Improvement in prescriptions while maintaining overall health outcomes: a prospective observational study conducted in Japanese facilities for older people.

BACKGROUND: Improvements in the use of polypharmacy or potentially inappropriate medication (PIM) may reduce medication costs in Japan. We aimed to evaluate the impact of improvement in prescription on both overall health outcomes and medication costs in Japanese facilities for older people. METHODS: Residents in Japanese facilities for older people between March 2019 and March 2020 were included in this study. The following five indices were used to evaluate overall health outcomes: EuroQoL-5D-5L, Barthel Index, Mini Mental State Examination, Dementia Behaviour Disturbance Scale, and Vitality Index. The team, which consisted of one physician and several pharmacists, suggested improved prescriptions for the attending physicians of the participants. The impact of improvement in prescriptions on the health outcomes score, medication costs, and the number of medications were evaluated through two comparison groups: those whose number of medications decreased (decrement group, DG) and those whose medications did not (not decrement group, NDG); those prescribed PIMs in March 2019 and those not prescribed PIMs in March 2020 (improvement group, IG) and those prescribed PIMs both in March 2019 and March 2020 (not improvement group, NIG). In both comparison groups, propensity score matching was performed to balance demographics, and all health outcome scores, medication costs, and the number of medications in March 2020 were assessed using a t-test. Statistical significance was set at a p-value of < 0.05. RESULTS: Eight-hundred-and-ninety-one participants (75.5% women, 86.2 ± 7.9 years old) were enrolled. After matching, in the comparison between the DG (N = 232, 77.2%, 85.7 ± 8.5) and NDG (N = 232, 78.5%, 86.0 ± 3.1), changes in the health outcomes score were nonsignificant. However, the medication costs and the number of medications significantly decreased. After matching, in the comparison between IG (N = 141, 75.2%, 86.7 ± 8.1) and NIG (N = 273, 74.2%, 86.2 ± 8.3), changes in health outcome scores and medication costs were not significant. However, the number of medications significantly decreased. CONCLUSIONS: Improvements in prescriptions did not adversely affect the overall health outcomes. However, it impacted medication costs and the number of medications. Improvement in prescriptions could decrease medication costs while maintaining overall health outcomes.

Impact of the Severity of Alzheimer's Disease on the Quality of Life, Activities of Daily Living, and Caregiving Costs for Institutionalized Patients on Anti-Alzheimer Medications in Japan.

BACKGROUND: Alzheimer's disease (AD) increases societal costs and decreases the activities of daily living (ADL) and quality of life (QoL) of the affected individuals. OBJECTIVE: We assess the impact of AD severity on ADL, QoL, and caregiving costs in Japanese facilities for the elderly. METHODS: Patients with AD in facilities for the elderly were included (47 facilities, N = 3,461). The QoL, ADL, and disease severity of patients were assessed using Barthel Index (BI), EuroQoL-5D-5L (EQ-5D-5L), and Mini-Mental State Examination (MMSE), respectively. Annual caregiving costs were estimated using patients' claims data. The patients were subcategorized into the following three groups according to the MMSE score: mild (21≤MMSE≤30), moderate (11≤MMSE≤20), and severe (0≤MMSE≤10). Changes among the three groups were evaluated using the Jonckheere-Terpstra test. RESULTS: Four hundred and one participants were on anti-AD medicines, of whom 287 (age: 86.1±6.4 years, 76.7% women) in the mild (n = 53, 84.0±6.9 years, 71.7%), moderate (n = 118, 86.6±5.9 years, 76.3%), and severe (n = 116, 86.6±6.5 years, 79.3%) groups completed the study questionnaires. The mean BI and EQ-5D-5L scores for each group were 83.6, 65.1, and 32.8 and 0.801, 0.662, and 0.436, respectively. The mean annual caregiving costs were 2.111, 2.470, and 2.809 million JPY, respectively. As AD worsened, the BI and EQ-5D-5L scores decreased and annual caregiving costs increased significantly. CONCLUSION: AD severity has an impact on QoL, ADL, and caregiving costs.

Prevalence of Pruritus in the Elderly with Dementia: A Multicenter Survey of Japanese Patients.

A total of 185 elderly Japanese patients with mild to severe dementia were surveyed on itch, using multiple methods of evaluation including self-evaluation of itch conducted by patients as well as evaluation of scratching behavior and scratching marks on the body surface conducted by others. As a result, 36.8% self-evaluated that they were suffering from itch, whereas 53.5% were found to scratch. Of those who by themselves denied the presence of itch, 31.4% were found to scratch. Dry skin was found in 74.1%, the severity of which was positively correlated to the rating of scratching behavior and marks. These results indicate a high prevalence of pruritus in patients with dementia, and suggest that one should not solely rely on self-evaluation but should refer to additional clinical information such as scratching for evaluation of pruritus in patients with dementia. Skin care with moisturizer may be important to control itch in patients with dementia.

Effect of walking on depression prevalence for diabetes using information communication technology: Prospective study.

AIM: This study aimed to evaluate the prevention of diabetic depression and its impact on medical costs through the implementation of a step count monitoring system using information and communication technology. METHODS: This study carried out a longitudinal analysis of a prospective cohort. A total of 296 participants were enrolled in the intervention group and 882 participants in the control group. The participants in the intervention group were provided with pedometers, which each participant was asked to scan using devices stationed throughout the city. Activity data were stored in real time by a cloud system. The experiment lasted 30 months. RESULTS: None of the diabetes patients in the intervention group was diagnosed with depression during the study period, compared with 4.09% in the control group. Thus, the intervention suppressed the increase in medical costs for the people who did not develop depression in the diabetic group. CONCLUSIONS: The prevalence rate of depression among the participants with diabetes was lowered significantly. The medical costs of the participants who did not have diabetes were also reduced by implementing the step count monitoring system with information and communication technology. This shows that the use of an information and communication technology pedometer system can have favorable effects in terms of preventing depression in diabetes patients and further benefits for non-diabetic people. Geriatr Gerontol Int 2019; 19: 1147-1152.

Corrosion Generation and Cleaning Effect on Surgical Instruments with Attached Radiofrequency Identification Tags in Long-Term Usage.

Background: Faulty cleaning of surgical instruments may lead to corrosion damage and a higher risk of surgical site infection. We have developed a method in which each instrument has an attached radiofrequency identification (RFID) tag for individual management. However, because of the structure of the instruments, a risk of corrosion from poor cleaning exists; therefore, observation during long-term usage is necessary. Methods: The cleaning effect at the jig of the RFID tag was verified by the amount of residual protein left by various cleaning methods. In our investigation of long-term usage, we examined 94 surgical instruments with RFID tags used in the operating room for 50 months employing a microscope to identify any corrosion at the jig. Results: The method using a washer disinfector (WD) was found to be highly effective. From observation after long-term usage, friction by the RFID tag occurred in about 70% of the jigs. However, no pitting or general corrosion was seen. Conclusions: When WD is used properly, there is only a minor risk of residual protein, and corrosion does not occur even with long-term use. By using surgical instruments with RFID tags, it is possible to determine the number of uses and the history at the individual level. This facilitates operation of safe surgical instruments by limiting the number of times a particular instrument is used.

Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan.

BACKGROUND: Abnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects' feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care. METHODS: The study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan's nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student's t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance. RESULTS: After intervention, abnormalities in the participants' feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated. CONCLUSION: In frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals' social participation increased, and their behavior improved. TRIAL REGISTRATION: University hospital Medical Information Network- Clinical Trials (UMIN-CTR) with the number: UMIN000034742 . Registration date: 11/01/2018.

Foot care to improve physical function and prevent falling of frail elderly adults with and without dementia.

Feet and toenail abnormalities are common among the elderly and can increase the risk of falls. We examined the changes in physical function after feet and toenails care for frail elderly adults and elderly adults with dementia. As a result, the abnormalities in the subject's feet and toenails improved, and the individuals' physical function and social participation increased.

Development of a quantitative measurement system for three-dimensional analysis of foot morphology using a smartphone.

Existing techniques for measuring foot morphology are invasive or cumbersome. A new technique was developed using a smartphone, which can measure foot morphology to within 1 mm. This is shown to be applicable to the prediction of hallux valgus, which allows for early intervention.

[A case of late-onset paraphrenia in a very elderly patient receiving home medical care].

A 94 year old woman with a late-onset paraphrenia was referred to our clinic from a community care center. The patient showed symptoms of paranoia and auditory hallucination. The patient was in conflict with her neighbors regarding noise-related problems and was experiencing loss of appetite. Because the patient had a strong aversion to outpatient treatment due to difficulty in commuting, home visits were commenced. Improvements were observed after administration of 2.5 mg per day of olanzapine.In home medical care, precise definitive diagnosis and determination of treatment approach is necessary under limited time and resources. The fact that elderly people often exhibit psychological symptoms such as hallucinations is well known among clinical professions. However, this is not well known among home care patients, families and other professionals, and, therefore, is often overlooked. As the population ages further, it can be predicted that cases of elderly patients requiring treatment for psychological symptoms will increase in home medical care situations. In Japan, with a super-aging society, understanding and continuously supporting late-onset paraphrenia among elderly people is a pressing issue for all communities in advancing home medical care and nursing.

Effects of Prescription Drug Reduction on Quality of Life in Community-Dwelling Patients with Dementia.

PURPOSE: Due to the use of multiple drugs and prevalence of diminished cognitive function, community-dwelling elderly individuals are more likely to have drug-related issues. We examined changes in quality of life (QOL) and activities of daily living (ADL) 3 months and 6 months after reducing drug use of dementia patients who had newly begun community-dwelling care. METHODS: Prescription drug use was reduced in the intervention group, whereas the non-intervention group continued their regimen or began using additional drugs. QOL and ADL were assessed with the Japanese version of the EQ-5D and the Barthel Index, respectively. RESULTS: Subjects were 32 individuals aged ≥65 years who had begun community-dwelling between March and July 2014 and had received approval for long-term care insurance. On average, the intervention group (n = 19) stopped using 2.6 prescription drugs. After 6 months, the differences in the QOL and ADL scores in the intervention group were -0.03 ± 0.29 and 6.32 ± 18.6, respectively, while the differences in the QOL and ADL scores in the non-intervention group (n = 13) were -0.13 ± 0.29 and -2.69 ± 23.7, respectively. In the intervention group, ADL scores were significantly increased by 14.0 ± 11.1 6 months after reduced benzodiazepine use. CONCLUSIONS: QOL was maintained with reduced drug use, while ADL score was slightly increased. In addition, the reduction of benzodiazepine use significantly increased ADL. In order to reduce polypharmacy among community-dwelling elderly patients, it is necessary to create an opportunity for pharmacists to re-examine their prescriptions.