Search

Objectives: Frailty is a significant cause of adverse health events including long-term care and hospitalization. Although information and communication technology (ICT) has become an integral part of modern life, it remains unclear whether ICT use is associated with frailty., Design: A cross-sectional study (Integrated Longitudinal Studies on Aging in Japan, ILSA-J)., Setting and Participants: Aged 75 and older data from the ILSA-J in 2017 (n = 2893)., Methods: ICT use was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Specifically, the use of mobile phones, ATMs, DVD players, and sending e-mails were rated as "yes" (able to do) or "no" (unable to do), with the first quintile (≤1 point) defined as ICT non-users. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria based on the phenotype model (e.g., weight loss, slowness, weakness, exhaustion, and low activity). Further, multivariate logistic regression analysis analyzed its association with ICT use. Subgroup analyses were stratified according to gender, years of education, and living arrangements., Results: Higher ICT use was not associated with frailty after adjusting for covariates (odds ratio [OR]: 0.53; 95%CI 0.39-0.73). Similar associations were found in the sub-groups of women (OR 0.45, 95%CI 0.30-0.66), <13 years of education (OR 0.48, 95%CI 0.34-0.67), living alone (OR 0.46, 95%CI 0.27-0.79), and living together (OR 0.57, 95%CI 0.38-0.85). No association existed between using ICT and frailty in the sub-groups of men and ≥13 years of education., Conclusions and Implications: Higher ICT use is associated with the absence of frailty in individuals 75 years and older. Such benefits may be particularly pronounced in women, those with lower levels of education, and older adults living alone or with others., (© 2024. The Author(s).)

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., (© 2023 Japan Geriatrics Society.)

Preventing frailty is crucial in aging societies. We examined the effectiveness of a community-based frailty-prevention program for delaying the onset of functional disability among community-dwelling older adults. From 2014 to 2019, 48 community-based frailty prevention classes (FPC, 60 min/session, once a week), comprising resistance exercise and nutritional or psychosocial programs, were established in Yabu City, Japan. We conducted a baseline survey in 2012 and followed up with participants for up to 6.8 years (4.8 years from establishing the first FPC). We analyzed data from 3350 older people. The primary and secondary outcomes were the onset of functional disability and cause-specific functional disability (including dementia and cardiovascular and orthopedic diseases), respectively. In addition to crude Cox proportional hazard regression, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM; 918 nonparticipants and 459 participants) were used to adjust for confounders. Participants were more likely to be female and have a healthy lifestyle than nonparticipants. During the follow-up, 690 individuals developed a functional disability. The hazard ratio of incident functional disability in the participants was significantly lower than that in nonparticipants in the IPTW (hazard ratio 0.53, 95% confidential interval 0.38-0.75) and PSM (0.52, 0.37-0.71) analyses. In age-stratified analysis, significant associations were observed only in the ≥75-year-old subgroup. In a cause-specific analysis, participation significantly and consistently reduced incident functional disability caused by dementia (IPTW 0.47, 0.25-0.86; PSM 0.45, 0.25-0.83). Community-based FPC may be effective for preventing functional disability, especially caused by dementia, in this population., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: Working in old age not only solves the labor shortage in Japan, but also benefits the health of the older workers; however, work-related accidents are a major concern. Functional impairment is an important factor in such accidents. The first aim was to examine the association between frailty status and work-related accidents, and the second aim was to identify those who utilize the opportunity to learn about safe work., Methods: The participants were 7265 members of the Silver Human Resource Center in Tokyo, engaged in non-regular and indeterminate paid work. The frailty status (robust, pre-frail and frail) was assessed using the frailty screening index. We obtained data on self-reported work-related accidents that occurred in the past year, and the experience of participation in workshops and reading brochures for safe work. Modified Poisson regression analysis was carried out to calculate the prevalence ratio., Results: The prevalence of robust, pre-frailty and frailty were 26.3%, 63.3% and 10.4%, respectively. The percentage of participants who reported work-related accidents was 9.4%. Relative to robust participants, pre-frail and frail participants showed 1.57-fold (95% confidence interval [CI] 1.28-1.93) and 2.31-fold (95% CI 1.79-2.98) higher prevalence ratios of work-related accidents, respectively. The prevalence ratio in pre-frail and frail participants were 1.08 (95% CI 1.04-1.11) and 1.14 (95% CI 1.09-1.20), respectively, for non-participation in workshops, and 1.17 (95% CI 1.06-1.29) and 1.39 (95% CI 1.20-1.61), respectively, for not reading brochures., Conclusions: These findings suggest the importance of support for older workers with functional impairment, as well as those without to continue to work safely. Geriatr Gerontol Int 2023; 23: 234-238., (© 2023 Japan Geriatrics Society.)

There is currently no tool to predict incident frailty despite various frailty assessment tools. This study aimed to develop risk prediction models for incident frailty and evaluated their performance on discrimination, calibration, and internal validity. This 2-year follow-up study used data from 5076 non-frail older adults (51% women) living in Tokyo at baseline. We used the Kaigo-Yobo checklist, a standardised assessment instrument, to determine frailty. Twenty questionnaire-based variables that include sociodemographic, medical, behavioural, and subjective factors were entered into binary logistic regression analysis with stepwise backward elimination (p < 0.1 for retention in the model). Discrimination and calibration were assessed by area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. For the assessment of internal validity, we used a 5-fold cross-validation method and calculated the mean AUC. At the follow-up survey, 15.0% of men and 10.2% of women were frail. The frailty risk prediction model was composed of 10 variables for men and 11 for women. AUC of the model was 0.71 in men and 0.72 in women. The P-value for the Hosmer-Lemeshow test in both models was more than 0.05. For internal validity, the mean AUC was 0.71 in men and 0.72 in women. Probability of incident frailty rose with an increasing risk score that was calculated from the developed models. These results demonstrated that the developed models enable the identification of non-frail older adults at high risk of incident frailty, which could help to implement preventive approaches in community settings., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: Neighborhood environmental attributes are associated with physical activity and health status. We examined cross-sectional associations of built and social environmental attributes with frailty among community-dwelling mid-to-older aged adults in Australia., Methods: Data from 3419 adults aged 50-74 years living in 200 neighborhoods in Brisbane, Australia, were used. Frailty status was assessed by a frailty index comprising 32 items. The built environment attributes examined were residential density, street connectivity, land use mix, park area and bus stop density. Self-reported levels of safety and social cohesion were used as social environmental factors. Associations were examined using multilevel logistic regression., Results: The prevalence of frailty was 12%. One standard deviation increment in street connectivity in a 1-km network buffer around participants' homes and in a neighbourhood was associated with 23% and 13% higher odds of being frail, respectively. One standard deviation increment in land use mix at the neighborhood level was associated with 12% lower odds of being frail. Higher levels of safety and social cohesion were consistently associated with a lower odds of being frail., Conclusions: Consistent with previous studies, we found that social environmental attributes were relevant to residents' frailty status, whereas the relationships between built environmental attributes and frailty were not clear (frailty was associated with lower street connectivity but with higher land used mix). Community-level initiatives to enhance safety and social cohesion might be effective to reduce frailty. Further research is required to explain the equivocal findings obtained for built environmental attributes and frailty. Geriatr Gerontol Int 2021; 21: 893-899., (© 2021 Japan Geriatrics Society.)

Aim: Using up to 13 years of repeated-measures data, we identified aging trajectories for an index in frailty score among older Japanese undergoing health checkups. In addition, we examined whether these trajectories were associated with all-cause and cause-specific mortality and healthcare costs., Methods: In total, 1698 adults aged ≥65 years completed annual assessments during 2002-2014. During follow-up, the average number of follow-up assessments was 3.9, and the total number of observations was 6373. Frailty was defined by using the following criteria from Fried's phenotype: slowness, weakness, exhaustion, low physical activity and weight loss., Results: We identified four aging trajectories for frailty. Specifically, 6.5%, 47.3%, 30.3% and 16.0% of participants were in the high, second, third and low trajectory groups, respectively. As compared with the low trajectory group, the high trajectory group had greater risks of cardiovascular disease (adjusted hazard ratios of 3.42) and other-cause death (adjusted hazard ratios of 3.04). The high trajectory group had the highest medical costs until late in the eighth decade of life, costs decreased after age 70 years and were lowest at age 90 years (estimated at $116.7); however, medical and long-term care costs greatly increased after age 80 years in the second and third trajectory groups., Conclusions: Higher aging trajectories in frailty score were associated with elevated risks for cardiovascular, other-cause and all-cause death among older Japanese receiving health checkups. Medical and care needs greatly increased for the second and third trajectory groups when their frailty level was progressed in later life. Geriatr Gerontol Int 2020; 20: 1072-1078.., (© 2020 Japan Geriatrics Society.)

This study examined differences in older adults' travel behaviours by frailty status in metropolitan, suburban, and rural areas of Japan. Data were collected from 9104 older adults (73.5 ± 5.7 years; 51% women; 19% frail) living in metropolitan (n = 5032), suburban (n = 2853), and rural areas (n = 1219) of Japan. Participants reported if they walked, cycled, drove a car, rode a car as a passenger, and used public transportation (PT) once per week or more. A standardised questionnaire was used to assess frailty status. We conducted logistic regression analysis to calculate the odds ratios of using each travel mode by frailty status stratified by locality. Relative to non-frail participants, frail participants were less likely to walk and drive a car in all three areas. Frail participants had significantly higher odds of being a car passenger in the suburban (OR = 1.73 (95% CI: 1.32, 2.25)) and rural areas (OR = 1.61 (1.10, 2.35)) but not in the metropolitan area (OR = 1.08 (0.87, 1.33)). This study found that frail older adults living in suburban and rural areas tended to rely more on cars driven by someone else, suggesting that transport disadvantage is more pronounced in suburban and rural areas than in metropolitan areas.

Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives　This study aimed to determine risk factors for frailty and lifestyle-related diseases impacting the incidence of loss of independence among Japanese community-dwelling older adults, and to measure the magnitude of these associations.Methods　We conducted an 8.1-year prospective study involving 1,214 residents of the town of Kusatsu, aged 65 years and over, who were initially free of disability and underwent the comprehensive geriatric assessment between 2002 and 2011. Loss of independence was defined as the incidence of disability or having died before the occurrence of disability was certified by the Long-Term Care Insurance program in Japan. Risk factors for lifestyle-related diseases and health status comprised hypertension, diabetes mellitus, overweight, chronic kidney disease, current smoking, past history of stroke, heart disease and cancer, frailty, underweight, anemia, hypoalbuminemia, and cognitive decline. Frailty was defined as the presence of three or more of the following criteria: Weight loss, weakness, exhaustion, slowness, and low levels of physical activity. Prefrailty was defined as the presence of one or two of these same criteria. Cox proportional-hazard regression model was used to estimate hazard ratios (HR) and the population attributable fraction (PAF) of loss of independence.Results　During the follow-up, 475 cases, including 372 disabilities and 103 deaths, were identified as having experienced loss of independence. The multivariable HRs for the loss of independence were 1.3 to 2.2-fold higher for the presence of frailty, past history of stroke, cognitive decline, prefrailty, and smoking. The PAF of loss of independence was the greatest for prefrailty (19%), followed by frailty (12%). The PAF was relatively large for prefrailty (19%) and smoking (11%) in men, and frailty (18%), prefrailty (18%), and chronic kidney disease (11%) in women. Stratified by age category, participants aged 65-74 years having frailty and several lifestyle-related diseases showed significantly higher HRs for loss of independence and greater PAFs for prefrailty (18%), frailty (13%), and smoking (11%).Conclusions　Loss of independence among Japanese community-dwelling older adults who underwent screening examinations was largely attributed to frailty and prefrailty. Our findings suggest that the screening and the intervention for frailty and lifestyle-related diseases in the early stages of old age might be beneficial in prolonging healthy life expectancy of Japanese community-dwelling older adults.

This study aimed to examine area differences in the prevalence of and factors associated with frailty. This cross-sectional study included metropolitan (eastern and western areas), suburban (districts A and B), and rural areas of Japan ( n = 9182, woman 50.9%). Frailty was defined by using a standardized questionnaire comprising three subcategories (fall, nutritional status, and social activities). The prevalence of frailty in the five areas was 14.2% to 30.6% for men and 11.5% to 21.4% for women. The areas with a high frailty prevalence had a significantly lower nutritional status or social activity, or both. Compared to the western metropolitan area, among men, the multivariable-adjusted prevalence ratio (APR) of frailty was significantly higher in the eastern metropolitan area and lower in suburban district A, and among women, the eastern metropolitan and rural areas had significantly higher APRs. Area-stratified multiple Poisson regression analysis showed that age, bone and joint disease, and a subjective economic status were associated with frailty in most areas and that some factors were area-specific, i.e., living alone (for men living in metropolitan areas) and underweight (for women living in suburban areas). The frailty prevalence differed by area, even after multivariable adjustment. Area-specific characteristics and factors associated with frailty may result in area differences.

Background Little is known about to what extent neighbourhood built and social environmental factors are associated with frailty among community-dwelling mid-to-older aged adults. Methods Participants of our cross-sectional study were adults aged 50-74 years residing in Brisbane, Australia. Frailty was assessed by a frailty index (FI), consisting of 32 items. Five built environmental attributes (population density, density of 4-way intersections, area of retail land, area of park land, and area of land for recreational facilities) and three social environmental attributes (safety, cohesion, and socio-economic status [SES]) were included. We performed multilevel logistic regression analysis to examine the associations between those attributes and frailty. Results Of 4,176 eligible participants (56.8% women), we found that 437 (10.5%) were frail (FI ≥ 0.35). After adjusting for potential confounders, one standard deviation (SD) increment in intersection density and retail land area was associated 26% (95%CI: 1.12, 1.41) and 18% (95%CI: 1.07, 1.30) higher odds of being frail, respectively. One SD increment in safety and area-level SES was associated with 24% (95%CI: 0.69, 0.84) and 30% (95%CI: 0.62, 0.79) lower odds of being frail. Conclusions This study found that mid-to-older aged adults with frailty are more likely to live in areas with higher intersection density, greater area of retail land, poorer safety, and higher levels of deprivation. Key messages There is spatial heterogeneity in the distribution of frailty. Future research should investigate behavioural mechanism for the distribution. [ABSTRACT FROM AUTHOR]