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In Japan, the mobility functions of principal arterial roads are hindered by lined-up roadside facilities and densely located signalized intersections. As one of the solutions, it is necessary to consider a functional hierarchy of road networks, based on the structure and traffic operations of each road. The purpose of this study was to propose an index to evaluate the degree to which the road network could be used hierarchically according to their mobility function, based on the location of the bases and the location of roads at each level of the hierarchy, and to propose a method to evaluate the road network using this index. To accomplish this, we proposed a four-level method for the evaluation of the functional hierarchy of road networks based on the derived index values. As a case study, we calculated the degree of hierarchy for the road networks in northern Mie and western Shizuoka. The results showed that the current evaluations of the functional hierarchy in these regions were low, and that introducing mid-level roads was necessary to improve the current situation. The evaluation method proposed in this study will enable us to examine the ideal network configuration for each road in the region to exhibit its mobility function as a preliminary step to studying solutions to various road network issues, such as ensuring the smooth movement between bases and safety. © 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0) Peer-review under responsibility of the scientific committee of the World Conference on Transport Research – WCTR 2023. • Proposed a four-level evaluation method for the functional hierarchy of road networks. • Focused on the utilization rate of road hierarchy according to trip length. • Effective for road planning from the viewpoint of hierarchical road use. [ABSTRACT FROM AUTHOR]

The Japanese Orthopaedic Association (JOA) introduced the concept of locomotive syndrome (LS), which indicates a decline in mobility function by musculoskeletal disorders with new 3-staged category. Additionally, sarcopenia indicates a decline in the quantity and/or quality of skeletal muscle. However, the relationship between low back pain (LBP) and LS or sarcopenia in older people has not been sufficiently understood. This study aimed to investigate the association between them through a cross-sectional locomotorium survey. A total of 302 participants were drawn from the aquatic exercise participants in a rural area of Japan. The body mass index, body fat percentage, skeletal muscle mass index (SMI), spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), and maximum stride of the participants were measured. LBP and LBP-related quality of life (QOL) were evaluated using the Oswestry Disability Index (ODI), visual analogue scale (VAS) of LBP, and the Short-Form 8 (SF-8). Associations between the investigating parameters and sarcopenia or LS were analyzed. There were no significant differences in the findings except grip strength between the non-sarcopenia and sarcopenia groups. However, the LS group showed significantly larger SIA, higher ODI, higher VAS of LBP, lower physical component score (PCS) of the SF-8, longer time in TUG, and lower value in maximum stride than the non-LS group. In addition, the ODI and PCS of the SF-8 significantly deteriorated as the LS stage progressed, and the GLFS-25 score was significantly correlated with ODI (r = 0.706, p < 0.001) and PCS (r = −0.643, p < 0.001) scores. LBP, LBP-related QOL, and physical performance were found to be significantly associated with LS, not sarcopenia, with LBP-related QOL and physical function being closely correlated with 3-stage categories of LS. Thus, these results suggested that LBP is a key factor for LS prevalence. [ABSTRACT FROM AUTHOR]

• Study suggests exercise may help prevent traffic injuries. • Elderly people who do not exercise have a gap between their awareness and behavior when crossing the street. • A high percentage of elderly people are able to react in some way when they are about to have an injury. Introduction: In recent years, the percentage of elderly fatalities in traffic crashes in Japan has been increasing and has exceeded 50% since 2010. The fatality rate is high for the elderly due to the deterioration of physical functions. Method: The purpose of this study was to reduce the high fatality rate of elderly people at the time of the crash and to find out the effective exercise elements for maintaining physical functions, and to deter traffic crashes and reduce the fatality rate of the elderly people. Results: The effect of exercise on improving and maintaining physical fitness was remarkable, and even when encountering a near miss injuries or crashes, the percentage of the group that was able to respond in some way to a near miss or crashes was higher in the group that regularly exercised. The elderly who do not exercise tend to take longer to start crossing and tend to check both sides of the road less often while crossing. In addition, when they were about to encounter a car, they tended to continue walking, which tended to lead to dangerous crossing. Conclusion: As a result of the questionnaire survey, the possibility of preventing traffic crashes by participating in sports was confirmed. As a result of running experiments using a crossing simulator, it was found that elderly people who do not exercise have a gap between their usual awareness of crossing and their actual behavior. Practical implications: Through the discovering elements of exercise that are useful in reducing injuries will make it possible to provide accurate guidance and training to elderly people with reduced physical functions, and it is expected that pedestrians will be able to avoid traffic injuries with their own abilities. [ABSTRACT FROM AUTHOR]

Background: Japan has now become a super-aged society. Notably, as the Japanese society ages, the prevalence of falls, which represent an aging-related problem, has increased. Locomotive syndrome (LS) is a condition of decreased mobility due to locomotive organ disorder. The loco-check is simple tool to detect early-stage LS. The loco-check comprises seven items relating to daily activities. Higher numbers of affirmative answers in the loco-check are negatively associated with physical functions. The purpose of this study was to examine the potential correlation between the number of affirmative answers given on the "loco-check" survey and the likelihood of experiencing at least one fall during the following one-year period.Methods: This prospective study included 154 cases (35 men, 119 women), all aged 65 years or older, answered the loco-check at baseline. As part of their normal treatment process, the participants made monthly visits to the out-patient department; thus, at each of these visits for the following 12 months a medical doctor interviewed each patient to determine whether they had experienced a fall during the previous month.Results: The mean age of the sample was 77.3 years, and the median number of affirmative answers given was 2.0. The number of affirmative answers significantly correlated with the cases which had a fall event within the follow-up period. Specifically, an increase in one "yes" answer on the loco-check increased the relative risk of fall (odds ratio: 1.32; 95% Confidence interval (CI): 1.03-1.70). In addition, the risk of fall was high in cases which showed the number of affirmative answers given on the loco-check ≥4 (odds ratio: 9.26; 95% CI: 1.05-81.7).Conclusion: The number of affirmative answers given on the loco-check is positively correlated with a fall event within the following year. [ABSTRACT FROM AUTHOR]

• Higher serum DHEA-S levels were associated with lower risk of frailty. • This was especially true for mobility-subtype frailty. • Low serum DHEA-S also showed a trend towards an association with weight loss. Previous studies suggest that lower serum levels of dehydroepiandrosterone sulfate (DHEA-S) are associated with physical frailty. Associations with subtypes of physical frailty have not been studied. This study aimed to investigate associations between serum DHEA-S levels and physical frailty and its subtypes in older Japanese community-dwellers using panel data. This study was conducted within the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). Repeated measurement data were collected from 1,886 older community-dwellers (60–91 years). Frailty was identified according to modified Cardiovascular Health Study criteria (weight loss, weakness, slowness, exhaustion, low physical activity) and was classified into following subtypes: mobility (weakness/slowness), non-mobility (weight loss/exhaustion), and low physical activity. Associations with serum DHEA-S (sex-specific tertiles [T1−T3]) were estimated by random-effects logistic regression models adjusting for age, sex, education, disease history (stroke, hypertension, heart disease, diabetes), smoking status, depressive symptoms, and survey wave. We found an average prevalence of 6.0% for frailty (mobility subtype, 7.0%; non-mobility subtype, 34.8%; low physical activity subtype, 9.4%) across survey waves. Mean (SD) sex-specific DHEA-S levels (μg/dL) at T1, T2, and T3 were 46.8 (20.8), 88.7 (28.4), and 158.0 (58.9), respectively. Compared with T1, the adjusted ORs (95% CIs) for frailty were 0.69 (0.44, 1.08) for T2 and 0.50 (0.30, 0.83) for T3 (P trend = 0.007). The corresponding values for mobility subtype were 0.80 (0.51, 1.24) for T2 and 0.55 (0.33, 0.90) for T3. Higher serum DHEA-S levels were associated with lower risk of frailty, especially mobility-subtype frailty, in older community-dwellers. [ABSTRACT FROM AUTHOR]

To compare the Fried criteria for frailty diagnosis with the Frailty Screening Index (FSI) and the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale in older patients with cardiovascular disease (CVD). We conducted a retrospective 1-year follow-up cohort study of adult inpatients who participated in a cardiac rehabilitation program between June 2016 and September 2018. We included 1472 Japanese patients age 65 years and older with CVD. After excluding 765 patients with incomplete frailty measurements, 707 patients were included in the analysis. Frailty and physical function were measured before hospital discharge according to each of the 3 definitions. Outcomes were all-cause mortality and physical dysfunction. The prevalence of frailty according to the Fried criteria, the FRAIL scale, and the FSI was 213 (30.1%), 181 (25.6%), and 186 (26.3%), respectively. The FSI and the FRAIL scale showed moderate agreement with the Fried criteria [vs FSI: K = 0.52, 95% confidence interval (CI): 0.45–0.59; vs FRAIL scale: K = 0.45, 95% CI: 0.37–0.52; all P <.001]. We found a significant correlation between all-cause mortality and frailty assessed by all of the definitions, even after multivariate adjustment [FSI: hazard ratio (HR): 2.43, 95% CI: 1.30–4.58, P =.006; FRAIL scale: HR: 2.32, 95% CI: 1.21–4.45, P =.011; Fried criteria: HR: 1.99, 95% CI: 1.04–3.82, P =.038). However, the prediction accuracy of the FRAIL scale was higher than that of the FSI and comparable to that of the Fried criteria for physical dysfunction. The FSI and the FRAIL scale showed moderate agreement with the Fried criteria regarding frailty diagnostic performance and had comparable prognostic value. However, only the FRAIL scale was as accurate as the Fried criteria in screening for physical dysfunction. [ABSTRACT FROM AUTHOR]

• Cognitive health is essential for the healthy life of older people. • We compared the venue and home-visit surveys in a sample of urban older people. • Rate of cognitive decline measured by the MMSE was higher in the home-visit survey. • Participants in the home visit-survey could be more difficult in their daily lives. • Home-visit surveys can help increase the representativeness of older people. We conducted surveys in older people at a venue and in home-visits, and compared cognitive and health status between the two groups to assess their cognitive and everyday functioning. Among 7,614 persons aged 70 years and older living in an urban area, 5,430 responded to a mail survey for sociodemographic characteristics and self-rated questionnaires including the Geriatric Depression Scale-short form (GDS-15). Of these, 1,360 agreed to attend a venue survey, and 693 agreed to take a home-visit survey. Trained nurses examined participants' blood pressure, medical history, and daily functions using the dementia assessment sheet for community-based integrated care system (DASC-21), and tested their cognitive function using the Mini-Mental State Examination (MMSE). Of 2,053 participants, 2,020 (venue: 1,352; home-visit: 668) completed the MMSE. Median MMSE scores for the venue and home-visit groups were 28 and 26 points, respectively, with 130/1,352 (9.6%) and 205/668 (30.7%) participants below the traditional 23/24 cutoff score. The home-visit group had lower mobility, lower frequency of going out, poorer mental health, and lower independence in instrumental daily activities. Notably, 39.9% and 43.7% of the venue and home-visit groups lived alone, respectively. In this sample of urban older people, the rate of cognitive decline detected using the MMSE was three times higher in the home-visit group than in the venue group. Home-visit participants were more likely to have difficulty in physical, cognitive, and everyday functioning, suggesting they have a greater need for daily living support to continue living in the community. [ABSTRACT FROM AUTHOR]

• Older adults generally do not report ADL limitation until 77 years old, and mobility limitation occurs at a various age in Taiwan and Japan. • Older adults generally do not face serious disability until 85 or 86 years old in Taiwan or Japan, respectively. • The speed of disability with age for older adults Taiwan was faster than Japan in ADL and IADL limitation, but not in mobility. Disability development using age as the axis was void in the literature. Identification of the age trajectory of disability development across populations enables preparation for aging-related policies when conducting cross-national comparisons. This study compared three indicators of the development of physical disability in populations of Taiwan and Japan. Data comprised two nationally representative panel surveys (1) the Taiwan Longitudinal Study on Aging (N = 3,037) in 1996–2011 and (2) the National Survey of the Japanese Elderly in 1996–2012 (N = 1,974). Older adults (65+) were examined longitudinally. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility disability development during aging were analyzed using multilevel models. After age standardization, Japan reported higher prevalence rate of ADL disability (14.95% vs. 9.65%) but lower IADL (19.30% vs. 30.36%) and mobility disability (36.07% vs. 49.82%) as compared with Taiwan. ADL limitation occur (ADL limitation>=1) at the age of 77.9 and 77.2 for populations in Japan and Taiwan, respectively. Populations reached three ADL limitations at the age of 86.7 and 85.0 in Japan and in Taiwan, respectively. IADL limitation occur (IADL limitation>=1) at the age of 79.1 and 74.5 for populations in Japan and Taiwan, respectively. Mobility limitation occur (Mobility limitation>=1) at the age of 70.7 and 65.3 for populations in Japan and Taiwan, respectively. Older adults generally do not report ADL limitation until 77 and do not face serious disability until 85 or 86 in Taiwan or Japan, respectively. Mobility limitation occurs at a various age in different countries. [ABSTRACT FROM AUTHOR]