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Backgrounds\\nAspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.\\n\\nMethodology and Principal Findings\\nWe conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76%) who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL), and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample) were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16–22.62, p < 0.001), daily oxygen therapy (OR = 8.29, 95% CI: 4.39–15.65), feeding support dependency (OR = 8.10, 95% CI: 6.27–10.48, p < 0.001), and urinary catheterization (OR = 4.08, 95% CI: 2.81–5.91, p < 0.001). In the multiple logistic regression analysis, the risk factors associated with aspiration pneumonia after propensity-adjustment (258 subjects each) were sputum suctioning (OR = 3.276, 95% CI: 1.910–5.619), deterioration of swallowing function in the past 3 months (OR = 3.584, 95% CI: 1.948–6.952), dehydration (OR = 8.019, 95% CI: 2.720–23.643), and dementia (OR = 1.618, 95% CI: 1.031–2.539).\\n\\nConclusion\\nThe risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing repetitive aspiration pneumonia.

Background: No studies in Japan have examined whether dispensing by family pharmacists, who are incentivized by reimbursement to provide continuous and exclusive medication management, results in prescription changes. Our primary objective was to identify the variables affecting prescription changes, particularly to investigate dispensing by family pharmacists as a possible factor.Methods: We identified 333,503 records of pharmacy claims data from patients aged 65 years or older who received medication instructions at outpatient pharmacies at Tsukuba, a medium-sized city near Tokyo, between April 2018 and March 2019. We extracted data on dispensing by family pharmacists, number of medicines, patient sex, patient age, and pharmacy category. A multilevel modified Poisson regression analysis was performed to analyze the correlation between dispensing by family pharmacists and pharmacist-initiated prescription change.Results: Dispensing by family pharmacists was 1.37 times more likely to involve a record of prescription change than dispensing by non-family pharmacists. Older age, female sex, polypharmacy, and small-scale pharmacies were also found to be factors.Conclusion: This study indicated that dispensing by family pharmacists was a potential factor for pharmacist-initiated prescription changes that may prevent excessive medication and limit pharmacological interactions. Since the likelihood of inappropriate prescriptions being issued varies from hospital to hospital, subsequent studies should take into account the quality of each institution.

Advance care planning can help provide optimal medical care according to a patient's wishes as a part of patient-centered discussions on end-of-life care. This can prevent undesired transfers to emergency departments. However, the effects of advance care planning on emergency department visits and ambulance calls in various settings or specific conditions remain unclear. To evaluate whether advanced care planning affected the frequency of emergency department visits and ambulance calls. Systematic review. This study was registered in PROSPERO (CRD42022340109). We assessed risk of bias using RoB 2.0, ROBINS-I, and ROBINS-E. We searched the PubMed, Cochrane CENTRAL, and EMBASE databases from their inception until September 22, 2022 for studies comparing patients with and without advanced care planning and reported the frequency of emergency department visits and ambulance calls as outcomes. Eight studies were included. Regarding settings, two studies on patients in nursing homes showed that advanced care planning significantly reduced the frequency of emergency department visits and ambulance calls. However, two studies involving several medical care facilities reported inconclusive results. Regarding patient disease, a study on patients with depression or dementia showed that advanced care planning significantly reduced emergency department visits; in contrast, two studies on patients with severe respiratory diseases and serious illnesses showed no significant reduction. Seven studies showed a high risk of bias. Advanced care planning may lead to reduced emergency department visits and ambulance calls among nursing home residents and patients with depression or dementia. Further research is warranted to identify the effectiveness of advanced care planning in specific settings and diseases.

Background The COVID-19 pandemic and the widespread use of face masks have exacerbated communication challenges, especially among individuals with hearing impairments. This study aimed to identify the factors influencing interpersonal communication difficulties among individuals with hearing impairment in Japan during the pandemic. Methods This cross-sectional study examined data from the 2022 Survey on Difficulty in Living. The study focused on individuals aged 12 years and older who held physical disability certificates for hearing impairments. The outcome was difficulties with interpersonal communication, with the primary factor of interest being the presence of a regular caregiver and the use of voice recognition software. Additional factors examined included sex, age, degree of hearing impairment, age at first hearing impairment certification, and the frequency of outings. Results Among 410 individuals with hearing impairments, 55.6% experienced communication difficulties during the COVID-19 pandemic. Multivariable analysis indicated that individuals with regular caregivers were less likely to experience communication difficulties (adjusted prevalence ratio (aPR) = 0.81, 95% confidence interval (CI): 0.66–0.99), while those using voice recognition software were more likely to face difficulties (aPR = 1.37, 95% CI: 1.04–1.80). In addition, individuals aged 40–64 years and those with more severe hearing impairment (Grade 2–4) were more likely to experience communication difficulties. Frequent outings were also associated with an increased likelihood of communication difficulties (aPR = 1.28, 95% CI: 1.03–1.58). Conclusions During emergencies such as the COVID-19 pandemic, self-reliant individuals with hearing impairments may require increased public support to mitigate communication barriers.

Objectives\\nThis study aimed to investigate longitudinal relations between leisure and social activities and mental health status, considering the presence or absence of other persons in the activity as an additional variable, among middle-aged adults in Japan. This study used nationally representative data in Japan with a five-year follow-up period.\\n\\nMethods\\nThis study focused on 16,642 middle-aged adults, age 50–59 at baseline, from a population-based, six-year panel survey conducted by the Japanese Ministry of Health, Labour and Welfare. To investigate the relations between two leisure activities ('hobbies or cultural activities' and 'exercise or sports') and four social activities ('community events', 'support for children', 'support for elderly individuals' and 'other social activities') at baseline and mental health status at follow-up, multiple logistic regression analysis was used. We also used multiple logistic regression analysis to investigate the association between ways of participating in these activities ('by oneself', 'with others', or 'both' (both 'by oneself' and 'with others')) at baseline and mental health status at follow-up.\\n\\nResults\\nInvolvement in both leisure activity categories, but not in social activities, was significantly and positively related to mental health status in both men and women.\\n\\nFurthermore, in men, both 'hobbies or cultural activities' and 'exercise or sports' were significantly related to mental health status only when conducted 'with others'. In women, the effects of 'hobbies or cultural activities' on mental health status were no differences regardless of the ways of participating, while the result of 'exercise or sports' was same as that in men.\\n\\nConclusions\\nLeisure activities appear to benefit mental health status among this age group, whereas specific social activities do not. Moreover, participation in leisure activities would be effective especially if others are present. These findings should be useful for preventing the deterioration of mental health status in middle-aged adults in Japan.

Background: Studies have shown that informal caregiving is associated with an increased risk of cardiovascular diseases. However, there is limited evidence on the mechanisms involved. To fill this knowledge gap, we investigated the association of informal caregiving with changes in health-related behaviors.Methods: We analyzed a nationally representative sample aged 50–59 years as of 2005 using fifteen waves of the Longitudinal Survey of Middle-Aged and Older Adults, which was conducted between 2005–2019. We investigated the association between the change in informal caregiving status and the change in health-related behaviors, including (1) heavy drinking, (2) smoking, (3) no exercise habits, and (4) no attendance at annual health checkups. We used multivariable logistic regression models with correlated random effects, adjusting for individual-level time-invariant characteristics.Results: Among 268,165 observations from 30,530 participants (median age 55; interquartile range, 52–57 years at baseline; 51.6% women), 32,164 (12.0%) observations from 10,224 individuals provided informal care. After adjusting for potential confounders, informal caregiving was associated with higher probabilities of deteriorating health-related behaviors, including heavy drinking (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI], 1.03–1.32; adjusted P = 0.032) and no exercise habits (aOR 1.09; 95% CI, 1.04–1.15; adjusted P < 0.001). We observed similar patterns for smoking (aOR 1.12; 95% CI, 1.001–1.26; adjusted P = 0.053) and no attendance at health checkups (aOR 1.05; 95% CI, 0.999–1.10; adjusted P = 0.053).Conclusion: This study showed that the transition into informal caregiving was associated with deteriorating cardiovascular-related health behaviors in Japan. These findings highlighted the importance of continued efforts to prevent the deterioration of caregivers’ health-related behaviors.

In Japan, which has the most rapidly aging population worldwide, the number of geriatric health service facilities (GHSFs) has been increasing. GHSF physicians play significant roles in integrated care for the elderly. However, little is known about the temporal trends of physicians working in GHSFs. We aim to examine temporal trends in the characteristics of GHSF physicians and identify physician factors associated with starting work at GHSFs. Cohort study. Physicians responding to biennial national physician census surveys conducted by the Ministry of Health, Labour and Welfare of Japan from 1996 to 2016. The response rate was approximately 90%. We estimated temporal trends in the number, proportion, and characteristics of GHSF physicians. A multivariable logistic regression analysis identified physician factors associated with starting work at GHSFs 10 years after 1996-2006 and 2006-2016 among physicians not working in GHSFs at baseline (1996 and 2006). GHSF physicians rapidly increased in the first decade from 1,127 (0.47%) in 1996 to 2,891 (1.04%) in 2006; this trend then slowed and was almost proportional to that of all physicians, reaching 3,345 (1.05%) in 2016. GHSF physicians aged ≥65 years increased from 61.2% in 1996 to 68.5% in 2016, while those aged <40 years decreased from 13.8% to 1.9%. The sex ratio (male vs. female physicians) increased from 5.7 in 1996 to 6.4 in 2016. Physician factors associated with starting to work at GHSFs included older age, female sex, rural area, working at hospitals, and majored in internal medicine and surgery specialties. The proportion of GHSF physicians among all physicians has stagnated, and GHSF physicians are aging. Facilitating the transition of younger physicians from clinical practice in hospitals to GHSFs will increase the number of GHSF physicians and improve the quality of care in GHSFs.

Background: This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan. Methods: We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level. Results: The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI], 0.87–0.92 for men and IRR 0.97; 95% CI, 0.95–0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54–2.56 and IRR 1.42; 95% CI, 1.20–1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01–1.18 and exp(β) 1.09; 95% CI, 1.05–1.14, respectively). Conclusions: This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.

Background: With increasing age globally, more people may become vulnerable to food choking. We investigated the nationwide epidemiology of food choking deaths in Japan. Methods: Using Japanese Vital Statistics death data between 2006 and 2016, we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract) as a primary diagnosis. We assessed the demographics of people with food choking deaths; temporal trends of food choking deaths by the year (overall and by age group), the day of year; and prefecture variations. Results: Overall, 52,366 people experienced food choking deaths (median age, 82 years, 53% were male, and 57% occurred at home). The highest numbers occurred January 1–3, and were lowest in June. Despite a stable total number of cases at around 4,000 yearly, from 2006 to 2016 the incidence proportion declined from 16.2 to 12.1 per 100,000 population among people aged 75–84 years. Among people ≥85 years, the incidence proportion peaked at 53.5 in 2008 and decreased to 43.6 in 2016. The number of food choking deaths varied by prefecture. Conclusions: There are temporal and regional variations of food choking deaths in Japan, possibly due to the consumption of Japanese rice cake (mochi), particularly over the New Year’s holiday.

Background\\nMeasures of aortic occlusion (AO) for resuscitation in patients with severe torso trauma remain controversial. Our aim was to characterize the current use of resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative open aortic cross-clamping (ACC), and to evaluate whether REBOA should be an alternative method to resuscitative open ACC.\\n\\nMethods\\nThis study was a retrospective cohort study between 2004 and 2013 from a nationwide trauma registry in Japan. Participants were selected who underwent either REBOA or ACC. Their characteristics, interventions, and outcomes were analyzed to compare REBOA and ACC directly. The primary outcome was in-hospital mortality and the secondary outcome was mortality in the emergency department. Logistic regression analysis was performed to compare the outcomes between REBOA and ACC with adjustment for severity; 1:1 propensity score matching was also performed.\\n\\nResults\\nOf the 159,157 trauma patients, 903 were eligible based on the selection criteria. Overall, 405/607 patients (67%) who had REBOA died compared to 210/233 patients (90%) who had ACC. Patients with REBOA had higher revised trauma score (RTS) (mean ± SD, 5.2 ± 2.0 vs. 4.2 ± 2.2; P < 0.001) but higher Injury Severity Score (ISS) (median (interquartile); 34 (25) vs. 34 (20); P < 0.001), and higher probability of survival (0.43 ± 0.36 vs. 0.27 ± 0.30; P < 0.001) compared to those with ACC. REBOA had an odds ratio (OR) for in-hospital mortality of 0.309 (95% confidence interval (CI) = 0.190–0.502) adjusting for trauma and injury severity score using a logistic regression model (n = 903). Similar associations were observed adjusting for RTS (OR = 0.224; 95% CI = 0.129–0.700) or adjusting for ISS (OR, 0.188; 95% CI, 0.116 to 0.303). In the propensity score-matched cohort (n = 304), REBOA was associated with lower mortality compared to ACC (OR, 0.261; 95% CI, 0.130 to 0.523). Patients with REBOA had less severe chest complications than those with ACC (Abbreviated Injury Scale thorax, 3.8 ± 0.8 vs. 4.2 ± 0.8; P < 0.001), although physiological severity and backgrounds were similar in this population.\\n\\nConclusions\\nPatients who underwent AO had a high mortality. REBOA might be a favorable alternative method to resuscitative ACC for severe torso trauma although some indication bias could still remain. Further studies are needed to elucidate optimal indications.