Background: Aspiration pneumonia (AsP), a phenotype of community-acquired pneumonia (CAP), is a common and problematic disease with symptomless recurrence and fatality in old adults. Characteristic factors for distinguishing AsP from CAP need to be determined to manage AsP. No such factorial markers in oldest-old adults, who are often seen in the primary-care settings, have yet been established. Methods: From the database of our Primary Care and General Practice Study, including the general backgrounds, clinical conditions and laboratory findings collected by primary care physicians and general practitioners, the records of 130 patients diagnosed with either AsP (n = 72) or CAP (n = 58) were extracted. Characteristic factors associated with the diagnosis of AsP were statistically compared between AsP and CAP. Results: The patients were older in the AsP group (median 90 years old) than in the CAP group (86 years old). The body temperature, heart rate, and diastolic blood pressure were lower in the patients with AsP than in those with CAP. Witnessed meal dysphagia by families and caregivers was reported only in AsP. Living in a nursing home, comorbidities of cerebral infarction and dementia (as positive factors) and hypertension (as a negative factor) were considered predictive to diagnose AsP in a stepwise logistic regression analysis. Conclusions: Among oldest-old adults in primary-care settings, living in a nursing home and the dysphagia risks are suggested to be characteristic factors for diagnosing AsP. Age and some relevant clinical information may help manage AsP and also be useful for families and caregivers.

The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services in Saitama Prefecture (from October 2014 to September 2015). Residents who used the ETC services were divided into four age groups (20–39, 40–64, 65–74, and ≥75 years old). The number of calls per 1000 persons (call rate, CR) was compared between the groups. The annual CR for the top 10 symptoms/events were assessed. The annual CR was 2.6/1000 persons. The annual CR was significantly higher for women (2.9) than for men (2.3) (p < 0.05). ETC use was the highest in the 20–39 age group for both sexes (3.3 and 4.4 in men and women, respectively). All groups had fever, abdominal pain, and nausea/vomiting in common. In older adults, the frequency of events such as bruises and head injury was high. Women and younger adults tended to use ETC services. There were similarities and differences in symptoms/events among the groups, which should be recognized by call centers to help foster call center staff.

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community’s healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.