Yuichiro Masuda

National Institute of Population and Social Security Research, Edo, Tōkyō, Japan

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Publications (60)56.63 Total impact

  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2012; 49(5):646.
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2011; 48(3):293.
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2011; 48(2):192.
  • Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2010; 47(5):483.
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    ABSTRACT: In Japan, the use of percutaneous transluminal coronary angioplasty (PTCA) for the treatment of acute myocardial infarction (AMI) is extraordinarily frequent, resulting in large medical expenditure. Using chart-based data and exploiting regional variations, we explore what factors explain the frequent use of PTCA, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving PTCA is affected by the density of medical resources in a region. Moreover, expenditure is higher for treated patients while there are no significant differences in hospitalization days, implying that the frequent use of PTCA is economically motivated.
    International Journal of Health Care Finance and Economics 07/2008; 8(2):123-44. · 0.49 Impact Factor
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    ABSTRACT: Because little attention has so far been paid to the impact of diabetes mellitus (DM) on caregiver burden in community settings, we sought to confirm the influence of DM on perceived caregiver burden among caregivers providing care to a home elderly person using data from the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE). The NLS-FE is a large prospective study of 1875 community-dwelling elderly. A total of 1592 pairs of dependents and caregivers were included in the analysis. The data we used in this study included the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), characteristics of caregivers and dependents, and caregiving situation. The pairs were sorted into one control and three DM groups: (i) no DM; (ii) DM taking no medications; (iii) DM taking oral medication only; and (iv) DM taking insulin. The differences in dependent and caregiver characteristics among the groups were assessed. Two hundred and twenty-eight dependents from the NLS-FE study had DM. Of these, 25% took no medication to treat it, 55% took oral medications only, and 20% used insulin. No statistical differences were found in age, gender or kinship among caregivers. No differences were found among the DM categories in levels of caregiver burden according to the J-ZBI, before and after adjusting for these baseline variables. Among the community-dwelling frail elderly, DM is not an independent predictor of caregiver burden.
    Geriatrics & Gerontology International 04/2008; 8(1):41-7.
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    ABSTRACT: Although it is not uncommon for there to be frail older people living in the community, who do not know their weight and/or height, the health-related outcomes of those older remains unknown. We examined whether missing these anthropometries are a predictor of mortality or hospitalization during a 2-year follow-up period in community-dwelling older people using various community-based services. This study was a prospective cohort analysis of 952 community-dwelling elderly. Data included the clients' demographic characteristics, basic activities of daily living (ADL), comorbidity, and anthropometric measurements at baseline. Analysis of mortality and hospitalization over the 2-year period was conducted using multivariate Cox proportional hazards models. Among the 952 participants, 342 and 292 had missing data for height and weight at baseline, respectively. Multivariate Cox proportional hazards models adjusting for potential confounders showed that the lack of data on weight was associated with 2-year mortality (hazard ratio, HR:1.54, 96% CI:1.09-1.79) as well as hospitalization (HR:1.34, 95% CI:1.01-1.79) during the 2-year follow-up, although the lack of height measurement was not associated with these adverse outcomes. Older people living in the community with unavailable weight data appear to be more likely to have a high risk of mortality and hospitalization.
    Clinical nutrition (Edinburgh, Scotland) 12/2007; 26(6):764-70. · 3.27 Impact Factor
  • Journal of the American Geriatrics Society 10/2007; 55(9):1484-6. · 4.22 Impact Factor
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    ABSTRACT: In the United States, a study has shown that dementia is a significant factor negatively associated with medical treatment. Because the increasing number of the elderly has resulted in cause a rise in patients with dementia or acute myocardial infarction (AMI), or both, we need to know the differences in in-hospital mortality between patients with or without dementia in patients with AMI. We used data from 13 acute care hospitals including in the data from the Tokai Acute Myocardial Infarction Study (TAMIS), a retrospective study of all patients admitted to these hospitals from 1995 to 1997 with a diagnosis of AMI. We abstracted the baseline and procedural characteristics from detailed chart reviews. A total of 22 patients with dementia and 1,030 with no dementia who were aged 65 and over were included in the present study, and were divided into two groups according to their diagnosis of dementia. We compared the baseline and procedure characteristics and clinical outcomes between the two groups. Patients with dementia were older and more likely to have either a lower body mass index score or ADL impairment. As for medical history, patients with dementia were more likely to have a history of cerebrovascular disease, and less likely to have a history of angina or smoking. Before and after multivariable adjustment, no significant difference was found in in-hospital mortality between patients with or without dementia. Our study demonstrates that AMI elderly patients with dementia were not less likely to be undertreated and did not have a higher in-hospital mortality rate than non-dementia patients.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 10/2007; 44(5):606-10.
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    ABSTRACT: It remains controversial whether mid-arm anthropometric measurements (MAAMs) are reflected with physical impairment or useful predictors of mortality in the frail elderly. We examined the following hypotheses: (1) MAAMs in frail community-dwelling elderly are lower than those of independent elderly, (2) the lower MAAMs are associated with physical function impairment, and (3) are independent predictors of 2-year mortality. This study was composed of cross-sectional and prospective cohort analyses of 957 community-dwelling elderly. Data included the clients' demographic characteristics, comorbidity, activities of daily living (ADL), and MAAMs at baseline. The mean scores of MAAMs of participants were compared with Japanese Anthropometric Reference Data. Survival analysis of 2-year mortality was conducted using multivariate Cox proportional hazards models. Significantly lower arm muscle area (AMA) and higher triceps skinfold (TSF) levels were observed in most of the age groups of the study participants than those of the standard Japanese population. ADL function was correlated with AMA but not with TSF, both of which were independent risk factors for 2-year mortality in the participants (highest tertile versus lowest, AMA, HR:2.03, 95%CI:1.36-3.02; TSF, HR:1.89, 95%CI:1.30-2.75). AMA and TSF were independent risk factors for 2-year mortality in the community-dwelling frail elderly.
    Clinical Nutrition 10/2007; 26(5):597-604. · 3.30 Impact Factor
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    ABSTRACT: Background: Although prior studies have shown that older patients with acute myocardial infarction (AMI) are less likely to receive percutaneous coronary intervention (PCI) than younger patients, the predictors of PCI use among the very elderly are unknown. We identified the predictors using data from the Tokai Acute Myocardial Infarction Study (TAMIS), a multi-hospital retrospective study performed in Japan.Methods: All of the study subjects were patients hospitalized for newly diagnosed AMI at one of 13 acute care hospitals between January 1995 and December 1997. We abstracted the baseline and procedural characteristics from detailed chart reviews. Multivariate analysis was performed, controlling for the variables found to be significantly different between AMI patients aged 75 and over with and without PCI by χ2 test or unpaired Student's t-test. We evaluated a total of 207 patients with PCI and 201 without PCI.Results: The univariable analysis abstracted four predictors: age, previous heart failure, hospital and maximum creatine phosphokinase. After multivariable adjustment, age (odds ratio [OR] = 0.89) and previous heart failure (OR = 0.36), and number of hospital beds (351–550, OR = 0.38; ≥551, OR = 0.17, respectively) were still independent predictors.Conclusions: Our results suggest that advanced age itself and number of hospital beds are important predictors of underuse of PCI among very elderly patients.
    Geriatrics & Gerontology International 09/2007; 7(3):215 - 220.
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    ABSTRACT: Background: Geriatric health services facilities (GHSF) are expected to assume a growing role in caring for the dying elderly. However, research in this area has so far been scant. The purpose of the present study is to reveal the status of non-medical palliative care and staff education aiming at improving and enhancing end-of-life care at GHSF.Methods: The subjects were 2876 chief nurses of GHSF. Data was collected through a mailed questionnaire in 2003. The questionnaire covered the following: (i) staff perception of end-of-life care policies; (ii) staff education; and (iii) available non-medical care. To evaluate the factors correlated with end-of-life care policies at GHSF, we divided the facilities into two groups.Results: We analyzed the answers collected from 313 facilities with a progressive policy toward end-of-life care (PP group) and 818 with a regressive policy toward it (RP group). It was found that staff training was conducted more frequently among PP facilities. Generally, nurses in the PP facilities were more confident that they could provide comprehensive on-site end-of-life care and grieving support, but did not feel so sure about their ability to provide better end-of-life environments for dying residents and family by organizing outside support from voluntary and/or governmental organizations and religious organization for healing and to pursue appropriately a written follow-up communication with the bereaved family.Conclusions: Our results suggest that providing GHSF staff with education about end-of-life issues or setting up collaboration with the outside is an important factor to enhance overall end-of-life care at these facilities.
    Geriatrics & Gerontology International 08/2007; 7(3):266 - 270.
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    ABSTRACT: Because long-term care facilities are being asked to care for more and more residents who are dying, the facilities require that new residents and families make decisions regarding their end-of-life care at the time of the admission process. An advance directive including "do-not resuscitate directives (DNR)" or "do-not-hospitalize directives (DNH)" is a written document that afford individuals the opportunity to determine the type and extent of end-of-life care when they are incapable of participation in medical decision making. It is expected that Japanese elderly and families make individual decisions regarding end-of-life care by a Japanese-style decision-making model including advance directives. The purpose of this study was to explore families' decision-making factors regarding cardiopulmonary resuscitate (CPR) and hospitalize orders in a long-term care hospital. We assessed 70 admissions in a long-term care hospital in Aichi prefecture from April 2005 to September 2006. All residents were divided into two groups according to their CPR or hospitalize order. Data on the admission characteristics of the residents were collected from medical charts. The prevalence of older age, functional dependence, and illness did not vary significantly with CPR or hospitalize order recorded by families, however, significant variation among physicians existed in the CPR and hospitalize orders. Wide variation in the likelihood of having CPR and hospitalize orders among physicians who explain an advance directive suggests a need for standardized methods for eliciting the end-of-life preferences of residents and families on admission to long-term care hospitals.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 08/2007; 44(4):497-502.
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    ABSTRACT: We conducted a national survey of senior medical students' attitudes about end-of-life care teaching programs for undergraduate students of Japanese medical schools from April 2004 to May 2006. Our questionnaire survey focused on the students' attitudes towards the following end-of-life areas: 1) end-of-life topics, 2) teaching methods, 3) putting theories into practice, and 4) overall end-of-life issue. Overall, 1,039 students from 16 medical schools responded to our survey. The students who took part in the program appreciated the class on communication techniques with dying patients or family members of dying patients. As for the students who did not participate in the program, they expressed the wish to join a class concerning these issues. These students also expressed an interest in visiting hospices or conducting interviews with dying patients as part of their training. Most of the students formulated good opinions toward end-of-life issues, but not toward end-of-life practices. Regardless of whether they joined the program or not, most of the students had a positive attitude towards end-of-life education programs. The survey highlighted the need to consider wider implementation and improvement of end-of-life care education in the Japanese curriculum.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 06/2007; 44(3):380-3.
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    ABSTRACT: Recent data suggest substantial variations in the treatment strategies for patients with acute myocardial infarction (AMI) based on age. This study aimed to compare the management and early outcomes of AMI across age groups in Japan. Data from 13 acute care hospitals that were included in the Tokai Acute Myocardial Infarction Study sample were used. This is a retrospective study of all patients admitted to the hospitals with the diagnosis of AMI from 1995–1997. We abstracted the baseline and procedural characteristics from detailed chart reviews. Patients were stratified into four age categories: up to 64; 65–74; 75–84; and 85 or more years of age. A total of 966 patients were aged up to 64 years, 608 were 65–74 years, 365 were 75–84 years, and 79 were 85 or more years. The rates at which the treadmill test, coronary angiography and percutaneous coronary intervention were performed decreased with advancing age (−14%, P < 0.01; −55%, P < 0.01; and −42%, P < 0.01, respectively, for the up to 64-year-old vs 85-year-old or more groups). Thrombolytic therapy was less often prescribed in the older groups (P < 0.01). At discharge, aspirin, β-blockers, angiotensin-converting enzyme inhibitors, nitrates, calcium antagonists, and anti-hyperlipidemics were prescribed less often in the older groups (P < 0.01, <0.05, <0.01, <0.01, <0.01, <0.01, respectively), while diuretics were prescribed more often in the older groups (P < 0.01). Our results suggest that fewer elderly patients were under-treated and had a significantly higher risk of in-hospital mortality.
    Geriatrics & Gerontology International 05/2007; 7(2):131 - 136.
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    ABSTRACT: Geriatric health services facilities (GHSF) are expected to assume a greater role in caring for the dying elderly in the future. However, very little research has dealt with the topic. The aim of this nationwide study is to clarify current end-of-life care policies and practices of GHSF. The subjects were 2876 managing directors of GHSF. Data was collected through mailed questionnaires in 2003. The content of the questionnaires included: (i) general characteristics; (ii) end-of-life care policies; (iii) available medical treatments; and (iv) staff education. To evaluate the factors associated with end-of-life care policies at GHSF, we divided the facilities into two groups, according to whether their policy toward end-of-life care was progressive or regressive. The response rate was 40.3%. The results indicated that a total of 513 GHSF implemented progressive policies for end-of-life care. The factors associated with a progressive policy for end-of-life care were: (i) availability of medical intervention within and outside of the facilities; (ii) staff education; and (iii) discussion about end-of-life care policy with residents and family. Duration of stay also was positively associated with a progressive policy. Our study highlights the need for a national consensus on reforming the end-of-life care system of long-term care facilities.
    Geriatrics & Gerontology International 05/2007; 7(2):184 - 188.
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    ABSTRACT: This study aimed to evaluate the relationship between anthropometric measurements and mortality among community-dwelling frail elderly. This study was a prospective cohort analysis of 520 community-dwelling elderly registered in the Nagoya Longitudinal Study for Frail Elderly (NLS-FE). Data included the participants' demographic characteristics, body mass index (BMI), mid-arm circumference (MAC), triceps skinfold (TSF), and arm muscle area (AMA), basic activities of daily living, comorbidity. BMI and TSF values were categorized into three groups, respectively, according to above the 75th percentile, the 25-75th percentile, and below the 25th percentile of Japanese Anthropometric Reference Data (JARD 2001). Survival analysis of 21-month mortality was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. BMI and TSF were independent risk factors for 21-month mortality in the study participants. Significant higher risk of 21-month mortality was observed in participants below the 75th percentile of BMI or below the 25th percentile of TSF set in JARD 2001. A striking increase in the risk of 21-month mortality, adjusting for potential confounding factors, was observed in the below 75th percentile of the BMI group with a below 25th percentile TSF of JARD 2001, compared with the 75th or above percentile BMI group with the 25th or above percentile TSF. The combination of BMI and TSF is a predictor of 21-month mortality among older people with ADL dysfunction.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 04/2007; 44(2):212-8.
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    ABSTRACT: We conducted a national survey to examine how programs to teach end-of-life care to medical students in Japanese medical schools influence their death attitude. Sixteen medical schools participated. We conducted a questionnaire survey on fifth- or sixth-year medical students' death attitude at each medical school. Attitude of death was analyzed by the Death Attitude Inventory formed by Hirai et al, which is composed of seven factors: Afterlife belief, Death anxiety, Death relief, Death avoidance, Life purpose, Death concern, and Supernatural belief. We studied how students' attitude to death relates to programs to teach end-of-life care. Overall 1,017 of 1,510 students (67.4%) from the 16 medical schools participated. The students who took a program to teach end-of-life care presented Afterlife belief, Death concern and Supernatural belief score higher than those who did not participate in any program. Multiple logistic regression analysis was conducted and it was found that those trend disappeared, and the students who took a program had greater Death anxiety significantly higher than those who took no program. We concluded that the attitude of medical students to death was not related to programs to teach end-of-life care in medical schools. Our survey suggested that improving end-of-life care education is needed to mold the attitude of medical students to death.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 04/2007; 44(2):247-50.
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    ABSTRACT: Background: Data on the differences between older and younger elderly cancer patients dying at home is sparse. To clarify age-related differences in symptom experience and care receipt of elderly cancer patients at end-of-life, we conducted a subanalysis study of the Dying Elderly at Home (DEATH) project, a multicenter study of 240 elderly aged 65 and older dying at home.Methods: We assessed the frequency of symptom experience and end-of-life care receipt in home elderly patients during the last 2 days of their lives and evaluated the differences between younger elderly (aged 65–74) and older elderly (aged 75+) cancer decedents. The general practitioners were asked to fill out a questionnaire immediately after the death of study patients. A total of 66 younger and 51 older elderly cancer decedents were included in the analysis.Results: Coma and dementia were common among younger and older elderly patients. Older decedents were less likely to experience anxiety, but, after adjustment for baseline characteristics, this age-related difference did not clearly appear. Older decedents were also less likely to receive opioids than younger decedents. There were no significant differences in volume of i.v. hydration between the two groups.Conclusions: Our results suggested that there were no differences in symptom experience and care receipt among older and younger decedents, except in opioid use, at end-of-life. These findings imply a similar need of end-of-life care for younger and older elderly cancer patients who opt for home death.
    Geriatrics & Gerontology International 03/2007; 7(1):34 - 40.
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    ABSTRACT: The relation between diabetes mellitus (DM) and mortality among patients with acute myocardial infarction is still controversial. We evaluated the influence of DM on the in-hospital mortality of acute myocardial infarction (AMI) patients using data from the Tokai Acute Myocardial Infarction Study-II, a multi-hospital prospective study performed in Japan. All of the study subjects were patients hospitalized for newly diagnosed AMI at 1 of 13 acute care hospitals between January of 2001 and December of 2003. We abstracted the baseline and procedural characteristics from detailed chart reviews. Multivariate analysis was performed, controlling for the variables found to be significantly different between AMI patients with and without DM by chi-square test or unpaired t-test. We evaluated a total of 940 DM and 2284 non-DM patients. DM patients had roughly twice the in-hospital mortality rate of non-DM patients, with an unadjusted odds ratio of 1.77 (95% CI, 1.37-2.30). However, according to the multivariate analysis, DM was not identified as an independent predictor of in-hospital death, with an adjusted odds ratio of 5.73 (95% CI, 0.97-33.88). DM is not an independent predictor of in-hospital mortality, and that there is a need for additional studies to confirm our conclusion.
    Diabetes Research and Clinical Practice 02/2007; 75(1):59-64. · 2.74 Impact Factor

Publication Stats

253 Citations
56.63 Total Impact Points

Institutions

  • 2008
    • National Institute of Population and Social Security Research
      Edo, Tōkyō, Japan
  • 2003–2008
    • Nagoya University
      • • Division of Geriatrics
      • • Graduate School of Medicine
      Nagoya, Aichi, Japan
  • 2000
    • University of Michigan
      • Department of Family Medicine
      Ann Arbor, Michigan, United States