Sumito Ogawa

Background: Sarcopenia is widely recognized that affects multiple organs, including the cardiovascular system. Clinical studies have consistently shown associations between sarcopenia and vascular aging phenotypes such as vascular calcification, atherosclerosis, and abdominal aortic aneurysms (AAA). However, the molecular mechanisms by which muscle deterioration contributes to vascular degeneration remain poorly understood. Methods: To elucidate muscle–vascular crosstalk, we established a murine model combining inflammation‐associated muscle atrophy induced by hindlimb immobilization with CaPO₄‐induced AAA. Vascular degeneration was evaluated by Elastica van Gieson staining for elastic fiber integrity and von Kossa staining for calcification. The role of the muscle‐derived myokine irisin was examined through recombinant irisin administration and pharmacological inhibition using the αVβ5 integrin antagonist cilengitide. Results: Muscle atrophy markedly accelerated vascular calcification and AAA formation in the combined model compared with AAA alone. This was accompanied by enhanced osteogenic phenotype, downregulation of the growth arrest‐specific gene 6 (Gas6)/pAkt survival pathways, and pronounced inflammatory responses in the aortic wall. We found that muscle atrophy significantly reduced muscular and circulating irisin levels. Irisin administration attenuated vascular calcification and AAA progression, whereas irisin signaling inhibition exacerbated these vascular pathologies. Conclusions: This study provides experimental evidence that muscle atrophy directly accelerates vascular calcification and AAA formation. We also identify irisin as a key molecular mediator linking muscle atrophy to vascular degeneration, highlighting muscle‐derived signaling as a critical target for preventing vascular pathologies.

Aim: To develop and validate a simple scoring system for dysphagia after fragility fracture or orthopedic surgery in older adults. Methods: This prospective cohort study included a total of 934 participants aged ≥ 65 years who were hospitalized due to fragility fractures or had undergone orthopedic surgery. The following outcomes were set: pneumonia during hospitalization, pneumonia‐related and dysphagia‐related mortalities (sum of pneumonia‐associated and choking‐associated deaths). The odds and hazard ratios were calculated for the candidate independent variables, and the risk factors for dysphagia were selected. Additionally, the weighted score of the scoring system was calculated using the odds and hazard ratios. Results: Pneumonia was diagnosed in 43 (4.6%) patients during hospitalization. During 2.0 years follow up period, thirty‐eight (21.8%) and two (1.1%) patients died due to pneumonia and choking, respectively. Among the collected independent variables, male sex, < 800 kcal/day calorie intake, and poor form of rice or main dish were selected as risk factors for dysphagia. The weighted risk score was determined as follows: 1 point for male sex, < 800 kcal/day calorie intake, and when the dietary form was rice porridge or chopped main dish; 2 points when the dietary form was rice in a blender, main dish in a blender, tube feeding, and nothing by mouth. After adjusting for covariates, pneumonia‐related and dysphagia‐related mortalities were 2.67–3.84 times for 1 point, 7.08–9.82 times for 2 points, and 44.55–53.74 times higher for 3 or 4 points, in comparison to 0 points. Conclusions: Early intervention is recommended for participants with score ≥ 1.

Background: Japan faces unprecedented demographic challenges as the world's most rapidly aging country, with 29.4% of the population aged ≥ 65 (2025) and projections estimating 38% by 2065. While Comprehensive Geriatric Assessment (CGA) is the gold standard for geriatric care, its implementation in Japan remains limited to geriatric specialists, creating a significant gap in delivering optimal care to Japan's growing older adult population. Objective: To propose an integrated model that combines the 5Ms framework (Mind, Mobility, Medications, Multicomplexity, Matters Most) with CGA to enhance accessibility, practicality, and continuity of geriatric care in Japanese healthcare systems. Methods: This position statement synthesizes evidence on CGA effectiveness and the educational and clinical utility of the 5Ms, evaluates cultural considerations in Japan, and proposes a three‐tiered implementation model. Results: The integration of CGA and the 5Ms framework creates a tiered assessment continuum that adapts to clinical contexts, facilitates team‐based care, and improves quality and continuity across settings. The model supports education, quality improvement, and culturally sensitive care planning. Conclusions: The integration of the 5Ms and CGA offers a practical framework to formalize, connect, and strengthen geriatric care already being delivered across Japanese healthcare settings. The Japan Geriatrics Society supports this model as a guiding structure for phased implementation, workforce development, and ongoing evaluation to enhance the delivery of person‐centered geriatric care in Japan.

Chronic kidney disease is a major global health burden, and its early detection is critical for delaying progression to kidney failure using recently developed targeted therapies. However, current diagnostic screening relies heavily on blood markers that are confounded by muscle mass, and on urine tests that frequently miss structural damage occurring without protein leakage. This creates a critical diagnostic blind spot that hinders timely intervention. Here we show a non-invasive liquid biopsy platform that quantifies a specific protein marker, MUC1, on urinary extracellular vesicles to accurately assess renal parenchymal integrity. By bypassing the systemic metabolic noise of traditional blood tests, our assay provides a remarkably stable, person-specific functional signature. Following extensive validation across diverse cohorts, our longitudinal analysis demonstrated that the discrepancy between this novel urine-based readout and standard blood tests unmasks hidden renal vulnerability, successfully predicting rapid functional decline. By comprehensively evaluating both tubular and glomerular integrity from a single spot urine sample, these findings establish a completely non-invasive, highly scalable prescreening tool that resolves the diagnostic blind spot, enabling broader early detection strategies and ushering in a new era of proactive risk management.

Background: Sarcopenia is driven by multifactorial insults, including undernutrition and disuse; however, the causal links between inadequate nutrition and the loss of muscle mass and strength remain unclear. This study aimed to establish mouse models of protein and/or fat deficiency and to investigate their interaction with disuse on skeletal muscle. Methods: Nine‐week‐old male C57BL/6J mice fed isocaloric diets for 8 weeks: normal chow (NC), low fat (LF), low protein (LP), or low protein and low fat (LPLF). Outcomes included body weight, grip strength test, gastrocnemius and soleus muscle weights, cross‐sectional area (CSA) of gastrocnemius muscle fibers, and gastrocnemius muscle mRNA expression of ubiquitin–proteasome system (UPS) markers (atrogin‐1, MuRF1) and inflammatory cytokines (TNF‐α, IL‐6, IL‐1β). After the 8‐week diet phase, a disuse model using bilateral hindlimb immobilization for 1, 3, or 7 days was applied under continued isocaloric feeding to assess diet–disuse interactions. Results: Compared with NC, the LF, LP, and LPLF groups showed reduced body weight, grip strength, muscle mass, and myofiber CSA. Upregulation of UPS‐related genes was observed in LPLF, whereas the expression of inflammation‐related genes did not differ from NC in LF, LP, and LPLF. When combined with immobilization, LP and LPLF diets further exacerbated the decreases in muscle mass and strength compared with NC, accompanied by increased expression of both UPS‐ and inflammation‐related genes. Conclusions: An animal model of diet‐induced reduction in muscle mass and strength was established, which will be useful for investigating the effects of protein and fat deficiency on skeletal muscle. Elucidating the detailed molecular pathways involved remains an important goal for future research and may provide new insights into nutritional approaches to prevent or treat sarcopenia.

Frailty is a multidimensional, progressive syndrome that has become a priority for early intervention in aging societies. Kampo medicine, a traditional multi-herbal therapy, may offer an additional treatment option. However, limited evidence exists on how physicians perceive and apply it in frailty care. We conducted a nationwide web-based survey of physicians in Japan (n = 8,351) to evaluate frailty recognition, Kampo prescription patterns, and treatment assessments. Overall, 46.4% reported diagnosing frailty. Clinic-based physicians prescribed Kampo medicine more often than hospital-based physicians (14.1% vs. 10.5%; P < 0.001) and most commonly for appetite loss, malnutrition, and sarcopenia. They also assessed effects earlier (within 2 weeks: 19.5% vs. 13.5%; P = 0.002). In adjusted analyses, Kampo prescribing was more likely among clinic-based physicians and those in internal medicine or surgery, and less likely in larger facilities (≥ 200 beds). Clinic-based physicians were also more likely to rate Kampo as highly effective. In contrast, physicians aged ≥ 60 years prescribed Kampo less often but were more likely to choose it for their own frailty management. This first nationwide study shows that practice setting, specialty, facility size, and physician age shape frailty care and Kampo use in Japan, highlighting the need for further evidence and education to guide integrative care.

Objectives: Few studies have examined how age and place of death among end-of-life patients are associated with the medical care they receive and the signs of death. Therefore, we aimed to clarify the characteristics of medical care, the implementation of living wills, and the signs of death in end-of-life patients by administering a self-developed questionnaire to physicians with expertise in end-of-life care. Methods: Data were obtained through a web-based questionnaire administered to physicians registered with the Japan Society For Dying With Dignity. Each physician was asked to share data on a patient they had cared for, such as age, sex, place of death, presence of medical procedures and a living will, and signs of death. Results: In total, 437 patients, aged 79.4 ± 15.3 years, were analyzed. Pain control and palliative care were provided to 225 and 278 patients, respectively. Moreover, 172 patients possessed a living will. After adjusting for factors using logistic regression analysis, the odds ratios (ORs) for pain control and palliative care were significantly lower in the older age groups. The OR for pain control in nursing homes, compared with home, was 0.305 [95% confidence interval (CI), 0.081–0.920], and the OR for palliative care was 0.212 [95% CI, 0.073–0.544]. The ORs of living wills were significantly lower in patients aged ≥90 years (0.401 [95% CI, 0.199–0.800]) than in those aged 20–64 and in hospitals (0.494 [95% CI, 0.294–0.815]) than at home. Factor analysis of 18 signs of death identified three factors. Factor 1 reflected global terminal decline, and receipt of palliative care was significantly associated with the signs loading on factor 1. Conclusion: Provision of pain control, palliative care, and living wills differed by age group and place of death. Our findings suggest priorities for end-of-life care across settings and for representative studies.

The aging of the hematopoietic system is central to physiological aging, with profound consequences for immune competence, tissue regeneration, and systemic health. Age‐related changes manifest as altered blood cell composition, functional decline in hematopoietic stem cells (HSCs), and deterioration of the bone marrow niche. Beyond hematologic dysfunction, hematopoietic aging acts as a systemic amplifier of age‐related diseases through clonal hematopoiesis and inflammatory remodeling. This review integrates recent insights into the mechanisms and systemic impacts of hematopoietic aging, reframing it as a modifiable axis of systemic aging. We highlight emerging rejuvenation strategies—senolytics, metabolic reprogramming, and microbiota‐targeted therapies—that aim to restore hematopoietic and immune function, offering promising avenues to improve healthspan and reduce age‐related multimorbidity.

Aim: Malnutrition is a common and costly challenge among hospitalized patients and those requiring postdischarge care. Oral nutritional supplements (ONSs) are a low‐cost intervention for undernourished individuals. This study used the Kokuho Database (KDB) to examine the health economic impact of prescribing ONSs at discharge for hospitalized older adults. Methods: This retrospective study included patients aged 75 years and older who were discharged from hospitals in Saitama Prefecture, as recorded in the KDB, from April 2017 to March 2022. Patients prescribed ONSs at discharge were classified as the ONS‐at‐discharge (ONSd) group, and those not prescribed were classified as the no‐ONS‐at‐discharge (non‐ONSd) group. Healthcare costs over 360 days postdischarge were compared using propensity score matching. Results: A total of 526 605 patients were enrolled: 13 042 in the ONSd group and 513 563 in the non‐ONSd group. After matching, 26 084 patients (13 042 per group) were included in the analysis. Over 360 days, healthcare costs were higher in the ONSd group than in the non‐ONSd group (935 092 yen vs. 860 588 yen, adjusted p < 0.001). Among patients not prescribed ONS during follow‐up, 360‐day costs remained higher in the ONSd group (882 465 yen vs. 847 700 yen, adjusted p < 0.001). Conversely, among patients prescribed ONS during follow‐up, 360‐day costs were lower in the ONSd group (1 040 830 yen vs. 1 185 919 yen, adjusted p < 0.001). Conclusion: Healthcare costs over 360 days were higher in the ONSd group compared with the non‐ONSd group. However, among patients who continued ONS use after discharge, costs were lower in the ONSd group.