CI: 0.87-1.00) for men and women, respectively, even after controlling for an individual's SP and other attributes. The results for other health outcomes showed a similar pattern. These findings suggest that high neighborhood SP has a favorable impact on health among middle-aged adults, independent of individual SP. Policy measures to enhance and promote neighborhood SP are thus needed in terms of public health.

Longitudinal Association Between Oral Status and Cognitive Decline Using Fixed-effects Analysis.

BACKGROUND: Although the feasibility of randomized trials for investigating the long-term association between oral health and cognitive decline is low, deriving causal inferences from observational data is challenging. We aimed to investigate the association between poor oral status and subjective cognitive complaints (SCC) using fixed-effects model to eliminate the confounding effect of unobserved time-invariant factors. METHODS: We used data from Japan Gerontological Evaluation Study (JAGES) which was conducted in 2010, 2013, and 2016. ß regression coefficients and 95% confidence intervals [CIs] were calculated using fixed-effects models to determine the effect of deteriorating oral status on developing SCC. Onset of SCC was evaluated using the Kihon Checklist-Cognitive function score. Four oral status variables were used: awareness of swallowing difficulty, decline in masticatory function, dry mouth, and number of teeth. RESULTS: We included 13,594 participants (55.8% women) without SCC at baseline. The mean age was 72.4 (standard deviation [SD], 5.1) years for men and 72.4 (SD, 4.9) years for women. Within the 6-year follow-up, 26.6% of men and 24.9% of women developed SCC. The probability of developing SCC was significantly higher when participants acquired swallowing difficulty (ß = 0.088; 95% CI, 0.065-0.111 for men and ß = 0.077; 95% CI, 0.057-0.097 for women), decline in masticatory function (ß = 0.039; 95% CI, 0.021-0.057 for men and ß = 0.030; 95% CI, 0.013-0.046 for women), dry mouth (ß = 0.026; 95% CI, 0.005-0.048 for men and ß = 0.064; 95% CI, 0.045-0.083 for women), and tooth loss (ß = 0.043; 95% CI, 0.001-0.085 for men and ß = 0.058; 95% CI, 0.015-0.102 for women). CONCLUSION: The findings suggest that good oral health needs to be maintained to prevent the development of SCC, which increases the risk for future dementia.

Remote Death Certification Using Telemedicine in Japan.

A 92-year-old woman diagnosed with dementia and end-stage gastric cancer received end-of-life care on the island where she lived. Informed consent concerning remote death certification based on the Japanese government's guidelines was obtained from a family member in case a physician was unavailable. A physical examination after cardiopulmonary arrest was conducted, supported by telemedicine and a well-trained registered nurse under remote supervision of the physician who last saw the deceased directly. Death certification was provided accordingly. To our knowledge, this was the first case of remote death certification using telemedicine in Japan.

Heated Tobacco Products Have Reached Younger or More Affluent People in Japan.

BACKGROUND: The trend of the diffusion of heated tobacco products (HTPs) is a great concern because HTPs have become available worldwide. This study examined the sociodemographic characteristics of HTPs users in Japan, where HTPs were first launched. METHODS: This cross-sectional study used data from an online survey conducted in 2017. A total of 4,926 participants, aged 20-69 years, were included. The dependent variable was the type of tobacco products used. The independent variables were age and equivalent income. Two analyses estimated the odds ratios (ORs) for 1) being smokers compared to "non-smokers," and 2) being "HTP smokers" compared to "only combustible cigarette smokers." Analyses were stratified by sex. Educational attainment and occupation were also used in the sensitivity analyses. RESULTS: The percentages of "non-smokers," "only combustible cigarette smokers," and "HTP smokers" were 82.8%, 14.2%, and 3.0%, respectively. When compared to the oldest participants (aged 60-69), the youngest participants (aged 20-29) tended to be "HTP smokers" (OR 7.90; 95% confidence interval [CI], 3.09-20.22 for men and OR 9.28; 95% CI, 2.14-40.28 for women). Compared to participants with the lowest incomes (<2 million), those with the highest incomes (≥4 million) tended to use HTPs (OR 2.93; 95% CI, 1.56-5.49 in men and OR 1.82; 95% CI, 0.73-4.54 in women). These trends were consistent when analyses included only smokers. There were consistent results in other SES measurements, including educational attainment and occupation. CONCLUSIONS: Younger or more affluent people tended to use HTPs, although smoking rates among these populations were generally lower. New tobacco control efforts are required.

Residents in a Remote Island Having Family Members in Distant Areas Showed Higher Preference for Place of End-of-Life Care: The Ajishima Study.

INTRODUCTION: To investigate the proportion of those having preferred place for end-of-life care among residents in a remote island and its association with family composition. METHODS: Cross-sectional questionnaire survey was conducted in Ajishima, an island 23 km away from the coast of Ishinomaki City, northeast of Japan. Between October 2017 and February 2018, the questionnaire was distributed to 288 eligible residents and 113 valid responses were analyzed. Primary outcome was whether the subjects had preferred place for end-of-life care. The explanatory variable was family composition defined as whether having family members inside or outside the island [none (In-/Out-), only inside the island (In+/Out-), only outside the island (In-/Out+), and both inside and outside (In+/Out+)]. Poisson regression analysis was used to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of showing preferred place in each group. RESULTS: The proportion of those having preferred place for end-of-life care was 72.6% in total. This rate significantly differed across family composition groups: 67.6%, 40.0%, and 82.9% for In+/Out+, In+/Out-, and In-/Out+ groups, respectively. The PR (95%CI) of having preferred place was 0.66 (0.33, 1.36) and 1.26 (1.01, 1.56) for In+/Out- and In-/Out+ groups, respectively, compared with In+/Out+ group. CONCLUSIONS: This study showed that significantly higher preference for place of end-of-life care was seen among residents who had family members only outside the island compared with those who had families both inside and outside. Health care professionals should consider family compositions when initiating end-of-life discussion to residents in remote areas.

[Trajectory of evacuees' health condition after the Great East Japan Earthquake: Health survey of residents in prefabricated temporary housing and private rented housing in the Miyagi prefecture].

Objectives The Great East Japan Earthquake occurred in March 2011. As of November 2018, 1100 survivors of its still lived in the Miyagi prefecture's temporary housing. Previous studies revealed that the residential relocation to temporary housing from their own houses due to damages caused by the earthquake exacerbated the evacuees' health. However, there is a lack of long-term observation of the trajectory of their health conditions in temporary housing. To the best of our knowledge, there is no study involving residents in public disaster housing. The aim of the present study was to reveal the trajectory of health conditions of residents of temporary and public disaster housing.Method This repeated cross-sectional study included residents aged 20 years and older, residing in private rented housing, prefabricated temporary housing, and public disaster housing. The survey period lasted for six years (2011 to 2017). We used self-rated health as the dependent variable, the year of the survey and type of house as independent variables, and sex and age as covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated using multivariate logistic regression analysis.Results In total, 179,255 participants were included in this study. The average age was the highest among the residents of public disaster housing: 63.0 years in 2017. The number of residents who reported poor self-rated health declined yearly of private rented housing, but not of prefabricated temporary housing. The highest number of residents reporting poor self-rated health was from public disaster housing, compared to other temporary housing. Multivariate analysis showed that self-rated health improved in recent years (P for trend <0.001). Compared to the residents of private rented housing, those from public disaster housing reported poorer health conditions (aOR, 1.20 ; 95% CI, 1.15-1.27), although no significant difference was observed among the residents of prefabricated housing.Conclusion Health conditions of residents of temporary housing and public disaster housing tended to improve on a yearly basis. Residents of public disaster housing reported poor health. Therefore, monitoring and adequate intervention should be offered.

Psychological distress after the Great East Japan Earthquake: two multilevel 6-year prospective analyses.

BACKGROUND: The Great East Japan Earthquake of 11 March 2011 led to the relocation of 300 000 survivors. Studies following disasters focus primarily on data collected in the immediate aftermath and neglect the influence of wider community factors. AIMS: A three-level prospective study examining associations between survivors' psychological distress and individual- and social-level factors in the 6 years following a complex disaster. METHOD: We drew on two multi-wave data collections in the 6 years after the earthquake, using residents from different forms of housing. Sample 1 included six waves of private-housing residents from 2011 to 2016 (n = 1084 per wave), sample 2 five waves of residents living in prefabricated housing from 2012 to 2016 (n = 1515 per wave). We analysed prospective associations between distress and time (level 1), pre-existing disorders and disaster experiences and behaviours (level 2) and city-wide measures of support and physical activity (level 3). RESULTS: Multilevel models with random coefficients demonstrated greater distress in earlier waves (samples 1 and 2 respectively, adjusted ß = -15 and ß = -0.16, P < 0.001), among female respondents (ß = 0.58, P = 0.01 and ß = 1.74, P = 0.001), in those with a previous psychiatric history (ß = 2.76, ß = 2.06, P < 0.001) with diminished levels of activity post-earthquake (ß = 1.40, ß = 1.51, P < 0.001) and those lacking in social support (ß = 1.95, ß = 1.51, P < 0.001). Support from spouses and friends was most protective of psychological health. City-level support was negatively associated with distress, but only among those in prefabricated housing. CONCLUSIONS: Psychological distress diminished with time, but varied across gender, psychiatric history, housing, levels of activity and availability of social support. Practitioners should consider individual- and city-level factors when devising effective interventions.

The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan.

This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18-64 years (n = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate.

Psychosocial Factors and Knee Pain Among Older People in Japan: The JAGES Cross-Sectional Study.

OBJECTIVES: Psychosocial factors are known to affect knee pain. However, the magnitude of depression on the associations between socioeconomic status (SES) and knee pain in older individuals remains unknown. This study aimed to determine (1) the associations between SES and knee pain and (2) how depression mediates the associations between SES and knee pain. MATERIALS AND METHODS: We conducted a survey across 30 Japanese municipalities to collect cross-sectional data. Functionally independent, community-dwelling adults aged 65 years or above (n=26,037) were eligible for the study. Self-reported knee pain in the past year was used as the dependent variable. Past occupation and equivalized household income were separately added to the models as independent variables. Poisson regression analysis was used to examine the associations between SES and knee pain, adjusting for covariates. Mediation analysis was applied to estimate how depression explains these associations. RESULTS: The 1-year prevalence of knee pain was 56.0% in our study population. We found that income levels were significantly associated with knee pain: the lowest income level was more prone to experience knee pain compared with the highest income level at a prevalence ratio of 1.22 (95% confidence interval, 1.15-1.28). Depression explained 36.8% of the association of income with knee pain in females and 41.9% in males. DISCUSSION: Significant socioeconomic inequalities were observed regarding knee pain among older individuals in Japan. Depression somewhat explained the association between SES and knee pain.

Are social inequalities in influenza vaccination coverage in Japan reduced by health policy?

Influenza vaccination is effective to prevent influenza infection. However, findings about association between socioeconomic status and influenza vaccination coverage are controversial. Online survey was conducted among 4995 participants between 20 and 69 years of age throughout Japan, January 2017. We asked about history of receiving vaccination in previous year and socioeconomic status, with their reasons for having vaccination or not. Age stratified multivariable logistic regression model was conducted to estimate the odds ratio (ORs) and 95% confidence intervals (CIs) of receiving vaccine for each educational level and income. Sex, self-reported health status, marital status and income were included as covariates. The rate for receiving influenza vaccine among ≤64 year-olds and ≥65 year-olds was 32.9% and 35.4%, respectively. Among younger adults, vaccination varied by each education: junior high school, 23.6%; senior high school, 27.2%; college, 32.6%; university, 36.2%; and graduate school, 39.8%. Compared to junior high school, those from graduate school tended to be more vaccinated (OR1.88, 95%CI 1.07-3.24). On the contrary, those aged above ≥65 years old received vaccination with no significant differences across education. Likewise, among respondents aged ≤64 year-olds, income was significantly associated with influenza vaccination. Despite being "Managed by school or company" (32.5%), having "No particular reason" was the frequent reason for both receiving influenza vaccination (23.8%) or not (34.3%). Adults with higher educational level were significantly more likely to receive vaccination. Subsidizing influenza vaccination may reduce inequality in receiving vaccination for adults. Strengthening vaccination through various approaches is necessary, such as managing by school or company.

Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study.

BACKGROUND: Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. OBJECTIVE: This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. METHODS: We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. RESULTS: Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)]. CONCLUSIONS: Older individuals with a lower SES were less likely to recover from a pre-frailty status.

Cohort Study on Laryngeal Cough Reflex, Respiratory Disease, and Death: A Mediation Analysis.

OBJECTIVE: To estimate quantitatively whether the presence of cough associated with dysphagia (laryngeal cough reflex) increased mortality through respiratory disease among community-dwelling older Japanese. DESIGN: A 6-year follow-up prospective cohort study (from 2010 to 2017). SETTING: Thirteen municipalities in Japan. PARTICIPANTS: Community-dwelling individuals aged 65 years or older (N = 32,682). MEASURES: The baseline survey was conducted through self-reported questionnaire. Exposure was experience of laryngeal cough reflex while drinking. The outcome was all-cause mortality. All covariates were selected from demographic, socioeconomic variables, baseline health and functional status, smoking, alcohol drinking, number of remaining teeth, and stroke. The mediator variable was respiratory disease. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for mortality. Parametric mediation analysis was conducted to estimate the effect of laryngeal cough reflex on the mean residual time to death mediated through respiratory disease. RESULTS: Among the 32,682 participants (mean age = 74.1 years, standard deviation = 5.9 years), 5550 (17.0%) experienced laryngeal cough reflex at baseline. A total of 4037 deaths occurred. Crude mortality rates of the participants with or without laryngeal cough reflex were 16.3% and 11.6%, respectively. After adjusting for covariates, laryngeal cough reflex [HR = 1.10; 95% confidence interval (CI) = 1.02 to 1.19] and respiratory disease (HR = 1.80; 95% CI = 1.62 to 2.00) were associated with mortality. The mediation analysis showed that respiratory disease significantly (P < .001) and partially mediated the association between laryngeal cough reflex, an indicator of 1 or more conditions such as chronic aspiration and mortality. CONCLUSIONS/IMPLICATIONS: Laryngeal cough reflex was a prevalent condition, and it was associated with all-cause mortality in community-dwelling older Japanese individuals. Clinicians could contribute to reduce mortality risk by addressing swallowing function problems using their interprofessional collaboration team (speech-language pathologist, dentist, rehabilitation doctor, otolaryngologist, respiratory physician, and gerontologist).