Background: Maintaining good exercise behavior contributes to the prevention of adverse health outcomes in older inpatients with musculoskeletal disorders. This prospective cohort study aimed to identify the predictors of poor exercise behavior in older inpatients with musculoskeletal disorders after discharge from a rehabilitation hospital. Methods: The study included 117 older inpatients aged ≥60 years with musculoskeletal disorders at a rehabilitation hospital, which consisted of the convalescent rehabilitation ward and the community-based integrated care ward. Baseline assessments, including demographics, physical function, cognitive function, psychological status, sleep disorders, and nutritional status, were obtained at discharge from the hospital. Exercise behavior was assessed using the transtheoretical model at baseline and at the 6-month follow-up after discharge from the hospital. Based on behavioral changes at baseline and follow-up, participants were classified into those with poor exercise behavior and those without. Logistic regression analyses were performed to identify the predictors of poor exercise behavior. Results: Of the 117 participants, 53 (45.3%) had poor exercise behavior. Lower exercise self-efficacy and more depressive symptoms at baseline were associated with poor exercise behavior during the 6-month follow-up after discharge. These associations remained significant after adjusting for age, sex, body mass index, comorbidities, and physical function measures. Conclusion Lower exercise self-efficacy and more depressive symptoms are predictors of poor exercise behavior after hospital discharge among older inpatients with musculoskeletal disorders. Our findings underscore the importance of strategies to enhance mental well-being and maintain good exercise behavior following discharge in this population.

BACKGROUND: The number of adults aged over 65 years is rapidly increasing in several Southeast Asian countries. Muscle mass decreases with age, leading to sarcopenia. The primary objective of this study was to determine whether differences exist in the body composition and physical strength, according to ethnicity, among community-dwelling Japanese and Thai older adults living in Chiang Mai Province, Thailand. METHODS: A survey was conducted in February and March 2019. Japanese and Thai adults aged ≥ 60 years living in Chiang Mai Province were recruited through community clubs. Participants completed a self-administered questionnaire that enabled collection of data on age, sex, educational background, marital status, annual income, current medical conditions, smoking and alcohol consumption, and exercise habits. Measurements were collected on height, weight, body composition, blood pressure, hand grip, and walking speed for 6 m. Body composition was measured using a standing-posture 8-electrode multifrequency bioimpedance analysis analyzer. Hand grip of each hand was measured with the patient in the standing position using a digital grip dynamometer. Multivariable logistic regression was used to determine factors associated with skeletal muscle mass index (SMI). RESULTS: Of the total 119 participants, 47 were Japanese (26 men, 21 women) and 72 were Thai (16 men, 56 women). The prevalence of a low SMI was 3/26 (12%), 1/21 (5%), 6/16 (38%), and 5/56 (9%) among Japanese men, Japanese women, Thai men, and Thai women, respectively. The prevalence of low muscle strength was 2/26 (8%), 2/21 (10%), 3/16 (19%), and 13/56 (23%) among Japanese men, Japanese women, Thai men, and Thai women, respectively. There were significant differences between ethnic groups in body mass index for both sexes, percentage body fat in women, SMI in men, and average grip strength in men. Ethnic group, sex, age, and body mass index were independent predictors of SMI. CONCLUSIONS Ethnicity had a clinically important effect on body composition and physical strength among older Japanese and Thai adults living in a similar environment.
Aged ; Aging/physiology* ; Asians/ethnology* ; Body Composition ; Body Mass Index ; Cross-Sectional Studies ; Electric Impedance ; Ethnicity ; Female ; Hand Strength ; Humans ; Independent Living ; Male ; Middle Aged ; Muscle Strength ; Thailand/ethnology* ; Walking Speed

　Recent advances in pediatric medicine have led to increasing numbers of severely disabled children who require medical care at home. Severely disabled children were defined as those who have or are at increased risk of having a chronic physical and developmental condition. On April 1, 2015, we conducted a survey of these children aged 18 years or younger living in the Saku region of Nagano Prefecture. Forty severely disabled children were identified in the Saku region, accounting for 0.02% of the population. Thirty children were being cared for at home and 10 had been institutionalized. The underlying illness or disorder occurred in the perinatal period in 21 children (52.5%). We further investigated the medical care and social support of those severely disabled children living at home. There were 8 children with an extremely severe disability and 7 with a moderately severe disability. Fifteen children did not fall into either category. One patient regularly received medical examination and care via visiting serv­ices and the remaining patients received outpatient care. Visiting nurses provided support and care for 10 children (33%), especially those who needed medical care, such as for tracheostomy and gastrostomy. Thirteen children (43.3%) used a short-stay service, and 19 children (63%) used outpatient support (after-school daycare service/day care service for holidays). Short-stay facilities and child day care services are lacking. The custody support system needs to be enhanced in this region for children and their family members to lead healthy lives.