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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]

Background: This study examined the factors related to intellectual activity in community-dwelling elderly persons. Methods: Self-administered questionnaires mailed to all people aged ≥65 years in a dormitory suburb in Japan (n = 15,210). The response rate was 72.2%. Analytical subjects (n = 8,910) were those who lived independently and completely answered questions about independent and dependent variables and covariates. Independent variables included psychosocial conditions (i.e., social activities, hobbies, and a sense that life is worth living (ikigai)), oral health (i.e., dental health behaviors and oral function evaluated by chewing difficulties, swallowing difficulties, and oral dryness), and dietary variety measured using the dietary variety score (DVS). A dependent variable was intellectual activity measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Covariates included age, gender, family structure, pensions, body mass index, alcohol, smoking, medical history, self-rated health, medications, cognitive function, depression, and falling. Logistic regression was used to estimate the odds ratio (OR) for poor intellectual activity. Results: Poor intellectual activity was reported by 28.9% of the study population. After adjustment for covariates and independent variables, poor intellectual activity was significantly associated with nonparticipation in social activities (OR = 1.90, 95%CI = 1.61–2.24), having neither hobbies nor ikigai (3.13, 2.55–3.84), having neither regular dental visits nor daily brushing (1.70, 1.35–2.14), the poorest oral function (1.61, 1.31–1.98), and the lowest DVS quartile (1.96, 1.70–2.26). Conclusion: These results indicate that psychosocial conditions, oral health, and dietary variety are independently associated with intellectual activity in elderly persons. The factors identified in this study may be used in community health programs for maintaining the intellectual activity ability of the elderly. [ABSTRACT FROM AUTHOR]

Background: Tooth loss may be a modifiable risk factor for memory disorders, but the causal relationship has not been evaluated sufficiently. Objective: This 5-year prospective cohort study investigated the effect of tooth loss on the development of mild memory impairment (MMI) among the elderly. Methods: Data are from the baseline and follow-up examinations of 2,335 community residents who were cognitively intact at baseline. The number of remaining teeth at baseline was classified as zero, 1-8, 9-16, 17-24, and 25-32. The main outcome for the analysis was the development of MMI at follow-up. Results: After adjustment for potential confounding factors in multivariable logistic regression analysis, the odds ratio of per 1 tooth loss at baseline was 1.02 (95% confidence interval, 1.00-1.03). The odds ratio of edentulism for MMI was 2.39 (1.48-3.86) compared to 25-32 teeth. The odds ratio of becoming edentulous compared to retaining 1-8 teeth in the 1-8 teeth group at baseline was 4.68 (1.50-14.58). Conclusion: Tooth loss predicts the development of MMI among the elderly. [ABSTRACT FROM AUTHOR]

Objective Metabolic syndrome contains many risks for medical diseases such as cardiovascular disease and diabetes, which might precipitate depressive symptoms in the older people. However, the association between depressive symptoms and metabolic syndrome in Japanese community-dwelling older people is unclear. This study was performed to answer this important question. Methods Cross-sectional analyses were performed on 3796 community-dwelling independent older people (≥65 years, 1911 men and 1885 women) from the 2007-2008 baseline examination of the Fujiwara-kyo study, a prospective cohort study on successful aging. Depressive symptoms were assessed using the 15-item short form of the Geriatric Depression Scale and metabolic syndrome was defined according to the 2005 International Diabetes Federation. Covariates were social supports, negative life events, health behavior, education, cognitive function, anthropometric status, and others. Multiple logistic regression analyses were performed to determine the relationships between depressive symptoms and these variables. Results The prevalence of depressive symptoms (Geriatric Depression Scale-15 ≥6) and metabolic syndrome were 14.8% and 16.6%, respectively. Significant protective factors against depressive symptoms were higher education, more opportunity for drinking of alcohol, better social supports, and more walking daily. Metabolic syndrome was statistically associated with depressive symptoms (adjusted odds ratio = 1.32, 95% confidence interval = 1.03-1.68). Other risk factors significantly associated with depressive symptoms were sleep disturbance, visual or hearing impairment, and negative life events. Conclusions The present study showed an association between metabolic syndrome and depressive symptoms in ambulatory Japanese older people, as in western countries. [ABSTRACT FROM AUTHOR]

Objective: The 15D is a self-administered questionnaire for assessment of health-related quality of life, which contains 15 questions with 5 response options each. This study was conducted to evaluate the reliability and validity of the Japanese 15D. Methods: The subjects were 430 community-dwelling elderly people. Each item of the 15D was scored on a 5-point Likert scale, with level 1 being the best, score 1. Reliability was assessed by determination of the internal consistency and test-retest reliability. Criterion-based validity was assessed using the Japanese version of the Nottingham Health Profile (NHP) and Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index). Acceptability was assessed by inquiring about the time required to complete the questionnaire and the burden felt in responding to it. Results: The answers of 423 individuals who responded to all items were analyzed. The median time required to complete the questionnaire was 5.0 minutes, and the proportion of subjects who indicated that the questionnaire was easy to complete was 98.3%. The Cronbach’s alpha coefficients for all 15 items in the 2 surveys were 0.793 and 0.792, respectively. The intraclass correlation coefficients for the 15 items ranged from 0.44 to 0.72. In the relationship between the 15D and the NHP, the correlation coefficients between the corresponding domains were higher than those between non-corresponding domains. The prevalence of disability in higher-level functional capacity was higher in the “level 2 to 5” group than in the “level 1” group. Conclusions: The Japanese version of the 15D showed sufficient internal consistency and moderate repeatability. Because of the short time required to complete the Japanese 15D and the significant relationships between the scores on the 15D and the NHP, and between the 15D and higher-level functional capacity, the acceptability and validity of the Japanese 15D were considered to be sufficient. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relationship between swallowing problems and the number of remaining teeth in healthy elderly people. Design Cross-sectional. Setting Nara, Japan. Participants Three thousand six hundred sixty-three male and female volunteers aged 65 and older who were living independently were analyzed. Measurements Swallowing problems were defined operationally using a questionnaire and the 30-mL water swallow test. Data were collected on the number of remaining teeth, maximum bite force, occlusal status, presence or absence of oral dryness, and medical history. Results The prevalence of swallowing problems was 15.1% (n = 554) in this population. A positive correlation was observed between the number of remaining teeth and maximum bite force. The number of remaining teeth was categorized according to tertiles. Multiple logistic regression analysis revealed that the adjusted odds ratios for 0 to 13 or 14 to 24 remaining teeth to 25 to 32 remaining teeth for swallowing problems were 2.04 (95% confidence interval ( CI) = 1.60-2.60) and 1.31 (95% CI = 1.02-1.70), respectively. Significant increases in these odds ratios were found in a trend test ( P < .001). Conclusion Tooth loss is associated with swallowing problems. Having fewer teeth inhibits masticatory ability, which disturbs the execution of smooth swallowing. Preventive measures against tooth loss at a younger age may be effective at reducing the risk of laryngeal penetration and aspiration at an older age. [ABSTRACT FROM AUTHOR]

Abstract: It has been reported that tooth loss is associated with Alzheimer''s disease (AD) and dementia. The purpose of this study was to investigate the association between tooth loss and mild memory impairment (MMI) among the elderly. We examined 3,061 community residents aged 65years or older who had a score of 24 or more on the Mini-Mental State Examination. The subjects were divided according to their score for the three-word delayed recall test into control (score: 3 or 2) and MMI (score: 1 or 0) subjects. The subjects underwent a dental examination, an interview to determine their medical history, a self-administered questionnaire (inclusive of higher-level functional capacity, drinking and smoking habits, and frequency of going out), and a 10-m walking test. Fewer remaining teeth, going out once a week or less frequently, and a slow walking speed on a 10-m walking test were found at a significantly higher prevalence in the MMI group (n =101) than in the control group (n =2,960), after adjustment for sex, age, and the level of education. Multiple logistic regression analysis using these items revealed that the odds ratio of 0–10 remaining teeth for MMI was 1.71 (95% CI 1.05–2.78), compared to individuals with 22–32 remaining teeth. A significant increase was also found in a trend test to examine the increasing odds ratios of 22–32, 11–21, and 0–10 remaining teeth. We consider that tooth loss is associated with MMI later in life. [Copyright &y& Elsevier]

Background: This cross-sectional study investigated the relationship between the number of remaining teeth to mild memory impairment (MMI), which is a preclinical stage of dementia, and to cognitive impairment. Methods: The subjects were aged 65 years or older and were grouped according to their score for the Mini- Mental State Examination (MMSE), the three-word delayed recall test in the MMSE, and the Geriatric Depression Scale into the control group (n = 3,696), the MMI group (n = 121), and the low MMSE score (23 or lower) group (n = 214). We collected data on the number of remaining teeth, the length of the edentulous period, healthrelated lifestyle, medical history, blood pressure, height, and body weight. Fasting venous blood samples were also obtained. Results: Multiple logistic regression analysis, adjusted for depressive symptoms, age, sex, length of education, and other explanatory variables, revealed that the odds ratios of 0-10 remaining teeth to 22-32 remaining teeth were 1.679 (95% CI 1.073-2.627) for MMI and 2.177 (95% CI 1.510-3.140) for a low MMSE score. A significant relationship was also found between the length of the edentulous period and the risk of a low MMSE score (odds ratio 3.102, 95% CI 1.432-6.720) (15 years or more/less than 15 years). Conclusions: Our findings suggest that tooth loss is associated with cognitive function. [ABSTRACT FROM AUTHOR]

Abstract: The present study was conducted to characterize the lifestyles and health status of non-participants and to investigate whether diminished higher-level functional capacity may cause selection bias in non-compulsory mass health screening for the elderly. Using a self-administered questionnaire for evaluating the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence) which consists of three sublevels, namely, instrumental self-maintenance, intellectual activity and social role, we conducted a survey of 1543 (mean age, 64.9±12.5 years, 677 males and 866 females) out of all the 1701 individuals over the age of 40 residing in a village where mass health screening is conducted annually. The mean TMIG Index of Competence score was the highest in Group V (composed of 434 individuals who participated in the mass health screening conducted by the village), followed, in that order, by the score in Group W (composed of 531 individuals who had undergone a health checkup organized at their workplaces or by their family physicians, but not the one conducted by the village, during the previous year) and that in Group N (composed of 578 individuals who had not undergone any health checkup during the previous year). Group N showed a significantly lower mean TMIG Index of Competence score than Groups V and W. In regard to the scores for the sublevels of the index, Group N had a significantly lower percentage of subjects, both men and women, with perfect scores than Group V for all the sublevels, and also a significantly lower percentage of subjects with a perfect score for the intellectual activity than Group W. However, there were no significant differences in the percentages of subjects habituated to exercise, drinking or smoking among the three groups. Thus, special attention may need to be paid to selection bias in mass health screenings caused by differences in the higher-level functional capacity. [Copyright &y& Elsevier]

Background: Several studies have suggested that periodontal disease can exacerbate the pro-inflammatory status of the brain. Tooth loss is one of the alternative evaluation indices of periodontal disease. There are few data on the relationship between tooth loss and memory impairment, depending on the apolipoprotein E (APOE) ɛ4 genotype.Objective: To determine if tooth loss is associated with mild memory impairment (MMI) and if this association is modified by the presence of the APOEɛ4 allele.Methods: A nested case-control study was conducted from 2007 to 2012 in Japan. Five hundred and thirty-seven Japanese subjects aged 65 years and over who were cognitively intact at baseline were analyzed. MMI at follow-up was evaluated.Results: The median number of teeth at baseline was significantly lower in MMI participants (n = 179) than in controls (n = 358) (MMI: median 21.0, interquartile range 10.0-25.0 versus controls: 24.0, 14.0-27.0). After adjustment for demographics, vascular risk factors, and APOEɛ4 allele, the multivariate adjusted odds ratio (OR) of ≤8 teeth was 1.97 (95% confidence interval [CI], 1.13-3.44) compared to 25-32 teeth. Participants with both the presence of at least 1 APOEɛ4 allele and ≤8 teeth had a higher risk of MMI compared with those with neither (OR, 2.82; 95% CI, 1.15-6.91). Those with either risk factor alone did not have a higher risk of MMI.Conclusions: A lower number of teeth is related to risk of MMI. This may be primarily true for those individuals with an APOEɛ4 allele. [ABSTRACT FROM AUTHOR]

Many studies have reported that patients with a history of gastrectomy (gastrectomized patients) have lower areal bone mineral density (aBMD) and higher fracture risk than those without. However, population-based studies on this topic are scarce, and little is known regarding the bone metabolic status of gastrectomized patients in the long-term. This study aimed to clarify the association of gastrectomy with aBMD, bone metabolism markers, and fracture risk in community-dwelling elderly Japanese men. A total of 1992 men aged ≥65 years completed baseline measurements including aBMD at the spine and hip, serum levels of intact parathyroid hormone (PTH), intact osteocalcin (OC), tartrate-resistant acid phosphatase isoenzyme 5b (TRACP5b), and undercarboxylated OC (ucOC), and an interview regarding past medical history including gastrectomy. Osteoporotic fractures (OPFs) that occurred during the 5-year follow-up period were determined through structured interviews. After excluding participants with type 1 diabetes mellitus and those with missing values, 1985 men, including 132 gastrectomized men, were analyzed. Gastrectomized men had significantly higher PTH, TRACP5b, and ucOC levels, and lower aBMD, than non-gastrectomized men. Gastrectomy was associated with a significantly higher risk of OPF after adjusting for confounding variables (hazard ratio (HR): 2.55, 95% confidence interval (CI): 1.17, 5.55), and the risk was no longer significant when further adjusted for PTH and aBMD. Even in this model, however, increase in OPF risk was significant in gastrectomized men who survived 20 years or more after the surgery (HR: 3.56, 95% CI: 1.33, 9.52). History of gastrectomy was associated with elevated bone resorption, decreased aBMD, and increased fracture risk in community-dwelling elderly Japanese men. This increase in fracture risk was more prominent long after gastrectomy. • Population-based studies on the association between gastrectomy and fracture risk are scarce. • Community-dwelling elderly gastrectomized Japanese men had higher fracture risk than non-gastrectomized men. • Longer period since gastrectomy, rather than reason for gastrectomy, was associated with an increased fracture risk. • People who have survived for a long period after gastrectomy are a target population for management of fracture risk. [ABSTRACT FROM AUTHOR]

Abstract Purpose Patients with type 2 diabetes mellitus have an increased fracture risk. However, population-based studies on the association between glycemic status and fracture risk are scarce, and none have targeted a Japanese population. In addition, patients in the lowest category of hemoglobin A1c (HbA1c) do not always show the lowest risk. This study aimed to clarify the association between glycemic status and fracture risk in community-dwelling elderly Japanese men. Methods A total of 1992 men aged ≥65 years completed baseline measurements including fasting plasma glucose (FPG), HbA1c, bone density, and an interview regarding past disease history. Osteoporotic fractures (OPFs) that occurred during the 5-year follow-up period were determined through interviews. An OPF at the spine, hip, proximal humerus, or distal radius was defined as a major OPF (MOF). Results After excluding participants who had a history of type 1 diabetes mellitus and thiazolidinedione therapy, 1951 men were analyzed. Men with hyperglycemia in the diabetic range had a significantly higher risk of OPF compared with those with normoglycemia, after adjusting for confounding factors including insulin therapy (hazard ratio (HR): 2.76, 95% confidence interval (CI): 1.17, 6.50 in FPG ≥ 126 mg/dl; HR: 2.49, 95% CI: 1.07, 5.77 in HbA1c ≥ 6.5%). An elevated risk of MOF was observed in participants in the prediabetic HbA1c category (HR: 2.15, 95% CI: 1.00, 4.62 in 5.7% ≤ HbA1c < 6.5%) in addition to those in the diabetic category. The intermediate glycemic status group showed intermediate risk, suggesting that the association was linear. Conclusions Hyperglycemia was associated linearly with elevated fracture risk in community-dwelling elderly men. MOF risk may be elevated in Japanese elderly men with prediabetic glycemic status. Highlights • Population-based studies on the association between glycemic status and fracture risk are scarce. • Elderly Japanese men with hyperglycemia had a higher fracture risk independently of confounders including insulin use. • Major osteoporotic fracture risk may be elevated in Japanese elderly men in the prediabetic category of hemoglobin A1c. • Previously reported J-shaped association between glycemic status and fracture risk was not observed in this population. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether there is a significant association between prior cataract surgery and cognitive function in an elderly Japanese cohort. Setting: Nara Medical University, Nara, Japan. Design: The Fujiwara-kyo Eye Study was a cross-sectional epidemiological study. Methods: The subjects were ≥ 68-years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects received comprehensive ophthalmological examinations, and answered questionnaires on their socio-demographic and medical history including prior cataract surgery. The association between prior cataract surgery and cognitive function was determined. Results: A total of the 2764 subjects whose mean age was 76.3±4.8 years (±standard deviation) was studied. Of these, 668 individuals (24.2%) had undergone cataract surgery. Of these, 150 (5.4%) had dementia as determined by the Mini-Mental State Examination (MMSE) score ≤23, and 877 individuals (31.7%) had mild cognitive impairment (MCI; MMSE score 24–26). The subjects who had prior cataract surgery had significantly lower odds ratio (OR) of having MCI (OR = 0.78, 95% confidence interval; CI 0.64–0.96, P = 0.019) than those who had not had cataract surgery after adjusting for age, sex, body mass index, education, hypertension, diabetes, depression, and history of stroke. The OR was still lower when the visual acuity was also added to the adjusted factors (OR 0.79, 95% CI 0.64–0.97, P = 0.025). However, prior cataract surgery did not contribute significantly to the low OR for dementia. Conclusions: Cataract surgery may play a role in reducing the risk of developing MCI independently of visual acuity but not for dementia. [ABSTRACT FROM AUTHOR]

Purpose Patients with type 2 diabetes mellitus (T2DM) have an increased fracture risk despite having higher areal bone mineral density (aBMD). This study aimed to clarify the association between glycemic and insulin resistance status and bone microarchitecture, and whether pentosidine and bone turnover markers play any roles in the association. Methods A total of 2012 community-dwelling men aged ≥ 65 years completed baseline measurements of spine aBMD, fasting plasma glucose (FPG) and serum insulin, hemoglobin A1c (HbA1c), osteocalcin, type I procollagen N-terminal propeptide, type I collagen C-terminal crosslinking telopeptide, tartrate-resistant acid phosphatase isoenzyme 5b, pentosidine, height and weight and an interview regarding past disease history. Homeostasis model assessment-insulin resistance (HOMA-IR) was also calculated. T2DM was defined as physician-diagnosed middle age or elderly-onset diabetes mellitus, or according to biochemical test results. To evaluate bone microarchitecture, trabecular bone score (TBS) was calculated at the same vertebrae as those used for aBMD measurement. Results After excluding participants who had a disease history and/or were taking medications affecting bone metabolism, 1683 men (age, 72.9 ± 5.2 years) were analyzed. Men with T2DM had significantly higher aBMD compared to those without T2DM. There was no significant difference in TBS. However, FPG, HbA1c and HOMA-IR levels were significantly inversely correlated with TBS after adjusting for age, BMI and aBMD. Multivariate linear regression analyses revealed that glycemic indices (FPG and HbA1c) were significantly associated with increased aBMD and decreased TBS, and that HOMA-IR was associated only with TBS. These associations did not change after further adjusting for bone turnover makers and pentosidine levels. Conclusions Hyperglycemia and elevated insulin-resistance were associated with low TBS independently of bone turnover and pentosidine levels. [ABSTRACT FROM AUTHOR]

Background: Tooth loss induces changes to the anatomy of the oral cavity. We hypothesized that tooth loss may disturb smooth swallowing in healthy elderly people. The purpose of this study was to investigate the effect of tooth loss on the development of swallowing problems in an independent elderly population.Methods: This was a 5-year prospective cohort study conducted in Nara, Japan. Included in this analysis were 1,988 community residents aged 65 years or older without swallowing problems at baseline. The participants were classified into quartile groups according to the number of remaining teeth at the baseline survey: 0-12, 13-22, 23-26, and 27-32 teeth. A decrease in the number of teeth during the survey was calculated by subtracting follow-up number from baseline number. Main outcome was the development of swallowing problems at follow-up.Results: During follow-up, 312 individuals developed swallowing problems. After adjustment for confounding factors by multiple logistic regression analysis, the odds ratios for developing swallowing problems in participants with 13-22 or 0-12 teeth were 2.42 (95% confidence interval [CI], 1.61-3.63) and 2.49 (95% CI, 1.68-3.69), respectively, compared to participants with 27-32 teeth, demonstrating a significant relationship. The odds ratio of per 1 tooth decrease over 5 years was 1.08 (95% CI, 1.02-1.13), showing a significant association.Conclusions: Swallowing problems due to aging are more likely to develop in individuals with fewer teeth. [ABSTRACT FROM AUTHOR]

Aim The present study investigated whether physical performance and musculoskeletal pain ( MSP) are associated with self-perceived hearing handicap ( HH) among high-functioning older adults. Methods We analyzed a total of 3982 community-dwelling high-functioning older adults (age 65 years and older). HH was assessed using the Hearing Handicap Inventory for Elderly- Screening. Self-reported hearing impairment ( HI) was evaluated using a single question. We measured handgrip strength, walking speed ( WS) and standing balance for assessments of physical performance. The severity of MSP assessed by interviews took into account its duration, limitation of daily activity and frequency. Results The prevalence of HH and HI in our sample was 22.2% and 28.1%, respectively. After adjusting for other two physical performance measures, MSP, sex, age, education, marital status, risk factors for hearing loss, instrumental activity of daily living, depression, cognitive function and self-reported HI, the odds ratios for HH in the second fastest, the second slowest, and the slowest WS quartile were 1.14 (95% CI = 0.81-1.58), 1.29 (95% CI = 0.92-1.79), and 1.58 (95% CI = 1.11-2.23), respectively, compared with the fastest WS quartile. A significant dose-response relationship was found between slower WS and HH ( P for trend = 0.01). No significant association with HH was found in handgrip strength, standing balance and MSP. Conclusion WS is associated with self-perceived HH in high-functioning older adults. The present study suggests that exercise programs to improve walking ability might be effective in preventing HH of self-sustainable older adults. Geriatr Gerontol Int 2015; 15: 745-754. [ABSTRACT FROM AUTHOR]

The Postoperative Quality of Recovery Scale (PQRS) is a multi-domain tracking scale to assess recovery after surgery. The PQRS is used in seven countries and five languages; however, the Japanese version of the PQRS (PQRSj) has not been established. We therefore translated the PQRS into Japanese, and examined the feasibility, reliability and validity of the PQRSj. The time taken to complete the test was measured to assess feasibility. Cronbach's alpha was calculated to assess reliability. The Mini Mental State Examination (MMSE) and the Japanese version of the Quality of Recovery Scale 40 (QoR-40 J) were performed for comparison with the PQRSj (validity). Fifty-one patients were enrolled in the study. The mean completion time was 3.9 min for baseline (feasibility). Cronbach's alpha was between 0.40 and 0.94 in each domain (reliability). A relationship was shown between cognitive domain and MMSE at baseline ( r = 0.65, P < 0.01); however, no relationship was found between the other domains and the MMSE and QoR-40 J. Ceiling effects were observed in 78 % of the questions. These results indicate that the PQRSj can be used to assess recovery after surgery, although it may be better to revise some of the questions to improve the validity of the PQRSj. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate non-urological cancer risks associated with benzidine (BZ) and beta-naphthylamine (BNA), a historical cohort study was undertaken. Methods: A total of 224 male workers exposed to BZ/BNA from a single factory were followed from 1953 to 2011. To estimate BZ/BNA exposure dose, duration of exposure (DOE) was defined as duration of employment between 1953 and 1972, the period when BZ and BNA were produced and used at this factory. Subjects were dichotomized (into long- and short-term groups) based on the median of DOE. Cancer-specific standardized incidence ratios (SIRs) were calculated using national and regional incidence rates as reference. Smoking history was obtained through questionnaires and other sources. Association between lung cancer (LC) or bladder cancer (BC) incidence and DOE was assessed using Cox's proportional hazards model. Results: Vital status follow-up was successful for 216 (96.4 %). Follow-up duration averaged 44.0 (SD 10.7) years. Increased SIRs based on national rates were found for all cancers (81 cases, SIR = 1.58, 95 % CI 1.26-1.98), LC (18 cases, SIR = 2.58, 95 % CI 1.53-4.07), and BC (7 cases, SIR = 4.70, 95 % CI 1.89-9.67). Among workers with >20 years after first exposure, the SIR for LC was statistically elevated in the long DOE group (15 cases, SIR = 3.34, 95 % CI 1.87-5.51). After adjustment for smoking, exposure to bis(chloromethyl) ether, and age at first exposure, a marginally significant hazard ratio (HR) was observed for the long DOE group (adjusted HR = 3.02, 95 % CI 0.84-10.93, p = 0.091), compared to the short DOE group. DOE did not affect BC incidence. Conclusions: This study confirms the high risk of LC besides BC, suggesting that BZ/BNA have the potential to cause LC. [ABSTRACT FROM AUTHOR]

Epidemiologic data have demonstrated associations of sleep-onset insomnia with a variety of diseases, including depression, dementia, diabetes and cardiovascular diseases. Sleep initiation is controlled by the suprachiasmatic nucleus of the hypothalamus and endogenous melatonin, both of which are influenced by environmental light. Exposure to evening light is hypothesized to cause circadian phase delay and melatonin suppression before bedtime, resulting in circadian misalignment and sleep-onset insomnia; however, whether exposure to evening light disturbs sleep initiation in home settings remains unclear. In this longitudinal analysis of 192 elderly individuals (mean age: 69.9 years), we measured evening light exposure and sleep-onset latency for 4 days using a wrist actigraph incorporating a light meter and an accelerometer. Mixed-effect linear regression analysis for repeated measurements was used to evaluate the effect of evening light exposure on subsequent sleep-onset latency. The median intensity of evening light exposure and the median sleep-onset latency were 27.3 lux (interquartile range, 17.9-43.4) and 17 min (interquartile range, 7-33), respectively. Univariate models showed significant associations between sleep-onset latency and age, gender, daytime physical activity, in-bed time, day length and average intensity of evening and nighttime light exposures. In a multivariate model, log-transformed average intensity of evening light exposure was significantly associated with log-transformed sleep-onset latency independent of the former potential confounding factors (regression coefficient, 0.133; 95% CI, 0.020-0.247; p = 0.021). Day length and nighttime light exposure were also significantly associated with log-transformed sleep-onset latency ( p = 0.001 and p < 0.001, respectively). In conclusion, exposure to evening light in home setting prolongs subsequent sleep-onset latency in the elderly. [ABSTRACT FROM AUTHOR]

Abstract: End-stage renal failure deteriorates bone mass and increases fracture risk. However, there are conflicting reports in the literature regarding the effects of mild to moderate renal dysfunction on bone mineral density (BMD). We investigated the association between renal function and BMD at the spine and hip and bone metabolism markers in community-dwelling elderly Japanese men. From 2174 male volunteers aged ≥65years, we examined 1477 men after excluding those with diseases or medications known to affect bone metabolism. Renal function was assessed by serum cystatin C and estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease Study equation. Bone metabolism was evaluated using levels of serum amino-terminal propeptide of type I procollagen (PINP) and tartrate-resistant acid phosphatase isoenzyme 5b (TRACP-5b), which represent bone metabolic status independent of renal function. eGFR was inversely associated with BMD after adjusting for potential confounders (P<0.01). Cystatin C showed a weaker but significant association with BMD. eGFR was modestly positively associated with PINP levels (P=0.04), although cystatin C concentrations were neither associated with PINP nor TRACP-5b levels. Since BMD integrates bone metabolism from the past to present, inverse associations between renal function and BMD may be attributed to past factors, such as obesity. Our findings suggest that low renal function does not affect bone metabolism in a population of community-dwelling elderly Japanese men. Longitudinal studies will be necessary to clarify whether low renal function affects bone loss. [Copyright &y& Elsevier]

Purpose: Little is known about the usefulness of the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and a single question (SQ) in assessing hearing impairment (HI) and the impact of HI on quality of life (QOL). The objective of this study was to examine the reliability, validity, and associations with QOL measures (i.e., subjective well-being, depressive symptoms, subjective loneliness, and physical functioning) of the HHIE-S and the SQ in the elderly community. Methods: A self-report questionnaire including HHIE-S, SQ, Philadelphia Geriatric Center Morale Scale, Geriatric Depression Scale, UCLA Loneliness Scale, and the Tokyo Metropolitan Institute of Gerontology Index of Competence was administered to community elderly (781 males and 950 females). Among them, 97 males and 100 females also responded voluntarily to a request for test-retest and auditory tests. The criterion validity was tested by using pure-tone averages. Results: Regarding the reliability of HHIE-S, Cronbach's alpha coefficient was 0.91, Spearman-Brown coefficient was 0.90, and intra-class correlation coefficient was 0.85. Regarding the test-retest reliability of SQ, kappa coefficient was 0.65. HHIE-S had significantly lower sensitivity in identifying >25-dB HI, but significantly higher specificity for the detection of >40-dB HI than SQ. HHIE-S had stronger associations with QOL measures than did SQ. Conclusions: HHIE-S had high reliability, while SQ had insufficient reliability. HHIE-S was more specific in detecting HI and more sensitive in assessing the impact of HI on QOL than SQ. HHIE-S is a more effective instrument for assessing HI and QOL research than SQ in the elderly community. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk factors for new-onset overactive bladder (OAB) in older subjects. Methods: The present study enrolled 4427 subjects aged ≥65 years who had participated in the Fujiwara-kyo study. The prevalence of OAB at baseline and 1 year later was evaluated using the OAB symptom score questionnaire. The incidence and remission rate of OAB were calculated. We identified the risk factors for OAB by evaluating the difference in characteristics (including sex, age, body mass index, life style, comorbidities, depressive status, metabolic syndrome, and sum of voiding symptoms) between those with and without new-onset OAB. In addition, the independent risk factors were determined by multivariate analysis. Results: Of the 4427 subjects, 3685 completely replied to the self-administrated questionnaires at baseline and 1 year later. The incidence and remission rate of OAB was 11.9% and 29.8%, respectively. The male/female ratio, sum of voiding symptoms, alcohol consumption and smoking, hypertension, and depressive status in subjects with new-onset OAB, were significantly greater than those in subjects without new-onset OAB. A multivariate analysis, including sex (odds ratio 2.0, P < .0001), sum of voiding symptoms (odds ratio 1.1, P < .0001), and depressive status (odds ratio 1.8, P < .0001) were independent factors for new-onset OAB in older subjects. Conclusion: The results of the present study have demonstrated that male sex, the sum of voiding symptoms, and depression were independent factors for new-onset OAB. It is necessary to determine whether the treatment of patients with voiding symptoms or depression controls for new-onset OAB. [ABSTRACT FROM AUTHOR]

Abstract: There are no data concerning a relationship between alcohol and bone status from a large-scale community-based study of elderly Japanese men. The baseline survey for the Fujiwara-kyo Osteoporosis Risk in Men Study was performed in 2174 male participants during the period from 2007 to 2008 in Nara Prefecture, Japan. Among them 1665 fitted the following inclusion criteria: (a) age ≥65years, (b) no diseases or drug therapy that could affect bone mineral density (BMD). We analyzed 1421 men with complete information about alcohol intake. We found that alcohol intake and BMD were positively correlated after adjustment for age, body mass index, natto intake, milk intake, smoking, physical activity, education, marital status, and hypertension. Adjusted total hip BMD of men with alcohol intake >39g/day was 0.90g/cm2 and that of abstainers was 0.85g/cm2. With regard to bone turnover markers, alcohol intake was inversely associated with serum levels of osteocalcin and tartrate-resistant acid phosphatase isoenzyme 5b. A two-piece linear regression model revealed a positive relationship between alcohol intake and crude mean BMD for the total hip in those with alcohol intake of less than 55g/day. In contrast, alcohol intake and BMD in those with an alcohol intake of 55g/day or more was inversely correlated. The present large-scale study of elderly Japanese men revealed that although an alcohol intake of <55g/day was positively correlated to BMD, alcohol intake of ≥55g/day was inversely correlated to BMD. [Copyright &y& Elsevier]

Abstract: Background: α-Klotho (αKl) regulates mineral metabolism such as calcium ion (Ca2+) and inorganic phosphate (Pi) in circulation. Defects in mice result in clinical features resembling disorders found in human aging. Although the importance of transmembrane-type αKl has been demonstrated, less is known regarding the physiological importance of soluble-type αKl (sαKl) in circulation. Objectives: The aims of this study were: (1) to establish a sandwich ELISA system enabling detection of circulating serum sαKl, and (2) to determine reference values for sαKl serum levels and relationship to indices of renal function, mineral metabolism, age and sex in healthy subjects. Results: We successively developed an ELISA to measure serum sαKl in healthy volunteers (n =142, males 66) of ages (61.1±18.5year). The levels (mean±SD) in these healthy control adults were as follows: total calcium (Ca; 9.46±0.41mg/dL), Pi (3.63±0.51mg/dL), blood urea nitrogen (BUN; 15.7±4.3mg/dL), creatinine (Cre; 0.69±0.14mg/dL), 1,25 dihydroxyvitamin D (1,25(OH)2D; 54.8±17.7pg/mL), intact parathyroid hormone (iPTH; 49.2±20.6pg/mL), calcitonin (26.0±12.3pg/mL) and intact fibroblast growth factor (FGF23; 43.8±17.6pg/mL). Serum levels of sαKl ranged from 239 to 1266pg/mL (mean±SD; 562±146pg/mL) in normal adults. Although sαKl levels were not modified by gender or indices of mineral metabolism, sαKl levels were inversely related to Cre and age. However, sαKl levels in normal children (n =39, males 23, mean±SD; 7.1±4.8years) were significantly higher (mean±SD; 952±282pg/mL) than those in adults (mean±SD; 562±146, P <0.001). A multivariate linear regression analysis including children and adults in this study demonstrated that sαKl correlated negatively with age and Ca, and positively with Pi. Finally, we measured a serum sαKl from a patient with severe tumoral calcinosis derived from a homozygous missense mutation of α-klotho gene. In this patient, sαKl level was notably lower than those of age-matched controls. Conclusion: We established a detection system to measure human serum sαKl for the first time. Age, Ca and Pi seem to influence serum sαKl levels in a normal population. This detection system should be an excellent tool for investigating sαKl functions in mineral metabolism. [Copyright &y& Elsevier]

Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors. Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models. We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests. Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men. • Slow walking speed increases the risk of osteoporotic fracture (OPF). • Neither poor balance nor muscle strength increases the risk of OPF. • Combination of slow walking speed and poor balance or muscle strength is associated with a higher OPF risk. [ABSTRACT FROM AUTHOR]

Cross-sectional studies have shown that patients with type 2 diabetes mellitus (T2DM) have low circulating levels of osteocalcin (OC) and undercarboxylated OC (ucOC). This longitudinal study aimed to examine whether low OC or ucOC levels at baseline are associated with the risk of incident T2DM. We examined 1700 community-dwelling Japanese men (≥65 years) after excluding those with history of diseases (other than T2DM) or medications that affect bone and glucose metabolism. T2DM was defined as fasting plasma glucose (FPG) ≥126 mg/dl or glycated hemoglobin A 1c (HbA1c) ≥6.5%. Participants without prevalent T2DM at baseline were invited to follow-up surveys 5 and 10 years after baseline. Among the participants, 309 with prevalent T2DM showed significantly lower serum OC and ucOC levels at baseline than those without. After excluding these participants, 46 and 57 participants with incident T2DM were identified in the first and second follow-up surveys, respectively. These participants did not show significantly different OC and ucOC levels at baseline relative to those without T2DM, although their FPG and HbA1c levels at baseline were significantly higher compared to those without incident T2DM. Increase in glycemic indices preceded decrease in OC and ucOC levels. OC and ucOC levels at baseline were not significantly associated with the risk of incident T2DM identified in the follow-up surveys. OC and ucOC levels at baseline were not significantly associated with the risk of incident T2DM. Our results do not support the findings of animal studies that ucOC is a hormone regulating glucose metabolism. • Patients with diabetes mellitus (DM) have low circulating osteocalcin (OC) levels. • Increase in glycemic indices preceded decrease in OC levels in patients with DM. • OC levels at baseline were not associated with subsequent risk of incident DM. • These results do not support findings in mice that OC regulates glucose metabolism. [ABSTRACT FROM AUTHOR]

The association between serum concentrations of uric acid (UA), a potent endogenous antioxidant, and fracture risk has not yet been examined for morphometric vertebral fracture (VF). This study aimed to determine whether serum UA concentrations are associated with risks of clinical osteoporotic fracture (OPF) and morphometric VF after adjusting for confounding factors including UA-lowering medications (ULMs). A total of 2012 Japanese men aged ≥65 years completed the baseline study, which included serum UA measurement and X-ray absorptiometry-based VF assessment. We conducted a follow-up study five years later to identify incident OPFs and VFs. OPF was identified through interviews. Incident VF was defined as a vertebra which showed reduction in any of its anterior, central, or posterior heights by ≥20% during follow-up, and satisfied grade one or higher fracture criteria in Genant's method on follow-up images. Bone mineral density (BMD) of the hip and spine was measured by dual-energy X-ray absorptiometry at baseline and follow-up. We identified 45 clinical OPFs from 2000 men and 39 VFs from 1530 men during a mean follow-up period of 4.3 years. Hip BMD was significantly higher in higher UA concentration groups after adjusting for age and body mass index. A significantly decreased multivariate-adjusted odds ratio (OR) of incident VF was observed for the highest quartile groups of serum UA concentrations compared with the lowest quartile group (OR: 0.17, 95% confidence interval: 0.05–0.62). This OR remained significant after further adjusting for ULM use. ULM users in the lowest quartile group of serum UA concentrations had a significantly higher incidence rate of VF compared to the other quartile groups. Higher serum UA concentrations were associated with a lower risk of morphometric VF independently of ULM in Japanese elderly men. Excessive reduction of serum UA concentrations by ULM might increase VF risk. • No study has examined the association between serum uric acid (UA) levels and morphometric vertebral fracture (VF) risk. • Elderly Japanese men with higher serum UA levels had lower VF risk independently of UA-lowering medications (ULMs). • ULM users in the lowest quartile of serum UA levels had a significantly higher VF incidence rate compared to higher groups. • Excessive reduction of serum UA concentrations by ULM might elevate VF risk. [ABSTRACT FROM AUTHOR]

Aim As the Japanese population ages, the number of older patients with chronic obstructive pulmonary disease (COPD) is expected to increase, but the prevalence of COPD in patients aged ≥80 years remains unclear. The purpose of the present study was to determine the prevalence of COPD in independent community-dwelling older adults aged ≥80 years. Methods We investigated the prevalence of COPD in 2862 independent community-dwelling older adults (1504 men, 1358 women, mean age 77.7 ± 7.0 years) who underwent spirometry in the Fujiwara-kyo study, a study of successful aging in older adults. Those participants with airflow limitation (forced expiratory volume in 1 s/forced vital capacity <0.7) who indicated on a self-administered questionnaire that they had a history of smoking and did not have bronchial asthma were considered to have COPD. Results The prevalence of COPD was 16.9% among all participants and 37.4% among smokers. The prevalence among individuals aged ≥80 years (19.7%) was significantly higher than that among those aged <80 years (16.0%; P < 0.05). When forced expiratory volume in 1 s/forced vital capacity lower limit of normal was used as the criterion for airflow limitation, the prevalence fell to 11.0%. Patients with mild-to-moderate airflow limitation (stage I/stage II) accounted for the great majority (91.2%) of COPD patients aged ≥80 years. Conclusions A high prevalence of mild-to-moderate COPD was observed even in the independent community-dwelling older adults aged ≥80 years. However, the benefits of the spirometric screening and treatment for these patients needs to be determined. Geriatr Gerontol Int 2017; 17: 2421-2426. [ABSTRACT FROM AUTHOR]