Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan.
Methods: This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services.
Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40).
Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.

In this case report, we describe a male patient with subacute thyroiditis with severe paresthesia in a glove-and-stocking type distribution and thyroid gland tenderness but with minimal symptoms of hyperthyroidism. His paresthesia improved and then disappeared within several days after low dose oral prednisolone was initiated. As possible mechanisms for his severe paresthesia, we propose the following: 1) thyrotoxic effect on the peripheral nerves, and 2) generalized inflammatory effect on the peripheral nerves akin to that in the thyroid gland. Subacute thyroiditis may need to be considered as one of differential diagnoses for severe paresthesia.

Obsessive-compulsive disorder (OCD) is characterized by multiple obsessions and compulsions. A 22 years old woman who had mental traumatic event started having laryngopharyngeal discomfort, short term mental disturbance, and urge of repetitive checking of home door, spelling, and calculations of simple arithmetic. There was no evidence of organic causes. The diagnosis of OCD was established by meeting DSM-V criteria, and cognitive behavioral therapy was started. We report this case since it is important to consider the possibility of OCD for patients with unexplained somatic symptoms as well as unusual behavioral symptoms.