Search

Aim: Respiratory sarcopenia (RS) has been newly defined in a position paper by four professional organizations in Japan, and it is necessary to examine its incidence and influencing factors using this new definition. So far, little work has been undertaken; we therefore conducted a longitudinal study to fill this gap. Methods: Our data were extracted from the China Health and Retirement Longitudinal Study. A total of 4301 older adults with complete data and without RS were chosen in 2011, of whom 3065 were followed up until 2015. The presence of low respiratory muscle strength plus low appendicular skeletal muscles mass was defined as RS based on t. A logistic regression model was used to identify the influencing factors for incident RS. Results: After an average of 4 years of follow‐up, the cumulative incidence of RS was 5.2%, and it was particularly high in participants aged >80 (20.9%). Logistic regression analysis showed that being unmarried/divorced/widowed (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.28–2.66, P = 0.001), not having dyslipidemia (OR = 0.35, 95% CI = 0.19–0.65, P = 0.001), having digestive disease (OR = 1.56, 95% CI = 1.11–2.19, P = 0.010), asthma (OR = 2.77, 95% CI = 1.55–4.94, P = 0.001), edentulism (OR = 1.73, 95% CI = 1.24–2.42, P = 0.001), low handgrip strength (OR = 2.82, 95% CI = 1.99–3.99, P < 0.001), or low 5‐m gait speed (OR = 1.92, 95% CI = 1.23–3.01, P = 0.004) were associated with a greater likelihood of developing RS. After further adjustment for age and body mass index, asthma, edentulism, and low handgrip strength remained significant. Conclusions: The identification and management of older adults with the influencing factors described above could be important in preventing RS. Geriatr Gerontol Int 2024; 24: 1015–1021. [ABSTRACT FROM AUTHOR]

Aim: In order to understand the digital divide among older adults during the coronavirus disease 2019 (COVID‐19) pandemic, we investigated the association between internet use and compliance with COVID‐19 preventive behaviors during the first state of emergency in Japan. Methods: A total of 8952 community‐dwelling citizens aged 75 years and above were asked about their preventive behaviors during the first state of emergency using a paper‐based questionnaire. Among them, 51% responded and were divided into internet users and non‐users. We used multivariable logistic regression models to estimate the adjusted odds ratios and 95% confidence intervals of internet use for compliance with preventive behaviors. Results: Approximately 40% of the respondents used the internet, and 9.29% used social media to collect COVID‐19‐related information. Internet usage was independently associated with compliance with using hand sanitizers, avoiding going out, avoiding eating out, avoiding traveling, getting vaccinated, and getting tested for COVID‐19; the adjusted odds ratios (95% confidence intervals) were 1.21 (1.05–1.38), 1.19 (1.04–1.37), 1.20 (1.05–1.38), 1.32 (1.15–1.52), 1.30 (1.11–1.53), and 1.23 (1.07–1.41), respectively. Exploratory subgroup analyses demonstrated that social media users might have shown early adaptation to newly recommended preventive behaviors during the first state of emergency. Conclusions: Results suggest that a digital divide exists, as evidenced by the varied compliance with preventive behaviors depending on internet use. Additionally, social media use may be associated with early adaptation to newly recommended preventive behaviors. Therefore, future studies regarding the digital divide among older adults should investigate differences depending on the types and content of internet resources. Geriatr Gerontol Int 2023; 23: 289–296. [ABSTRACT FROM AUTHOR]

Aim Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods Data of the I- Lan Longitudinal Aging Study ( ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36-45. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to assess the subjective quality of life (SQOL) and its correlates among older adults in rural communities of Vietnam and Indonesia. Methods: The paper uses the data from the INDEPTH/WHO Study on global aging and adult health (SAGE). The study was carried out in the FilaBavi Health and Demographic Surveillance System (HDSS) site in Vietnam and in Purworejo HDSS in Indonesia. All people aged 50 years and over who lived in these two HDSS areas were surveyed. Face-to-face household interviews were carried out by trained surveyors using the standardized summary version of the INDEPTH/WHO SAGE questionnaire. The SQOL was assessed by asking the respondents 'How would you rate your overall quality of life?' The response set was a five-point scale where 1 = Very good, 2 = Good, 3 = Moderate, 4 = Bad, 5 = Very bad. Results: In both countries, the SQOL was reported to be higher among (i) men; (ii) people with higher education; (iii) people who were in a marital partnership; (iv) people who lived with other family members; and (v) those with higher economic status, compared with that in those of other category(ies) of the same characteristic. In Vietnam, people who belonged to the second to fifth economic quintiles and had more than 6 years of education were sevenfold more likely to report very good/good quality of life compared with those who belonged to the first economic quintile (poorest) and had no formal education. The corresponding figure was 2.7 for Indonesia. Conclusions: The patterns of sociodemographic determinants of SQOL show that inequality in quality of life exists among older adults in the two study settings. Geriatr Gerontol Int 2012; 12: 397-404. [ABSTRACT FROM AUTHOR]

Aim: To examine the effects of employment engagement, classified by frailty and working status, on the incidence of disability in urban community‐dwelling older adults. Methods: We used data from 6386 initially nondisabled residents aged 65–84 years from Ota City, Tokyo, Japan, in 2016. The observation duration was 3.6 years. Self‐administered questionnaires applied the Cox proportional hazard model by assessing the existence of frailty through Check‐List 15 (with a score ≥4 indicating the state of frailty), controlling for age, sex, living situation, education level, equivalent income, chronic conditions, body mass index, instrumental activities of daily living, self‐rated health, drinking and smoking status, and social activities. We evaluated the predictive value of working status (full‐time, part‐time, temporary, or nonworker) at baseline for cause‐specific disability (dementia‐type vs. non–dementia‐type) incidence, identified using the long‐term care insurance system's nationally unified database. Results: Of the 6386 participants, 806 (63/1134 full‐time workers; 58/1001 part‐time workers; 61/547 temporary workers; 624/3704 nonworkers) presented with disabilities during the 3.6‐year‐long duration. Adjustments for conventional covariates showed that nonfrail full‐time and part‐time workers, as well as frail full‐time workers, had significantly lower risks of all‐cause disability incidence. Furthermore, nonfrail and frail full‐time workers had significantly lower risks of dementia‐type and nondementia‐type disabilities, respectively. Conclusions: The incidence of disability in older adults was influenced by working and frailty status. Engaging in full‐time work thus prevents disabilities in older adults, regardless of their frailty status. Meanwhile, nonfrail older adults are able to avoid disabilities even when engaging in part‐time work. Geriatr Gerontol Int 2023; 23: 855–863. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to conduct a meta‐analysis to evaluate the methods and effects of interventions to increase life‐space mobility among community‐dwelling older adults. Methods: Records were identified through nine databases. Eligible study designs for inclusion in the review were randomized controlled trials of interventions on life‐space mobility for community‐dwelling older adults. The risk of bias was assessed using the Risk of Bias 2 tool. We followed the Grading of Recommendations, Assessment, Development, and Evaluation approach to summarize the evidence. Results: Four studies (558 participants) identified via search strategies were included. Two studies involved individualized exercise and lifestyle interventions. In three out of the four studies, individual interventions were applied. Overall, when compared with a control group, the intervention group was more likely to positively affect increasing life‐space mobility (standardized mean difference 0.47, 95% confidence interval [0.020 to 0.92]). The heterogeneity statistic indicated considerable heterogeneity (I2 = 84%). The evidence was downgraded one step owing to imprecision. Conclusions: Interventions on increasing life‐space mobility for community‐dwelling older adults have a positive effect. Combination interventions may be more effective than single interventions, and individual interventions may be more effective than group interventions. However, owing to the limited number of studies, conducting further research to enhance the generalizability of results is crucial. Additionally, subgroup analysis should be conducted to clarify differences in intervention methods and effects. Geriatr Gerontol Int 2023; 23: 842–848. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to compare the effects of virtual supervision and minimal supervision in a 12‐week home‐based physical exercise program on the mental health and quality of life of community‐dwelling older adults. Methods: This study presents a secondary analysis of a randomized clinical trial conducted during the COVID‐19 pandemic. The sample comprised 38 elderly men and women (81.6% women, mean age 68 ± 6.4 years; mean weight 69.8 ± 12.1 km) without physical and/or cognitive impairments. The volunteers were divided into two groups: one group received virtual supervision (monitored via videoconference), while the other group received minimal supervision (monitored through weekly text messages). Both groups followed the same home‐based physical exercise program, consisting of three sessions per week, differing only in the supervision strategy. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS‐21) in conjunction with the POMS questionnaire, which evaluates mood, and quality of life was assessed using the WHOQOL‐OLD questionnaire. Results: Our findings demonstrated statistically significant superiority of virtual supervision compared with minimal supervision in relation to depression (−2.92, 95% confidence interval = −5.22 to −0.63). Conversely, minimal supervision exhibited superiority over virtual supervision regarding quality of life (−6.70, 95% confidence interval = −11.66 to −1.73). Conclusions: Virtual supervision yielded better outcomes for the depression indicator, while minimal supervision favored the quality of life of older adults at the conclusion of the 12‐week home‐based physical exercise program. Geriatr Gerontol Int 2023; 23: 864–870. [ABSTRACT FROM AUTHOR]

Aim: To enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five‐item checklist (OF‐5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community‐dwelling older adults. Methods: This population‐based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long‐term care needs. Baseline data were collected in 2012, and follow‐up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF‐5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long‐term care insurance receipt database were followed for 9 years. Results: Of 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF‐5 points had significantly increased prevalence and new‐onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF‐5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14–1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11–1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty. Conclusions: The OF‐5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; 23: 651–659. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the link between handgrip strength (HGS) asymmetry and mortality risk among older Chinese adults. Methods: These analyses were conducted using data from adults aged 60 years and older from the 2011–2013 waves of the China Health and Retirement Longitudinal Study, using baseline participant data collected in 2011. Proxy‐reported information was used to assess the mortality outcomes of the participants over a 2‐year follow‐up. The highest recorded HGS values for each hand were used to compute the HGS asymmetry ratio (non‐dominant HGS/dominant HGS) and HGS weakness (Male<26 kg, Female<16 kg). Covariate‐adjusted Cox models were employed to gauge the relationship between abnormal HGS and mortality risk. Results: Overall, 5083 adults were enrolled in this study, of whom 50.15% (2549/5083) were male. The proportions of low HGS alone, HGS asymmetry alone, and asymmetric and low HGS were 6.43%, 30.95%, and 9.22%, respectively, in males, and 4.81%, 35.87%, and 9.55%, respectively, in females. A total of 96 and 78 deaths were recorded for male (3.77%) and female (3.08%) participants, respectively, over the 2‐year follow‐up period. Significant differences in mortality were observed between the different HGS groups for both sexes. An adjusted Cox regression analysis model confirmed that only low HGS (P = 0.047, hazard ratio [HR] = 1.949, 95% confidence interval [95% CI]: 1.008–3.768) and low HGS with asymmetry (P = 0.007, HR = 2.152, 95% CI: 1.231–3.764) were significantly associated with mortality risk in older males. Conclusions: The results revealed that low HGS with or without asymmetry was associated with a higher risk of death over a 2‐year follow‐up interval in older Chinese males. Geriatr Gerontol Int 2023; 23: 692–699. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to verify the impact of low body mass index (BMI) on mortality in nursing home residents undergoing hemodialysis and to clarify other associated mortality risk factors. Methods: This retrospective study included patients admitted to a nursing home affiliated with Nagasaki Renal Center between April 2014 and March 2022. Medical data were collected on admission, and participants were divided into low and high BMI groups according to their median BMI values. The patients were followed up until March 2023. The association between survival and patient history was also analyzed. Results: Of the 106 patients (average age, 81.3 ± 7.9 years; male, 36.8%; median dialysis vintage, 32.5 [interquartile range (IQR), 13.8–79.3] months), 52 and 54 were classified into the low (median < 18.4 kg/m2) and high (≥18.4 kg/m2) BMI groups, respectively. Multivariable Cox proportional hazards analysis indicated that BMI (hazard ratio, 0.87; 95% confidence interval [CI]: 0.82–0.94; P < 0.001) was closely associated with survival. Multivariable logistic regression revealed that dementia was associated with low BMI (odds ratio: 2.89, 95% CI: 1.07–7.83, P = 0.03). Conclusions: Low BMI was an important factor contributing to poor patient survival. Dementia was associated with low BMI. Therefore, the management of both nutrition and dementia is essential for nursing home residents undergoing hemodialysis. Geriatr Gerontol Int 2023; 23: 660–664. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia. Methods: A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment. Results: Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500‐ and 1000‐days follow‐up. At 2000‐days follow‐up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia). Conclusions: Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595–602. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between locomotive syndrome and anemia among community‐dwelling older adults. Methods: This cross‐sectional study was conducted at specific health checkup centers in Japan between 2019 and 2020. We sent a questionnaire to older adults aged ≥65 years who participated in health checkups. A total of 2507 community‐dwelling older adults were included in this study (mean age = 72.3 years, 51.4% women). Locomotive syndrome was measured using a 25‐question Geriatric Locomotive Function Scale with a score range of 0–100, and was defined as ≥16 points. Anemia was defined using World Health Organization criteria, as a hemoglobin concentration of <13.0 g/dL in men and <12.0 g/dL in women. Logistic regression analyses were performed to investigate the association between locomotive syndrome and anemia, adjusted for age, sex, body mass index, depression symptoms, self‐reported comorbidities (cancer, rheumatoid arthritis, knee osteoarthritis, fractures, and spinal disease), hypertension, and renal function. Results: Of all the participants, 11.6% had locomotive syndrome and 12.8% had anemia. Even after adjustment, a relationship between locomotive syndrome and anemia was observed (adjusted odds ratio = 1.9, 95% confidence interval = 1.3–2.7). Conclusions: Community‐dwelling older adults with anemia had a significantly higher prevalence of locomotive syndrome than those without. This finding suggests that older adults with anemia are at risk of locomotive syndrome, and appropriate measures should be taken for prevention. Geriatr Gerontol Int 2023; 23: 426–429. [ABSTRACT FROM AUTHOR]

Aim Subjective memory complaints scales are expected to be useful for the prediction of future cognitive decline. In Japan, the 'Kihon Checklist-Cognitive Function' (KCL-CF), which consists of three items, is used for primary screening of high-risk older adults. However, the predictive validity of the KCL-CF remains unknown. The aim of the present cohort study was to examine whether the KCL-CF can predict the incidence of dementia. Methods Information on the KCL-CF score (0-3 points) was collected from community-dwelling older adults (≥65 years) through a questionnaire. Data on incident dementia were retrieved from the Long-term Care Insurance database. The Cox model and receiver operating characteristic curve analysis were used. Results Among 13 974 participants, the 5.7-year rate of incident dementia was 8.8%. All KCL-CF items significantly predicted the risk of incident dementia even after adjustment for age and sex ( P-trend < 0.0001). A higher KCL-CF score was associated with a higher risk of dementia; the age- and sex-adjusted hazard ratios (95% confidence interval) were 1.00 (reference) for a KCL-CF score of 0 points, 1.89 (1.65-2.15) for 1 point, 3.01 (2.59-3.50) for 2 points, and 6.20 (4.87-7.90) for 3 points ( P-trend < 0.0001). A cut-off score of ≥1 points had a specificity of 65.1% and a sensitivity of 60.2%, and the area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.63-0.66). Conclusions The KCL-CF was able to predict incident dementia. However, because a false-negativity rate of approximately 40% would be expected, the KCL-CF score alone might not be sufficient for screening of dementia incidence. Geriatr Gerontol Int 2017; 17: 1300-1305. [ABSTRACT FROM AUTHOR]

The article discusses fostering positive attitudes toward dementia patients' social involvement among the general population in Japan. It explores factors impacting perceptions and willingness to engage, aiming to combat social isolation and enhance support. Topics include analyzing societal attitudes toward dementia, understanding factors influencing involvement, and devising strategies to develop a more inclusive environment for people with dementia.

Aim: We investigated the difference in the relationship between physical activity and low muscle mass resulting from the choice of diagnostic criterion for low muscle mass. Methods: Our study was cross‐sectional, using data from the 2008–2011 National Health and Nutrition Examination Survey. Muscle mass was measured by dual‐energy X‐ray absorptiometry. Low muscle mass was defined as height‐adjusted and weight‐adjusted low muscle mass. Odds ratios (ORs) and 95% confidence intervals (CIs) of low muscle mass in relation to physical inactivity were analyzed using multivariate logistic regression analysis. Results: Our study included 3977 older people (1698 men and 2279 women). The prevalence of height‐adjusted and weight‐adjusted low muscle mass was 4.1% and 11.8%, respectively, in the physically inactive group, and 3.9% and 7.9%, respectively, in the physically active group. The prevalence of weight‐adjusted low muscle mass increased by 48% in the physically inactive group in the fully adjusted model (OR, 1.48; 95% CI, 1.13–1.95) and increased by 61% in men and 50% in women (men: OR, 1.61; 95% CI, 1.12–2.31 and women: OR, 1.50; 95% CI, 1.20–2.20) compared with the physically active group. The risk of height‐adjusted low muscle mass in men tended to be higher in the physically inactive group than in the physically active group. However, this trend was not observed among women. Conclusions: Physical inactivity was associated with an increased prevalence of low muscle mass in weight‐adjusted measures among elderly adults in Korea. Height‐adjusted low muscle mass in women is less useful as an indicator of the relationship between low muscle mass and physical inactivity. Geriatr Gerontol Int 2023; 23: 71–77. [ABSTRACT FROM AUTHOR]

Aim: Despite a growing interest in decision‐making by care recipients, few empirical studies have examined the everyday care decisions of community‐dwelling older adults. This study aimed to examine the association of recipient‐ and caregiver‐related factors with decision‐making involvement of community‐dwelling older care recipients. Methods: We conducted secondary data analysis using publicly available cross‐sectional data from a dyadic survey with care recipients aged ≥65 years and their primary caregivers in two regions of Japan, one urban and another rural, in 2003. In total, 643 pairs with no missing data on any variable were included in the analysis. The level of care recipients' perceived decision‐making involvement was assessed using one dichotomized item (not involved or involved). We examined care recipient‐ and caregiver‐related factors described by previous studies as having the potential to inhibit or facilitate care recipient's subjective decision‐making involvement. Results: Of the care recipients, 60.2% were women, 72.2% were >75 years, and 83.7% were involved in decision‐making. Of the primary caregivers, 72.0% were women, 49.0% were <65 years, and 47.9% were spouses. Multivariable logistic regression analysis showed that care recipients were more likely to be involved in decision‐making when their caregivers respected their decisions (odds ratio = 3.03 [95% confidence interval: 1.90–4.86], P < 0.001). Care recipients with more care needs were less likely to be involved in decision‐making than those with less care needs (odds ratio = 0.53 [95% confidence interval: 0.32–0.89], P = 0.015). Conclusions: Our results suggest that family caregivers play a crucial role in increasing care recipients' decision‐making involvement regarding daily care. Geriatr Gerontol Int 2022; 22: 876–882. [ABSTRACT FROM AUTHOR]

Aim: In sarcopenic dysphagia, confirmation of recovery of the swallowing function and activity of daily living is insufficient. The aim of this study was to examine differences in the recovery of the swallowing function and activities of daily living between sarcopenic dysphagia patients and non‐sarcopenic dysphagia patients. Methods: The registry data of the Japanese Sarcopenic Dysphagia Database were used for the analysis; 440 patients met the eligibility criteria of the study. Dysphagia was evaluated according to the Food Intake Level Scale and a five‐step diagnostic algorithm for the disorder. Patients were divided into two groups according to the presence or absence of sarcopenic dysphagia. Results: Sarcopenic dysphagia was found in 268 cases (60.9%). The rate of improvement in the Food Intake Level Scale was 47.4% in sarcopenic dysphagia patients and 62.2% in non‐sarcopenic dysphagia patients. The rate of improvement in the Food Intake Level Scale was lower in the sarcopenic dysphagia patients (P = 0.008). A multiple regression analysis showed that the presence of sarcopenic dysphagia had a significant influence on changes in the Food Intake Level Scale and Barthel Index (β = −0.191, 95% confidence interval, −1.484 to −0.530, P < 0.001, β = 0.112, 95% confidence interval, 0.587 to 10.450, P = 0.028). Conclusion: Improvement in the swallowing function was poor in patients with sarcopenic dysphagia. Sarcopenic dysphagia should be examined to improve swallowing function. Geriatr Gerontol Int 2022; 22: 839–845. [ABSTRACT FROM AUTHOR]

Aim: Hearing loss and depression in older adults are associated with a lower social participation rate. However, few studies have thoroughly analyzed the relationship between them. Methods: The data were obtained from the China Health and Retirement Longitudinal Study carried out in 2011, 2013 and 2015, and data from 24 306 participants ranging in age from 50 to 80 years were used in this study. Hearing loss, depression and social participation were assessed by self‐reported hearing status, the 10‐item Center for the Epidemiological Studies of Depression Short Form, and self‐reported social participation activity types and frequency. The fixed effects logistic regression and random effects logistic regression were used to examine the relationship between hearing loss and social participation. The Sobel method was used to explore the relationship between hearing loss, depression and social participation. Results: Compared with older adults without hearing loss, persons with hearing loss engaged in significantly fewer types of activities (β = −0.070, 95% CI −0.109, −0.031, P < 0.001) and at a lower frequency (β = −0.176, 95% CI −0.260, −0.093, P < 0.001). Depression significantly existed in the relationship between hearing loss and social participation as a mediating variable, and the percentage of indirect effects in this relationship were 16.5% and 20.8%. Conclusions: The findings of this study suggest that when facing an aging society, improving the hearing status of older adults should be considered by policymakers. More efforts should be made to help older adults cope with depression. Geriatr Gerontol Int 2022; 22: 529–535. [ABSTRACT FROM AUTHOR]

Aim: To estimate the risk of disability associated with high‐risk prescribing, such as polypharmacy and drugs with sedative or anticholinergic properties, using long‐term care needs certification as a proxy of incident disability. Methods: A case–control study nested within a cohort of older adults (89% aged ≥65 years) was carried out between 2014 and 2019 using the combined medical claims and long‐term care needs certification database of Tsukuba City, Japan. We identified 2123 cases who received their first long‐term care certification, and matched them to 40 295 controls based on age, sex, residential area and observation period (≥36 months). The risk of long‐term care needs certification associated with high‐risk prescribing exposure 7–30 months before the index month was estimated using conditional logistic regression adjusting for baseline comorbidities and health service use. Results: Polypharmacy (5–9 drugs; adjusted odds ratio [aOR] 1.32, 95% confidence interval [95% CI] 1.18–1.47), hyperpolypharmacy (≥10 drugs; aOR 1.87, 95% CI 1.57–2.23) and cumulative dose of drugs with sedative or anticholinergic properties (1–364 defined daily dose [DDD]; aOR 1.07, 95% CI 0.97–1.19; 365–729 DDD; aOR 1.25, 95% CI 1.07–1.45; ≥730 DDD; aOR 1.33, 95% CI 1.19–1.62) had dose–response relationships with long‐term care certification risks. Conclusions: High‐risk prescribing was associated with the risk of long‐term care needs certification in the general older population. Further studies are warranted to examine whether a decrease in prescribing drugs with sedative or anticholinergic properties could reduce the long‐term care burden on society. Geriatr Gerontol Int 2022; 22: 497–504. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the type and frequency of social interaction during the state of emergency due to coronavirus disease were associated with self‐rated health (SRH) after the state of emergency. Methods: Data from a cross‐sectional study were collected for 889 oldest‐old adults in Bibai City, Hokkaido, Japan. In total, 612 participants (mean age: 83.0 ± 4.3 years; women: 51.8%) were included in the analysis, taking biological sex into account. The self‐reported questionnaire included questions about demographic variables, SRH (July 2020, after the emergency), and the type and frequency of social interaction (March 2020, during the state of emergency). Results: There was no significant association between social interaction and SRH in men (P > 0.05). Women who had social interactions (both face‐to‐face and non‐face‐to‐face) more than once a week during the state of emergency reported higher SRH after the emergency than those who did not (odds ratio 2.17, 95% confidence interval 1.07–4.41). Conclusions: Having both types of interaction more than once a week during the state of emergency was related to higher SRH after the emergency among oldest‐old women. It is suggested that having opportunities for both types of interaction at least once a week would potentially be beneficial for high SRH in women, even in situations where the declaration of a state of emergency restricts face‐to‐face interaction. Geriatr Gerontol Int 2022; 22: 405–411. [ABSTRACT FROM AUTHOR]

Aim: Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. Methods: This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) sampled from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall‐risk‐increasing medication use, self‐rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. Results: In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall‐risk‐increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. Conclusions: Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022; 22: 338–343. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the association between alcohol consumption and the risk of Alzheimer's disease (AD). Methods: PubMed and Web of Science databases were systematically searched as of 1 September 2019. Relative risk and 95% CI were used to evaluate the association between alcohol consumption and AD risk. Subgroup analyses based on the type of alcohol, ethnicity, study design and sex were carried out. An alcohol dose–response meta‐analysis was carried out. Results: A total of 13 studies were included in the quantitative synthesis, and six were used in the dose–response meta‐analysis. Compared with non‐drinkers, individuals who drank had a lower risk of AD (relative risk 0.68, 95% CI 0.53–0.87; I2 = 87.9%, P < 0.001). In subgroup analyses, drinking wine was found to reduce the occurrence of AD (relative risk 0.71, 95% CI 0.51–0.96). When stratified by ethnicity, sex and study design, no association was seen between AD risk and alcohol use. There was an overall non‐linear, but not significant, association between alcohol intake dose and AD risk. A significant non‐linear association was observed between excess AD risk and alcohol intake dose in men (overall P = 0.023; P for non‐linearity = 0.025) starting from 14.8 drinks per week. Women's alcohol intake dose <16.9 drinks per week showed a significant non‐linear association with decreased AD risk (overall P = 0.002; P for non‐linearity = 0.019). Conclusions: Drinking alcohol could reduce the risk of AD. Alcohol dose had a non‐linear, but non‐significant, relationship with the development of AD. The amount of alcohol consumption showed significant sex‐specific effects on AD. Geriatr Gerontol Int 2022; 22: 278–285. [ABSTRACT FROM AUTHOR]

Aim: Maintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging. Methods: This community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals. Results: During about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively. Conclusions: These findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74. [ABSTRACT FROM AUTHOR]

Aim: To investigate the optimal treatment strategy in patients older than 80 years with non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS). Methods: All published randomized, placebo‐controlled trials (RCTs) reporting on comparisons between invasive and conservative strategies for patients aged 80 years or older with NSTE‐ACS were identified. The literature search was performed using PubMed, EMBASE, Cochrane Library, and the ISI Web of Science, from their establishment to July 2021 with no language restriction. The pooled risk ratios (RRs) with 95% confidence intervals (CI) for dichotomous outcomes were calculated. Results: Three RCTs involving a total of 893 cases met the inclusion criteria. Compared with the conservative group, the invasive strategy could significantly improve the incidence rate of composite endpoint (I2 = 21.9%; RR 0.727, 95% CI 0.619 to 0.855, P < 0.001), recurrent myocardial infarction (MI) (I2 = 0.0%; RR 0.585, 95% CI 0.441 to 0.776, P < 0.001) and revascularization (I2 = 0.0%; RR 0.239, 95% CI 0.126 to 0.455, P < 0.001). However, no benefits were observed on outcomes of all‐cause death (I2 = 0.0%; RR 0.888, 95% CI 0.681 to 1.160, P = 0.384), cardiac death (I2 = 0.0%; RR 0.769, 95% CI 0.412 to 1.433, P = 0.408) and stroke (I2 = 0.0%; RR 0.778, 95% CI 0.392 to 1.543, P = 0.473). The major bleeding events were comparable between the two groups (I2 = 0.0%; RR 1.582, 95% CI 0.622 to 4.025, P = 0.336). Conclusions: Compared with a conservative strategy, the invasive treatment could reduce the incidence of composite endpoint, recurrent MI, and revascularization in the very elderly with NSTE‐ACS. However, no benefits were observed on mortality. Geriatr Gerontol Int 2022; 22: 36–41. [ABSTRACT FROM AUTHOR]

Aim: Family caregivers can experience psychological distress, resulting in physical and mental health problems, and discontinuation of caregiving. This study's objective was to examine factors associated with caregiver psychological distress. Methods: We analyzed data from the Comprehensive Survey of Living Conditions in 2007, 2010, 2013 and 2016, which included 12 504 pairs of caregivers and care recipients sharing a household in Japan. Kessler's Psychological Distress Scale (K6) was used to measure caregiver psychological distress. Multivariable logistic regression analyses identified factors associated with caregiver psychological distress (K6 score ≥5). Results: Caregivers' median K6 score was 3 (interquartile range 0–7), and 38.6% had a K6 score ≥5. K6 scores ≥5 were positively associated with female sex (adjusted odds ratio 1.35, 95% CI 1.21–1.51), poor caregiver health status (compared with "very good," 9.48, 95% CI 7.91–11.37 for "not very good/poor"), longer care time (compared with "help only when needed," 1.40, 95% CI 1.25–1.58 for "almost all day") and dementia (1.16, 95% CI 1.05–1.28), lower respiratory tract disease (1.25, 95% CI 1.06–1.49) and diabetes (1.16, 95% CI 1.00–1.33) in care recipients. K6 scores ≥5 were negatively associated with older caregiver age (compared with 20–54 years, 0.65, 95%CI 0.58–0.74 for 55–64 years, 0.54, 95%CI 0.46–0.63 for 65–74 years and 0.50, 95% CI 0.40–0.62 for ≥75 years), employment (0.88, 95% CI 0.80–0.97) and being a care recipient's child‐in‐law (compared with spouse 0.75, 95% CI 0.61–0.92). Conclusions: The findings identified several factors associated with caregiver psychological distress, showing that particular attention might need to be paid to caregivers with these risk factors. Geriatr Gerontol Int 2021; 21: 855–864. [ABSTRACT FROM AUTHOR]

Aim: Although poor childhood rearing environment is known to negatively impact late‐life cognitive function, there is a scarcity of evidence on the contribution of positive parenting behaviors. The present study investigates the association between parental involvement in childhood and late‐life cognitive function. Methods: A total of 266 older adults aged between 65 and 88 years living in Wakuya City, Miyagi Prefecture, Japan, without indication of mild cognitive impairment or dementia, participated in a survey. Parental involvement in childhood was assessed by a questionnaire, and late‐life cognitive function was measured by the Japanese version of the Quick Mild Cognitive Impairment (QMCI) screening test (range: 0–100). Multiple regression analysis was performed to investigate the association, adjusting for potential confounders and mediators. Results: After adjusting for age, sex, other child‐rearing environment, and academic performance in grade 6, older adults with a high level of positive parental involvement in childhood scored 6.00 (95% CI: 2.39, 9.61) points higher for the QMCI total score than those without. Parental involvement in childhood showed significant dose–response positive associations with the QMCI total score (P < 0.001), clock‐drawing test score (P < 0.05), and verbal fluency score (P < 0.001). Among the six types of positive parental involvement, book reading showed a significant independent positive association with QMCI total score (P < 0.01) and logical memory score (P < 0.01). Conclusions: Greater parental involvement in childhood, particularly book reading, was associated with better late‐life cognitive function. Geriatr Gerontol Int 2021; 21: 794–801. [ABSTRACT FROM AUTHOR]

Aim: The study assessed the association between boosting the workforce supply by types of long‐term care services and in‐home deaths among older people at the municipality level. Methods: A fixed‐effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full‐time equivalent numbers of care workers engaged in in‐home services, day services, short‐stay services, and long‐term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates. Results: Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008–0.17). Although statistically non‐significant, the number of care workers providing in‐home services was positively associated with the proportion of home deaths, whereas the number of those providing short‐stay services and providing long‐term care facilities and nursing home services were inversely associated with home deaths. Conclusions: Given the increased number of care‐dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; 21: 712–717. [ABSTRACT FROM AUTHOR]

Aim: Although the glycemic target in older diabetes patients is based on cognition, activities of daily living and multimorbidity in the Japanese guideline, evidence of the relationships is limited. Thus, we aimed to assess the relationship between functional category and mortality in older people with diabetes. Methods: We evaluated the data of 843 older diabetes patients in a 6‐year prospective study, and the association between functional categories and all‐cause mortality. The patients were divided into three functional categories based on cognition, instrumental activities of daily living and basic activities of daily living using the Mini‐Mental State Examination, Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index at baseline, respectively (model 1). Those with multimorbidity (≥4 of 8 morbidities) were classified into category III (model 2). The functional category assessed using eight items from the Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index was also constructed (model 3). Hazard ratios and 95% confidence intervals were calculated in the Cox regression analysis using age, sex, body mass index, glycated hemoglobin level, total cholesterol level, estimated glomerular filtration rate and frequency of severe hypoglycemia as covariates. Results: During the 6‐year follow up, 64 incident mortalities occurred. The hazard ratios for mortality in categories II and III (as the reference of category I) were 1.83 (95% confidence interval 1.06–3.14, P = 0.030) and 3.05 (95% confidence interval 1.12–8.26, P = 0.029) after adjustment for covariates, respectively (model 1). Models 2 and 3 showed similar associations between functional category and mortality. Conclusions: The functional categories predicted all‐cause mortality in older adults with diabetes. Geriatr Gerontol Int 2021; 21: 512–518. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether late‐career unemployment is associated with increased physical frailty among older adults in Taiwan by the design of a population‐based cohort study. Methods: Data were retrieved from the Taiwan Longitudinal Study on Aging. The study examined data from the period 1999 to 2007. A total of 652 subjects were included in the final analysis, and they were categorized as normally employed or unemployed depending on their employment status in 1999. Frailty was defined using the Fried criteria. Multiple confounding factors were adjusted in a multilevel analysis. Results: The average age of the participants in 1999 was 59.0 years. A total of 491 participants were normally employed, and 161 participants were unemployed. After adjustment for gender, age, level of education, income, marital status, and number of chronic diseases, late‐career unemployment was associated with increased frailty [odds ratio (OR) = 1.61; 95% confidence interval (CI) = 1.00–2.59]. The risk of developing frailty was higher for participants who were unemployed during late career and had poor self‐rated health [OR = 3.54; 95% CI = 1.37–9.20]. Conclusions: Late‐career unemployment is associated with increased frailty, especially for those who also have poor self‐rated health. Older adults should be encouraged to maintain normal employment during the later stages of their career before retirement. Employers should apply strategies to prevent possible late‐career unemployment, and the government should provide resources and help to unemployed older workers so that they can minimize poor health outcomes in late life. Geriatr Gerontol Int 2021; 21: 353–358. [ABSTRACT FROM AUTHOR]

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. Methods: Cross‐sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end‐of‐life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end‐of‐life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345–352. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship between multiple medications and falls. Methods: This case–control and case–crossover study was carried out at Kudanzaka Hospital in Chiyoda, Tokyo, Japan. A total of 325 patients who experienced their first falls when hospitalized between January 2016 and November 2018, and 1285 controls matched by sex, age and clinical departments were included in this study. Hospitalization duration and fall risk score were adjusted for in the analyses. Results: In the case–control study, multivariable logistic regression showed that increasing the intake of oral medications was not significantly associated with the incidence of falls (odds ratio 1.02, 95% confidence interval 0.998–1.049). In contrast, drugs prescribed with special caution in accordance with the Elderly Oral Medication Guidelines were significantly associated with falls (odds ratio 1.17, 95% confidence interval 1.09–1.26). A similar pattern was observed in the case–crossover analysis. Among the drugs to be prescribed with special caution according to the guidelines, atypical antipsychotics, non‐benzodiazepine hypnotics and magnesium oxide were significantly associated with the risk of falls. Conclusion: The drugs to be prescribed with special caution according to the guidelines were associated with an increased fall risk. The risk of falls in hospitalized older people due to multiple medications varies among medications. Geriatr Gerontol Int ••; ••: ••–••Geriatr Gerontol Int 2021; ••: ••–••. [ABSTRACT FROM AUTHOR]

Aim: Existing evidence links social isolation with poor health. To examine differences in the mortality risk by social isolation, and in socio‐economic correlates of social isolation, we analyzed large‐scale cohort studies in Japan and England. Methods: Participants were drawn from the Japan Gerontological Evaluation Study (JAGES) and the English Longitudinal Study of Ageing (ELSA). We analyzed the 10‐year mortality among 15 313 JAGES participants and 5124 ELSA respondents. Social isolation was measured by two scales, i.e., scoring the frequency of contact with close ties, and a composite measurement of social isolation risk. We calculated the population attributable fraction, and Cox regression models with multiple imputations were used to estimate hazard ratios (HRs) for mortality due to social isolation. Results: The proportion of those with contact frequency of less than once a month was 8.5% in JAGES and 1.3% in ELSA. Males, older people, those with poor self‐rated health, and unmarried people were significantly associated with social isolation in both countries. Both scales showed that social isolation among older adults had a remarkably higher risk for premature death (less frequent contact with others in JAGES: hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.05–1.33, in ELSA: HR = 1.27, 95% CI: 0.85–1.89; and high isolation risk score in JAGES: HR = 1.30, 95% CI: 1.12–1.50, in ELSA: HR = 2.05, 95% CI: 1.52–2.73). The population attributable fraction showed less frequent contact with close ties was attributed to about 18 000 premature deaths annually in Japan, in contrast with about 1800 in England. Conclusions: Negative health impacts of social isolation were higher among older Japanese compared with those in England. Geriatr Gerontol Int 2021; 21: 209–214. [ABSTRACT FROM AUTHOR]

Aim: This large epidemiological survey of older people examined oral hypofunction and the relationship between oral hypofunction and frailty. Methods: Participants were community‐dwelling adults aged 65–85 years in Japan. The oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue–lip motor function, tongue pressure, masticatory function and swallowing function), and oral hypofunction was defined as having abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre‐frail and frail) according to the total Kihon Checklist score. We analyzed 978 subjects with complete data. The relationship between oral function and frailty status was analyzed using multivariate multinomial logistic regression analyses. Results: Approximately 60% of the older adults had oral hypofunction. The multivariate odds ratios (ORs) for a pre‐frail or frail status were significantly higher for older people with reduced occlusal force, reduced tongue–lip motor function and deteriorated swallowing function than in those without deterioration of those items. Of the oral function items, swallowing function was most strongly associated with the frailty status, and the ORs (95% confidence interval [CI]) for deteriorated swallowing function in pre‐frail and frail patients were 6.4 (3.9–10.8) and 10.2 (5.4–19.1), respectively. Those with oral hypofunction had significantly higher adjusted ORs for pre‐frail (OR 1.4, 95% CI 1.1–2.0) and frail (OR 2.1, 95% CI 1.2–3.5) statuses. Conclusion: Many community‐dwelling older people have reduced oral function or oral hypofunction, which is significantly associated with frailty in older people. Geriatr Gerontol Int 2020; 20: 917–926. [ABSTRACT FROM AUTHOR]

Aim: To test whether alerting clinicians to severe weight loss in older patients leads to higher dietitian visit rates, to higher body mass index (BMI) levels and, mainly, to lower annual death risk. Methods: The randomized controlled trial included patients aged ≥75 years, with BMI ≤23 kg/m2 that decreased ≥2 kg/m2 during the previous 2 years. All participants received usual care. Additionally, an email alert was sent only to clinicians of participants assigned to the email alert group. The follow‐up period was 12 months. Results: Among 706 participants (mean age 83 ± 6 years; mean baseline BMI 20.5 kg/m2), the BMI record was updated in 541 (77%) participants, and 123 participants died. Dietitian visits were reported for 22 patients (6%) in the email group (n = 362) and 14 patients (4%) in the control group (n = 344; OR 1.5, 95% CI 0.8–2.9; P = 0.24). Measured BMI were raised by a mean of 0.69 (95% CI 0.43–0.95) kg/m2 versus 0.79 (95% CI 0.48–1.1) kg/m2 (P = 0.63). A total of 77 patients (21%) died in the intervention group versus 47 (14%) in the control group (P = 0.008; number needed to harm = 13; 95% CI 7–43). Conclusions: In this trial, alerting clinical staff to severe weight loss in patients aged ≥75 years was not associated with higher visit rates to a dietitian or change in BMI, but was associated with a significantly higher death rate than usual clinical care. Geriatr Gerontol Int 2020; 20: 329–335. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the Probability of Repeated Admission (Pra) scale performance in predicting healthcare utilization and death in a community sample of Rio de Janeiro city, Brazil. Methods: This was a prospective longitudinal study. The sample was composed of community‐dwelling older people who participated in the research network Frailty in Brazilian Older People Study, Rio de Janeiro section. It analyzed data from the baseline and the follow up. At the baseline, 764 older adults were stratified by the Pra, and, 3 years later, data on health services utilization and survival status were collected. The Pra accuracy, obtained by the area under the curve, the sensitivity and the specificity to predict hospitalization in 3 years; visits to the emergency department; and death were determined. Cox regression estimated the survival curves, according to the risk strata. Results: The accuracy, the sensitivity and the specificity of Pra were 62% (95% CI 57–68%), 8.8% and 95.4% for hospitalization in 3 years; 59% (95% CI 53–64%), 8.3% and 94.8% for emergency room visits; 66% (95% CI 59–74%) and 68% (95% CI 63–73%), 15.0% and 96.0% for death. Survival curves showed that high‐risk individuals were more likely to die compared with the low‐risk individuals, adjusted to covariables (P < 0.001). Conclusions: The Pra presented low accuracy, low sensitivity and high specificity for all outcomes observed, indicating a poor performance to screen vulnerable older adults in Brazil. Therefore, this tool should not be used alone, as a case‐finding instrument. Geriatr Gerontol Int 2020; 20: 360–365. [ABSTRACT FROM AUTHOR]

Aim: To describe general practitioners' (GPs) perspectives on end‐of‐life care of nursing home residents. Methods: We carried out a cross‐sectional study. A questionnaire was sent to a random sample of 1121 GPs in the German federal states of Bremen and Lower Saxony in 2018. Data were compared between GPs with a qualification in palliative medicine and those without such qualifications, and multivariable logistic regression was performed. Results: Overall, 375 questionnaires were returned (response rate 34%). The majority of GPs (71%) agreed that nursing home residents are treated too often in hospitals at the end of life, and more than half rated end‐of‐life care in nursing homes as "rather poor" (54%). For both questions, GPs with a qualification in palliative medicine showed higher agreements. In the multivariable analysis, a prior qualification in palliative medicine was also strongly associated with rating end‐of‐life care as "rather poor" (OR 1.89, 95% CI 1.10–3.23). Respondents cited higher staffing ratios and better trained nursing staff as the most important measures to improve end‐of‐life care. Furthermore, it was estimated that just 37% of residents have an advance directive, with only one‐third including valid information on end‐of‐life hospitalizations. Conclusions: This study showed that GPs tend to be critical regarding end‐of‐life care in nursing homes. To improve end‐of‐life care, better training in palliative care for nursing staff and GPs might be warranted. In addition, advance care planning can help to ensure that residents' wishes are respected. Geriatr Gerontol Int 2020; 20: 25–30. [ABSTRACT FROM AUTHOR]

Aim: To analyze the impact of clinical medication reviews (CMR) on reducing unplanned hospitalizations owing to polypharmacy among older adults using an intervention. Methods: Our meta‐analysis complied with PRISMA guidelines. The literature review comprised a search for articles published between January 1972 and March 2017 on MEDLINE and Google Scholar. We identified randomized controlled trials focusing on CMR that evaluated unplanned hospitalization and re‐hospitalization among older adults as a primary outcome. The keywords used were "CMR" or "medication review" in their titles, and the phrases "elderly" or "older adults" or "geriatric" and "polypharmacy." The randomized controlled trials selected were divided according to the three types of CMR to analyze the characteristics of each review. Results: We included nine randomized controlled trials that examined the impact of CMR of polypharmacy in older patients. Five trials corresponded to CMR type I (prescription only review) or II (adherence review), whereas four corresponded to type III (comprehensive clinical evaluation for disease management). Type I/II increased the number of unplanned hospitalizations (RR 1.22, 95% CI 1.07–1.38, P = 0.002), whereas type III decreased hospital admissions (RR 0.86, 95% CI 0.79–0.95, P = 0.001). Conclusions: The present findings show the need for an intervention standardization for CMR, particularly for type III in older adults with polypharmacy, to decrease hospitalizations. Geriatr Gerontol Int 2019; 19: 1275–1281. [ABSTRACT FROM AUTHOR]

Aim: Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods: This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results: In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions: Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between a decrease in the frequency of going out and oral function in independent older adults living in the urban area of Tokyo. Methods: The participants analyzed were 785 older adults from the "Takashimadaira Study" (344 men and 441 women, age 77.0 ± 4.6 years). This study investigated the following items: decrease in frequency of going out; basic characteristics (sex, age); physical factors, such as oral function (difficulty chewing, difficulty swallowing, dry mouth); body pain; the Japan Science and Technology Agency Index of Competence; physical activities; psychological factors, such as the Geriatric Depression Scale‐15 score; and social and environmental factors, such as the presence or absence of participation in organization activities. Results: To investigate the factors associated with a decrease in frequency of going out, logistic regression analysis showed an association with age (OR 1.08, 95% CI 1.03–1.13), difficulty chewing (OR 2.41, 95% CI 1.52–3.83), dry mouth (OR 1.68, 95% CI 1.07–2.64), body pain (OR 1.78, 95% CI 1.14–2.78), Japan Science and Technology Agency Index of Competence scores (OR 0.91, 95% CI 0.84–0.99), physical activities (OR 0.99, 95% CI 0.98–1.00), Geriatric Depression Scale‐15 scores (OR 1.13, 95% CI 1.05–1.21) and organization activities (OR 1.94, 95% CI 1.22–3.07). Covariance structural analyses showed that both "difficulty chewing" and "dry mouth" significantly affected "decrease in frequency of going out." In addition, decrease in frequency of going out was significantly affected by " Geriatric Depression Scale‐15 scores" through oral function. Conclusions: The relationship between oral function and decrease in frequency of going out was clarified, after the multifaceted factors were adjusted. Geriatr Gerontol Int 2019; 19: 792–797. [ABSTRACT FROM AUTHOR]

Aim: Limited information is available on the prevalence of drug–drug interactions (DDI) in residents of long‐term care facilities who often receive multiple drugs. This study aimed to evaluate the prevalence of clinically relevant cytochrome P450‐mediated potential DDI in residents of intermediate care facilities for older adults (called Roken) in Japan. Methods: A nationwide drug utilization study was carried out for Roken residents in 2015 (up to five residents per facility). Potential DDI were identified with an explicit list of drugs that can be involved in clinically relevant cytochrome P450‐mediated DDI in Japan. Logistic regression was used to evaluate the association of the number of drugs prescribed with the presence of potential DDI, adjusted for age, sex and long‐term care needs level. Results: The study included 1222 residents of 348 Roken who were prescribed two or more active drug substances. The participants who received ≥6 and ≥10 drugs represented 49% and 10% of total participants, respectively. In total, 42 two‐drug combinations involving potential DDI were identified in 33 participants (2.7%) – benzodiazepines, proton pump inhibitors, calcium channel blockers and anti‐epileptic drugs were frequently involved. The adjusted odds ratios for potential DDI were 2.84 (95% confidence interval 1.15–7.02) or 7.82 (95% confidence interval 2.96–20.70) in residents receiving six to nine drugs or ≥10 drugs, compared with those receiving two to five drugs. Conclusions: Approximately 3% of Roken residents were at risk for clinically relevant DDI. Reducing the number of drugs prescribed through medication reviews would mitigate the potential risk. Geriatr Gerontol Int 2019; 19: 513–517. [ABSTRACT FROM AUTHOR]

Aim: Many studies have reported the preventive effects of community social capital on health outcomes, such as mortality and incidence of diseases. However, evidence on the association between community social capital and dementia‐related outcomes remains sparse. The present study examined the contextual association of social capital with subjective symptoms of dementia among community‐dwelling older adults in Japan, using a population‐based, large‐scale questionnaire survey. Methods: Data were used from a cross‐sectional survey for all community‐dwelling individuals aged ≥65 years in Adachi Ward, Tokyo (n = 132 005). Subjective dementia symptoms were assessed using a self‐administered dementia checklist, which was validated by the Clinical Dementia Rating Scale. Social capital was assessed by neighborhood cohesion (neighborhood trust, neighborhood attachment and sense of belonging to the neighborhood) and neighborhood network (i.e. social relationships with neighbors). Individual responses from each district were aggregated to create indicators of district‐level social capital. Results: A total of 75 338 questionnaires were analyzed (covering 260 districts). The average age of participants was 73.8 ± 6.0 years (45.0% men). A multilevel binomial logistic regression analysis by sex showed that a denser neighborhood network in a district was associated with a lower likelihood of subjective dementia symptoms (odds ratio 0.89, 95% confidence interval 0.83–0.96) among women. No association was found for men between district‐level social capital and subjective dementia symptoms. Conclusions: Fostering structural aspects of social capital in a community is a potential dementia‐prevention strategy, and policymakers should focus on such community‐based approaches as well as on approaches that target individuals. Geriatr Gerontol Int 2018; 18: 1537–1542. [ABSTRACT FROM AUTHOR]

Aim: There is a lack of studies on the prevalence of frailty, and the association between frailty and mortality in a Norwegian general population. Findings regarding sex differences in the association between frailty and mortality have been inconsistent. The aim of the present study was to investigate the association between the frailty phenotype and all-cause mortality in men and women in a Norwegian cohort study. Methods: We followed 712 participants (52% women) aged ≥70 years participating in the population-based Tromsø 5 Study in 2001-2002 for all-cause mortality up to 2016. The frailty status at baseline was defined by a modified version of Fried's frailty criteria. Cox regression models were used to analyze the association between frailty and mortality with adjustment for age, sex, disability, comorbidity, smoking status and years of education. Results: In total, 3.8% (n = 27) of participants were frail (women 4.4%, men 3.2%) and 38.1% (n = 271) were pre-frail (women 45.8%, men 29.9%). During follow-up (mean 10.1 years), 501 (70%) participants died. We found an increased risk of mortality for frail older adults (multivariable-adjusted HR 4.16, 95% CI 2.40-7.22) compared with non-frail older adults. In sex-stratified analysis, the adjusted HR was 7.09 (95% CI 3.03-16.58) for frail men and 2.93 (95% CI 1.38-6.22) for frail women. Results for pre-frailty showed an overall weaker association with mortality. Conclusions: While frailty was more prevalent in women than in men, the findings suggest that the association between frailty and mortality is stronger in men than in women. [ABSTRACT FROM AUTHOR]

Aim: Body mass index (BMI) is regarded as a predictor of life expectancy and a determinant of mortality. However, the effect of age on BMI‐related mortality remains unclear. The aim of the present study was to examine the prognostic effect of BMI to mortality risk among Korean older persons. Methods: Data were collected from the Korean National Health Insurance Services’ Senior Cohort database. This study analyzed the data of 79 341 men and 91 298 women aged ≥65 years who underwent health examinations in the 2007 fiscal year. Individual mortality was identified 5 years after 2008. The participants were stratified into seven groups according to basal BMI. Hazard ratios of death were calculated through Cox proportional hazards model after adjusting for age, sex, smoking status, exercise, alcohol intake and income. Results: During the 5‐year follow up, 11 651 men and 7 235 women died. In both sexes, a lower BMI had a higher hazard ratio (HR), but the trend of increasing HR at high BMI was not clear. For men, the lowest HR was 0.79 (95% CI 0.71–0.87) at a BMI of 27.5–30.0 kg/m2. For women, the lowest HR was 0.84 (95% CI 0.78–0.91) at a BMI of 25.0–27.5 kg/m2. For both sexes, the relative mortality risk was associated with a lower BMI. Conclusions: A high BMI is not associated with increased mortality in older adults aged ≥65 years, whereas a lower BMI is associated with an increased mortality risk in later life in this population. Geriatr Gerontol Int 2018; 18: 538–546. [ABSTRACT FROM AUTHOR]

Aim: To review the best available evidence on nutritional supplementation for activities of daily living and functional ability of older people in residential facilities. Methods: Electronic searches were carried out using CENTRAL, MEDLINE and EMBASE databases for the years 2006–2016. Randomized controlled trials and cluster‐randomized controlled trials that examined the effects of nutrition interventions aimed at improving the energy or protein intake alone or both in combination were included. Two authors independently reviewed all potential studies for inclusion against the eligibility criteria. We reviewed studies for outcome relevance and methodological rigor. Any disagreement was resolved by discussion. Results: A total of eight studies were included, containing four randomized controlled trials and four cluster‐randomized controlled trials involving 698 participants. There was significant improvement in handgrip strength (mean difference 1.65 kg, 95% confidence interval 0.09–3.22 kg, P = 0.04), but no difference in activities of daily living (mean difference 2.06, 95% confidence interval −18.28–22.40, P = 0.84), balance (mean difference −1.10, 95% confidence interval −3.04–0.84, P = 0.27), gait velocity (mean difference 0.00, 95% confidence interval −0.03–0.03, P = 1.00) and death (RR 1.90, 95% confidence interval 0.61–5.99, P = 0.27). Conclusions: Nutritional intervention with older people in residential facilities was effective in improving handgrip strength, but did not significantly improve scores for activities of daily living, balance, gait velocity or preventing death. Further studies with larger sample sizes and of high quality are required to investigate appropriate intervention methods and specific target participants. Geriatr Gerontol Int 2018; 18: 197–210. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We developed a simple self‐screening method, the “Yubi‐wakka (finger‐ring)” test to assess sarcopenia swiftly. This prospective cohort study aimed to examine the validity of this test as a practical method among community‐dwelling older adults for identifying sarcopenia, and for predicting disability and mortality. Methods: We followed 1904 older adults, and analyzed associations between this “Yubi‐wakka” test result at baseline in 2012 and sarcopenia at baseline, new‐onset sarcopenia followed until 2014, and new‐certification for the long‐term care insurance and mortality followed until 2016. The “Yubi‐wakka” test checks whether the maximum non‐dominant calf circumference is bigger than the individual's own finger‐ring circumference, which is formed by the thumb and forefinger of both hands. We divided participants into three groups, “bigger,” “just fits” and “smaller” based on a comparison between the calf and finger‐ring circumference. Results: Of 1904 participants (mean age 72.8 ± 5.4 years), 53% were grouped as “bigger,” 33% were in “just fits” and 14% were in “smaller.” Relative to “bigger,” the test results statistically associated with sarcopenia (“just fits” OR 2.4, 95% CI 1.4–4.1 and “smaller” OR 6.6, 95% CI 3.5–13), by multivariate analyses. The test results also increased the risk of new‐onset sarcopenia (“just fits” HR 2.1, 95% CI 1.2–3.8 and “smaller” HR 3.4, 95% CI 1.8–6.4). Furthermore, the “smaller” had 2.0‐ and 3.2‐fold increased risks for needing long‐term care insurance services and mortality, respectively. Conclusions: The “Yubi‐wakka” test is an extremely practical method to identify older adults at risk of sarcopenia, disability and mortality. This test might contribute to increased primary prevention for sarcopenia by serving as an early wake‐up call for older adults against becoming sarcopenic. Geriatr Gerontol Int 2018; 18: 224–232. [ABSTRACT FROM AUTHOR]

Aim The time-course for changes in muscle size and strength is not well understood, particularly in women. In addition, contributions of muscle size to strength are commonly assessed utilizing a pre-post change score; however, a more appropriate within-subject correlational analysis has never been used. Methods To determine the time-course for thigh muscle size and strength in young (aged 18-25 years) and older (aged 50-65 years) women, and determine the relationship between size and strength after 8 weeks of training carried our three times per week. Results Anterior muscle thickness at the 50% site increased after 1 week of training, and exceeded the measurement error after 2 weeks (mean difference 0.23 cm, 95% CI 0.12-0.34 cm). Anterior muscle thickness at the 70% site increased and exceeded the measurement error after 2 weeks (mean difference 0.30 cm, 95% CI 0.15-0.45 cm). Posterior muscle thickness at the 50% site increased after 1 week of training, and exceeded the measurement error after 2 weeks (mean difference 0.24 cm, 95% CI 0.03-0.44 cm). Posterior muscle thickness at the 70% site increased after 1 week, and exceeded the measurement error after 3 weeks (mean difference 0.21 cm, 95% CI 0.07-0.35 cm). Muscle strength, assessed through one-repetition maximum, increased by 2 weeks in most measurements, and the within-subject variance explained by changes in muscle size ranged between 9% and 35%. Conclusions Muscle growth appeared to occur early into a training program in both young and older women. Furthermore, although a large portion remains unexplained, the variance in muscle strength explained by muscle size is greater than previous studies not utilizing within-subject correlations. Geriatr Gerontol Int 2017; 17: 2000-2007. [ABSTRACT FROM AUTHOR]

Aim Not only cardiovascular disease (CVD) itself, but also subclinical major electrocardiographic (ECG) abnormalities are related to frailty in older adults. We investigated whether major ECG abnormality was associated with first support/care-need certification in Long-Term Care Insurance or death in community-dwelling older adults. Methods We analyzed 1078 community-dwelling older adults with no history of certification aged 65-94 years. Relationships between baseline major ECG abnormality and risk of first certification or death were estimated using the Cox proportional hazards model. Results During 5 years, 135 first certifications and 53 deaths occurred. Among participants with no prior history of CVD ( n = 875), those with major ECG abnormality ( n = 282) showed significantly higher adjusted hazard ratios (HR) for certification (HR 2.42, 95% CI 1.58-3.69, P < 0.001) and for death (HR 2.44, 95% CI 1.27-4.69, P = 0.008) compared with control participants without major ECG abnormality ( n = 593). The impact of major ECG abnormality on certification in this group was more evident in older adults with age ≥75 years, female sex or hyperuricemia. Participants with either arrhythmia or ST/T abnormality on ECG examination tended to have higher HR for certification as a result of dementia. In participants with a prior history of CVD ( n = 203), the impact of major ECG abnormality ( n = 126) on certification was not significant. Conclusions These observations show that subclinical major ECG abnormality predicts higher risk for later support/care-need certification in community-dwelling older adults with no prior history of CVD. Geriatr Gerontol Int 2017; 17: 1967-1976. [ABSTRACT FROM AUTHOR]

Aim Although older adults have high dental care needs as a result of prevalent oral health problems, they have high unmet needs. The purpose of the present study was to examine factors associated with unmet dental care needs among older adults living in the community. Methods This study analyzed 1419 adults aged 65 years and older who participated in both the health interview survey and oral examination of the Fifth Korea National Health and Nutrition Examination Survey carried out in 2010. Predisposing (age, sex, education, marital status), enabling (place of residence, work status, income, health insurance) and need (self-rated oral health, difficulty chewing, toothache, number of teeth, dental caries, periodontal disease) factors associated with self-perceived unmet dental care needs were analyzed through multiple logistic regression analysis. Results Unmet dental care needs accounted for 27.9% in older adults. Age, income, difficulty chewing and the presence of permanent tooth caries were significantly associated with unmet dental care needs, adjusting for covariates. Compared with those aged 75 years and older, the 65-69 years age group showed 1.86-fold higher odds of unmet dental care needs. Lower household income was associated with a higher likelihood of not receiving dental care when required. Unmet dental care needs were significantly higher among those with chewing difficulty (OR 2.14, 95% CI 1.55, 2.95) and permanent tooth caries (OR 1.86, 95% CI 1.28-2.70). Conclusions Unmet dental care needs are prevalent in older people who are socioeconomically disadvantaged and vulnerable in oral health. Geriatr Gerontol Int 2017; 17: 1936-1942. [ABSTRACT FROM AUTHOR]

Aim Little is known about the association between fear of falling (FOF) and the risk of mortality. The aim of the present study was to investigate the association between FOF and mortality among community-dwelling older adults. Methods A total of 3814 older adults aged 65 years and older living in the Shih-Pai area in Taiwan participated in this 7-year follow-up longitudinal study. A structured questionnaire was used to record participants' FOF, history of falling, demographic characteristics, medical conditions, history of insomnia, depression symptoms and subjective health from 1999 to 2002. Follow-up all-cause mortality data were obtained from the National Death Registry of the Department of Health to identify the occurrence of deaths from the initial interview through to 31 December 2008. Results At the baseline assessment, the mean age of the participants was 73.8 ± 5.8 years, 56.4% were men and 53.4% had FOF. Cox regression showed that participants with FOF had an increased risk of mortality (aHR 1.16, 95% CI 1.02-1.33) after adjusting for sex, history of falling, age, body mass index, marital status, education level, smoking status, alcohol use, living status, chronic condition, depression and subjective health. Furthermore, FOF was a significant risk factor for male participants (aHR 1.17, 95% CI 1.00-1.38), but had a marginal risk for female participants (aHR 1.24, 95% CI 0.95-1.60) after adjusting for other risk factors, as in the full model except for sex. Conclusions The findings of the present study suggest that FOF is a significant risk factor of mortality, especially in older male adults. Further research on the mechanism and effects of fear of falling on mortality is necessary. Geriatr Gerontol Int 2017; 17: 2216-2223. [ABSTRACT FROM AUTHOR]