Community Healthcare and Geriatrics

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Japan is entering an unprecedentedly super-aged society, and as a result, Japanese geriatric medicine and healthcare for older adults have become medical fields attracting attention not only domestically but also worldwide. Medical care for older adults cannot be completed within hospitals alone; it must be considered in conjunction with community-based and home-based care. Therefore, in addition to diagnosing and treating diseases in older adults, physicians are required to possess a wide range of skills, including collaboration with other healthcare professionals, coordination with welfare and social services, and an understanding of the social systems surrounding older adults.

Furthermore, there remain many unexplored areas in geriatric research, and our department is engaged in research themes that hold significant potential for societal contribution. As evidenced by physicians from various other specialties seeking to gain experience in geriatric care, this field equips practitioners from all clinical backgrounds with competencies that contribute to solving challenges in community medicine as well.

Our department was established in 1979 and has an exceptionally long history as a specialized department in geriatric medicine and healthcare for older adults. Currently, as a central hub of geriatric medicine in Japan, we actively conduct clinical practice and research with a view toward the super-aged society, and work collaboratively with other medical institutions to develop innovative models of care.

We aim to foster human resources suited to community-based integrated care, including comprehensive care for older adults with multiple comorbidities, home medical care, and dementia care. In addition, we seek to cultivate physicians who can demonstrate leadership in interprofessional collaboration, as well as researchers capable of responding to evolving healthcare needs in a super-aged society and pioneering the future of geriatric medicine.

RESEARCH PROJECTS

1. Research on Quality Improvement in Acute Care １．Hospitalization for Older Adults

With the progression of population aging and advancement of medical care, improving the quality of acute care for elderly patients has become an urgent priority. Elderly patients often have multiple comorbidities and are susceptible to functional decline and complications triggered by hospitalization, which significantly impact patient functional outcomes, quality of life (QOL), length of hospital stay, and efficient use of healthcare resources. However, the current reality is that the actual conditions, risk factors, and inter-facility variations in acute care for the elderly have not been systematically understood.
Through multicenter collaborative research in which medical institutions nationwide collect and accumulate clinical data within a common framework, we are working to visualize challenges in acute care for the elderly, elucidate risk factors and develop predictive models, and generate evidence that contributes to preventive interventions and quality improvement (QI) of care.
The insights gained from this research are intended not only for academic dissemination but also for direct application to daily clinical practice, ward management, and healthcare quality improvement. Through collaboration across multiple institutions and professions, we are building a foundation toward the realization of "acute care that enables elderly patients to recover safely and return to their desired lives."

2.A Clinical Study on the Association Between Cognitive and Physical Function Decline in Geriatric Outpatient Settings

Cognitive decline and physical function decline in older adults are increasingly recognized as interrelated pathological processes that play critical roles in the development and progression of frailty, sarcopenia, and dementia. However, in routine outpatient clinical settings, few studies have systematically examined the association between these conditions through the simultaneous application of detailed cognitive assessments and quantitative physical function measurements.
In this study, we aim to investigate older adults attending a geriatric outpatient clinic by comprehensively assessing:

• Cognitive function using standardized neuropsychological tests, covering global cognition, memory, executive function, attention, and processing speed; and
• Physical function and body composition, with a particular focus on gait speed, handgrip strength, and skeletal muscle mass.

Through these assessments, we seek to elucidate both cross-sectional and longitudinal associations between cognitive decline and physical function decline.
We place particular emphasis on the relationships between domain-specific cognitive impairments and indicators of mobility, muscle strength, and muscle mass, as well as their associations with frailty and sarcopenia phenotypes. By doing so, we aim to identify shared pathophysiological mechanisms and clinically meaningful subtypes within the spectrum of cognitive and physical decline in later life.
Grounded in the framework of Comprehensive Geriatric Assessment (CGA) and utilizing assessment batteries that are feasible for implementation in outpatient clinical practice, this study seeks to generate evidence that will contribute to:

• early identification of dementia and frailty;
• risk stratification for cognitive decline based on physical function impairment; and
• optimization of multidisciplinary interventions and preventive strategies.

In future phases, longitudinal follow-up will be conducted to examine the temporal trajectories of cognitive and physical function and their associations with clinically relevant outcomes, including decline in activities of daily living (ADL), falls, need for long-term care, and hospitalization. Ultimately, this research aims to contribute to the development of an integrated geriatric care model that simultaneously addresses cognitive and physical function in older adults.

3. Prevention of Dementia, Frailty, and Sarcopenia Through Exercise

In recent years, numerous studies have demonstrated that habitual exercise or physical activity is effective in preventing dementia as well as frailty and sarcopenia. However, it remains unclear which specific components of exercise are most optimal for preventing these conditions. Aerobic exercise and resistance training have been widely reported as effective modalities for improving cognitive and physical function.

We are conducting randomized controlled trials involving community-dwelling older adults to compare the effects of aerobic exercise, resistance training, and combined exercise programs on cognitive and physical function. Outcome assessments include cognitive function tests, physical performance measures, blood biomarkers, and brain imaging, allowing us to clarify the mechanisms through which exercise exerts its effects on the body and brain. Through this research, we aim to propose effective exercise intervention programs for the prevention of dementia, frailty, and sarcopenia, and to develop evidence-based guidelines for exercise instruction in long-term care prevention.
Beyond establishing exercise interventions as efficacious programs, our laboratory places strong emphasis on their sustainable implementation in community settings. By leveraging community resources—such as opportunities for going out, mobility options, and venues for social participation—we promote out-of-home activities and advance implementation-oriented evaluations that include acceptability, sustainability, and operational burden.

Beyond establishing exercise interventions as efficacious programs, our laboratory places strong emphasis on their sustainable implementation in community settings. By leveraging community resources—such as opportunities for going out, mobility options, and venues for social participation—we promote out-of-home activities and advance implementation-oriented evaluations that include acceptability, sustainability, and operational burden.

Through interdisciplinary collaboration with the field of informatics, we are also advancing research that utilizes AI-based dialog systems as well as time-series analysis and machine learning to support behavior change and to enable early detection and risk estimation using data derived from daily life. In partnership with engineering disciplines, we are designing and building policy and impact evaluation frameworks to quantify how mobility interventions—such as public transportation and demand-responsive transport—affect health indicators and financial indicators (e.g., healthcare and long-term care expenditures) via changes in going-out behavior, physical activity, and social participation.

Furthermore, through industry–academia collaboration, we are promoting implementation research that leverages daily-life data collected from in-home living-support devices for early detection and risk stratification of frailty and mild cognitive impairment (MCI), and for linking these insights to preventive interventions. By quantifying changes in daily rhythms and activity patterns using time-series analysis and machine learning, we aim to connect individuals to risk-stratified interventions involving exercise, outings, and social participation, thereby establishing a model for continuous preventive support in everyday living environments.

BIBLIOGRAPHY