Potentially avoidable hospitalizations, non-potentially avoidable hospitalizations and in-hospital deaths among residents of long-term care facilities

AimThe present study aimed to examine the percentage of and risk factors for potentially avoidable hospitalizations (PAH), non‐PAH and in‐hospital deaths among residents of special nursing homes for the elderly (SNH) and geriatric health service facilities (GHSF).MethodsLong‐term care and national health insurance claims data (April 2012 to September 2013) were obtained from a suburban city in Chiba prefecture, Japan. Study participants were aged ≥75 years and resided in either SNH (n = 1138) or GHSF (n = 885). The PAH were defined using 17 medical condition groups, and the percentage of PAH, non‐PAH and in‐hospital deaths was identified, and associated factors were compared using multilevel logistic regression models for SNH and GHSF, respectively.ResultsA total of 34.5% SNH residents experienced any hospitalization, and this was composed of PAH (16.3%), non‐PAH (12.2%) or in‐hospital deaths (6.1%). Of the GHSF residents, 23.8% experienced any hospitalization, and this was comprised of PAH (9.5%), non‐PAH (10.6%) and in‐hospital death (3.7%). More than 70% of the PAH were related to respiratory infections, urinary tract infections or congestive heart failure. In both SNH and GHSF, artificial nutrition was positively associated with PAH and non‐PAHs, and male sex was positively associated with non‐PAHs and in‐hospital deaths. However, there were also discrepancies between SNH and GHSF in terms of risk factors for PAH.ConclusionsThe percentage of PAH was higher in SNH than in GHSF, which might be related to their different personnel and managerial regulations. The linkage of health and long‐term care claims data might facilitate data‐based evidence on policy‐making. Geriatr Gerontol Int 2018; 18: 1272–1279

A Pilot Survey: Oral Function as One of the Risk Factors for Physical Frailty

Background: The aim of this study was to examine the association of the multiple facets of oral, motor, and social functions in community-dwelling older adults, to identify factors that might influence the risk of frailty. Methods: Of the 82 participants included in the study, 39 (5 males and 34 females) were young-old adults, with an average age of 70.5 ± 2.8 years, and 43 (14 males and 29 females) were old-old adults, with an average age of 78.7 ± 2.9 years. We assessed the risk factors for frailty among oral, motor, and social functions. Results: Statistical analysis showed a significant difference in the oral diadochokinesis between the groups (p = 0.006). According to the Spearman correlation analysis, a significant association was observed with age and oral diadochokinesis (rs = −0.262, p = 0.018), and social support (rs = −0.219, p = 0.049). Moreover, binomial logistic regression analysis revealed a significant association of frailty with the occlusal force (odds ratio, 0.031; 95% confidence interval (95% CI), 0.002–0.430; p = 0.010), General Oral Health Index (odds ratio, 0.930; 95% CI, 0.867–0.999, p = 0.046), and availability of social support (odds ratio, 0.803, 95% CI, 0.690–0.934, p = 0.004). Conclusions: To prevent frailty at an early stage, assessments of oral functions, and also that of the availability of social support, are important

Literature review on the well-being of community-dwelling older adults engaged in their community

This article aims to derive a hypothesis about the experiences of community-dwelling older adults who are engaged in their community, focusing on the concept of well-being. This article centers on the idea of well-being to reveal the possibility that community-dwelling older adults may be able to live richer lives through community involvement; instead, they are used as“ community human resources” in this“ life of 100 years.” To reach the goal, three aspects of well-being̶hedonic, eudaimonic, and social well-being̶were examined to consider the diverse experiences of older adults, analyzed through a literature review. This study found no fixed definitions of the aspects described above. However, since they are related to each other, when measuring the well-being of older adults engaged in community involvement, it is assumed that there are not only specific emotions (e.g., aspects of eudaimonic well-being) but also various ways of feeling (e.g., aspects of eudaimonic and social well-being or eudaimonic and hedonic well-being). In the future, it will be necessary to investigate the relationship with the concept of ikigai in Japan.本研究は科学技術振興機構未来社会創造事業（課題ID：21471019）の研究助成を受けて実施された

Household income relationship with health services utilization and healthcare expenditures in people aged 75 years or older in Japan: A population-based study using medical and long-term care insurance claims data

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

Identification of baseline gene expression signatures predicting therapeutic responses to three biologic agents in rheumatoid arthritis: a retrospective observational study

Ranked gene list by GSEA (TCZ analysis). (XLSX 984 kb

Inhibition of interleukin-6 decreases atrogene expression and ameliorates tail suspension-induced skeletal muscle atrophy

BackgroundInterleukin-6 (IL-6) is an inflammatory cytokine. Whether systemic IL-6 affects atrogene expression and disuse-induced skeletal muscle atrophy is unclear.\nMethodsTail-suspended mice were used as a disuse-induced muscle atrophy model. We administered anti-mouse IL-6 receptor antibody, beta-hydroxy-beta-methylbutyrate (HMB) and vitamin D to the mice and examined the effects on atrogene expression and muscle atrophy.ResultsSerum IL-6 levels were elevated in the mice. Inhibition of IL-6 receptor suppressed muscle RING finger 1 (MuRF1) expression and prevented muscle atrophy. HMB and vitamin D inhibited the serum IL-6 surge, downregulated the expression of MuRF1 and atrogin-1 in the soleus muscle, and ameliorated atrophy in the mice.ConclusionSystemic IL-6 affects MuRF1 expression and disuse-induced muscle atrophy

第1107回千葉医学会例会・第8回環境生命医学研究会

<p>Prevalence of severe depressive symptoms with 95% confidence intervals by sarcopenia and obesity status in the Kashiwa study.</p

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

BackgroundThe occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan.MethodsMedical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level.ResultsThe mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915).ConclusionsUsing a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone