"Yubi-wakka" (finger-ring) test: A practical self-screening method for sarcopenia, and a predictor of disability and mortality among Japanese community-dwelling older adults.

AIM: We developed a simple self-screening method, the "Yubi-wakka (finger-ring)" test to assess sarcopenia swiftly. This prospective cohort study aimed to examine the validity of this test as a practical method among community-dwelling older adults for identifying sarcopenia, and for predicting disability and mortality. METHODS: We followed 1904 older adults, and analyzed associations between this "Yubi-wakka" test result at baseline in 2012 and sarcopenia at baseline, new-onset sarcopenia followed until 2014, and new-certification for the long-term care insurance and mortality followed until 2016. The "Yubi-wakka" test checks whether the maximum non-dominant calf circumference is bigger than the individual's own finger-ring circumference, which is formed by the thumb and forefinger of both hands. We divided participants into three groups, "bigger," "just fits" and "smaller" based on a comparison between the calf and finger-ring circumference. RESULTS: Of 1904 participants (mean age 72.8 ± 5.4 years), 53% were grouped as "bigger," 33% were in "just fits" and 14% were in "smaller." Relative to "bigger," the test results statistically associated with sarcopenia ("just fits" OR 2.4, 95% CI 1.4-4.1 and "smaller" OR 6.6, 95% CI 3.5-13), by multivariate analyses. The test results also increased the risk of new-onset sarcopenia ("just fits" HR 2.1, 95% CI 1.2-3.8 and "smaller" HR 3.4, 95% CI 1.8-6.4). Furthermore, the "smaller" had 2.0- and 3.2-fold increased risks for needing long-term care insurance services and mortality, respectively. CONCLUSIONS: The "Yubi-wakka" test is an extremely practical method to identify older adults at risk of sarcopenia, disability and mortality. This test might contribute to increased primary prevention for sarcopenia by serving as an early wake-up call for older adults against becoming sarcopenic. Geriatr Gerontol Int 2018; 18: 224-232.

Development of a gateway for interoperability in community-based care: An empirical study.

BACKGROUND: Information and communications technology has attracted attention as a useful way of sharing care records in community-based care. Such information sharing systems, however, imposed the burden of inputting the same records into different information systems due to a lack of interoperability of the systems. OBJECTIVES: The purpose of this study was to develop a gateway that links information systems and to investigate the functionality and usability of the gateway through an empirical study. METHODS: We developed a gateway with healthcare and welfare professionals in Kashiwa city, Japan. The gateway system consisted of two sub-systems: a data exchange sub-system and a common sub-system. Regarding the security, we used the transport layer security 1.2 and a public key infrastructure. For document formats, we utilized the health level seven international, extensible markup language, and portable document format. In addition, we performed an empirical study with 11 scenarios of four simulated patients and a questionnaire survey to the professionals. RESULTS: Professionals of eight occupations participated the empirical study and verified the gateway to link information systems of six vendors. For a questionnaire survey, 32 professionals out of 40 reported that the gateway would eliminate the burden of inputting the same records into different information systems.

Development of an inter-professional educational program for home care professionals: Evaluation of short-term effects in suburban areas.

Objective　To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods　From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results　The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion　Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.

Cooperation between Single-Handed and Group Practices Ensures the Replacement of Gastrostomy Tubes and Tracheal Cannulas in Home Medical Care Settings.

In Japan, patients who require home medical care are increasing especially in the elderly. In home medical care settings, devices such as gastrostomy tubes, tracheal cannulas, and urethral catheters are usually replaced by visiting physicians or nurses. However, device replacement services are not always available in Japan. Unless device replacement services are sufficiently provided to patients at home, patients have to suffer various disadvantages, including a forced visit to a hospital for device replacement despite inability to walk. We therefore investigated background factors of clinics and nursing stations providing home-care visits using a cross-sectional postal survey from August to September 2013. We targeted physicians from 5,828 clinics providing home medical care and nurses from 1,798 home-visit nursing stations across six prefectures (Tokyo, Kanagawa, Saitama, Chiba, Miyagi and Iwate). Responses were received from 933 clinics (16.5%) and 552 stations (31.3%). We analyzed the responses using multivariable logistic regression with two models. "Model 1" mainly included the number of full-time staff and the availability of a 24-hour care service system, and "Model 2" mainly included the number of clinics, the number of home-visit nursing stations, and the ratio of the population aged ≥ 65 years to study the influence of medical resources. We thus found that clinic staff numbers and 24-hour care availability were associated with physicians' replacement of gastrostomy tubes and tracheal cannulas (p < 0.001 for each). In conclusion, single-handed and group practices need to cooperate to ensure the replacement of these devices in home medical care settings.

Catheter replacement structure in home medical care settings and regional characteristics in Tokyo and three adjoining prefectures.

AIM: The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics. METHODS: An anonymous self-administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home-visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher- and lower-density regions) based on the number of clinics, number of home-visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by "physicians in principle" were compared between the groups. RESULTS: Responses were received from 842 clinics (16.3%) and 499 home-visit nursing stations (31.4%). In the higher-density regions, the rate of physicians who reported urethral catheters for male patients were replaced by "physicians in principle" was significantly higher than in the lower-density regions (P < 0.001). In the lower-density regions, the rate of nurses who reported urethral catheters for male patients were replaced by "nurses in principle" was significantly higher compared with the higher-density regions (P < 0.016). CONCLUSIONS: In home medical care settings, urethral catheters for male patients are replaced by nurses in regions where physician resources are limited. Geriatr Gerontol Int 2017; 17: 628-636.

The Association between Sarcopenic Obesity and Depressive Symptoms in Older Japanese Adults.

The effects of sarcopenic obesity, the co-existence of sarcopenia and obesity, on mood disorders have not been studies extensively. Our objective was to examine the association of depressive symptoms with sarcopenia and obesity status in older Japanese adults. We analyzed data from 1731 functionally-independent, community-dwelling Japanese adults aged 65 years or older (875 men, 856 women) randomly selected from the resident register of Kashiwa city, Chiba, Japan in 2012. Sarcopenia was defined based on appendicular skeletal muscle mass, grip strength and usual gait speed. Obesity was defined as the highest sex-specific quintile of the percentage body fat. Depressive symptoms were defined as a Geriatric Depression Scale 15-item score ≥ 6. Multiple logistic regression was employed to examine the association of depressive symptoms with four groups defined by the presence/absence of sarcopenia and obesity. The prevalence of depressive symptoms was 10.1% and the proportions of sarcopenia/obesity, sarcopenia/non-obesity, non-sarcopenia/obesity, non-sarcopenia/non-obesity were 3.7%, 13.6%, 16.9% and 65.8%, respectively. After adjustment for potential confounders, sarcopenia/obesity was positively associated with depressive symptoms compared with non-sarcopenia/non-obesity, whereas either sarcopenia or obesity alone was not associated with depressive symptoms. The association was particularly pronounced in those aged 65 to 74 years in age-stratified analysis. We conclude that our findings suggest a synergistic impact exerted by sarcopenic obesity on the risk of depressive symptoms, particularly in those aged 65 to 74 years.

Eating Alone as Social Disengagement is Strongly Associated With Depressive Symptoms in Japanese Community-Dwelling Older Adults.

OBJECTIVES: Depression in later life poses a grave challenge for the aging countries. The reported key risk factors include social disengagement, but the lack of social companionship during mealtimes, namely eating alone, has not been examined extensively, especially in relation to living arrangement. Past studies on changes along geriatric trajectories in the association between social engagement and depression also remain inadequate. This study aims to examine the association between social engagement and depressive symptoms with a particular focus on eating alone and how the association changes along the aging and mental frailty trajectories. DESIGN: A cross-sectional study. SETTING: Kashiwa-city, Chiba-prefecture in Japan. PARTICIPANTS: A total of 1856 community-dwelling older adults. MEASUREMENTS: The 15-item Geriatric Depression Scale was used to measure depressive symptoms. The indicators used to assess social engagement included eating alone, living arrangement, reciprocity of social support, social participation, social stressors and social ties. RESULTS: Social engagement was significantly associated with depressive symptoms. Those who live with their families yet eat alone were found to be at particular risk (odds ratio = 5.02, 95% confidence interval 2.5-9.9 for young-old; odds ratio = 2.41, 95% confidence interval 1.2-4.8 for old-old). Younger and less mentally frail populations showed stronger associations. CONCLUSIONS: Eating alone was a key risk factor for depressive symptoms in community-dwelling older adults. The living arrangement in which they eat alone is important in identifying those with the greatest risk. Mental health management for older adults requires comprehensive assessment of their social relations that takes into account their companionship during mealtimes. Social preventive measures need to involve early interventions in order to augment their effectiveness against mental frailty.

Development of a simple screening test for sarcopenia in older adults.

AIM: To develop a simple screening test to identify older adults at high risk for sarcopenia. METHODS: We studied 1971 functionally independent, community-dwelling adults aged 65 years or older randomly selected from the resident register of Kashiwa city, Chiba, Japan. Data collection was carried out between September and November 2012. Sarcopenia was defined based on low muscle mass measured by bioimpedance analysis and either low muscle strength characterized by handgrip or low physical performance characterized by slow gait speed. RESULTS: The prevalence of sarcopenia was 14.2% in men and 22.1% in women. After the variable selection procedure, the final model to estimate the probability of sarcopenia included three variables: age, grip strength and calf circumference. The area under the receiver operating characteristic curve, a measure of discrimination, of the final model was 0.939 with 95% confidence interval (CI) of 0.918-0.958 for men, and 0.909 with 95% CI of 0.887-0.931 for women. We created a score chart for each sex based on the final model. When the sum of sensitivity and specificity was maximized, sensitivity, specificity, and positive and negative predictive values for sarcopenia were 84.9%, 88.2%, 54.4%, and 97.2% for men, 75.5%, 92.0%, 72.8%, and 93.0% for women, respectively. CONCLUSIONS: The presence of sarcopenia could be detected using three easily obtainable variables with high accuracy. The screening test we developed could help identify functionally independent older adults with sarcopenia who are good candidates for intervention.

[A new attempt to promote home medical care in Kashiwa city-usefulness of information and communication technology with seamless multidisciplinary cooperation].

Due to the rapidly increasing super-aging society, medical policy in Japan should be redefined. Therefore, the medical and nursing home care system should now be revised greatly. We need to change the current principle that is based on cure only. The patients should receive hospitable care closely connected with their life in their home-town(region)throughout their lifetime. This is termed as "home medical care system". Here, we promote patient-centered medical home care, which implements the chronic and/or End-Of-Life care models, in Kashiwa city, Chiba prefecture. This system is a promising framework for primary care transformation. There is a need for a multidisciplinary team-based care system using information and communication technology(ICT)with smooth and seamless cooperation. However, increased awareness among the workers engaged in home medical care is first required.

[Development of a home care educational program for community physicians and other professionals-a trial in Kashiwa City].

From May to October 2011, we conducted an 8-day homecare educational program for physicians, dentists, pharmacists, visiting nurses, long-term care managers, and hospital staff in Kashiwa city, Chiba, which was primarily intended to increase home visits by physicians. The characteristics of the program were as follows: 1) active and busy community physician participation, 2) attendance of practical training by physicians, 3) interprofessional discussion, 4) recruitment of participants from the same city, 5) recommendation of participant recruitment by a community-level professional association such as Kashiwa City Medical Association. By comparison of the pre- and post-program questionnaires completed by participants, the motivation for homecare practice, knowledge about homecare, and interactions with other professionals have increased. We will further standardize and generalize this program in order to contribute to homecare promotion in Japan.

Interactions of household composition and required care level with functional and cognitive status among disabled Japanese elderly living in a suburban apartment complex.

AIM: In the forthcoming super-aging society, the appropriate assessment of functional and cognitive conditions of disabled elderly people will become increasingly significant in providing care services. Care level and household composition would be key factors to assess function. There might also be an interaction between the two factors with the function. The present study examined the associations of household composition and care level with functional and cognitive status among the disabled elderly living in a suburban apartment complex with a high rate of aged residents (39% in 2009). METHODS: Participants were 190 disabled elderly persons aged 65 years and over who lived in the apartment complex. Cross-sectional data were collected between May 2009 and August 2010, including care level, household composition, basic activities of daily living (BADL), instrumental activities of daily living (IADL) and the independence level in relation to cognitive status. Lower scores meant less independence in BADL and IADL, and as determined by the cognitive/independence scale. RESULTS: Approximately half of the participants lived alone. Generalized linear model procedure showed significant interactions with the BADL score and cognitive/independence scale between household composition and care level. Scores for BADL and the cognitive/independence scale in groups receiving a higher care level were lower; however, the slope of the trend for the elderly living alone was more gradual than for the elderly living with others. CONCLUSION: It is important for health-care providers to assess in detail the status of the disabled elderly considering both their household composition and care level in planning and providing assistance for them.

[Home medical care center project for an aging society].

We have to create a new paradigm for home medical care system towards a historical increase of elderly population in Japan. Tokyo University and Chiba University have been collaborating to erect a home medical care support center in Kashiwa, Chiba prefecture. We have been constructing a support center as well as a home care doctor system, and also created a teaching course for GPs to learn a home care doctor activity. We have also been constructing a regional network system called IT Net in Chiba, which connects all the entire medical and care staff. We will expand this model in many places and to instruct medical students and residents there in the near future.

The 7th Asia Cancer Forum: from the perspective of human security, how can we collaborate as Asians in order to place cancer on the global health agenda? How can we fill in the gaps that exist among us?

This forum has continued to discuss the inclusion of cancer on the global health agenda, and specifically the Millennium Development Goals. The seventh forum presented an overview of activities to date, supplemented by reports from Korea, local governments in Japan and representatives from the pharmaceutical industry. Discussion focused on how to engage in measures to tackle cancer prevention and achieve early detection and effective treatment, using limited resources. It was recognized that with non-communicable diseases gaining increasing attention in international dialogue, it is now of the utmost importance to share an accurate recognition of cancer research and treatment throughout Asia and the wider world. Participants concurred that cancer issues are decoupled from the development aid agenda and that cooperation should be advanced on the basis of international cooperation without recourse to governmental development aid.