Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

{"title":"Re-Evaluating the Zarit Caregiver Burden Interview: Limitations of the Unitary Construct and the Promise of Network Pluralism.","authors":"Ryouhei Ishii","doi":"10.1111/psyg.70168","DOIUrl":"10.1111/psyg.70168","url":null,"abstract":"<p><p>The Zarit Caregiver Burden Interview (ZBI), including its Japanese validation by Arai and colleagues in 1997, has become one of the most widely utilised instruments for measuring caregiver burden in dementia care and psychogeriatrics worldwide. While acknowledging the instrument's clinical utility in identifying at-risk caregivers and its historical role in legitimising caregiver experiences, this review examines the theoretical and practical limitations that have emerged from treating burden as a unitary construct amenable to simple quantification. Through the lens of network pluralism-a philosophical framework increasingly influential in psychiatry-we argue that the ZBI's psychometric reductionism has constrained our understanding of the complex, relational and emergent nature of caregiving experiences. This review critically examines three domains of concern: (1) the epistemological limitations of treating caregiver burden as a latent variable rather than an emergent network phenomenon, (2) the temporal coincidence between burden measurement instruments and healthcare policy transformations in contexts such as Japan's Long-Term Care Insurance system and (3) the cultural and ethical implications of imposing measurement frameworks across diverse caregiving contexts. While the ZBI has demonstrated predictive validity for caregiver health outcomes and has facilitated resource allocation, the instrument's widespread adoption has occurred without adequate consideration of its theoretical assumptions and potential unintended consequences. We propose that network pluralism offers a complementary framework that preserves the practical benefits of standardised assessment while incorporating contextual, relational and systemic dimensions of caregiving. Specific recommendations for integrating network approaches into clinical practice are provided, including multi-method assessment strategies that combine quantitative metrics with qualitative exploration of caregiver experiences, care relationships and support systems.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70168"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prefrontal Cortical Asymmetry and Motor Slowing in Older Women: EEG Evidence That Fear of Falling Modulates Emotional Valence and Reaction Time.","authors":"Guilherme Augusto Santos Bueno, Murielle Celestino da Costa, Katarine Souza Costa, Renato Canevari Dutra da Silva, Elton Brás Camargo Júnior, Germano Gabriel Lima Esteves, Ruth Losada de Menezes","doi":"10.1111/psyg.70174","DOIUrl":"10.1111/psyg.70174","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the relationship between cortical activation and motor performance in older women with different levels of fear of falling (FoF) and fall history.</p><p><strong>Methods: </strong>Fifty-five participants were evaluated, including 40 older adults divided into four groups (NotFall-LFoF, NotFall-HFoF, Fall-LFoF, Fall-HFoF) and 15 younger controls. Motor reaction time was assessed using adapted TRT_S2012 software, while cortical activity was recorded via EEG (EMOTIV EPOC+). Cortical arousal was indexed by the β/α ratio, and valence by (αF4/βF4) - (αF3/βF3) asymmetry. Statistical analyses included ANOVA and Pearson's correlation (α ≤ 0.05).</p><p><strong>Results: </strong>Groups were homogeneous in demographic and cognitive characteristics. Significant differences were observed in cortical arousal (p = 0.014) and valence (p = 0.004). Higher FoF levels were associated with reduced prefrontal symmetry and slower reaction times. Strong negative correlations were found between valence and reaction times (r > -0.9). FES-I scores showed positive correlations with motor latency (r = 0.8-0.9) and negative correlations with cortical indices (r = -0.7 to -0.9).</p><p><strong>Conclusions: </strong>Fear of falling modulates prefrontal cortical activation, shifting motor control from automatic to more conscious processing, which impairs motor efficiency. FoF emerges as a potential cortical biomarker of motor vulnerability, reinforcing the importance of neurorehabilitation strategies integrating emotional and cortical regulation to improve mobility and reduce fall risk in aging populations.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70174"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Suspected Donanemab-Induced Infusion-Related Reactions Presenting With Premature Ventricular Contractions.","authors":"Manami Inoue, Hitoshi Iida, Yoshikazu Kitai, Hideki Matsuoka, Masato Masuda, Muneaki Ogata, Masahiro Ishida, Hiroko Sugawara, Hikaru Hori","doi":"10.1111/psyg.70169","DOIUrl":"https://doi.org/10.1111/psyg.70169","url":null,"abstract":"","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70169"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agitation Severity and Psychotropic Prescription in Acute Patients With Delirium Superimposed on Dementia.","authors":"Justine Falciola, François R Herrmann, Christophe E Graf, Aline Mendes","doi":"10.1111/psyg.70171","DOIUrl":"https://doi.org/10.1111/psyg.70171","url":null,"abstract":"<p><strong>Background: </strong>We aimed to compare agitation severity in dementia with versus without delirium (DSD vs. DwD); to identify clinical factors linked to agitation severity; and to examine psychotropic prescribing patterns, including clinical correlates.</p><p><strong>Methods: </strong>We retrospectively analysed 1709 consecutive patients with dementia admitted to acute geriatric units, comparing those with and without delirium. Delirium and dementia were identified from discharge diagnoses documents. Agitation severity was assessed with the Pittsburgh Agitation Scale (PAS) during the first 72 h. Functional status at admission was documented according to the Functional Independence Measure (FIM). Psychotropic exposure included antipsychotics and benzodiazepines. Multivariable linear regressions examined associations between psychotropics and PAS; logistic regressions identified predictors of psychotropic prescribing.</p><p><strong>Results: </strong>DSD occurred in 680 patients (39.8%). Compared with dementia alone, DSD was associated with higher PAS scores (5.3 vs. 4.0, p < 0.001), poorer functional status (FIM 48.6 vs. 57.8, p < 0.001) and more frequent in-hospital falls (29.9% vs. 17.5%, p < 0.001). Psychotropic use was common in both groups but more prevalent in DSD group (73.5% vs. 56.0%, p < 0.001), whereas treatment intensity was similar between the two groups. In regression models, psychotropic exposure was associated with higher PAS scores (β = 2.48, 95% CI 1.63-3.34), with haloperidol, quetiapine, lorazepam and alprazolam independently associated with greater agitation. Logistic models showed that delirium, in-hospital falls and hypoxia significantly increased the likelihood of psychotropic prescribing, while Parkinsonism markedly reduced antipsychotic use.</p><p><strong>Conclusion: </strong>DSD was linked to more severe agitation and psychotropic use. These findings support PAS-based monitoring and development of DSD-specific interventions prioritising non-pharmacological strategies.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70171"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homocysteine Is Associated With Cognitive Impairment and Sarcopenia in Alzheimer's Disease.","authors":"Fang-Bo Li, Xiao-Ting Ma, Lin-Lin Yao, Shan-Wen Liu, Xiao-Fen Weng, Chun-Feng Liu, Hua Hu","doi":"10.1111/psyg.70172","DOIUrl":"https://doi.org/10.1111/psyg.70172","url":null,"abstract":"<p><strong>Objective: </strong>To investigate differences in neuropsychological characteristics between patients with Alzheimer's disease (AD) with and without sarcopenia, and to examine their associations with serum homocysteine (HCY) levels.</p><p><strong>Methods: </strong>A total of 41 patients with AD diagnosed at a memory clinic with Aβ-PET confirmation were enrolled, including 21 patients with sarcopenia (ADSa) and 20 without sarcopenia (ADNSa). In addition, 35 cognitively normal individuals were recruited as normal controls (NCs) from a health examination center. Demographic characteristics, sarcopenia-related parameters, neuropsychological assessments, and serum HCY levels were collected. Group differences in neuropsychological performance and HCY levels were compared, and partial correlation analyses were performed after adjustment for potential confounders.</p><p><strong>Results: </strong>HCY levels were significantly higher in the AD group than in the NC group. The AD group had a higher prevalence of sarcopenia, and its muscle strength, mass, and physical function were significantly worse than those of the NC group (all p < 0.05). The AD-NSa group performed worse on neuropsychological tests such as MoCA, DST, BNT, and AFT. After adjusting for confounding factors, HCY was positively correlated with CDR and five-times sit-to-stand test scores and negatively correlated with MMSE, DSST, and ASMI scores (all p < 0.01). Using a logistic regression model to calculate the odds ratio (OR), the significant correlation between HCY levels and AD status remained after adjusting for potential confounding factors (all p < 0.01).</p><p><strong>Conclusion: </strong>Elevated serum HCY levels are significantly associated with sarcopenia and multidimensional cognitive impairment in patients with AD. In an AD cohort with amyloid pathology confirmed by Aβ-PET, this study provides the first integrative analysis of the associations among HCY, sarcopenia, and cognitive function. These findings suggest that HCY may represent a potential biomarker linking the comorbidity of AD and sarcopenia and may offer a theoretical basis for dual-target interventions addressing both HCY metabolism and muscle function in this vulnerable population.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70172"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Social Frailty and Satisfaction With the Outcomes of Social Activities in Community-Dwelling Older Adults in Japan: A Cross-Sectional Study.","authors":"Ryu Kobayashi, Yukihiro Gomi, Tomohiro Kakehi, Naotoshi Kimura, Hideaki Ishii, Takeki Ishida, Yoko Sakurai, Tomohiro Omori, Yusuke Nishida","doi":"10.1111/psyg.70177","DOIUrl":"10.1111/psyg.70177","url":null,"abstract":"<p><strong>Background: </strong>Social frailty is characterised by a decline in social resources, engagement in social activities and self-management capacity. Reduced subjective satisfaction with the outcomes of social activities is associated with social frailty. However, existing instruments do not adequately capture this dimension, and few studies have reported differences in satisfaction by severity of social frailty. The Social Activities-Related Daily Life Satisfaction Scale (SARDLSS) provides a more comprehensive measure. We investigated the association between social frailty and satisfaction with the outcomes of social activities among community-dwelling older adults in Japan.</p><p><strong>Methods: </strong>This cross-sectional analysis included community-dwelling adults aged ≥ 65 years who participated in a community health survey. Social frailty was assessed using the Makizako Social Frailty Index and stratified into robust, pre-social frailty and social frailty. Satisfaction with the outcomes of social activities was quantified using the SARDLSS. Group differences were examined, and ordinal logistic regression models were fitted to estimate the association between social frailty status and satisfaction with the outcomes of social activities, adjusting for confounding factors, including age, walking speed and cognitive function.</p><p><strong>Results: </strong>A total of 141 participants were included in the analysis; 27.7% were robust, 36.9% had pre-social frailty and 35.4% had social frailty. Ordinal logistic regression analyses indicated that higher satisfaction was independently associated with lower odds of belonging to a more severe social frailty category after adjusting for potential confounders (odds ratio = 0.95, 95% confidence interval: 0.91-0.98, p = 0.004). Domain-level analyses corroborated this pattern, with satisfaction with friendships, health and physical fitness and contributions to others and society showing significant associations with social frailty status.</p><p><strong>Conclusion: </strong>Social frailty among community-dwelling older adults was associated with their satisfaction with the outcomes of social activities. Addressing both quantitative and qualitative aspects of social engagement is warranted for preventing or mitigating social frailty.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70177"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hierarchical Bayesian Analysis of Suicidal Ideation Among Middle-Aged and Older Adults in South Korea.","authors":"Kee Yeun Lee, Minyoung Kwak","doi":"10.1111/psyg.70173","DOIUrl":"https://doi.org/10.1111/psyg.70173","url":null,"abstract":"<p><strong>Background: </strong>Research on suicidal ideation has largely relied on population-average models that implicitly generalize group-level associations into individual outcomes. This study examines the extent to which risk and protective factors for suicidal ideation operate differently across individuals among middle-aged and older adults.</p><p><strong>Methods: </strong>Data from the Korean Welfare Panel Study (2012-2024) included 2500 adults aged 51 and above. We employed hierarchical Bayesian logistic regression with an individual-specific random intercept and random slopes for time-varying predictors. Demographic characteristics (sex, age, education) accounted for part of the heterogeneity in the individual-specific coefficients, with the remaining heterogeneity captured by person-specific random effects.</p><p><strong>Results: </strong>Substantial individual heterogeneity emerged in the effects of risk and protective factors on suicidal ideation. Demographic characteristics explained part of this heterogeneity. Specifically, spousal presence was more protective for men, and higher education buffered material hardship effects. Remaining heterogeneity was reflected in person-specific random slopes (sensitivity parameters), which varied substantially across individuals even after accounting for demographic characteristics. Scenario analyses demonstrated that high-sensitivity individuals experienced greater risk increases than low-sensitivity individuals under the same stressor changes across psychosocial conditions, and an illustrative case showed substantial predicted risk elevation at modest symptom levels in an individual with high depression sensitivity.</p><p><strong>Conclusions: </strong>These findings highlight the importance of shifting from group-average effects towards individualized risk stratification that accounts for individual-specific vulnerability profiles. The hierarchical Bayesian approach shows promise for generating person-specific risk estimates that may support the identification of higher-risk subgroups for targeted screening and prevention planning.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70173"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Year Changes in Cognitive and Brain Functions Among Community-Dwelling Older Adults Who Continue Working.","authors":"Naotoshi Kimura, Daisuke Hirano, Yoshinobu Goto, Takamichi Taniguchi","doi":"10.1111/psyg.70175","DOIUrl":"https://doi.org/10.1111/psyg.70175","url":null,"abstract":"<p><strong>Background: </strong>Prevention of cognitive decline in older adults is a critical public health issue in rapidly ageing societies. Studies indicate that engagement in instrumental activities of daily living (IADL) and social participation is associated with better cognitive function. Employment incorporates elements of IADL and social participation; however, longitudinal evidence describing cognitive and brain function changes in older adults who continue working is scarce. Hence, this study aimed to longitudinally examine changes in cognitive and brain functions over a three-year period among older adults who continued working.</p><p><strong>Methods: </strong>The participants were 23 community-dwelling older adults aged 65 years and older who completed baseline and follow-up assessments. Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J), Trail Making Test Parts A and B (TMT-A and TMT-B) and behavioural performance on a Go/No-go task. Brain function was evaluated using event-related potentials (ERPs), focusing on the No-go P3 component as an index of inhibitory control. The baseline and follow-up data were compared using paired statistical analyses.</p><p><strong>Results: </strong>The MoCA-J scores significantly improved at follow-up compared with those of baseline (p < 0.001). In the Go/No-go task, No-go accuracy significantly increased (p = 0.017). ERP analyses revealed that the No-go P3 amplitude significantly increased at follow-up at the Fz (p < 0.001), Cz (p = 0.002) and Pz (p = 0.004) electrodes, whereas the No-go P3 latency showed no significant change.</p><p><strong>Conclusions: </strong>Older adults who continued working displayed improvements in global cognitive function, behavioural measures of inhibitory control and associated neural activity over a three-year period. Although causal relationships cannot be established in the absence of a non-working comparison group, our study provides longitudinal descriptive evidence of cognitive and neural changes in older adults who remain employed.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70175"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Regional T1/T2-Weighted Ratio Index in Patients With Semantic Dementia.","authors":"Miho Ota, Yuko Koshibe, Ayako Kitabatake, Takumi Takahashi, Kiyotaka Nemoto, Tetsuaki Arai","doi":"10.1111/psyg.70170","DOIUrl":"https://doi.org/10.1111/psyg.70170","url":null,"abstract":"<p><strong>Background: </strong>Semantic dementia (SD) is a type of frontotemporal dementia primarily characterised by semantic aphasia, which involves the loss of meaning of words and objects. In SD, the pattern of alteration in the regional T1/T2-weighted ratio index, a proxy for myelin content, remains to be clarified. The present study examined the regional changes in the T1/T2-weighted ratio index associated with SD.</p><p><strong>Method: </strong>Nineteen patients with SD and 21 healthy participants underwent a 1.5-Tesla magnetic resonance imaging scan. Differences in index values between the two diagnostic groups were assessed.</p><p><strong>Results: </strong>Patients with SD had significantly reduced index values in bilateral temporal poles and nuclei accumbens. A significant positive relationship was found between the index values in the left parahippocampal region and the 'naming' subscore in the Mini-Mental State Examination.</p><p><strong>Conclusions: </strong>These results suggest that the T1/T2-weighted ratio approach is useful for differentiating the patients with SD from healthy participants.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70170"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction of a Machine Learning-Based Risk Prediction Model for Cognitive Frailty in Older Adults With Type 2 Diabetes Mellitus.","authors":"Li Li, Yanping Ying, Zhiling Ren, Haini Mo, Liu Yang, Suyi Wu, Zirong Li, Qiufang Lu","doi":"10.1111/psyg.70176","DOIUrl":"https://doi.org/10.1111/psyg.70176","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to identify factors associated with cognitive frailty (CF) in older adults with type 2 diabetes mellitus (T2DM) and to develop a machine learning-based risk prediction model.</p><p><strong>Methods: </strong>Between December 2023 and December 2024, 349 participants were recruited through convenience sampling from the Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University. The participants were randomly divided into a training set (n = 244) and a test set (n = 105) at a ratio of 7:3. Participants completed a structured questionnaire and were classified into CF and non-CF groups. Univariate and binary logistic regression analyses identified significant predictors, which were used as input features for six Machine Learning (ML) algorithms. Shapley additive explanations (SHAP) ranked feature importance and provided interpretability.</p><p><strong>Results: </strong>Of 349 older adult patients with T2DM, 87 (23.5%) had CF. Six significant predictors were identified: advanced age, lower educational attainment, insufficient physical activity, depression, malnutrition and a higher number of chronic diabetes-related complications. All models achieved satisfactory performance (AUC > 0.750). The Support Vector Machine (SVM) model performed best (AUC 0.836, accuracy 0.759, precision 0.495, recall 0.699, F1-score 0.575). A web-based application (https://webpredict1.streamlit.app/) was developed from the SVM model to enable individualised CF risk estimation.</p><p><strong>Conclusion: </strong>ML models effectively identified CF in older adult patients with T2DM, with the SVM model achieving the highest accuracy. Addressing the identified risk factors may help reduce CF risk and improve outcomes in this population.</p><p><strong>Impact: </strong>This study provides nurses with a risk prediction tool for identifying older adults with T2DM who are at high risk of CF and may facilitate the development of effective interventions for CF risk management.</p><p><strong>Implications for the profession and/or patient care: </strong>High-risk older adults with T2DM can be identified early through this model, enabling nurses to implement tailored interventions that may reduce CF and improve outcomes.</p><p><strong>Reporting method: </strong>The study has adhered to STROBE guidelines.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":74597,"journal":{"name":"Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society","volume":"26 3","pages":"e70176"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}