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

Objectives To investigate the association between loss of muscle mass and aspiration pneumonia ( AP). Design Prospective observational cohort. Setting Acute geriatric hospital. Participants Individuals admitted to the hospital for AP (N = 151; mean age 85.9; 49.7% male). Measurements Appendicular skeletal muscle index ( ASMI; appendicular skeletal muscle mass divided by height squared) was used to evaluate muscle mass. Data on age, sex, body mass index, Mini Nutritional Assessment-Short Form score, Barthel Index score, Charlson Comorbidity Index score, and pneumonia severity (Japanese version of the CURB-65 (C (confusion), U (blood urea nitrogen ≥20 mg/ dL), R (respiratory rate ≥30 breaths/min), B (systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg), 65 (aged ≥65) severity score (A- DROP)) were obtained. Outcomes included 30- and 90-day mortality. Results Mild, moderate, severe, and extremely severe AP were observed in 1.3%, 70.2%, 25.8%, and 2.6% of participants, respectively. On Kaplan-Meier analysis, participants in the lowest ASMI quartile for each sex were more likely to die than those in the other quartiles (log-lank test P = .005). Multivariate logistic analyses showed that ASMI and A- DROP were independent predictors of 90-day mortality; only A- DROP was a significant predictor of 30-day mortality ( P < .001). Cox regression analysis also showed that the first ASMI quartile was independently associated with mortality (hazard ratio = 2.19; 95% confidence interval = 1.06-4.52; P = .03). Conclusion Low muscle mass is a potential predictor of long-term mortality in individuals with AP. Prospectively preventing muscle mass deterioration may be beneficial for recovery from AP in older adults. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

A letter to the editor is presented concerning a retrospective cohort study studying factors associated with people dying at night in an Japanese acute care hospital which reports a multivariate logistic regression analysis found the only independent predictor of dying at night was being aged 75 or older.

The article discusses a study of a comprehensive geriatric assessment (CGA) of elderly people in a rural community in Japan which focused on the association between cognitive status and cardiovascular indicators including blood pressure.

The article reports on research conducted to investigate whether there were associations between mild cognitive decline and poor sleep quality indicators in older Japanese citizens. Researchers conducted a community-based geriatric assessment of 691 subjects between the ages of 75 and 102. They found that there was a mild association between cognitive function and sleep quality and concluded that the cognitive function of older people should be assessed to prevent the development of insomnia-related diseases.

A letter to the editor is presented which is concerned with Werner syndrome in Japan.

A letter to the editor is presented which is concerned with research which investigated the association between geriatric function and subjective economy in elderly adults living in a rural community in Japan.