Taku Fujimoto

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.

Aim: Sarcopenia increases the risk of long‐term care, disease development, and mortality in older adults. It is also a risk factor for cardiovascular disease and vice versa. Using cross‐sectional and longitudinal cohort study designs, we investigated the association between the carotid intima‐media thickness (CIMT) and sarcopenia in older adults. Methods: Data were extracted from the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Using data from Wave 3 of the SONIC participants, we examined the association between CIMT and sarcopenia using cross‐sectional analysis and the association between CIMT at baseline and sarcopenia status 3 years later (Wave 4) in a longitudinal study. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Results: The cross‐sectional study included 735 participants (347 males, mean age: 76.0 ± 0.9 years); the longitudinal study included 498 participants (247 males, mean age: 75.9 ± 0.9 years). In the cross‐sectional study, 130 (17.7%) participants had sarcopenia; multiple logistic regression analysis revealed an odds ratio (OR) of 1.55 (95% confidence interval [CI]: 1.15–2.07) for sarcopenia for every 1 mm increase in the maximum CIMT. In the longitudinal study, 100 participants (20.1%) had sarcopenia at Wave 4. Multiple logistic regression analysis revealed an OR of 1.63 for sarcopenia (95% CI: 1.13–2.36) for each 1 mm increase from the baseline maximum CIMT. Conclusion: CIMT was associated with sarcopenia. These results help clarify the pathophysiology of sarcopenia and the possible use of the CIMT as a marker to identify individuals at high risk of sarcopenia.

Aims/Introduction: Diabetes mellitus (DM) increases postoperative risks and may worsen physical function through muscle loss. Patients undergoing malignancies surgery are aging, and age‐related declines in physical function, particularly sarcopenia, also adversely affects outcomes. As DM and physical decline are interrelated, we aimed to examine how they impact outcomes in older patients undergoing gastrointestinal cancer surgery. Materials and Methods: This single‐center retrospective cohort study included 1,063 older patients ≥65 years who underwent preoperative evaluation for gastrointestinal cancer between 2012 and 2019. We stratified patients based on current DM and physical function assessed by grip strength. The main outcome was postoperative survival. Cox proportional hazards models examined associated factors. Results: After exclusions, 655 without DM (non‐DM group) and 257 patients with DM (DM group) were analyzed (mean age: 79.1 ± 4.1 years, 66.8% male). Compared with the non‐DM group, the DM group had higher body mass index (21.5 vs 22.6 kg/m ² ), higher cardiovascular disease prevalence (26.9 vs 41.2%), and more frequent weak grip strength (53.9 vs 65.8%). Postoperative survival analysis showed no significant difference between the two groups ( P = 0.651). Multivariate analysis showed current DM was not an independent risk factor, whereas grip strength remained significantly associated with poor outcomes (HR 0.97 95% CI 0.95–1.00), and no significant interactions were found ( P = 0.656). Conclusions: Current DM did not significantly affect postoperative outcomes; however, lower grip strength was an independent risk factor for poor outcomes. The prognostic impact of reduced physical function was consistent regardless of DM status.

Aim: To investigate the impact of preoperative exercise and nutritional interventions on postoperative complications, physical function, and activities of daily living ( ADL ) 1 year postoperatively in frail older patients with gastrointestinal cancer. Methods: This single‐center, randomized controlled trial enrolled 62 patients aged ≥ 70 years scheduled to undergo elective surgery for gastrointestinal cancer with decreased grip strength or walking speed between October 2017 and December 2022. Participants were randomly assigned to control ( n = 33) and intervention ( n = 29) groups; the latter performed resistance exercises and consumed amino acid‐containing jelly daily at home for 14 days. All participants were followed‐up for 1 year. Results: After exclusion, 27 and 18 patients were enrolled in the control and intervention groups, respectively. The average age was 80.4 years, and 37.8% were male. Postoperative complications were observed in 51.9% and 44.4% of the control and intervention groups, respectively (95% confidence interval [CI] 0.62–2.19), with postoperative delirium observed in 25.9% and 33.3%, respectively (95% CI 0.31–1.94). There were no significant inter‐group differences in grip strength, walking speed, or skeletal muscle index. However, the intervention group showed superior knee extension strength maintenance (preoperatively: 100.2% ± 18.3% vs. 119.1% ± 68.8%, p = 0.19; discharge: 86.7% ± 22.0% vs. 119.3% ± 72.0%, p = 0.044), and lower rates of decreased ADLs or death 1 year postoperatively (42.3% vs. 23.5%; RR 0.56, 95% CI 0.08–1.92). Conclusions: This 14‐day preoperative exercise and nutritional intervention program did not significantly reduce postoperative complications in frail older patients with gastrointestinal cancer; however, it aided in maintaining knee extension strength at discharge.