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Objectives To determine the standard values of and age-related changes in objective oral function of healthy older people; compare oral function of robust, prefrail, and frail older people; and determine the association between oral function and frailty. Design Cross-sectional analysis. Setting General community. Participants Elderly adults (≥65) from the Obu Study of Health Promotion for the Elderly were included and assigned to the robust, prefrail, and frail groups (N = 4,720). Measurements Each participant underwent detailed physical testing to assess frailty. The frailty phenotype was defined according to the presence of limitations in three or more of the following five domains: mobility, strength, endurance, physical activity, and nutrition. The numbers of present teeth and functional teeth were counted, and occlusal force, masseter muscle thickness, and oral diadochokinesis ( ODK) rate were measured, along with sociodemographic and functional status, comorbidities, and blood chemistry. Results The number of present teeth, occlusal force, masseter muscle thickness, and ODK rate decreased with age. The frail group had significantly fewer present teeth (women aged ≥70), lower occlusal force (women aged ≥70; men aged ≥80), lower masseter muscle thickness, and lower ODK rate than the robust group. Multivariate analysis indicated that age, Geriatric Depression Scale score, skeletal muscle mass index, Mini-Mental State Examination score, hypertension, diabetes mellitus, albumin and triglyceride levels, and oral function were significantly associated with frailty. Conclusion Age-related differences in oral function were found in older adults. Moreover, frail older individuals had significantly poorer oral function than prefrail and robust individuals. The risk of frailty was associated with lower occlusal force, masseter muscle thickness, and ODK rate. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether social participation ( SP) in older adults is associated with ability to perform instrumental activities of daily living ( IADLs). Design Prospective cohort study. Setting Two local municipalities of Nara, Japan. Participants Individuals aged 65 to 96 (n = 2,774 male, n = 3,586 female) free of IADL disability at baseline. Measurements SP and IADLs were assessed using self-administered questionnaires. SP was categorized into five types and assessed using the number and type of social activities. IADLs were evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression analysis stratified according to sex was used to examine change in IADLs according to SP, with nonparticipation as a reference. Results During the 3-year follow-up, 13.6% of men and 9.0% of women reported IADL decline. After adjusting for age, family structure, body mass index, pension, occupation, medical treatment, self-rated health, drinking, smoking, depression, cognitive function, and activities of daily living, participation in various social activities was inversely associated with change in IADLs in women but not men. Participation in the following types of social activities had significant inverse associations with IADL disability: hobby clubs (odds ratio ( OR) = 0.68, 95% confidence interval ( CI) = 0.49-0.94) for men and local events ( OR = 0.68, 95% CI = 0.48-0.95), hobby clubs ( OR = 0.53, 95% CI = 0.36-0.79), senior citizen clubs ( OR = 0.74, 95% CI = 0.56-0.97), and volunteer groups ( OR = 0.56, 95% CI = 0.32-0.99) for women. Conclusion Participation in a variety of different types of social activities was associated with change in IADLs over the 3 years of this study in women, and participation in hobby clubs was associated with change in IADLs in men and women. Recommending that community-dwelling elderly adults participate in social activities appropriate for their sex may promote successful aging. [ABSTRACT FROM AUTHOR]

Objectives To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults. Design Prospective cohort study. Setting Tsurugaya district, Sendai, Japan. Participants Community-dwelling individuals aged 70 and older (N = 834). Measurements The outcome measurement was incident functional disability, defined as first certification of long-term care insurance in Japan, which is determined on the basis of a strictly established uniform nationwide standard. During a median follow-up of 7.9 years (interquartile range 4.8-7.9 years), information on long-term care insurance was obtained from the Sendai Municipal Authority. Oral health was assessed according to number of remaining teeth and presence or absence of regular dental care. Data were also collected on age, sex, body mass index, medical history, smoking, alcohol consumption, duration of education, depressive symptoms, cognitive impairment, physical functioning, and social support. Results Participants with 10 to 19 teeth (adjusted hazard ratio ( aHR) = 1.42, 95% confidence interval ( CI) = 1.03-1.94), one to nine teeth ( aHR = 1.46, 95% CI = 1.04-2.03), and no teeth ( aHR = 1.49, 95% CI = 1.03-2.14) were more likely to develop functional disability than those with 20 or more teeth. There was no significant difference in risk of functional disability between participants with 20 or more teeth and those with zero to 19 teeth who were receiving regular dental care, whereas those with zero to 19 teeth without regular dental care had a significantly greater risk of functional disability than those with 20 or more teeth ( HR = 1.46, 95% CI = 1.11-1.92). Conclusion Tooth loss was associated with greater risk of functional disability in community-dwelling elderly Japanese. Regular dental care might moderate the risk of functional disability in elderly individuals with missing teeth. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between four markers of overall nutritional status (a serum biomarker (albumin) and three anthropometric indices (body mass index ( BMI), midarm circumference ( MAC), calf circumference ( CC))) and incident hearing impairment in older Japanese adults. Design Community-based prospective cohort study. Setting Kurabuchi Town, Gunma Prefecture, Japan. Participants Individuals aged 65 and older (143 men, 195 women) without hearing impairment at baseline examination (2005-06) who participated in repeated examinations 4 years later (2009-10) (N = 338). Measurements The three anthropometric indices were measured at baseline, and nephelometry was used to assess serum albumin levels. Hearing impairment was defined as failure to hear a 30- dB hearing level signal at 1 kHz and a 40- dB signal at 4 kHz in the better ear on pure-tone audiometry. Results Over the 4-year period, 16.3% of participants developed hearing impairment. Those with lower marker values had greater risk of hearing impairment than those with higher marker values (multivariable adjusted odds ratio ( aOR) = 2.18, 95% confidence interval ( CI) = 1.05-4.57 for albumin ≤4.0 g/ dL; aOR = 2.72, 95% CI = 1.10-6.71 for BMI <19.0 kg/m2). The pattern of association showed a similar tendency for MAC and CC. Excluding obese participants did not changed the results substantially. Conclusion Further research is needed to determine whether interventions that improve markers of nutritional status may help prevent age-related hearing loss in older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To clarify the relationship between self-reported hearing loss (HL) and 5-year decline in higher-level functional capacity in high-functioning elderly adults. DESIGN: Population-based, prospective cohort study. SETTING: The Fujiwara-Kyo Study, Nara, Japan. PARTICIPANTS: Community-dwelling individuals aged 65 and older with a perfect baseline and valid follow-up instrumental activity of daily living (IADL) (n = 3,267), intellectual activity (IA) (n = 2,925), and social role (SR) (n = 2,698) scores. MEASUREMENTS: Self-reported HL was evaluated using a single question: "Do you feel you have hearing loss?" IADLs, IA, and SR were measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) subscales. Geriatric syndromes (depressive symptoms, cognitive impairment, sleep disturbance, falls, urinary incontinence, visual impairment) were self-reported at baseline. Blood tests were performed to measure cardiovascular risk factors. RESULTS: During 5-year follow-up, new declines developed for 213 participants in IADLs, 272 in IA, and 327 in SR. After adjustment for all covariates, including geriatric syndromes, using multiple logistic regression analysis, self-reported HL at baseline was associated with a decline in IA (odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.04-1.86) and SR (OR = 1.34, 95% CI = 1.02-1.76) but not IADLs (OR = 1.07, 95% CI = 0.76-1.48). CONCLUSION: Self-reported HL was found to be a significant predictor of decline in IA and SR. Preventive intervention against age-related HL may contribute to maintaining high-level functional capacity in independent elderly adults. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between protein intake and risk of higher-level functional decline in older community-dwelling adults. Design Prospective. Setting Ohasama Town, Japan. Participants Residents (N = 1,007; mean age 67.4 ± 5.5) free of functional decline at baseline; follow-up was conducted for 7 years. Measurements Nutrient and food intakes were determined using a validated 141-item food frequency questionnaire. Participants were divided into quartiles according to intake levels of total, animal, and plant protein. Subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence subscales were used to assess higher-level functional decline. Logistic regression analysis was used to examine the future risk of higher-level functional decline in relation to protein intake, with lowest protein intake as reference. Results During the study period, 24.4% of eligible participants reported declines in higher-level functional capacity. After adjustment for putative confounding factors, men in the highest quartile of animal protein intake had significantly lower risk of higher-level functional decline than those in the lowest quartile (odds ratio ( OR) = 0.41, 95% confidence interval ( CI) = 0.20-0.83; P for trend .01). These associations were not seen in women ( OR = 0.76, 95% CI = 0.41-1.34; P for trend .37). No consistent association was observed between plant protein intake and future higher-level functional decline in either sex. Conclusion Higher protein, particularly animal protein, was associated with lower risk of decline in higher-level functional capacity in older men. Animal protein intake may be a modifiable indicator for early detection and prevention of higher-level functional decline in elderly adults. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of a twice-weekly multitarget stepping ( MTS) task combined with a multicomponent exercise program on stepping accuracy, gaze behavior, fall risk factors, and fall rates. Design Randomized controlled trial. Setting Community. Participants Community-dwelling adults aged 65 and older in Japan (N = 264) were randomized into an MTS group (n = 132) and a control group (n = 132). Intervention Twenty-four weeks of a twice-weekly community-based MTS program in combination with a standardized multicomponent exercise program. Measurements Number of falls and fall-related fractures during a 12-month follow-up period after completion of the intervention, stepping accuracy, gaze behavior while performing the MTS test, and results of four clinical tests relevant to assessment of risk of falls ( Timed Up and Go ( TUG), functional reach ( FR), 10-m walking, and Five Chair Stand (5 CS)) were measured. Results Thirteen participants (11.6%) in the MTS group and 39 (33.0%) in the control group fell during the 12-month follow-up period (incidence rate ratio = 0.35, 95% confidence interval ( CI) = 0.19-0.66). Three participants in the MTS group and 13 in the control group experienced fall-related fractures during the 12-month follow-up period (relative risk = 0.22, 95% CI = 0.06-0.80). After the intervention, a subset of participants in the MTS group had significantly greater improvement in stepping accuracy and gaze behavior during the MTS test, and all participants in the MTS group had significantly greater improvement in performing the TUG and 10-m walking ( P < .001). Conclusion Participants who performed MTS tests combined with a multicomponent exercise program showed greater improvements in stepping accuracy, gaze behavior, and physical performance in a virtually complex environment. Considering the less-frequent fall rate in the follow-up assessment, these improvements could contribute to preventing falls in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether self-reported hearing loss in older adults is associated with a decline in their ability to perform instrumental activities of daily living ( IADL) or a decline in social participation. Design Prospective follow-up. Setting Community. Participants One thousand two hundred fifty-four adults aged 65 to 98. Measurements Self-reported hearing loss, IADL, and social participation were evaluated through home-visit surveys. Self-reported hearing loss was measured according to responses to the question, 'Do you have difficulty hearing and understanding what a person says to you in a quiet room if they speak normally to you, even when wearing your hearing aid?' Levels of IADL and social participation were measured using the subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence ( TMIG- IC). Results Of the 921 participants with a perfect baseline IADL score and valid follow-up scores, 105 also self-reported hearing loss at baseline. Of this group, 44.8% (total n = 105) reported a decline in their IADL score over the 3-year follow-up period. After adjusting for major confounders, a statistically significant difference in experiencing an IADL decline over the 3-year period was found between those with hearing loss at baseline and those without (odds ratio ( OR) = 1.79, 95% confidence interval ( CI) = 1.12-2.87). Self-reported hearing loss at baseline did not have a statistically significant effect on decline in social participation ( OR = 1.05, 95% CI = 0.63-1.76) over the 3-year follow-up period. Conclusion Self-reported hearing loss was associated with a decline in IADL, but not with social participation. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of lavender olfactory stimulation intervention on fall incidence in elderly nursing home residents. Design Randomized placebo-controlled trial. Setting Three randomly selected nursing homes in northern Japan. Participants One hundred and forty-five nursing home residents aged 65 and older. Intervention Participants were randomly assigned to the lavender (n = 73) or placebo group (n = 72) for a 360-day study period. The lavender group received continuous olfactory stimulation from a lavender patch. The placebo group received an unscented patch. Measurement The primary outcome measure was resident falls. Other measurements taken at baseline and 12 months included functional ability (assessed using the Barthel Index), cognitive function ( Mini- Mental State Examination ( MMSE)), and behavioral and psychological problems associated with dementia ( Cohen- Mansfield Agitation Inventory ( CMAI)). Results There were fewer fallers in the lavender group (n = 26) than in the placebo group (n = 36) (hazard ratio ( HR)=0.57, 95% confidence interval ( CI) = 0.34-0.95) and a lower incidence rate in the lavender group (1.04 per person-year) than in the placebo group (1.40 per person-year) (incidence rate ratio = 0.51, 95% CI = 0.30-0.88). The lavender group also had a significant decrease in CMAI score ( P = .04) from baseline to follow-up in a per protocol analysis. Conclusion Lavender olfactory stimulation may reduce falls and agitation in elderly nursing home residents; further research is necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives To determine the approximate percentage of women in nursing homes who have vitamin D deficiency and to investigate whether, in assessing vitamin D status in elderly women, there are problems with measuring only 25 hydroxy-vitamin D3 (25( OH) D3) and whether decreased vitamin D activation as a result of poor renal function needs to be considered. Design Cross-sectional study. Setting Forty-eight nursing homes in Japan. Participants Four hundred three women with a mean age of 86.5 living in nursing homes who had participated in a clinical trial for hip protectors and were not bedridden. Measurements At the start of the trial, in addition to general biochemical data, 25( OH) D3, 1,25-dihydroxy-vitamin D3 (1,25( OH)2 D3), intact parathyroid hormone (intact PTH), calcium (Ca), phosphorus (P), bone alkaline phosphate ( BAP), cross-linked N-telopeptide of type I collagen ( NTx), and osteocalcin were measured in participants' blood, and statistical analysis was performed. Results 25(OH)D3, which is thought to reflect vitamin D status in the body, was surveyed and found to have a mean value of 16.7 ng/mL. 25(OH)D3 was less than 16 ng/mL in 49.1% of all participants. Creatinine clearance ( CCr) was less than 30 mL/min in 20.1% of participants. Participants with serum 25(OH)D3 less than 16 ng/mL and CCr less than 30 mL/min had significantly higher levels of intact PTH and serum NTx. Participants with a CCr less than 30 mL/min had significantly lower levels of 1,25(OH)2D3. Conclusion Frail elderly adults living in nursing homes with poor renal function had lower 1,25( OH)2 D3 and higher intact PTH levels and were thus thought to have poorer vitamin D activating capacity. Supplementation with cholecalciferol may be insufficient in people who have poor renal function. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between dental health status and onset of functional disability in older Japanese people. Design Prospective cohort study. Setting Six Japanese municipalities. Participants Four thousand four hundred twenty-five community-dwelling individuals aged 65 and over. Measurements The outcome measure was the onset of functional disability based on public records of people receiving long-term care insurance benefits, determined through a standardized multistep assessment of functional and cognitive impairment including a personal interview and an examination by a physician. Disability data were analyzed for 4,425 respondents during 2003 to 2007. Self-reported number of remaining teeth and eating ability were used as measures of dental health status. Age, sex, body mass index, self-rated health, present illness, smoking, alcohol, exercise, and equivalent income were used as covariates. Results In the age- and sex-adjusted Cox proportional hazard models, there were significant associations between number of remaining teeth, eating ability, and onset of disability. After adjusting for sociodemographic, behavioral, and health status variables, respondents with 19 or fewer teeth had a significant 1.21 (95% confidence interval = 1.06-1.40) times higher hazard ratio for the onset of functional disability. In contrast, eating ability was not significantly associated with the onset of disability. Conclusion Poor dental status was associated with a higher risk of onset of functional disability in older Japanese people. Sociodemographic, behavioral, and health status covariates explained the association between eating ability and onset of disability. [ABSTRACT FROM AUTHOR]

Objectives To elucidate the independent relationship between masticatory and physical performance in community-living oldest old people (mean age ± standard deviation 87.8 ± 2.2, range 85-102). Design Cross-sectional analysis . Setting University research center or home-based examination. Participants Four hundred eighty-nine community-living individuals (219 men, 270 women) aged 85 and older. Measurements Maximum occlusal force ( MOF) was measured using an occlusal force measuring device. Sociodemographic and functional factors, oral health, comorbidities, blood chemistry, lower extremity performance, and handgrip strength were assessed. Blood chemistry analyses included serum albumin, C-reactive protein, interleukin ( IL)-6, and total and free testosterone. Results MOF was significantly associated with age, body mass index, and cognitive impairment in men but not in women. Comorbidities and blood chemistry were not associated with MOF except for a significant association with IL-6 concentration in women. In a multivariate model adjusted for various confounders, lower MOF was associated with greater risk for poor performance on the timed up and go ( TUG) test in men and women (men: odds ratio ( OR)=2.34, 95% confidence interval ( CI)=1.02-5.38; women: OR=2.44, 95% CI=1.12-5.33). MOF was similarly associated with performance in chair standing, one-leg standing, and handgrip strength only in men. These associations remained after adjustment for number of natural teeth. Conclusion MOF was strongly and independently associated with all measures of physical performance in men and with the TUG test in women after adjustment for various confounders, suggesting that age-related declines in masticatory and skeletal muscle functions share common mechanistic pathways in older age, particularly in men. [ABSTRACT FROM AUTHOR]

Objectives To determine the characteristics of health behaviors related to higher-level functional decline in older community-dwelling adults. Design Prospective. Setting Ohasama Town, Japan. Participants One thousand fifty residents (mean age: 67.5) free of functional decline at baseline. Measurements Health behaviors including smoking status, alcohol consumption, frequency of exercise, sleep duration, dietary habits (supplement use, breakfast, late-night snacking, eating regularly, and eating out), and self-rated health were obtained from a self-administered questionnaire at baseline. Higher-level functional decline was examined using the subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results During the 7-year follow-up, 27.5% of eligible participants reported decline in higher-level functional capacity. After adjustment for putative confounding factors, health behaviors that were significant predictors for declines in higher-level functional capacity at the 7-year follow-up were current smoking (odds ratio ( OR) = 1.58, 95% confidence interval ( CI) = 1.06-2.36), sleep duration of 9 hours or longer ( OR = 2.15, 95% CI = 1.49-3.11), and poor self-rated health ( OR = 1.93, 95% CI = 1.40-2.67). Conclusion Several modifiable health behaviors contribute to higher-level functional decline. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To study white matter lesions (WMLs) and 5-year cognitive decline in elderly Japanese-American men. DESIGN: Longitudinal cohort study. SETTING: Population-based study in Honolulu, Hawaii. PARTICIPANTS: Japanese-American men aged 74 to 95 from the Honolulu-Asia Aging Study (HAAS) who were free of prevalent dementia, underwent a protocol brain MRI scan at the fifth HAAS examination (1994-1996), and returned for cognitive testing 5 years later (N=267). MEASUREMENTS: WMLs were dichotomized as present (grade 3-9, 38.2%) or absent (grade 1-2, 61.8%). Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI), and 5-year cognitive decline was defined as a drop in CASI score of 12 points or more (1 standard deviation). RESULTS: Men with WMLs on MRI at baseline were significantly more likely to experience cognitive decline at 5 years than those without (22.4% vs 34.4%, P=.03). Using multiple logistic regression, adjusting for age, education, apolipoprotein (Apo)E4 allele, large or small infarcts on MRI, baseline CASI score, and hypertension, those with WMLs were significantly more likely to develop 5-year cognitive decline (odds ratio=2.00, 95% confidence interval=1.10-3.65, P=.02). This association was stronger in men who were cognitively intact and free of the ApoE4 genotype and clinical stroke at baseline. CONCLUSION: Presence of WMLs on MRI was significantly associated with higher odds of 5-year cognitive decline in older Japanese-American men. Presence of WMLs may help identify people at risk for developing dementia, who may benefit from early intervention. [ABSTRACT FROM AUTHOR]