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Aim: Despite efforts toward health promotion and preventive care for older adults, including health checkups and postal Kihon Checklist survey, one fifth of community‐dwelling older adults do not participate in them. The aim of the present study was to examine the relationship between this non‐participation and the end of certification‐free survival in older adults. Methods: In a cohort of 4120 older adults with no prior history of Long‐Term Care Insurance certification, the associations of non‐participation with risk of later death without certification and support/care‐need certification for 72 months were evaluated using Cox proportional hazards analysis. Results: Of them, 4022 (mean age 72.7 years, 54.7% women) were followed up (97.6%). At baseline, 1072 received health checkups, 2085 replied to the Kihon Checklist alone and 865 did not participate. During 72 months, 310 deaths without certification and 701 certifications occurred. After adjustment, non‐participating individuals had significantly higher hazard ratios for death up to 72 months and for certification up to 36 months, compared with the other two groups. The Kruskal–Wallis test showed associations of increasing incidence of certification due to stroke in pre‐old (aged 65–74 years) men for 72 months, and due to arthralgia/fracture and dementia in old (aged ≥75 years) women for 24 months, with non‐participation in health promotions. Certified non‐participating individuals incurred higher estimated Long‐Term Care Insurance expenditure per person for 72 months, especially in pre‐old men and old women. Conclusions: Health promotion by health checkup and even Kihon Checklist survey increases certification‐free survival in older residents, and decreases Long‐Term Care Insurance expenditure. Geriatr Gerontol Int 2019; 19: 1206–1214. [ABSTRACT FROM AUTHOR]

Aim: Chronic kidney disease (CKD), diabetes and lower glycated hemoglobin (HbA1c) range in diabetes patients are associated with higher mortality. We investigated whether these conditions were associated with the risk of loss of independence in community‐dwelling older adults. Methods: We analyzed 1078 older adults with no history of support/care‐need certification in Long‐Term Care Insurance aged 65–94 years. Associations of baseline CKD, diabetes, and lower HbA1c range of <6.0% in the diabetes patients, at baseline health checkup with risk of later certification and/or death for 5 years were estimated using the Cox proportional hazards regression model. Results: The prevalence of both CKD and diabetes in the total population increased with age, due to a net increase in the coexistence of CKD and diabetes. The prevalence of the lower HbA1c range also increased with age in participants with the coexistence. During 5 years, 135 certifications and 53 deaths occurred. After adjustment, patients with comorbidity of the triad of CKD, diabetes and the lower HbA1c range had significantly higher hazard ratios (HR) for certification (HR 3.52, 95% confidence interval [CI] 1.91–6.48, P < 0.001) and for death (HR 3.79, 95% CI 1.46–9.85, P = 0.006) compared with those without CKD and diabetes. The harmful impact of the lower HbA1c range on later certification compared with higher HbA1c range of ≥6.0% was maintained in diabetes patients with use of antidiabetic agents and CKD (HR 2.40, 95% CI 1.06–6.45, P = 0.036). Conclusions: Excessive HbA1c reduction might cause discontinuance of disability‐free survival in community‐dwelling older diabetes patients with CKD. Geriatr Gerontol Int 2018; 18: 521–529. [ABSTRACT FROM AUTHOR]

Aim Although lower glycated hemoglobin (HbA1c) has been believed to be an important marker of improvement of glycemic control in order to maintain better quality of life for patients with diabetes mellitus, a too low HbA1c might be harmful in older adults. We investigated whether this was the case with respect to risk of support/care-need certification in community-dwelling older patients with type 2 diabetes mellitus. Methods We analyzed 184 diabetes patients aged 65-94 years receiving glucose-lowering medication/insulin. The end-points were first support/care-need certification and/or death. The relationships between four classes of HbA1c and risk of support/care-need certification and/or death were determined using the Cox proportional hazards regression model. Results During 5 years, 42 first support/care-need certifications and 13 deaths occurred. The association of HbA1c with risk of support/care-need certification after adjustment for age, sex and confounding variables was J-shaped, with the nadir at an HbA1c level of 6.5 to <7.0%, and with an increased risk of support/care-need certification (HR 3.45, 95% CI 1.02-11.6, P = 0.046) at an HbA1c level of <6.0% compared with the nadir. When compared with patients with HbA1c ≥6.0%, those with HbA1c <6.0% showed a higher risk of support/care-need certification as a result of dementia (HR 12.5, 95% CI 3.00-52.2, P = 0.001), but not as a result of arthralgia/fracture, stroke or other disorders. Conclusions These observations show that a too low HbA1c might be associated with a later risk of incident disability as a result of dementia in community-dwelling older diabetes patients. Geriatr Gerontol Int 2017; 17: 1858-1865. [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]

Objective Although many large-scale trials showed efficacies of antihypertensive treatment in patients with diabetes mellitus and hypertension for reduction of cardiovascular ( CV) morbidity/mortality, blood pressure ( BP) targets in older hypertensive patients with diabetes still represent the object of debate. We investigated adequate BP targets with respect to the risk of incident disability or mortality in community-dwelling elderly hypertensive patients with and without diabetes. Methods We analyzed 139 diabetic and 431 non-diabetic patients receiving antihypertensive treatment aged 65 years or older. The end-point was the composite outcome of first certification for support/care need or mortality. Relationships among each of four classes of systolic BP ( SBP) or diastolic BP ( DBP) and the risk of events were estimated using Cox hazards analysis. Results Over 4 years, diabetic patients showed significantly higher rates of all events including first certification for support/care need or mortality compared with the non-diabetic subjects (29 [20.8%] and 48 [11.1%] cases, unadjusted hazard ratio [ HR] 1.99, 95% confidence interval ( CI) 1.26-3.16, P = 0.003). After adjustment for confounding variables, the risk of events was significantly higher in non-diabetic subjects with SBP <120 mmHg ( HR 3.90, 95% CI 1.32-11.5, P = 0.014) and SBP ≥160 mmHg ( HR 3.42, 95% CI 1.22-9.57, P = 0.019), but only those with SBP ≥160 mmHg ( HR 22.8, 95% CI 4.83-118, P < 0.001) in diabetic patients, compared with non-diabetic control subjects with baseline SBP of 140-159 mmHg. Conclusion These observations showed the critical importance of intensive control of SBP to <160 mmHg for disability-free survival in elderly hypertensive patients with diabetes mellitus. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]

: PurposeAspiration due to an age-related reduction in cough is a major cause of pneumonia in elderly persons. Because the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene (ACE) has been associated with the cough reflex, we studied whether this genetic polymorphism was also associated with the risk of pneumonia.: Subjects and methodsWe studied 1011 elderly inpatients (221 men and 790 women, mean [± SD] age of 82 ± 7 years) in a long-term care hospital. The association between the ACE I/D polymorphism and the incidence of pneumonia (defined using specific criteria that included radiographic abnormalities) was assessed during an 8-month period that excluded the winter. Data were analyzed using proportional hazards models, with adjustment for age, sex, and other potential confounders.: ResultsDuring follow-up, 87 cases (9%) of pneumonia occurred, 38 of which were fatal. The ACE DD allele (vs. ID + II) was associated with an increased risk of pneumonia (relative risk [RR] = 2.9; 95% confidence interval [CI]: 1.7 to 4.8, P < 0.001) and fatal pneumonia [RR = 4.4; 95% CI: 2.1 to 9.0; P < 0.0001).: ConclusionThe ACE D allele is an independent risk factor for pneumonia in elderly persons. [Copyright &y& Elsevier]