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During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population 65 years of age and above to ∼28%. This study aimed to examine the changes in major health-related measures, including a physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, this study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, body mass index, walking speed, grip strength, and instrumental activity of daily living, between 2007 (±2 years) and 2017 (±2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of this study indicate that the phenomenon of “rejuvenation” is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be reacknowledged.

Ascertaining progress in building age-friendly cities (AFCs) requires community diagnostic indicators. This study examines the relationship between social participation and happiness at the municipal level. The data from the Japan Gerontological Evaluation Study (JAGES) from 2013, 2016, and 2019, comprising 442,079 older people from 289 municipalities, are used. We also employ linear mixed-effects models to evaluate the association between social participation and happiness. In these models, we adjust for seven variables as potential confounders. This study reveals that the higher the social participation, except for neighborhood association, the higher the state of happiness (B = 0.14–0.30). Our study suggests that social participation is useful, as a community diagnostic indicator, for monitoring the progress of building AFCs, developing strategies, and creating evidence.

As the population ages, it is important to consider whether older adults tend to have healthier lives. This study examined temporal trends in cognitive function among community-dwelling Japanese older adults.The data source for this study was Integrated Longitudinal Studies on Aging in Japan (ILSA-J). We collected representative values for the Mini-Mental State Examination (MMSE) score obtained in 2010 and 2017; mean, standard deviation, and prevalence of ≤23 as cognitive impairment and ≥28 as intact cognitive function. Six cohorts (n=8,575) in 2010 and seven cohorts (n=6,089) in 2017 were included (age range 65-89). One-group meta-analyses were conducted to calculate pooled means of MMSE scores, the pooled prevalence of MMSE scores ≤23 and ≥28, and 95% confidence intervals (CIs).The mean MMSE score was higher in 2017 than in 2010 for all age groups in both men and women. The prevalence of MMSE ≤23 was lower in 2017 than in 2010 for all age groups for men and was lower in 2017 than in 2010 for all age groups other than for women aged 75-79 years. The prevalence of MMSE ≥28 was higher in 2017 than in 2010 for all age groups in both men and women. In addition, the pooled means of years of education was lower in 2010 than in 2017, which might be an explanatory factor.This study suggests that the cognitive function of community-dwelling Japanese older adults has improved in recent years. Future studies need to identify factors associated with the improvement.

This paper aims to explore three walking behaviors of older pedestrians that may increase their crash risks when crossing urban streets. Older and younger pedestrians' start-up delay in initiating a crossing and number of head turns during street crossing are observed at 30 pedestrian crossings in Seoul, South Korea, using video recorders. In addition, their estimation of the safe crossing distance to an approaching vehicle is collected in a survey. Our study shows that older pedestrians have a shorter start-up delay time than younger pedestrians, older pedestrians crossing streets turn their heads less frequently, and older pedestrians provide less reliable estimates about the distance of an approaching vehicle. Safety technologies, campaigns and environmental designs should target these behaviors to improve the safety of older pedestrians.

On 11 March 2011, the great earthquake hit Japan, resulting in 15,895 deaths, 6156 serious injuries, and 2539 missing persons. This event affected the health and lives of older residents, and reports showed an increase in the number of people eligible for long-term care afterward. In this study, among the places affected by the 2011 Great East Japan Earthquake and tsunami, we focused on 15 municipalities, including designated municipalities based on the Special Act on Nuclear Evacuation in Fukushima Prefecture, and aimed to clarify the medium-term effects (six years post-disaster) on the long-term care certification rate and expenditure for provision of services. We used the Ministry of Health, Labour, and Welfare Monthly Status Report on Long-Term Care Insurance and the Ministry of Internal Affairs and Communications Population Register for 2011, 2014, and 2017. In 2011, we found no intergroup differences among the 15 Fukushima municipalities and other municipalities in either the long-term care certification rate or the per-person expenditure for use of services. In 2014, after the earthquake, the long-term care certification rate was 5.4% higher in the 15 Fukushima municipalities than in other municipalities for those aged 75 years or older. The rate of 2014&ndash, 2017 has not increased significantly, partly because of stability after the disaster and change in the population structure. Nevertheless, the long-term care certification rate in the 15 Fukushima municipalities is higher than that of the other two groups even after six years since the earthquake. Similarly, the per-person expenditure for use of services for one month was 11,800 yen higher in the 15 Fukushima municipalities than in other municipalities in 2014, and this trend continued into 2017. Strong, ongoing governmental support is needed, especially for those aged 75 or older, following a disaster.

Ageing drivers experience a higher risk of intersection crashes because of their decrease in driving efficiency, including the decline in cognitive ability, head and neck flexibility, and visual acuity. Although several studies have been conducted to examine the factors associated with ageing driver crashes at intersections, little research has been conducted to examine the differences in the factors related to ageing drivers' turning paths and intersection geometric features. This study aims to improve the safety of ageing drivers at intersections by identifying the maneuvers that are risky for them and tracking their turning movements at selected intersections. We find that ageing drivers experience more crashes at intersections than younger drivers, especially crashes involving turning movements. Furthermore, ageing drivers experience more crashes at unchannelized intersections compared to channelized intersections. In addition, this study finds that ageing drivers exhibit greater and more inconsistent offsets during turning movements compared to those of younger drivers at both channelized and unchannelized intersections. Ageing drivers also tend to make relatively sharper or tighter turns than younger drivers. Hence, transportation engineers and road safety professionals should consider appropriate countermeasures to reduce the risks of crashes involving ageing drivers at intersections.

Aim To examine whether the outcomes of fever treatment through home care differ from those through hospitalized care for older people who regularly receive home care in Japan. Methods A retrospective survey of medical record-based data for 679 older people who regularly received home care provided by a clinic in Japan. From these data, 61 fever cases (21 cases treated in the hospital and 40 treated at home and assigned to the hospitalized and home-care groups, respectively) were selected for analysis through a matching process. We compared the two groups in terms of mortality rate at 90 days after fever onset, and concerning changes in respective ranks for "Degree of Independent Living for the Elderly with Disability" and "Degree of Independent Living for the Elderly with Dementia" from immediately before fever onset to 90 days after fever onset. Results The mortality rate tended to be higher in the hospitalized group than in the home-care group (33% vs. 13%, respectively, P = 0.05). The hospitalized group also had a higher proportion of patients whose disability had worsened (43% vs. 23%, respectively, P = 0.16) and a significantly higher proportion of patients whose dementia had worsened (29% vs. 6%, respectively, P = 0.03). Conclusions Our findings suggest that home care is more effective than hospitalized care for treating fever in older people who regularly receive home care in Japan, as it leads to lower mortality and better maintenance of activities of daily living capabilities. Geriatr Gerontol Int 2020; 20: 482-487.

Background This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity. Design Retrospective, observational, longitudinal study. Setting Acute phase hospitals. Participants From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0–3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8–60 days. Main outcome measures The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation. Results Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke. Conclusions These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.

AIM To investigate the effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle strength, muscle mass, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation. METHODS We carried out an 8-week, multicenter, randomized, controlled, blinded outcome, two-cohort parallel group intervention trial of sarcopenic older adults undergoing in-hospital rehabilitation. The eligibility criteria included older adults (aged ≥65 years) with low muscle strength (handgrip strength) and low muscle mass (calf circumference) according to the cut-off values for older Asians. The intervention group received branched-chain amino acids and vitamin D supplementation, whereas the control group did not. Both groups underwent low-intensity resistance training in addition to the post-acute rehabilitation program. The primary outcome of physical function (Functional Independence Measure-motor scores), and the secondary outcomes of muscle strength (handgrip strength), muscle mass (calf circumference) and nutritional status (body mass index) were measured at baseline and at the end of the intervention. RESULTS Finally, a total of 68 patients were analyzed (intention-to-treat analysis): 35 in the intervention group and 33 in the control group. Functional Independence Measure-motor scores increased significantly in both groups over time (P

Summary Background & aims Oral health is an integral part of nutrition and rehabilitation. The purpose of this study was to investigate the impact of impaired oral health status on clinical and functional outcomes in post-acute in-hospital rehabilitation. Methods We conducted a prospective cohort study of hospitalized patients undergoing rehabilitation at a 225-bed post-acute rehabilitation hospital in Japan. All newly admitted patients were eligible to enroll during the two-year research period. Oral health status was evaluated on admission using the Revised Oral Assessment Guide (ROAG). Nutritional status, assessed using the Mini Nutritional Assessment-Short Form; activities of daily living, assessed by Functional Independence Measure motor scores; home discharge; all-cause in-hospital mortality; and length of hospital stay were measured as clinical and rehabilitation outcomes. Multivariate analyses were used to determine whether the ROAG score on admission was associated with these outcomes at discharge. Results Of the 1066 patients enrolled, 1056 were included in the final analysis. The mean age was 70 ± 17 years. Fifty-two percent of patients were women. Stroke (21.7%) and musculoskeletal disorders (30.5%) were the most common reasons for admission. Slight or moderate to severe oral health problems were detected in 609 (57.7%) and 163 (15.4%) patients, respectively. Eighteen patients died during hospitalization. The ROAG score at admission was independently associated with Functional Independence Measure motor scores at discharge (P = 0.022), home discharge (P = 0.005), in-hospital mortality (P = 0.039), and length of hospital stay (P = 0.045), after adjusting for potential confounders. Conclusions Impaired oral health status may be associated with rehabilitation outcomes in hospitalized patients. Early detection of oral health problems and treatment by dental professionals, or through cooperation between medical and dental professionals, should be implemented in these patients.

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79, urban = 0.83), hobby groups (HR: rural = 0.76, urban = 0.90), and work (HR: rural = 0.83, urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

We analyzed the relationships between forgetfulness and social participation, social contact, and social support by municipality to develop community diagnosing indicators. The analysis subjects included 105 municipalities that agreed to provide data for the 2013 Survey of Needs in Spheres of Daily Life in Japan (n = 338,659 people). Forgetfulness as a risk factor for dementia was used as the dependent variable. The variables of social environment factors were (1) social participation, (2) social contact, and (3) social support. The ratio of people responding that they experienced forgetfulness differed among municipalities, with a mean of 19.0% (7.1&ndash, 35.6%). Higher levels of social participation, social contact, and social support were associated with lower levels of forgetfulness, even after adjusting for age and regional variables. The results of the present study suggest that it is appropriate to use forgetfulness and social participation at least a few times a year in any social activity as community diagnosing indicators. Municipalities could encourage their inhabitants to participate by developing and providing engaging social activities.

Sarcopenia is known to increase the risk of adverse outcomes, including disability, loss of independence, hospitalization, longer length of hospital stay, and mortality, but there is little data about the prevalence of sarcopenia and the factors associated with increased physical dependency and cognitive decline among older patients hospitalized in a long-term care (LTC) ward in Japan. A cross-sectional study was conducted in 79 consecutive patients (34 men, 45 women) with a median age of 81 y hospitalized in an LTC hospital. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia. Skeletal muscle mass index (SMI) was assessed by using bioelectrical impedance analysis. Physical dependency and cognitive decline were evaluated by the Functional Independence Measure (FIM). Nutritional status was evaluated by using the Mini Nutritional Assessment-Short Form and daily intake of energy and protein. Multivariate analyses were applied to examine factors associated with increased physical dependency and cognitive decline. Median SMI was 4.9 kg/m2 (interquartile range [IQR], 4.0-5.3 kg/m2) in men and 3.3 kg/m2 (IQR, 2.9-3.8 kg/m2) in women, showing that all participants had an SMI below the cut-off value. Seventy participants (88.6%) were unable to perform the hand grip strength test, and all participants were unable to perform the gait speed test. Multivariate analysis showed that oral nutritional access and daily energy intake were associated both with physical and cognitive level (p

To investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting. A randomized controlled trial. (UMIN Clinical Trials Registry ID: UMIN000006238). A rehabilitation hospital. 39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit. A combination of resistance training plus nutritional supplementation (R/N group) or resistance training alone (R group). The training and supplementation were conducted essentially from the patient’s admission to discharge (2–6 months). The patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass (calf circumference [CC] as a primary outcome, and arm circumference [AC]), hand grip strength (HG), Mini-Nutritional Assessment-Short Form (MNA®-SF) score, serum albumin level (Alb), body mass index (BMI), and activities of daily living (ADL) as represented by the Barthel Index (BI) score. Significant treatment effects were seen for CC, AC, BI, Alb in the R/N group compared to the R group. A mean treatment effect of 3.2 (95%CI: 2.0–4.4) was seen in CC, 1.4 (95%CI: 0.8–2.1) was seen in AC, 11.2 (95%CI: 0.5–21.8) was seen in BI, 0.3 (95%CI: 0.1–0.5) was seen in Alb. The results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living.

Promoting social and leisure activity participation in older adults could be effective in preventing their health decline. However, gender or regional differences in those activities remain unclear despite the necessity of gender- or region-specific approaches to their promotion. This study examined gender and urban-rural differences in going-out, social, and leisure activities among community-dwelling older adults. Data were obtained from the Japan Gerontological Evaluation Study (JAGES). Those analyzed were 103,621 people aged 65 or older who were functionally independent and lived in one of 31 municipalities. A total of seven activity variables were assessed with weekly going out, engagement in paid work, monthly and any frequency of engagement in group activities, monthly and any frequency of contact with friends, and having hobbies. We additionally assessed the contents of the group activities and hobbies. Gender, age groups (young-old: 65-74; old-old: 75 and over), and region groups, which were categorized as rural, urban, or metropolitan, were assessed along with education, depression, and other covariates. A chi-square test and multivariate logistic regression analysis were conducted to examine the age group-stratified differences in the going-out, social, and leisure activities among gender and region groups (P.01). Multivariate logistic regression analysis showed that men were more likely to engage in weekly going out, paid work, and hobbies but less likely to engage in group activities and contact with friends, either monthly or at any frequency. Most activities were also found to differ significantly among the region groups. For instance, people in metropolitan areas were 2.3 times more likely to engage in weekly going out but were 0.4 (old-old group) or 0.5 times (young-old group) less likely to engage in contact with friends. Percentages of engagement in hobby- or sport-groups were over 20% in all gender and region groups; on the other hand, about 30% differences were found in the percentages of engagement in senior clubs or neighborhood associations between metropolitan and rural men. As for having hobbies, walking/jogging and gardening were popular across all gender and region groups, while the percentages of engagement in a variety of hobbies differed among gender and region groups. Our findings suggest 1) differences in the levels of social and leisure activities among gender and region groups and 2) both similarities and differences in the popular group activities or hobbies among gender and region groups. Activity promotion for older adults should be targeted considering these gender and region group characteristics.

Objectives The purpose of the present study was to examine the potential benefits of additional training in patients admitted to recovery phase rehabilitation ward using the data bank of post-stroke patient registry. Subjects and Methods Subjects were 2507 inpatients admitted to recovery phase rehabilitation wards between November 2004 and November 2010. Participants were retrospectively divided into four groups based upon chart review; patients who received no additional rehabilitation, patients who were added with self-initiated off hours training, patients who were added with off hours training by ward staff, patients who received both self-initiated training and training by ward staff. Parameters for assessing outcomes included length of stay, motor/cognitive subscales of functional independent measures (FIM) and motor benefit of FIM calculated by subtracting the score at admission from that at discharge. Results Participants were stratified into three groups depending on the motor FIM at admission (≦28, 29∼56, 57≦) for comparison. Regarding outcome variables, significant inter-group differences were observed in all items examined within the subgroup who scored 28 or less and between 29 and 56. Meanwhile no such trends were observed in the group who scored 57 or more compared with those who scored less. In a decision tree created based upon Exhaustive Chi-squared Automatic Interaction Detection method, variables chosen were the motor FIM at admission (the first node) additional training (the second node), the cognitive FIM at admission(the third node). Conclusions Overall the results suggest that additional training can compensate for the shortage of regular rehabilitation implemented in recovery phase rehabilitation ward, thus may contribute to improved outcomes assessed by motor FIM at discharge.

BACKGROUND: Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups. METHODOLOGY/PRINCIPAL FINDINGS: The analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14-2.80]) than in women (HR = 1.88 [95% CI: 1.44-2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74-3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83-2.50]; p for education interaction = 0.549). CONCLUSIONS: The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females. Language: en