Discussion
muscle mass, muscle mass decreases, diabetes
SECONDARY, DIABETES
In this study, community pharmacies were two groups. The pharmacies were assigned randomly to either the intervention during medication guidance group (IG) or the usual medication guidance group (UG: control group). The subjects were older persons with chronic conditions who used the pharmacies in the two groups every month, and who were encouraged by the pharmacists to exercise at home when they were provided with their medication. We investigated the changes in their muscle mass and frailty improvement index six months after the start of the study (+ 6 M). The IG showed a trend toward increased muscle mass, which was the primary endpoint. The IG showed a significantly higher value in cases in which the time for the Five Times Sit-To-Stand test, which was one of the secondary endpoints, was faster the second time than the first time.Eduardo et al. reported that strength training significantly increased muscle mass in people in their 90s who were at risk of falling and, as a result, reduced their incidence of falls [We believe the reasons why we did not observe a statistically significant difference for the primary endpoint in this study were as follows: The first is the fact that there was variation in the way that the patients understood the information provided by the pharmacists; the second is the possibility that the period during which the efficacy of the intervention was determined (six months) may have been too short; the third is the fact that there were limitations to the detection ability that was assumed at the outset of the study. Concerning the first issue, although it has been reported that the muscle mass of those in elderly care facilities who undergo muscle strength training under the guidance of an expert trainer increases [Indeed, it is known that muscle mass decreases as one ages, and it has been reported that among those in their eighties, total muscle mass decreases by 40–50% of that of those in their twenties when measured using the creatinine method [Another achievement of this study was that it demonstrated that pharmacists can provide guidance to patients in a limited number of pharmacies, within the time they have to provide it, in order to encourage them to take action. In other words, the pharmacists were able to utilize the nudge theory to motivate the patients to exercise on their own at home.Nudge theory is also applied to health guidance, and a systematic review reported that it is possible to use nudge theory to change the health behaviors of diabetes patients [Although this was a pragmatic randomized controlled trial, it has the limitations of one intervention group and participants being randomized but not blinded.The Japan Agency for Gerontological Evaluation Study (JAGES), a longitudinal study conducted in 2013—2016 reported that elderly individuals aged 75 years and older who participated in the “Kayoi-no-Ba” (“place to go”) program kept worsening their risk of requiring nursing care by 46% as compared to those who did not participate [Pharmacists are expected to play a role in a large number of fields, including filling prescriptions, the sale of over-the-counter (OTC) medications, and community health promotion. Another of these roles is in the prevention of frailty among older persons with chronic conditions. It is of major significance that pharmacists endeavor to prevent frailty through their routine pharmacy activities to allow older persons to undergo medical treatment and recovery from illness in a comfortable environment in the communities that they are used to. This study provides evidence for this.