18/06/2025
【UTH News Letter-No.113, April 2025: From the University of Tokyo Hospital to the World: Department of Geriatric Medicine】
Comprehensive and Holistic Medical Care for older patients:
Aiming to Extend Healthy Life Expectancy
Department of Geriatric Medicine
Sumito Ogawa, Professor
Mitsutaka Yakabe, Lecturer
1. What is Geriatric Medicine?
As a division of internal medicine, geriatrics provides comprehensive and holistic medical care for older adults.
As Japan is a super-aged society, providing medical care that takes into consideration the characteristics of older adults is becoming increasingly important. Older adults have multiple diseases and tend to take many medications (polypharmacy). In addition, age-related decline in mental and physical functions leads to various symptoms called geriatric syndrome, such as falls, incontinence, dizziness, shortness of breath, loss of appetite, and difficulty walking. Some patients suffer from poor physical conditions without knowing the cause. In many cases, these patients can be treated at our department since specialized medical care categorized by organ or disease does not fit them.
"Healthy life expectancy" refers to the period during which a person's daily life is not restricted by health problems. It is important to extend healthy life expectancy as well as average life expectancy.
In our department, comprehensive geriatric assessment (CGA) is performed on a wide variety of older patients to understand the overall picture, including life functions and living conditions. In addition, we aim to extend healthy life expectancy by not only treating sickness but also physical function and quality of life (QOL).
In the outpatient clinic, we primarily care for older adults with multiple diseases, such as dementia, osteoporosis, lifestyle-related diseases (such as diabetes, hypertension, and dyslipidemia), emphysema, and sarcopenia. We also provide emergency care for older adults with acute illnesses such as pneumonia and stroke.
In recent years, advanced care planning (ACP) has gained increasing attention. ACP is a process in which patients, their families, and healthcare and care teams discuss the kind of medical care the patient would like to receive in the future. Also known as a 'life conference,' ACP supports the patient's decision-making. Our department is actively engaged in promoting and practicing this approach.
2. Distinctive Features of Outpatient Clinic
●Outpatient Clinic for Frailty and Sarcopenia
Frailty is a condition characterized by a gradual decline in physical function due to aging. Although individuals with frailty remain independent in their daily lives, their physical resilience is reduced. As a result, even minor illnesses or stressors can lead to a need for long-term care (Figure 1). Since frailty is a reversible condition through physical function improvement, early diagnosis and intervention are essential.
Sarcopenia is a condition characterized by a loss of muscle mass and strength throughout the body as people age. It not only reduces physical function and QOL, but also increases the risk of death and lifestyle-related diseases. Frailty and sarcopenia are closely connected and often occur at the same time.
The Department of Geriatrics has an outpatient clinic for frailty and sarcopenia by specialized doctors on Wednesday afternoons and Thursday mornings.
We measure body composition using a meter and measure grip strength to evaluate frailty and sarcopenia.
We aim to improve physical function and QOL by providing highly individualized interventions such as nutrition guidance, exercise guidance, and treatment of complications for each patient who has various backgrounds and complications.
●Amnesia Clinic
As people get older, more of them begin to worry about forgetfulness. While age-related forgetfulness is common and usually not a cause for concern, more serious memory problems may need medical attention.
Dementia is a condition in which the person's cognitive abilities decline beyond what is expected with aging and begin to interfere with daily life. There are various causes of dementia, including neurological disorders (such as Alzheimer's disease), cerebrovascular disorders, endocrine disorders (such as hypothyroidism), and psychiatric disorders. Mild cognitive impairment refers to an early stage of cognitive decline, and people with MCI are at increased risk of developing dementia in the future.
Our department provides medical care in cooperation with primary care physicians (Figure 2). Patients with forgetfulness or other symptoms can be referred by their primary care physicians to our first outpatient clinic. Then, they will be admitted to the hospital or performed in an outpatient clinic, and diagnosis will be made and a treatment plan will be decided. After that, they will be referred back to their primary care physicians (reverse referral), but if their symptoms change, they will visit our department again. In some cases, patients may continue to receive outpatient treatment at our department, or they may also see their primary care doctor.
In addition to memory loss, patients with dementia may have behavioral and mental symptoms. In order to maintain their current lifestyle, long-term care insurance plays an important role. At our department, dementia specialists not only provide medication but also care for various aspects of the patient. We also provide treatment for Alzheimer's disease with anti-amyloid beta antibody drugs (such as Lecanemab).
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Figure 1: Frailty Model
Figure 2: Collaboration with Primary Care Physicians
Department of Geriatrics Medicine
The University of Tokyo Hospital:
http://geriatrics.umin.jp
https://www.h.u-tokyo.ac.jp/english/centers-services/clinical-divisions/geriatric-medicine/index.html
The University of Tokyo ospital News:
https://www.h.u-tokyo.ac.jp/cooperation/dayori/__icsFiles/afieldfile/2025/04/25/dayori113.pdf
