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Aim: Grip strength (GS) as a surrogate for muscular strength, waist circumference (WC) as a surrogate marker of visceral fat, and body mass index (BMI) as a surrogate marker of obesity should also be considered markers for the management of risks associated with type 2 diabetes mellitus (T2DM). However, in terms of the management of T2DM in elderly patients, the accentuated heterogeneity of sarcopenic change might modify the associations between those factors and glycemic control. In this cross-sectional study, we aimed to clarify the impact of GS, WC, and BMI on hemoglobin A1c (HbA1c) in elderly Japanese patients with T2DM. Methods: GS, WC, and BMI were measured in 327 patients. Odds ratios (ORs) and 95% confidence intervals (CIs) for good glycemic control (HbA1c < 7.0%) were investigated to analyze the three variables as numerical values by dividing them into tertiles. All results were expressed after adjustment was made for the confounders of age, sex, and number of diabetes medications being used by the study participants. Results: The ORs of GS, WC, and BMI for well-controlled HbA1c were 1.056 (95% CI, 1.016-1.098), 0.986 (95% CI, 0.960-1.013), and 1.032 (95% CI, 0.959-1.111), respectively. The OR of 3.726 (95% CI, 1.831-7.581) in the high tertile for GS was significantly higher than the OR in the low tertile, and no differences were observed among the tertiles for WC and BMI. Conclusions: Based on that result, GS was found to have more potential as an effective marker of glycemic control than WC or BMI among elderly Japanese patients with T2DM. [ABSTRACT FROM AUTHOR]

Aim: To clarify the association between constipation, diarrhea, and long‐term laxative use in Japanese nursing home residents. Methods: Data from 306 residents with chronic constipation aged over 75 years for basic characteristics, medication use, activities of daily living, and concurrent illness were collected via two consecutive 6‐monthly surveys conducted using the Japanese interRAI assessment tool. We used bivariate and multivariate analyses to examine the associations between chronic constipation, diarrhea, and continuous laxative use. Results: Chronic constipation persisted in 74.5% of residents despite their continuous use of laxatives. Additionally, 14.4% experienced chronic diarrhea while on laxatives. Residents using salt laxatives had significantly lower chronic constipation than those not using salt laxatives (adjusted odds ratio [AOR] 0.52), while residents using novel laxatives had significantly higher chronic diarrhea than those not using novel laxatives (AOR 4.28). Conclusions: Our findings reveal that bowel movement‐related problems remain a concern and highlight the need for further research on the use of novel laxatives in nursing home residents. Geriatr Gerontol Int 2024; 24: 133–139. [ABSTRACT FROM AUTHOR]

Aim: The gut microbiota has emerged as a new intervention target for sarcopenia. Prior studies in humans have focused on the association between gut microbiota and skeletal muscle quantity, while the evidence on muscle function and quality is lacking. This study aimed to identify gut microbiota genera associated with skeletal muscle function, quantity, and quality in a general population of Japanese adults. Methods: This cross‐sectional study included 164 participants aged 35–80 years, women and men recruited from urban areas of Japan. Fecal samples were collected and analyzed using 16S rRNA gene amplicon sequencing. Skeletal muscle function was measured using handgrip strength and leg extension power (LEP), while skeletal muscle mass was estimated using bioelectrical impedance analysis. Phase angle was used as a measure of skeletal muscle quality. Multivariate linear regression analysis stratified by age group was used to examine the association between the dominant genera of the gut microbiota and skeletal muscle variables. Results: A significant association was found between Bacteroides and Prevotella 9 with LEP only in the ≥60 years group. When both Bacteroides and Prevotella 9 were included in the same regression model, only Bacteroides remained consistently and significantly associated with LEP. No significant associations were observed between skeletal muscle mass, handgrip strength, and phase angle and major gut microbiota genera. Conclusions: In this study, we observed a significant positive association between Bacteroides and leg muscle function in older adults. Further studies are required to elucidate the underlying mechanisms linking Bacteroides to lower‐extremity muscle function. Geriatr Gerontol Int 2024; 24: 53–60. [ABSTRACT FROM AUTHOR]

Aim: Although studies have analyzed the relationship between frailty and human senses, few have comprehensively evaluated and examined their correlations. This study aimed to clarify the relationship between frailty and the senses of sight, hearing, smell, and taste. Methods: The subjects were outpatients at the Locomo Frail Outpatient Clinic. Sensory organ items were evaluated subjectively, and frailty was classified as nonfrail or frail using the Kihon Checklist. Univariate analysis was performed using the presence or absence of frailty as the dependent variable. Logistic regression analysis (forced entry method) was performed for the variables that showed significant differences. Results: A total of 269 and 226 participants were assigned to the nonfrail and frail groups, respectively. The frequency of sensory organ impairment was 10.1% for taste, 12.7% for smell, 44.6% for vision, and 58.3% for hearing. Univariate analysis using the presence or absence of frailty as the dependent variable was determined to be significant for years of education, number of medications, Geriatric Depression Scale, Mini‐Mental State Examination, Mini Nutritional Assessment–Short Form, grip strength, gait speed, sense of taste, sense of smell, sense of vision, and sense of hearing. Logistic regression analysis using the presence or absence of frailty as the dependent variable, adjusted for age, showed significant correlations with the Geriatric Depression Scale, gait speed, Mini Nutritional Assessment–Short Form, and olfactory impairment. Conclusions: Olfactory impairment had the strongest correlation with frailty. Although the sense of smell decreases with disease and aging, olfactory impairment may be correlated with frailty as a symptom of neurodegenerative diseases. Geriatr Gerontol Int 2023; 23: 871–876. [ABSTRACT FROM AUTHOR]

Aim: To assess the validity of self-reported articulatory oral motor skill against objectively measured repetitive articulatory rate (oral diadochokinesis [oral-DDK]) as a gold standard index for articulatory oral motor skill in community-dwelling older Japanese adults. Methods: This cross-sectional study included 607 Japanese adults (mean age = 73.9 years). A single-item self-report questionnaire for articulatory oral motor skill was developed. Study participants completed a 1-month-interval test-retest protocol to assess reliability of the questionnaire, and the protocol was tested by the kappa statistic. Oral-DDK with/ta/(i.e., the number of repetitions of the monosyllable/ta/per second) was measured during the on-site examination. Low oral-DDK performance was defined as <5.2 times/s in men and <5.4 times/s in women. Oral-DDK performance, oral functions other than articulatory oral motor skill, and physical frailty were compared in the groups with and without self-reported low articulatory oral motor skill as determined by the response to the questionnaire. Results: Self-reported low articulatory oral motor skill was identified in 18.5% of the study population. The self-report questionnaire had good test-retest reliability, with a kappa statistic of 0.71. Self-reported low articulatory oral motor skill was significantly associated with a lower value of oral-DDK with/ta/and a higher proportion of low oral-DDK performance, difficulties in chewing and swallowing, dry mouth, and physical frailty. Self-report had high specificity (83.1%) but low sensitivity (42.1%) for detecting low oral-DDK performance. Conclusions: A single-item self-report questionnaire for articulatory oral motor skill had acceptable test-retest reliability and was associated with objectively measured articulatory oral motor skill. [ABSTRACT FROM AUTHOR]

Aim: The effects of statins on muscle health are not well established. Therefore, this study investigated the impact of statin use on muscle strength and mass recovery in patients with sarcopenia after stroke. Methods: This retrospective cohort study included stroke patients with sarcopenia hospitalized between 2015 and 2021 at a post‐acute rehabilitation hospital. Sarcopenia was diagnosed using handgrip strength and skeletal muscle mass index measured using bioelectrical impedance analysis according to the 2019 criteria of the Asian Working Group for Sarcopenia. The study outcomes included handgrip strength and skeletal muscle mass index at hospital discharge. We used multivariate analyses to examine whether statin use was independently associated with the outcomes. Statistical significance was set at P < 0.05. Results: Of the 586 patients enrolled, 241 (mean age 79.3 years, 44.4% men) presented with sarcopenia and were included in the analysis. Statin use was observed in 61 (25.3%) patients. Statin use was independently negatively associated with handgrip strength at discharge (β = −0.095, P = 0.032), but not with skeletal muscle mass index at discharge (β = 0.019, P = 0.692). Conclusions: Statin use was negatively associated with muscle strength recovery, but not with muscle mass in patients with sarcopenia who underwent rehabilitation after stroke. To maximize outcomes, sufficient consideration is needed for statin use in these patients. Geriatr Gerontol Int 2023; 23: 676–683. [ABSTRACT FROM AUTHOR]

The article explores the relationship between polypharmacy and renal function among elderly individuals. It discusses the number of medications influences renal health and emphasizes the implications for managing medication regimens in aging populations. It mentions the study originates from the Division of Geriatric and Community Medicine at Tohoku Medical and Pharmaceutical University in Sendai, Japan, authored by multiple researchers including Saki Nakayama, Yurika Hirota, and Yuiko Suzuki.

Aim: Housing structures differ according to the local culture, climate, and lifestyle, and these unique characteristics usually act as potential hazards for falls, trips, and slips. The purpose of this study was to identify environmental hazards in a Japanese house and their association with falls, trips, and slips among older people. Methods: A total of 97 older people aged ≥75 years were included in this cross‐sectional study. The number of environmental hazards was measured using a 46‐item tool designed specifically for this study, and the associations of environmental hazards with falls, trips, and slips were analyzed using univariate and multivariate logistic regressions. Results: All houses had at least one environmental hazard, and 3–30 environmental hazards were identified. Although the number of environmental hazards was not associated with falls experienced during the past 6 months, a greater number of environmental hazards at home was correlated with the daily experience of trips and slips (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.02–1.18). The association remained significant even after adjusting for demographic characteristics and other fall risk factors (OR: 1.11; 95% CI: 1.02–1.21). Conclusion: We found that Japanese housing structures had unique environmental hazards that might cause trips and slips in older people. Appropriate housing assessments and modifications may help to promote aging‐in‐place among older people. Geriatr Gerontol Int 2022; 22: 305–310. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the validity of the care‐needs levels classified in Japan's long‐term care insurance system (LTCI‐CNLs) when compared with patients' self‐perceived functioning, disability and physical performance among patients receiving home medical care. Methods: This was a multicenter cross‐sectional study in Japan. Patients who were receiving continuous home medical care and who could respond to the questionnaire were enrolled in this study. In addition to the LTCI‐CNLs, the 12‐item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the SARC‐F were used to measure functioning, disability and physical performance (sarcopenia). In addition, correlations and associations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were analyzed using Spearman correlations and linear mixed models. Results: Data from 181 patients were included in the analyses. The LTCI‐CNLs varied, ranging from support level 1 (5.5%) to care‐needs level 5 (10.5%), with care‐needs level 2 being the most prevalent (24.9%). Moderate correlations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were found (ρ = 0.58 and 0.44, respectively). Although WHODAS 2.0 and SARC‐F scores varied within each LTCI‐CNL, predicted WHODAS 2.0 and SARC‐F scores increased as LTCI‐CNL increased. Dementia was not associated with WHODAS 2.0 or SARC‐F. Conclusions: The LTCI‐CNLs was associated with self‐reported functioning, disability and physical performance among home medical care patients. Future studies can use the LTCI‐CNLs as an outcome variable for specific care approaches or as a proxy covariate for casemix status. Geriatr Gerontol Int 2021; 21: 229–237. [ABSTRACT FROM AUTHOR]

The article focuses on assessing handgrip strength in older Japanese adults using a simple question about their ability to open polyethylene terephthalate (PET) bottle caps. It aims to determine if this question can accurately predict handgrip strength, offering a practical screening tool for identifying decreased muscle strength, especially in settings without specialized equipment.

The article discusses a 2022 study in Japan on the serological response induced by two doses of the BNT162b2 mRNA vaccine between long-term care facilities (LTCF) residents and healthcare workers (HCW). Results suggest that LTCF residents are immunocompromised by factors like aging, comorbidity, and malnutrition, and that they should be included for a third booster vaccine. Also noted are the study's limitations.

Aim: We evaluated several sarcopenia‐related hormones, cytokines and uremic toxins to identify the humoral factors associated with sarcopenia and frailty in Japanese hemodialysis patients. Methods: Twenty Japanese patients aged ≥65 years who underwent maintenance hemodialysis therapy at Uonuma Kikan Hospital for more than 6 months were included in this retrospective cross‐sectional study. Clinical data, including physical function and mental state, were obtained from the clinical records collected during the regular evaluation at the beginning of each hemodialysis therapy session, 3 days after the previous hemodialysis therapy. The diagnosis of sarcopenia and frailty was based on the Asian Working Group for Sarcopenia 2019 and the Japanese version of the Cardiovascular Health Study, respectively. The mental state of patients was evaluated using the Japanese version of the Patient Health Questionnaire 9 (J‐PHQ‐9). Results: In univariate analyses, plasma brain‐derived neurotrophic factor (BDNF) levels were significantly lower in patients with severe sarcopenia and frailty. The plasma BDNF concentration was correlated with muscle strength and physical performances, such as the 6‐m walk test, Short Physical Performance Battery and 5‐time chair stand test. BDNF was also correlated with body weight, hemodialysis vintage, and serum levels of total protein and indoxyl sulfate but not with body mass index, appendicular skeletal muscle mass, serum interleukin 6 levels, or J‐PHQ‐9 scores. The odds ratio per 100 pg/mL of BDNF for the prevalence of frailty was 0.353. Conclusions: BDNF is associated with decreased physical performance and the prevalence of severe sarcopenia and frailty in Japanese maintenance hemodialysis patients. Geriatr Gerontol Int 2021; 21: 27–33. [ABSTRACT FROM AUTHOR]

Aim: Although various neutrophilic immunosenescence mechanisms have been shown, there are few clinical studies on age‐related differences in leukocytosis against acute bacterial infections, including acute colonic diverticulitis. Methods: We performed a retrospective study of 26 patients ≥65 years old and 211 patients 16–64 years old who were hospitalized for acute colonic diverticulitis at Toho University Medical Center Omori Hospital between 2010 and 2016. We compared patients' characteristics, including sex, immunocompromised status, diverticulitis site, complications, severity, previous diverticulitis, vital signs, leukocyte counts, neutrophil‐to‐lymphocyte ratio and serum C‐reactive protein on admission. To adjust for confounding factors, we performed a logistic regression analysis. Results: Univariate comparisons showed that leukocyte count (older: 10 850 [interquartile range, 9400–12 000]/mm3 vs. younger: 12 600 [interquartile range, 10 500–15 000]/mm3, P = 0.004) and prevalence of leukocytosis (leukocytes >11 000/mm3) were lower in older compared with younger patients. There were significantly more female, left‐sided diverticulitis and immunocompromised patients in the older compared with the younger group. Logistic regression showed that leukocyte count, prevalence of female patients, and left‐sided diverticulitis were independent predictors for the older patients: Their odds ratios were 0.866 (95% confidence interval [95% CI] 0.753–0.996), 2.631 (95% CI, 1.032–6.707) and 5.810 (95% CI, 2.328–14.497), respectively. Conclusion: Caution should be taken when managing older patients with colonic diverticulitis because reactive leukocytosis might be poor, possibly reflecting immunosenescence. Geriatr Gerontol Int 2020; 20: 951–955. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to clarify the relationship between cognitive function and the serum albumin/globulin ratio (A/G ratio) in community‐dwelling Japanese older adults. Methods: Randomly extracted residents in both urban and rural parts of Japan were enrolled in this study. A total of 1827 participants with a mean age of 70 or 80 years were recruited. A venue survey method was carried out with comprehensive studies, including interviews, blood collection, physical examination and cognitive function tests. Results: Univariate analysis showed a significant positive correlation between the total Japanese version of the Montreal Cognitive Assessment score and the serum A/G ratio at the age of 70 and 80 years, in which better cognitive function was associated with a high serum A/G ratio. Multiple regression analysis with the total Japanese version of the Montreal Cognitive Assessment score as the dependent variable showed that the serum albumin level, serum globulin level, serum A/G ratio, C‐reactive protein, years of formal education and sex were related to the Japanese version of the Montreal Cognitive Assessment total score at the age of 70 years, and that the serum albumin level, serum globulin level, serum A/G ratio, C‐reactive protein, years of formal education and stroke were related at the age of 80 years. The serum A/G ratio showed a better correlation than the serum globulin levels at the age of 70 and 80 years (70 years: β = 0.131 vs –0.111, 80 years: β = 0.108 vs –0.071). Conclusions: We found a correlation between cognitive function and the serum A/G ratio in community‐dwelling older people, suggesting that nutritional status and chronic inflammation might influence cognitive function. Geriatr Gerontol Int 2019; 19: 967–971. [ABSTRACT FROM AUTHOR]

Aim: The use of problem lists is encouraged to overcome the inconsistency in reporting comprehensive geriatric assessment results. The present study aimed to identify the latent variables influencing the use of geriatrician problem lists. Methods: Surveys were sent to all geriatricians registered with the Japan Geriatrics Society (n = 1439) as of November 2015, and responses (n = 204) were analyzed with univariate and exploratory factor analyses. To account for active, inactive and tentative items, the survey addressed "disease," "symptom" and "condition" separately. Results: Most geriatricians (34.8%) composed problem lists for interdisciplinary information sharing. Nearly half of the respondents (46.6%) created problem lists for every patient. Information omissions were mainly due to the exclusion of information from other specialties (26% for omitted diseases and 12.3% for omitted symptoms), lack of time (25.5% for omitted diseases, 22.1% for omitted symptoms and 26.5% for omitted conditions), and lack of standardization of terminologies regarding observed diseases, symptoms and conditions (12.3% for omitted diseases, 19.6% for omitted symptoms and 16.7% for omitted conditions). An exploratory factor analysis, based on 20 predefined symptoms and conditions that are frequently omitted from problem lists, showed that considering the symptom "geriatric syndromes" and the condition "assistance needs in medication management" are crucial for improving problem list comprehensiveness. Conclusions: Geriatricians commonly use problem lists; however, there is considerable variation regarding the problems listed and their relationships. The listings of "geriatric syndrome" and "assistance needs in medication management" are crucial for improving problem list comprehensiveness. Geriatr Gerontol Int 2019; 19: 159–164. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to examine whether behavioral and psychological symptoms of dementia at the time of admission could be a predictor of falls in older people with dementia residing in geriatric health service facilities. Methods: Three geriatric health services facilities located in Fukushima Prefecture, Japan, were the targeted facilities. Of the 305 people admitted between May 2013 and November 2014, 242 (74 men, 168 women) who scored ≤20 points on the Hasegawa Dementia Scale‐Revised were targeted for analysis. A total of 15 items from the Long‐term Care Certification Questionnaire Group 4 were used to assess behavioral and psychological symptoms of dementia, and were compared by the presence or absence of falls. Results: Of the 242 participants, 153 were non‐fallers and 89 were fallers. After adjusting for sex, age, Revised Hasegawa Dementia Scale‐Revised, degree of care (which showed a significant relationship with falls in univariate analysis), activities of daily living and history of falls, the influence of behavioral and psychological symptoms of dementia on falls was examined, and showed a significant association with falls and a significant increase of hazard ratio for the behavioral symptoms "wandering" 2.23 (95% confidence interval 1.35–3.68) and "agitation" 1.94 (95% confidence interval 1.24–3.04). Conclusions: Because the risk of falling is high for residents who at the time of admission have the behavioral and psychological symptoms of dementia of "wandering" and "agitation," it is necessary to predict the possibility of falling at an early stage, monitor the residents and adjust the environment. Geriatr Gerontol Int 2018; 18: 1573–1577. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Polypharmacy, which is often observed in elderly patients, has been associated with several unfavorable outcomes, including an increased risk of potentially inappropriate medications, medication non‐adherence, drug duplication, drug–drug interactions, higher healthcare costs and adverse drug reactions. A significant association between polypharmacy and adverse outcomes among older people living in the community has also been confirmed. A reduction in the number of medications should thus be pursued for many older individuals. Nevertheless, the factors associated with polypharmacy in elderly home‐care patients have not been reported. Here, we investigated those factors in elderly home‐care patients in Japan. Methods: We used the data of the participants in the Observational Study of Nagoya Elderly with Home Medical investigation. Polypharmacy was defined as the current use of six or more different medications. We carried out univariate and multivariate logistic regression analyses to assess the associations between polypharmacy and each of several factors. Results: A total of 153 home‐care patients were registered. The mean number of medications used per patient was 5.9, and 51.5% of the patients belonged to the polypharmacy group. The multivariate model showed that the patients’ scores on the Charlson Comorbidity Index and the Mini‐Nutrition Assessment Short Form were inversely associated with polypharmacy, and potentially inappropriate medication was most strongly associated with polypharmacy (odds ratio 4.992). Conclusions: The present findings showed that polypharmacy was quite common among the elderly home‐care patients, and they suggest that home‐care physicians should prescribe fewer medications in accord with the deterioration of home‐care patients’ general condition. Geriatr Gerontol Int 2018; 18: 33–41. [ABSTRACT FROM AUTHOR]

The article focuses on the study of the association between locomotive syndrome (LS) and methotrexate (MTX) discontinuation due to adverse events in rheumatoid arthritis (RA) patients. It informs that LS is a condition of reduced mobility due to disorders of the musculoskeletal system. It notes that as RA causes cartilage degeneration, and destruction of bones and joint structure, RA patients are more likely to develop LS, and complications of RA, or RA drugs, are also expected to increase.

The article analyzes Japanese outpatients aged 65 years and above to investigate the ability of the QMCOO (Questionnaire for Medical Checkup of Old-Old) to identify physical frailty. It informs that the QMCOO, the standard procedure in the medical checkup of older Japanese adults in the latter stages of life, aims to evaluate the general health status of older adults. It concludes that the QMCOO had good screening ability for physical frailty among older Japanese outpatients.

Aims Dementia is closely connected with frailty, and these two conditions are common in older adults. However, the biological mechanism that causes frailty in patients with Alzheimer's disease (AD) is not fully understood. We determined whether oxidative stress and inflammatory mechanisms could be associated with physical frailty in patients with AD. Methods We studied 140 elderly outpatients with mild-to-moderate AD. Frailty status was determined according to the presence of the following five measurable characteristics: weight loss, exhaustion, low physical activity, slowness and weakness. We measured oxidative stress markers, including plasma levels of diacron reactive oxygen metabolite and biological anti-oxidant potential, endogenous plasma anti-oxidants, such as albumin, bilirubin and uric acid, and urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) and 8-epiPGF2α (8-isoprostane), and inflammatory markers, including interleukin-6 and tumor necrosis factor-α. Results Among patients, 44 (31%) were non-frail, 62 (44%) were prefrail and 34 (24%) were frail. Frail and prefrail patients were older, more likely to be women and had more comorbid medical conditions than non-frail patients. Frail or prefrail patients showed significantly higher diacron reactive oxygen metabolite and lower biological anti-oxidant potential levels, a significant decrease in bilirubin, a significant increase in urinary 8-OHdG and 8-isoprostane levels, and a significantly higher interleukin-6 level, in contrast to non-frail patients. Conclusions Physical frailty is common in old and female AD patients with comorbid medical diseases. The present results strongly suggest that oxidative stress and inflammation are involved in the pathophysiology of frailty status in individuals with AD. Geriatr Gerontol Int 2017; 17: 913-918. [ABSTRACT FROM AUTHOR]

Aim To examine whether posterior teeth occlusion is associated with functional dependence regardless of the number of natural teeth among Japanese nursing home residents. Methods The present cross-sectional study included 234 residents aged >60 years from eight nursing homes in Aso City, Japan. Functional dependence in basic activities of daily living was measured using the Barthel Index, and the primary outcome was independence for essential personal care (Barthel Index ≥ 60 points). Posterior teeth occlusion was assessed by a dentist using the total number of functional tooth units, depending on the number and location of the remaining natural and artificial teeth on implant-supported, fixed, and removable prostheses. Logistic regression models were used to assess univariate and multivariate associations between the total number of functional tooth units and independence for essential personal care. Models were sequentially adjusted for the number of natural teeth, demographic characteristics, socioeconomic status, health behaviors and comorbidities. Results Independence for essential personal care was found in 14.1% of participants. Greater total numbers of functional tooth units were significantly associated with greater odds of independence for essential personal care (odds ratio 1.12; 95% confidence interval 1.01-1.24). The association remained significant after adjustment for the number of natural teeth and other possible confounders (odds ratio 1.14, 95% confidence interval 1.01-1.29). Conclusions Posterior teeth occlusion was independently associated with functional dependence among nursing home older residents in Japan. The maintenance and restoration of posterior teeth occlusion might be preventive factors against late-life functional decline. Geriatr Gerontol Int 2017; 17: 622-627. [ABSTRACT FROM AUTHOR]

Aim To develop and validate a scale that assesses quality of life in patients receiving home-based medical care. Methods A new quality of life scale was developed and evaluated in four phases: (i) item generation; (ii) first field study with a 14-item questionnaire; (iii) preliminary validation study, to reduce the number of items to four; and (iv) second field study comprising 40 patients, to evaluate the validity of the final version. Participants were requested to answer both the final version of the scale and the Short Form-8, to enable identification of any relationship between the two. Results Items were generated after discussions with doctors and care managers, and 14 items were selected for the draft version. In the preliminary validation study, 10 items were deleted, based on the results of statistical analysis of the data from the first field study. A psychometric analysis showed that the final four-item questionnaire had internal consistency ( Cronbach's α = 0.7), and a significant association with the Short Form-8. Conclusions We created the first quality of life scale for patients receiving home-based medical care. The scale's internal consistency was confirmed, as well as its external validity. This scale can be used independently of factors such as a patient's age, sex, level of independence in the presence of dementia or disability, swallowing function, hearing ability and communication ability, and can be used with ease in routine clinical practice. Geriatr Gerontol Int 2017; 17: 440-448. [ABSTRACT FROM AUTHOR]

Aim To clarify whether the number of present teeth, independent of other well-known factors, was associated with the total bacterial count in the saliva of older people requiring care at nursing homes in a multicentered epidemiological survey. Method The participants were 618 older people (mean age 86.8 ± 6.9 years; 122 men, 496 women) residing in 14 nursing homes across Japan. The dependent variable was the participant's salivary bacterial count, and the independent variables were basic demographic data, oral conditions and activity of daily living (measured by Barthel Index). Statistical analysis was first carried out by Student's t-test, Pearson's correlation coefficient analysis and Spearman's rank correlation coefficient analysis. Independent variables found to have a significant relationship to their salivary bacterial count by the univariate analyses were further examined by stepwise multivariate analysis. Results The independent variables shown by univariate analysis to have a significant positive relationship with higher salivary bacterial count were presence of food residue ( P = 0.001), absence of mouth dryness ( P = 0.001), need of oral care assistance ( P = 0.001), inability to keep the mouth opened ( P = 0.009), inability to gargle ( P = 0.002), denture use ( P = 0.004), higher number of present teeth ( P = 0.006) and lower Barthel Index ( P = 0.001). Subsequent multivariate analysis identified presence of food residue ( P = 0.031), higher number of present teeth ( P = 0.043) and lower Barthel Index ( P = 0.001) as independent associated factors for higher salivary bacterial count. Conclusions The present study found that presence of food residue, higher number of present teeth and decreased activity of daily living were significantly related to higher bacterial count in the saliva of older people requiring care. Geriatr Gerontol Int 2017; 17: 219-225. [ABSTRACT FROM AUTHOR]

Aims To validate the Functional Independence and Difficulty Scale, a new instrument that assesses both independence and difficulty in carrying out basic activities of daily living. Methods First, we developed an item list for our construct through a literature review. Second, an expert panel evaluated the item list using the modified Delphi method. Third, to evaluate psychometric properties, a random sample of 593 community-dwelling older adults aged ≥ 65 years from Shiki City, Japan, was surveyed by mail. Results We developed an instrument comprising 14 items: getting up from bed, standing up from a chair, standing up from the floor, dressing, putting on pants, eating, cleaning after toileting, washing, brushing teeth, opening a PET bottle, cutting toenails, walking inside, walking outside and going up or down four to six steps. Function scores for basic activities of daily living ranged from 14-42, with higher scores representing better function. Internal consistency was acceptable ( Cronbach's alpha = 0.92). Spearman's partial correlation coefficients controlled for sex and age between the new assessment tool, and the Katz Index and Tokyo Metropolitan Institute of Gerontology Index of Competence were 0.81 ( P < 0.01) and 0.63 ( P < 0.01), respectively. Conclusions This new tool for assessment of the basic activities of daily living showed good internal consistency and validity. This assessment tool might be applicable in research and clinical practice to evaluate the basic activities of daily living of community-dwelling elderly Japanese people. Geriatr Gerontol Int 2016; 16: 1127-1137. [ABSTRACT FROM AUTHOR]

Aim The objective of the present study was to verify how socioeconomic and physical/mental health status would be associated with activity limitations by age and sex among older adults, using nationally representative cross-sectional data in Japan. Methods The present study focused on 8373 older adults aged 65 years or older extracted from the Comprehensive Survey of Living Conditions conducted in 2007 by the Japanese Ministry of Health, Labor and Welfare. Univariate and multiple logistic regression analyses and population-attributable risk were applied to validate the relationships of socioeconomic and physical/mental health status with activity limitations among the total population, and by age groups (young-old or old-old) and sex. Results Mental health showed the highest odds ratio and population-attributable risk in the total population. In addition, low back pain was associated with activity limitations regardless of age and sex. Other musculoskeletal diseases, such as arthropathy and osteoporosis, were related to activity limitations for women, regardless of age, whereas cardiovascular diseases, including angina pectoris/myocardial infarction and cerebral stroke, were associated with activity limitations for men in any age group. There were no statistically significant correlations between socioeconomic status and activity limitations in any groups. Conclusion Mental health was the most important factor of activity limitations in Japanese older adults. Furthermore, low back pain regardless of age and sex, other musculoskeletal diseases only for women and cardiovascular diseases mainly for men could also be significant risk factors to activity limitations. Therefore, preventive approaches of activity limitations considering sex differences are important for older adults in Japan. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]

Aim The present study investigated the risk factors for dysphagia among older adults who require long-term care, and also examined their systemic decrease in skeletal muscle mass. Methods We evaluated 399 people who required long-term care and who were residing in Omori town, Yokote city, Akita prefecture, Japan. We then analyzed data from 255 participants who had complete information available regarding their sex, age, case history (stroke, Parkinson's disease and dementia), Barthel Index, Skeletal Muscle Mass Index, oral function test and modified water swallowing test results. Participants' water swallowing test results were used to create groups with good or poor swallowing function, and a univariate analysis was carried out for each parameter. Parameters with a P-value of <0.25 in the univariate analysis were subsequently included in a multiple logistic regression model as explanatory variables, and good or poor swallowing function were defined as the dependent variables. Results After adjusting for age and sex, our analysis showed that poor tongue motility (odds ratio 17.23, 95% confidence interval 5.90-50.31, P < 0.001) and decreased Skeletal Muscle Mass Index (odds ratio 3.36, 95% confidence interval 1.41-7.99, P = 0.006) were significantly correlated with decreased swallowing function. Conclusions Decreased swallowing function was closely correlated with poor tongue motility, and this finding is similar to those of previous studies. However, the present results also show that decreased Skeletal Muscle Mass Index is a novel risk factor for dysphagia among older adults who require long-term care. Geriatr Gerontol Int 2015; 15: 1185-1192. [ABSTRACT FROM AUTHOR]

Aim To investigate the factors related to communications in home medical care settings, and the association between such factors and a patient's place of death. Methods A questionnaire survey of 295 families of patients who had previously received home medical care was carried out in June and July 2011. The response rate was 83.8% ( n = 227). Following the exclusion of families where the patient was still alive, or where the place of death was unknown, 143 questionnaires were available for analysis. Logistic regression was used to identify significant associations between possible factors related to communication and occurrence of home death. Results Home death was observed in 66.4% ( n = 95) of the families analyzed. Home death was significantly associated with the frequency of doctor home-visits per week ( OR 2.835, 95% CI 1.436-5.597, P = 0.003). There was no statistically significant association between home death and any of the other variables included: malignant tumors as primary disease, independence in daily activity, duration of home medical care, duration of doctor's visits, experience of doctor-patient communication without family, doctor-family communication without the patient or explanation from the doctor on the phone, existence of home-visit nursing services, existence of family's anxieties and/or questions, age of primary caregiver(s) and sex of primary caregiver(s). Conclusion The frequency of doctor home-visits was the only factor identified that was positively associated with the occurrence of home death in home medical care settings. Geriatr Gerontol Int 2015; 15: 465-471. [ABSTRACT FROM AUTHOR]

Aim The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia. Methods Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group ( n = 26) and the control group ( n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention. Results A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months ( P < 0.05). Conclusions The present study suggests that the educational program targeting oral function improvement is effective among the independent older population. Geriatr Gerontol Int 2015; 15: 481-489. [ABSTRACT FROM AUTHOR]

Aim We compared differences between laypeople and healthcare professionals in the recognition of and intent to use gastrostomy and ventilator treatments in older patients with dementia. Methods Between November 2011 and January 2012, a questionnaire survey was carried out. People who underwent a general health check-up at Nomura Hospital Preventive Medical Center were recruited as the laypeople group. Physicians and nurses working in Mitaka, Tokyo, Japan, were recruited as the healthcare professional group. We assessed the recognition rate of ventilator and gastrostomy treatments. Then we provided two scenarios for participants to determine whether these methods represented life-sustaining treatments that will simply delay an inevitable death. Intentions were compared between cases with and without advance directives. Results Approximately 60% of laypeople did not know what gastrostomy is. Healthcare professionals were more likely to recognize a ventilator as a life-sustaining treatment; in contrast, there were no significant differences in judgments regarding gastrostomy. Both groups were more likely to have intent to use a gastrostomy and a ventilator for family members than themselves. Furthermore, healthcare professionals were more likely to want to use these items for patients than their family members. Advance directive for withholding life-sustaining treatment reduced the intention to use these treatments. Conclusion It is necessary to increase our understanding regarding knowledge of end-of-life care options of both laypeople and healthcare professionals. Geriatr Gerontol Int 2015; 15: 318-325. [ABSTRACT FROM AUTHOR]

Aim Neuronal degeneration in the locus coeruleus occurs in the early phase of Alzheimer's disease, similar to mild cognitive impairment. The locus coeruleus produces norepinephrine, a deficiency of which causes both memory disturbance and psychological symptoms. Thus, we evaluated signal alterations in the locus coeruleus of patients with Alzheimer's disease and mild cognitive impairment using a high-resolution fast spin-echo T1-weighted imaging. Methods A total of 22 patients with Alzheimer's disease, 47 patients with mild cognitive impairment and 26 healthy controls were prospectively examined by high-resolution fast spin-echo T1-weighted imaging at 3 Tesla. Signal intensities in the locus coeruleus were manually measured and expressed relative to those in the adjacent white matter structures as contrast ratios. Results Locus coeruleus contrast ratios were significantly reduced in patient groups with Alzheimer's disease, mild cognitive impairment that converted to Alzheimer's disease and mild cognitive impairment that did not convert to Alzheimer's disease (1.80-16.09% [median, 9.30%], 3.45-14.84% [median 6.87%] and 3.01-19.19% [median 7.72%], respectively) compared with the healthy control group (6.24-20.94% [median 14.35%]; P < 0.0001). The sensitivity and specificity for discriminating these diseases were 85.0% and 69.2%, respectively, which suggests that this measurement can be carried out reliably. There was no significant difference in the locus coeruleus contrast ratios among the Alzheimer's disease, mild cognitive impairment-converted and mild cognitive impairment-non-converted groups. Conclusions High-resolution fast spin-echo T1-weighted imaging can show signal attenuation in the locus coeruleus of patients with Alzheimer's disease or with mild cognitive impairment whose pathology may or may not eventually convert to Alzheimer's disease. Geriatr Gerontol Int 2015; 15: 334-340. [ABSTRACT FROM AUTHOR]

Aim Habitual moderate vigorous-intensity physical activity ( MVPA) positively affects lower-extremity performance. It is unclear whether habitual light-intensity physical activity ( LPA), such as leisurely walking, has similar effects on lower-extremity performance. The aim of the present study was to identify the associations between habitual LPA and lower-extremity performance in older adults. Methods This cross-sectional study included 802 community-dwelling Japanese older adults, 187 men and 615 women, aged 60-96 years. A uniaxial accelerometer measured physical activity intensity for over 10 h/day continuously for 7 days. Lower-extremity performance was assessed by repeated chair stands ( RCS), single-leg stance ( SLS) and Timed Up & Go ( TUG). Multiple regression analysis was used to identify whether LPA was associated with lower-extremity performance, independent of potential confounders. Results The multiple regression analysis showed that longer LPA was significantly associated with better performance of RCS and TUG. In the results of stratified analyses, LPA was significantly associated with RCS in participants aged ≥75 years and in those with at least one medical condition or joint pain. LPA was also associated with TUG in participants aged ≥75 years, in those with at least one medical condition or joint pain and in those with low MVPA (<13.9 min/day). Conclusions These results suggest that habitual LPA is a useful lifestyle indicator of better performance in lower-extremity strength and gait with dynamic balance. Maintaining a higher level of LPA could be a recommended approach for preserving lower-extremity performance, especially among physically frail older adults. Geriatr Gerontol Int 2015; 15: 268-275. [ABSTRACT FROM AUTHOR]

Aim The renin-angiotensin system ( RAS) is involved in the pathogenesis of ischemic brain damage, and is suggested to have therapeutic potential in stroke by large clinical trials. However, the changes of serum RAS components in patients with acute stroke are totally unknown. We assessed the serum levels of RAS components in acute stroke patients, and investigated the relationship between RAS and stroke subtype. Methods Levels of angiotensin-converting enzyme ( ACE), ACE2 and angiotensin II in serum from patients with acute stroke ( n = 117; male 75, female 42, age 69 ± 13 years) were measured by an established enzyme-linked immunosorbent assay method. Diagnosis of subtypes of ischemic stroke was based on the Trial of Org10172 in Acute Stroke Treatment classification. The Kruskal- Wallis test with post-hoc Mann- Whitney U-test with Bonferroni correction was carried out for statistical analysis. Results Classification of stroke was as follows: large-artery atherosclerosis ( n = 44), cardioembolism ( n = 33), small-vessel occlusion ( n = 31), stroke of other determined etiology ( n = 9). Levels of angiotensin II and ACE did not show significant differences among each group. However, serum ACE2 level was significantly higher in the cardioembolism group than in the small-vessel occlusion group (cardioembolism 13 ± 9.3 ng/mL, large-artery atherosclerosis 10.2 ± 6.8 ng/mL, small-vessel occlusion 7.2 ± 3.7 ng/mL, stroke of other determined etiology 10.2 ± 7.3 ng/mL). ACE2 level showed a positive correlation with serum brain natriuretic peptide level ( P = 0.031). In contrast, angiotensin II concentration showed a negative correlation with National Institute of Health Stroke Scale score on admission ( P = 0.023). Conclusions These findings suggest that changes of serum RAS components could reflect stroke subtypes and predict stroke severity. Geriatr Gerontol Int 2014; 14: 793-798. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to evaluate risk factors for postoperative urinary retention ( POUR) in female patients with femoral neck fractures. Methods We recruited 72 female patients (age 86.5 ± 6.7 years) from among 90 cases of hip surgery carried out between January and December 2011 at Goto Chuo Hospital. We evaluated the risk factors for POUR, including the administration of anticholinergic drugs, diabetes mellitus, preoperative dementia and/or delirium, neurological disorders, age, hypertension, overactive bladder, and the postoperative duration of the use of an indwelling urethral catheter using a multiple logistic regression analysis. Results In the present study, POUR occurred in eight out of 72 cases (11.1%). The multivariate analysis showed that the indwelling period of the urethral catheter (per 1-day increase; P = 0.04, OR 0.33 95% CI 0.11-0.96), and preoperative dementia and/or delirium ( P = 0.03, OR10.4, 95% CI 1.21-89.2) correlated with the occurrence of POUR. Diabetes mellitus ( P = 0.78), anticholinergic agents ( P = 0.23), neurological disorders ( P = 0.83), age ( P = 0.86), hypertension ( P = 0.76) and overactive bladder ( P = 0.34) did not significantly correlate with the occurrence of POUR. Conclusions The present study showed that the early removal of the urethral catheter, and preoperative dementia and/or delirium had significant correlations with POUR. The femoral neck fractures and the surgical procedure used for the hip surgery do not induce damage to the bladder and nerve system related to the voiding function, and the voiding function in all of the patients recovered after short-term intermittent catheterization. Physicians should not place permanent indwelling urethral catheters without carrying out urological assessments. Geriatr Gerontol Int 2014; 14: 636-639. [ABSTRACT FROM AUTHOR]

Aim Falling is the leading cause of injury-related deaths in older adults, and a loss of balance is often the precursor to a fall. However, little is known about the rate at which balance declines with age. The objective of the present study was to determine whether there is an age-associated decline in static ( SB) and/or dynamic ( DB) balance in community-dwelling older women. Method SB and DB were determined in 971 older women. Intraclass correlation coefficients ( ICC) were used to determine test-retest reliability. Sway velocity was used to measure SB standing on a platform and foam with eyes open and closed. DB was characterized by limits of stability ( LOS) that measured end-point excursion ( EXE) and maximum excursion ( MXE) of the body's center of pressure. Results ICC for EXE and MXE for the LOS test were excellent ( EPE = 0.96, MXE = 0.96). ICC for SB tests, except for the eyes open firm surface condition ( ICC = 0.10), showed a high level of reproducibility ( ICC = 0.88 and 0.90). Relationships existed between age and SB ( r = 0.31, P < 0.001), and between age and DB ( r = −0.46-−0.48, P < 0.001). The rate of decline for both DB and SB was approximately 1% per year. Age was significantly associated with all balance measures. DB got significantly lower with advancing age until 80 years, and then plateaued. SB did not decline with age until 80 years, and then decreased significantly thereafter. Conclusion Although large individual variation was found with balance ability, an age-related decline was found with both dynamic and static balance for Japanese older women. Geriatr Gerontol Int 2014; 14: 556-560. [ABSTRACT FROM AUTHOR]

Aim Decreased amyloid β ( Aβ) clearance from the brain to blood might play a key role in the development of Alzheimer's disease ( AD). Aβ is normally bound to and transported by albumin in blood, thus possibly maintaining constant concentration of free Aβ in the blood. We therefore hypothesized that decreased blood levels of albumin- Aβ complexes could be associated with decreased Aβ removal from the brain to blood, resulting in Aβ accumulation in the brain. Methods We carried out a cross-sectional investigation of the association between serum levels of albumin- Aβ complexes ( SLAAC) and AD prevalence in 89 patients who visited our outpatient clinic, and gave written informed consent between August 2008 and May 2012. Results We confirmed 45 cases of AD. Low SLAAC was associated with an increased prevalence of AD ( OR 0.27; 95% CI 0.14-0.51) in a univariable logistic model and multivariable logistic models. In addition, decreased SLAAC was associated with decreased levels of Aβ42 in CSF ( r = 0.38, P = 0.0221) and increased levels of p-tau in CSF ( r = −0.43, P = 0.0090), findings that have been shown to be associated with AD progression. Conclusions This novel method might be very useful for monitoring of the progression of AD. Geriatr Gerontol Int 2014; 14: 716-723. [ABSTRACT FROM AUTHOR]

Aim To study whether there is an association between serum immunoglobulin G4 ( IgG4) concentration and cardiac function among cardiology inpatients. Methods This retrospective study included 91 patients who had sinus rhythm. Of 91 patients, 70 patients (77%) were aged ≥60 years (elderly group) and the remaining 21 patients (23%) were aged <60 years (younger group). Results Serum IgG4 concentrations were found to be negatively correlated with brain natriuretic peptide ( BNP) and with E/e′, an indicator for cardiac diastolic function in the elderly group, but not in the younger group. In contrast, IgG4 was significantly correlated with neither left ventricular mass nor ejection fraction in either group. Multivariate regression analysis showed that, in the elderly group, the association between IgG4 and E/e′, and that between IgG4 and BNP, were independent of age, sex, systolic blood pressure and renal function; log-transformed IgG4 showed a negative association with log-transformed E/e′ and log-transformed BNP, with a standardized correlation coefficient of −0.26 (95% confidence interval −0.49 to −0.03, P = 0.030 and −0.22 (95% confidence interval −0.44 to −0.11, P = 0.043), respectively. Conclusion Serum IgG4 concentration might be associated with cardiac diastolic function among elderly cardiology inpatients. Geriatr Gerontol Int 2014; 14: 582-588. [ABSTRACT FROM AUTHOR]

Aim Poor sleep can affect physical and mental health, and consequently people's quality of life ( QOL); however, only a few studies have addressed the potential associations of physical and mental health with quality of sleep ( QOS) in Japan. The present study aimed to investigate the association of QOS with sociodemographic and lifestyle characteristics, cognitive status, nutrition, depression, seclusion, and QOL in Japanese community-dwelling older adults. Methods Data were collected through self-administered questionnaires and other specific tests in 145 (age 73 years [range 70-77 years]) participants. The χ2-test or Fisher's exact test were used to compare categorical variables stratified by QOS, and the Mann- Whitney U-test was used for continuous variables. Furthermore, logistic regression analyses were carried out to verify the associations with QOS. Results The poor QOS group had more males ( P < 0.05), a shorter self-reported sleep duration ( P < 0.001), higher body mass index ( P < 0.05) and higher risk of depression ( P < 0.05), whereas the good QOS group showed higher scores in the QOL summary and domains of physical component ( P < 0.01), general health ( P < 0.001), bodily pain ( P < 0.001) and vitality ( P < 0.001). In the logistic regression model, cognitive status ( OR 0.13, 95% CI 0.03-0.55), bodily pain ( OR 0.91, 95% CI 0.84-1.00) and vitality ( OR 0.82, 95% CI 0.73-0.92) were associated with QOS. Conclusion The present study provides evidence that QOS is linked to cognitive status, bodily pain and vitality in Japanese older adults. We maintain that screening a person's sleep characteristics in a community setting might be relevant to identify those older adults at risk of a poor QOL and frailty in the early phase, triggering further health analyses. Geriatr Gerontol Int 2014; 14: 628-635. [ABSTRACT FROM AUTHOR]

Aim Nursing and healthcare-associated pneumonia ( NHCAP) is a modified category of healthcare-associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP. Methods We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community-acquired pneumonia ( CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A-DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP. Results The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status ( PS) and more comorbidities than those with CAP. The frequency of potentially drug-resistant ( PDR) pathogens and in-hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively ( P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A-DROP score was poor at predicting mortality in most patients with NHCAP. Conclusion The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community-acquired pneumonia patients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP. Geriatr Gerontol Int 2013; 14: 362-371. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effectiveness of a strength and balance enhancing exercise intervention as a means of preventing falls in community-dwelling elderly Japanese women with a history of falls, while comparing functional fitness, fall and fracture rate in excluded subjects. Methods A 1-year follow-up trial was carried out on 105 participants over the age of 70 years, who were randomly assigned to the exercise or education group, and also on 91 women excluded based on the exclusion criteria. The exercise group attended a 60-min exercise class twice a week for 3 months. Falls, injuries, fractures, and functional fitness assessments were measured at baseline, post-intervention and 1-year follow up. Results During the follow up, fall rates were 19.6% in the exercise group, 40.4% in the education group and 40.8% in excluded subjects (χ2 = 7.069, P = 0.029). Compared with the exercise group, the odds ratio ( OR) for falls was greater in the education group ( OR 2.78, 95% confidence interval ( CI) 1.17-6.96) and excluded participants ( OR 2.83, 95% CI 1.25-6.80). The OR for fractures was over fourfold greater in excluded participants (OR 4.30, 95% CI 1.02-9.70) than the exercise group. Conclusions The exercise intervention for participants with fall history effectively decreased incidences of falls and fractures. However, fall and fracture rates in excluded people were high. Further research focusing on feasible countermeasures for falls in excluded people who are at high risk of fractures is required. Geriatr Gerontol Int 2013; 14: 285-292. [ABSTRACT FROM AUTHOR]

Aim To develop a simple screening test to identify older adults at high risk for sarcopenia. Methods We studied 1971 functionally independent, community-dwelling adults aged 65 years or older randomly selected from the resident register of Kashiwa city, Chiba, Japan. Data collection was carried out between September and November 2012. Sarcopenia was defined based on low muscle mass measured by bioimpedance analysis and either low muscle strength characterized by handgrip or low physical performance characterized by slow gait speed. Results The prevalence of sarcopenia was 14.2% in men and 22.1% in women. After the variable selection procedure, the final model to estimate the probability of sarcopenia included three variables: age, grip strength and calf circumference. The area under the receiver operating characteristic curve, a measure of discrimination, of the final model was 0.939 with 95% confidence interval ( CI) of 0.918-0.958 for men, and 0.909 with 95% CI of 0.887-0.931 for women. We created a score chart for each sex based on the final model. When the sum of sensitivity and specificity was maximized, sensitivity, specificity, and positive and negative predictive values for sarcopenia were 84.9%, 88.2%, 54.4%, and 97.2% for men, 75.5%, 92.0%, 72.8%, and 93.0% for women, respectively. Conclusions The presence of sarcopenia could be detected using three easily obtainable variables with high accuracy. The screening test we developed could help identify functionally independent older adults with sarcopenia who are good candidates for intervention. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 93-101. [ABSTRACT FROM AUTHOR]

Aim To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community-based care at home and dehospitalization. Methods Participants were older adults with dementia newly admitted to intermediate facilities. A total of 158 in the intervention group who claimed Long- Term Care Insurance for three consecutive months, and 54 in the control group were included in the analysis. The interventions were carried out in a tailor-made manner to meet individual needs. The personal sessions were carried out three times a week for 3 months after admission by physical, occupational or speech therapists. Outcome measures were cognitive tests ( Hasegawa Dementia Scale revised [ HDS-R] and Mini- Mental State Examination), and observational assessments of dementia severity, activities of daily living ( ADL), social activities, behavioral and psychological symptoms of dementia ( BPSD) using a short version of the Dementia Disturbance Scale ( DBD13), depressive mood, and vitality. Results Significant improvement in the intervention group was shown in cognitive function measured by HDS-R (interaction F[1, 196] = 5.190, P = 0.024), observational evaluation of dementia severity ( F[1,198] = 9.550, P = 0.002) and BPSD (DBD13; F[1,197] = 4.506, P = 0.035). Vitality, social activities, depressive mood and ADL were significantly improved only in the intervention group, although interaction was not significant. Conclusions Significant improvement by intervention was shown in multiple domains including cognitive function and BPSD. Cognitive decline and worsening of BPSD are predictors of care burden and hospitalization, thus intensive rehabilitation for dementia was beneficial for both individuals with dementia and their caregivers. Geriatr Gerontol Int 2014; 14: 206-211. [ABSTRACT FROM AUTHOR]

Aim The aim of the present retrospective study was to investigate the time-courses of the cognitive, behavioral and physical status of day care service users with dementia, and to determine the factors associated with the long-term use of day care in order to aid the development of better interventions. Methods We analyzed the data of 162 consecutive patients who attended our day care clinic for 1 year or more between 1 April 2000 and 31 March 2010. The patients were divided into three groups according to the length of their day care attendance (the 1-year, 3-year and 5-year groups). Then, we investigated the time-courses of their cognitive, behavioral and physical status. Logistic regression analysis was used to detect the factors that affect the duration of day care service attendance in dementia patients. Results The Hasegawa Dementia Scale- Revised ( HDS-R), Assessment Scale for Symptoms of Dementia ( ASSD) and Nishimura's Activities of Daily Living ( N- ADL) scores of the three groups all significantly deteriorated during the study period except for the HDS-R score of the 3-year group. Higher age and a high ASSD score were associated with a short period of day care service attendance, whereas the patients' daughters-in-law acting as a caregiver was related to the long-term use of day care services in model 1. Conclusions It is better to control behavioral and psychological symptoms in order to improve the utilities of day care for dementia patients. The caregiving environment of dementia patients might be associated with the length of day care attendance. Geriatr Gerontol Int 2014; 14: 138-145. [ABSTRACT FROM AUTHOR]

Aim Single photon emission computed tomography ( SPECT) studies showed that regional cerebral blood flow ( rCBF) abnormalities in idiopathic rapid eye movement ( REM) sleep behavior disorder ( iRBD) are similar to those seen in Parkinson's disease ( PD) and dementia with Lewy bodies ( DLB). The aim of the present study was to assess the longitudinal rCBF changes in patients with iRBD using repeated SPECT. Methods Nine patients with iRBD (7 men and 2 women; mean age 71.1 ± 3.2 years) underwent baseline and follow-up SPECT studies (a mean interval of 22.8 ± 9.2 months). Results A decrease in rCBF was found in bilateral parietotemporal and occipital areas at the first and second SPECT. Compared with the first SPECT, the second SPECT showed a decreased rCBF in the medial portions of the parietooccipital lobe with a significant decrease in rCBF of the right posterior cingulate. None of the patients showed any neurological deficits, including extrapyramidal and cerebellar signs, visual hallucinations, and neuropsychological impairments during the study. Conclusion These findings suggest that longitudinal measurements of rCBF can show the presence of progressing neurodegenerative process in iRBD. Longitudinal SPECT study can be used to monitor the progression of degenerative process in patients with iRBD, even though there were no evolving neurological and neuropsychiatric impairments. Geriatr Gerontol Int 2014; 14: 115-120. [ABSTRACT FROM AUTHOR]

Aim To investigate whether positive affect independently predicts a lower risk of functional decline among community-dwelling older Japanese. Methods A 2-year prospective study was carried out among 505 residents of Tosa Town aged 65 years and older without disability in carrying out basic activities of daily living ( B ADL) at baseline. Positive and negative affect was measured using the 15-item Geriatric Depression Scale, which includes items that reflect positive affect, as well as items that reflect negative affect. Information on functional ability, sociodemographic factors and medical conditions was obtained using a self-administered questionnaire. Results A total of 72 (14.3%) participants reported a decline in B ADL at the 2-year follow up. The sum-score of the positive items was significantly associated with a lower risk of functional decline ( OR 0.78, 95% CI 0.64-0.97), after controlling for potential confounding factors. Of the five positive items, three items (feeling satisfied with life OR 0.49, 95% CI 0.25-0.95; feeling happy most of the time OR 0.50, 95% CI 0.25-0.99; and feeling full of energy OR 0.46, 95% CI 0.22-0.95) were significantly associated with functional decline after adjusting for confounders. These associations were also independent of negative affect. In contrast, none of the negative items predicted functional decline after controlling for confounding factors. Conclusions Positive psychological well-being, specifically the feeling of satisfaction with life, happiness and energy, might have a favorable effect on the maintenance of functional ability, regardless of negative affect. Geriatr Gerontol Int 2013; 13: 1051-1058. [ABSTRACT FROM AUTHOR]

Aim This study aimed to compare relationships of leisure-time, household, and work-related physical activity ( PA) with physical performance by age and gender in older Japanese adults. Methods This cross-sectional study included 525 community-dwelling older adults (73.3 ± 5.2 years) recruited in 2009-2011 in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess PA variables. Physical performance was evaluated by 11 performance tests: grip strength, single-leg balance, functional reach, sit-and-reach, standing time from long sitting position, sit-to-stand, timed up and go, habitual walk, hand working, and simple and choice reaction times. Results After adjusting for potential confounders, leisure-time PA in young-old (≤74 years) men correlated significantly with eight performance tests (absolute value of Spearman's partial rank correlation coefficient: r = 0.18-0.39), whereas in old-old (≥75 years) men it correlated with three performance tests ( r = 0.20-0.23). Although leisure-time PA correlated with six performance tests ( r = 0.19-0.22) in young-old women, there were no significant correlations between leisure-time PA and performance tests in old-old women. Household PA of young-old men ( r = 0.20-0.23) and old-old women ( r = 0.26-0.34) correlated with four performance tests. In old-old men and young-old women, no significant correlation was found between household PA and performance tests. Work-related PA did not relate significantly to any performance tests in any groups. Conclusion This study showed that leisure-time PA is related to physical performance, especially in young-old men and women, and household PA is especially related in young-old men and old-old women. Our findings suggest that supporting strategies for maintaining physical functions would differ by gender and age. Geriatr Gerontol Int 2013; 13: 919-927. [ABSTRACT FROM AUTHOR]

Aim This study sought to confirm the test-retest reliability and validity of the National Center for Geriatrics and Gerontology functional assessment tool ( NCGG-FAT), a newly developed assessment of multidimensional neurocognitive function using a tablet personal computer ( PC). Methods This study included 20 community-dwelling older adults (9 females, aged 65-81 years). Participants were administered the NCGG-FAT twice, separated by approximately 30 days to determine test-retest reliability. To test the validity of the measure, participants underwent established neurocognitive measurements, including memory, attention, executive function, processing speed and visuospatial function within a week from the first administration of the NCGG-FAT. Results Test-retest reliability was in an acceptable range for each component of the NCGG-FAT, with intraclass correlation coefficients ranging from 0.764 to 0.942. Each task in the NCGG-FAT showed a moderate to high correlation with scores on widely-used conventional neurocognitive tests ( r = 0.496 to 0.842). Conclusion We found that the NCGG-FAT using a tablet PC was reliable in a sample of community-dwelling older adults. The NCGG-FAT might be useful for cognitive screening in population-based samples and outcomes, enabling assessment of the effects of intervention on multidimensional cognitive function among older adults. Geriatr Gerontol Int 2013; 13: 860-866. [ABSTRACT FROM AUTHOR]

Aim This study examined the factors that allow elderly individuals to stay at home continuously by considering the roles of the family caregiver, the use of services and characteristics of the elderly individual. Methods We analyzed 432 elderly individuals living at home with family. The outcome was that participants remained at home continuously over a 24-month period. The participants were stratified into two care-needs levels, and then multiple logistic regression analyses were carried out to examine relationships between staying at home and the Japanese version of the Zarit Burden Interview ( J-ZBI), public Long-term Care Insurance ( LTCI) service use, family caregivers' characteristics and elderly peoples' characteristics. Results Low scores on the J-ZBI were related to outcome in both care-needs subgroups (low care-needs subgroup: OR 2.11; 95% CI 1.31-3.43, high care-needs subgroup: OR 5.03; 95% CI 1.04-31.1). Regarding LTCI services, the use of home-visit nursing ( HN) service was related to staying at home continuously in the high care-needs group ( OR 37.39; 95% CI 3.31-879.1). Conclusions Alleviation of caregiver' burden was essential for continuous stay at home of elderly people regardless of care-needs levels. Also, the HN service was founded as the relevant LTCI service factor for staying at home continuously. The HN service use might affect the outcome when we consider the causal relationship. Therefore, the policy for the promotion of HN service use will be important to achieve the ultimate goal of LTCI, which is to allow elderly people to live in their communities for as long as possible. Geriatr Gerontol Int 2013; 13: 764-773. [ABSTRACT FROM AUTHOR]

Aim: Functional status of those who have very mild cognitive impairment have not been sufficiently investigated. In the current study, we analyzed the characteristics of functional awareness in older adults who had cognitive impairment and were at high risk of requiring support/care (termed as specified elderly at high risk for care needs in the long-term care insurance scheme). Methods: The answers of a health check, which is provided by the local municipal government for those aged 75 years or older who have not been certified as eligible for care services, were analyzed. The differences of the variables between the two groups regarding yes/no answers to each of three cognition-related questions were analyzed. Then, a multiple logistic analysis was carried out to investigate the association of yes/no answers of the three cognition-related questions and the awareness of functional decline. Results: The participants who had cognitive impairment had greater awareness of functional declines. Multiple logistic regression analysis showed that subjective memory impairment and disorientation were significantly associated with a wider range of awareness of functional decline. Conclusions: Subjective cognitive impairment was associated with a wide range of awareness of functional decline in older adults at high risk for care need. Geriatr Gerontol Int 2013; 13: 77-82. [ABSTRACT FROM AUTHOR]