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Hisashi Kawai, Yu Taniguchi, Satoshi Seino, Ryota Sakurai, Yosuke Osuka, Shuichi Obuchi, Yutaka Watanabe, Hunkyung Kim, Hiroki Inagaki, Akihiko Kitamura, Shuichi Awata, Shoji ShinkaiTokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, JapanBackground: Gait measures such as gait speed, stride length, step width, and stance duration change with advanced age and are associated with adverse health outcomes among older adults. The stride-to-stride variabilities of gait measures are also related to falls and cognitive decline in older adults; however, reference values of these gait parameters in older Japanese adults do not exist. This study aimed to determine the reference values of gait parameters as measured by a plantar pressure platform in community-dwelling older Japanese adults.Methods: Community-dwelling adults (N=1,212) who were independent in basic activities of daily living and aged 70–96 years (491 men, 721 women) completed the gait performance measurement in a geriatric health assessment. We assessed 10 gait performance measures with a plantar pressure platform system (P-WALK, BTS Bioengineering) and calculated means and coefficient of variations (CVs) of the gait measures as well as quintiles for those gait parameters per age group among men and women.Results: Mean (SDs) of gait speed, stride length, step width, and stance durations were 1.26 (0.24) meters per second (m/s), 121.9 (19.8) cm, 24.0 (3.2) cm, and 552.4 (60.4) milliseconds (ms), respectively, in men, and 1.27 (0.21) m/s, 115.7 (16.3) cm, 17.9 (2.8) cm, and 517.6 (59.8) ms, respectively, in women. Mean of CVs (SD) of stride length, step width, and single-stance duration were 2.76 (1.35), 12.06 (3.98), and 5.74 (2.66), respectively, in men and 2.69 (1.24), 15.65 (4.53), and 5.77 (2.40), respectively, in women. Gait parameters (except CVs of step width) declined significantly with age regardless of gender (P< 0.01 for trends).Conclusion: This study determined age group dependent gait parameter reference values, presented as means with quintile ranges, in community-dwelling older Japanese adults. These reference values may be useful metrics for gait assessment in the elderly.Keywords: gait parameter, variation coefficient, community-dwelling, older adult, reference value

Ken Nishihara,1 Hisashi Kawai,2 Takeshi Kera,2,3 Hirohiko Hirano,4 Yutaka Watanabe,2 Yoshinori Fujiwara,2 Kazushige Ihara,5 Hunkyung Kim,2 Masashi Tanaka,4 Shuichi Obuchi2 1Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan; 2Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; 3Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan; 4Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; 5Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan Purpose: The purpose of this study was to clarify the reference values of muscle thicknesses by age and to elucidate the association of muscle thickness with physical function in a large group of community-dwelling elderly individuals.Participants and methods: The muscle thicknesses of the rectus femoris (RF), vastus intermedius (VI), and quadriceps femoris (QF) in 777 of 831 enrolled elderly individuals were measured by ultrasonography, and physical function was measured using knee extension strength (KES), one-legged stance, walking, Timed Up and Go, and grip strength tests. Muscle thickness data were divided by sex and categorized into 5-year age groups. Differences in muscle thickness and KES among the age groups were examined, and correlations between muscle thickness and physical function test results were compared by age. The non-parametric independent two-sample Mann–Whitney U-test, Kruskal-Wallis test, and Spearman’s correlation coefficients were used in the statistical analysis.Results: Thickness of the RF showed fewer significant differences among all groups and less decreases compared to thickness of the VI in older age groups, especially in men. Thicknesses of the RF, VI, and QF correlated with KES in almost all the thicknesses of muscles in the 65–69 and 70–74 years age groups in men and in almost all age groups in women. The decrease in muscle thicknesses and degree of correlations with aging were different between men and women.Conclusions: Reductions in the thicknesses of the muscles and KES differed by age group and sex. Our results could be used for prescribing exercise in community-dwelling elderly individuals of varying ages. Keywords: community-dwelling elderly individual, physical function, muscle thickness, ultrasonogram

OBJECTIVE: To evaluate the effects of short-term exercise intervention on falls self-efficacy and to evaluate the relationships between baseline falls self-efficacy and changes in physical function in older people. DESIGN: Single-blinded randomized controlled trial. The participants were 171 subjects aged 65 and older. They were randomly assigned into an exercise intervention group or a health education group. The subjects in the exercise intervention group performed an exercise program for 3 mos. Falls self-efficacy was measured using the falls efficacy scale (FES). The measurements of physical function included static and dynamic balance, walking velocity, flexibility, and strength. RESULTS: There was no significant improvement of FES in either group. But there were significant negative correlations between baseline FES score and the change in maximum walking velocity (r = -0.29, P < 0.018) and knee extensor strength (r = -0.25, P < 0.040. Linear regression analysis showed that the change in static balance was related to baseline FES. CONCLUSIONS: The results suggest that a short-term exercise intervention had no effect, possibly because of the high baseline FES scores of the participants, on the confidence of community-dwelling older persons. However, the negative association between FES score and increases in some measures of function suggest that short-term exercise may be beneficial to a subset of older persons with lower FES scores. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the effects of a perturbed walking exercise using a bilateral separated treadmill in physically disabled elderly. DESIGN: Participants of the study were 32 long-term care facility residents and outpatients aged 66-98 yrs. Participants were randomly assigned to a usual exercise group or to a treadmill exercise group. Perturbed gait exercise on a treadmill continued for 6 mos. Number of falls and time to first fall during a 6-mo period, balance and gait functions, and reaction time were evaluated before and after intervention. RESULTS: The treadmill exercise group showed significant improvement in balance and reaction time when compared with the usual exercise group. Number of falls in the treadmill exercise group was 21% lower than that in the usual exercise group. However, this difference was not significant. No significant differences were seen in time to first fall. CONCLUSIONS: Gait training with unexpected perturbation seems to have a beneficial impact on physical function in disabled elderly individuals. The results suggest that this program may be used as an exercise intervention to reduce falls in institutional settings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the relationship between dynamic balance functions in young adults and elderly adults while standing and walking. DESIGN: In standing balance tests, the Sensory Organization Test (SOT) of six combinations of three visual and two support-surface conditions was used to measure standing balance, and the Motor Coordination Test (MCT) was used to provoke automatic postural reactions through a series of sudden translations of support surface. The gait test measured maximum anterior acceleration (MAA) and maximum posterior acceleration (MPA) of the trunk during perturbed walking using a bilaterally separated treadmill, and calculated latency until MAA and latency until MPA. RESULTS: The elderly adults showed more significant functional decline than young adults in SOT1, SOT4, SOT6, medium intensity MCT, large intensity MCT, and MPA. In the correlation analysis of the outcome from the standing examinations, close correlations among SOT4, SOT5, and SOT6 conditions were observed in both groups of young adults and elderly adults. In the MCT, there was very close correlation between varied translation intensity in two groups. On the other hand, the only weak correlation between SOT and MCT findings was between SOT4 and large intensity MCT in elderly adults (r = -0.471, P = 0.049). In the gait test, although correlation was not significant in young adults, the significant correlations between MAA and latency until MAA (r = 0.705, P = 0.001) and latency until MAA and latency until MPA (r = 0.497, P = 0.036) were recognized in elderly adults. In the balance function findings of the standing examinations and the gait examinations, there was significant correlation between medium intensity MCT and latency until MAA (r = -0.552, P = 0.018) in young adults, and SOT6 and latency until MPA (r = -0.473, P = 0.047) in elderly adults. However, no relationship was observed in most of other factors. CONCLUSIONS: Most falls experienced by elderly people are caused by tripping or slipping during walking. The fact that walking balance function did not correlate with standing balance function indicates that multifaceted evaluation is important to comprehend dynamic balance function while standing and walking. [ABSTRACT FROM AUTHOR]

Age-related hearing loss (ARHL) and impaired gait both independently heighten the risk of accidental falls among older adults. However, the combined impact of these factors remains unclear. We analyzed the data of 786 community-dwelling Japanese older adults. Hearing was evaluated at frequencies of 1.0 and 4.0 kHz, with participants categorized into ARHL (> 25 dB) and non-ARHL groups. Gait was also assessed, defining slow gait (SG) as speeds one standard deviation below the age- and sex-specific mean. Participants were divided into four groups based on their ARHL and SG statuses and were monitored annually for 8 years to track falls and related injuries. Throughout the follow-up, incidents included 328 single falls (9.6/100 person-years), 117 multiple falls (2.8/100 person-years), 249 minor injuries from falls (6.7/100 person-years), and 55 fractures due to falls (1.3/100 person-years). Cox proportional hazard regression models showed that participants without ARHL but with SG faced a significantly increased risk of frequent falls. Furthermore, ARHL combined with SG significantly raised the risk of both single and frequent falls, and increased the incidence of both minor and severe fall-related injuries, including fractures. In contrast, no significant association was found between ARHL alone and fall-related incidents. These findings suggest that the previously reported risk associated with hearing loss in fall incidents predominantly relates to gait impairment. The co-occurrence of ARHL and SG significantly escalates the risk of falls and related injuries, highlighting the critical need for routine gait monitoring., (© 2024. The Author(s), under exclusive licence to American Aging Association.)

Objectives　While Community gathering places known as "kayoi-no-ba" providing communal meals play a crucial role in promoting the health of older adults, the researches supporting their operations and maintenance is limited. Social marketing has been successful in implementing strategic public health programs. This study aimed to identify factors associated with declining participation in kayoi-no-ba providing communal meals using a social marketing framework based on the 4Ps marketing mix (product, promotion, place, and price).Methods　In November 2019, this cross-sectional study surveyed kayoi-no-ba providing communal meals nationwide via a mail. A total of 580 kayoi-no-ba organizers with complete data participated. Changes in the number of participants were assessed using a questionnaire in order to determine the decrease since their establishment. Survey items were organized based on the 4Ps marketing mix framework and treated as independent variables. Multivariate Poisson regression analysis was conducted with participant decrease as the dependent variable, and prevalence ratios (PR) were calculated. The opening period and the number of participants at the time of the survey were included as covariates.Results　A total of 154 kayoi-no-ba experienced the decline in participants (26.6%). Multivariate analysis revealed the following. For product variables, a high frequency of monthly events was significantly associated with a lower PR for participant decrease (0.92). Among promotion variables, kayoi-no-ba with a registration system had a significantly higher PR for participant decrease (1.49). For place variables, a higher population density in the region was significantly associated with a lower PR (0.90), whereas a higher ratio of the population aged 65 years and older was significantly associated with a higher PR (1.05). The price variables did not show a significant association with the decrease in participants.Conclusions　Except price, the other three marketing 4Ps were significantly associated with decreases in participants at kayoi-no-ba providing communal meals. Future efforts should focus on developing and evaluating kayoi-no-ba strategies to ensure sustained participant engagement and promote the health of older adults through communal meals.

The objective of the study is to investigate the safety, feasibility, and degradation profile of a novel Mg alloy-based bioresorbable coronary scaffold (JFK-PRODUCT BRS) with thin struts (110 μm). Polymer- or Mg alloy-based BRSs have not replaced nondegradable metal stents because of the higher prevalence of scaffold thrombosis and restenosis in clinical practice; these poor clinical outcomes were due to inadequate scaffold designs, including thick struts (more than 150 μm) and their inappropriate degradation processes. Fourteen healthy pigs received 17 JFK-PRODUCT BRSs in the coronary arteries and were sacrificed at 1, 6, 12, 18, and 26 months after implantation. Angiography, optical coherence tomography, microfocus X-ray computed tomography (µCT), scanning electron microscopy with energy-dispersive X-ray spectrometry (SEM-EDX), and histopathological evaluation were performed. The JFK-PRODUCT had a median percent late recoil of 11.28% at 1 month. The µCT observation confirmed that scaffold discontinuity reached 64.8% at 12 months with increased scaffold inner area thereafter, suggesting artery positive remodeling. The inflammation was mild, peaked at 18 months, and decreased thereafter. The SEM-EDX analysis demonstrated gradual degradation of the scaffold with formation of inorganic deposits, presumed to be calcium phosphates. It also revealed the disappearance of calcium phosphates at 26 months, achieving almost complete replacement of the scaffold by biocomponents. The current study demonstrated the safety and feasibility of JFK-PRODUCT with a lower acute recoil rate despite its thin struts. The scaffolds were almost completely disappeared at 26 months after implantation., (© 2024. The Author(s).)

Background: Living alone has been associated with cognitive impairment; however, findings have been inconsistent. Social isolation among older adults who live alone may contribute to cognitive impairment. This study was carried out to examine the association of social isolation and living alone with cognitive impairment in community-dwelling older adults., Methods: In this cross-sectional study, data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which comprises pooled data from five community-based geriatric cohorts, was used. Social isolation was defined as infrequent interactions with others. Participants were categorized into four groups based on their social isolation and living alone statuses. Cognitive function was assessed using the Mini-Mental State Examination, with a score <24 indicating cognitive impairment. The association between social isolation combined with living alone and cognitive impairment was analyzed using logistic regression., Results: Of the 4362 participants included in the analysis (mean age 75.6 years, 44.3 % male), 11 % had cognitive impairment. Regardless of living alone, social isolation was associated with cognitive impairment (no social isolation x not living alone: reference, social isolation x not living alone; odds ratio (OR): 1.74, 95 % confidence interval (CI): 1.29-2.33, social isolation x living alone; OR: 2.10, 95 % CI: 1.46-3.01)., Conclusions: Social isolation is associated with cognitive impairment; however, living alone is not intrinsically associated with cognitive impairment in older adults. Healthcare providers must focus on social interactions to prevent cognitive impairment in older adults rather than simply focusing on living arrangements., 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 © 2024 Elsevier B.V. All rights reserved.)

Objectives　Community residents experience changes over time, including those in the care prevention system, governmental expectations, and their motivations. To support community-based prevention activities, it is necessary to clarify these changes. This study used a qualitative research method to examine changes in roles and feelings among "Kaigoyobou leaders" who had been involved in community-based care prevention activities for 10 years.Methods　The study participants were nine leaders (six men and three women) who had been active in community-based care prevention for approximately 10 years. Through one-hour semi-structured interviews, we explored their current activities, reasons for taking the leader training course, changes in the content of their activities since completing the course, changes in their roles in activities and feelings about the activities, and what they recognized as important in their activities. Interviews were transcribed verbatim and analyzed using a modified grounded theory approach. From the transcripts, we extracted "concepts" related to changes among the leaders and generated "categories" to summarize the concepts.Results　The analysis identified 28 concepts summarized into 12 categories. The categories included: "belief in the activities" (e.g., "focusing on preventive effects"), "learning through trial and error" (e.g., "learning continuously"), "developing the activities" (e.g., "expanding the activities"), "commitment to the community" (e.g., "valuing connections with people involved in the activities"), "increasing required roles" (e.g., "taking consultations from juniors"), "relationship with the government" (e.g., "responding to requests from the government"), "benefits from the activities" (e.g., "receiving a sense of accomplishment and satisfaction from the activities"), "burden due to the activities" (e.g., "a shortage of group members"), "aging of stakeholders" (e.g., "increasing age of the participants"), "preparing for continuity" (e.g., "new people wishing to participate"), "considering ending activities" (e.g., "reducing activities due to increasing age of the leaders themselves"), and "impact of the coronavirus."Conclusion　Leaders' strong belief in their activities and their ability to adapt based on successful experiences were crucial. They responded effectively to environmental changes, including evolving government relationships. Fostering leadership belief, highlighting the benefits of activities, and supporting collaborative responses to environmental changes are essential for ongoing success.

Aim: The Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height 2 ) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations., Methods: Participants of our cohort study in 2015 of 468 community-dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height 2 , and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut-off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut-off values for each parameter, including ASM/height 2 , from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut-off values for ASM/height 2 and PEFR or %PEFR on a three-dimensional chart to observe the relationship between the different cut-off values and HR., Results: A total of 31 people died during the 5-year observation period. With ASM/height 2 cut-off values of approximately 7.0 kg/m 2 for men and 5.7 kg/m 2 for women and %PEFR cut-off values of 66-75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36-3.27, point estimation range)., Conclusions: The definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; ••: ••-••., (© 2024 Japan Geriatrics Society.)

Introduction: Social isolation is associated with increased mortality risk. On the other hand, some older adults prefer to be alone. Additionally, predictors of isolation are mostly unchanged across interventions. Therefore, knowledge of how to prevent negative health outcomes in isolation would be beneficial. One of the factors that reduces the risk of mortality is regular exercise. However, to date, no studies to our knowledge have examined whether regular exercise reduces mortality among socially isolated individuals. This study aimed to determine the effects of the combination of social isolation and regular exercise on mortality among community-dwelling older adults., Methods: This prospective cohort study was part of the larger Otassha Study of community-dwelling older adults living in Itabashi Ward, Tokyo, Japan. In October 2012, 835 individuals (males = 350, females = 485; mean age 73.1 years) completed a comprehensive baseline health survey. Individuals were considered socially isolated if their frequency of interactions with others averaged less than once per week. Regular exercise was defined as exercise performed at least twice a week. The participants were assigned to one of the following four groups: (1) not isolated with regular exercise, (2) not isolated without regular exercise, (3) isolated with regular exercise, and (4) isolated without regular exercise. All-cause mortality information was obtained from the ward office database. Follow-ups were conducted until 1 November 2020. A Cox proportional regression analysis was performed., Results: A final analysis was performed on a complete dataset of 735 participants (males = 303, females = 432; mean age 72.9 years). A total of 132 (18.0%), 426 (58.0%), 27 (3.7%), and 150 (20.4%) participants were assigned to groups 1, 2, 3, and 4, respectively. The mortality rates in groups 1, 2, 3, and 4 were 6.1%, 9.2%, 7.4%, and 19.3%, respectively. Compared with group 1, isolated individuals who did not perform regular exercise had a significantly higher mortality rate [adjusted hazard ratio (aHR), 2.48; 95% confidence interval (CI), 1.12-5.52]. However, no significant association was noted in isolated individuals who performed regular exercise (aHR, 1.25; 95% CI, 0.26-5.91)., Conclusion: Regular exercise was associated with a decrease in mortality risk, regardless of social isolation status. Thus, our results indicate that encouraging isolated older adults to exercise regularly may reduce their negative health outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ejiri, Kawai, Imamura, Fujiwara, Ihara, Hirano and Obuchi.)

Background: Maintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear., Aims: This study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese., Methods: Participants were 3,169 community-dwelling older Japanese who participated in the 2012-2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65-90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined., Results: Three patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable., Discussion: The instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped., Conclusions: To maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented., (© 2024. The Author(s).)

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).)

Objectives: To investigate the trajectories of social networks and interactions among older Japanese individuals during the COVID-19 pandemic., Study Design: We used data from a cohort of community-dwelling older individuals from the Otassha study's 2019-2022 survey. Participants comprised 606 older individuals who participated in the 2019 survey and were followed up at least once., Main Outcome Measures: Social networks were assessed using the Lubben Social Network Scale-6 (LSNS-6), whereas social interactions were assessed by the frequency of face-to-face or non-face-to-face contact with non-resident family members and friends. Trajectories of the LSNS-6 and face-to-face and non-face-to-face interactions were identified using group-based semiparametric mixture modeling. The trajectories of change in the LSNS-6 from 2019 were also identified. The factors associated with the changes in trajectory patterns were examined using logistic regression analysis., Results: Three LSNS-6 trajectories were identified, with slightly decreasing patterns over time. Specifically, face-to-face interactions tended to decrease over time, whereas non-face-to-face interactions exhibited almost no change. The reduction in LSNS-6 in the decreased pattern failed to recover to its pre-pandemic level. The group of participants with the decreased pattern had a significantly higher proportion of people participating in group activities [odds ratio (95 % confidence interval): 2.27 (1.12-4.59)] and performing calisthenics twice a week than the group with the maintained pattern [2.08 (1.18-3.68)]., Conclusions: During the three years of the pandemic, no changes were observed in the social networks of community-dwelling older Japanese individuals., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty., Methods: We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score ≤3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score ≥3)., Results: A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94)., Conclusions: Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. Geriatr Gerontol Int 2024; 24: 371-377., (© 2024 Japan Geriatrics Society.)

Aim: This study aimed to examine the relationships between levels of competence and impaired physical and cognitive functions in older adults., Methods: We used a data set of the Integrated Longitudinal Studies on Aging in Japan for 2017 including 5475 community-dwelling older adults. Levels of competence were assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). Grip strength (low grip strength: <28 kg for men and <18 kg for women) and gait speed (slow gait speed: <1.0 m/s for both sexes) were evaluated as physical function measurements, and the Mini-Mental State Examination (cognitive decline: <24 on the Mini-Mental State Examination) was used to assess cognitive function., Results: The JST-IC had areas under the curve estimated from receiver operating characteristic analysis ranging from 0.65 to 0.73 for detecting low function as assessed by these tests. Restricted cubic spline curves showed that the shape of the association between the JST-IC and impaired function depended on sex and the test used. The comparison between perfect and imperfect JST-IC scores showed significant differences in the prevalence of low grip strength in both sexes, slow gait speed in women, and cognitive decline in men., Conclusions: It may be insufficient to identify those with impaired physical or cognitive function using the JST-IC. The shape of the association with the JST-IC varies across their measurements. Our findings can help interpret JST-IC scores in the context of low physical and cognitive functions. Geriatr Gerontol Int 2024; 24: 352-358., (© 2024 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Introduction: Social isolation has been recognized as a contributing factor to negative health outcomes. Although living alone is associated with health-related outcomes, existing findings are inconsistent. It is not the act of living alone that may predict poor health, but rather social isolation that can lead to increased mortality risk. This study investigated the combined associations of social isolation and living alone with mortality among community-dwelling older adults., Methods: We included older adults from Itabashi ward, Tokyo, who participated in comprehensive health checkups. Participants were categorized into four groups based on their social isolation status and living alone. The primary outcome was all-cause mortality, analyzed using Cox proportional hazards models., Results: Of the 1,106 participants (mean age 73, 42% male), 4.5% experienced both social isolation and living alone. This combination was associated with a worse prognosis regarding all-cause mortality (hazard ratio (HR): 2.08 [95% confidence interval (CI), 1.08-4. 00]). Those who were socially isolated but not living alone also showed a trend towards higher mortality risk (HR: 1.41 [95% CI, 0.90-2.20]). Contrastingly, those who were not socially isolated and lived alone did not show an increased mortality risk (HR: 0.81 [95% CI, 0.44-1.49])., Discussion and Conclusion: Living alone is not inherently associated with a poor prognosis in older adults; however, social isolation was associated with a higher mortality risk. Healthcare providers should focus on enhancing social interactions and support for older adults because of their effects on health rather than solely addressing living arrangements to prevent adverse health events., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Imamura, Kawai, Ejiri, Sasai, Hirano, Fujiwara, Ihara and Obuchi.)

Social isolation among older adults affects their physical and mental health. Ego-resilience is associated with flexible adaptation to various environments and acceptable behaviors. However, its association with social isolation among older people is unclear. Therefore, a health survey was conducted with 510 adults aged 65 years or older to assess social isolation, its associated factors, and ego resilience. The results showed that the social isolation group had a lower median ego-resiliency scale score (42.0) compared to the non-social isolation group (38.0). The social isolation group were mostly males without spouses, took time to move, had more depressive moods, and poorer subjective health status. The non-social isolated group had faster maximum walking speed. Low ego-resilience was newly identified as a factor associated with social isolation among older people, as were being male, having no spouse, and depressive symptoms. Mediation analysis revealed that ego-resilience affected social isolation and was partially mediated by depressive symptoms., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s).)

This study examined the ability of a computer-based cognitive assessment tool (CompBased-CAT) to predict mild cognitive impairment (MCI) in community-dwelling older adults. A two-year longitudinal study was conducted using data from 2016 to 2018 from the Otassha study cohort of community-dwelling older adults. MCI was defined as a Mini-Mental Status Examination (MMSE) score of <27. The CompBased-CAT was used at baseline, with each subtest score converted into a Z-score. Subsequently, the total Z-scores were calculated. Participants were divided into robust and MCI groups, and all variables were compared using the t-test or χ2 test. Receiver operating characteristic (ROC) curves and logistic regression analyses were conducted, with MCI and total Z-scores as dependent and independent variables, respectively. Among the 455 participants (median age, 72 years; range, 65-89 years; 282 women and 173 men), 32 developed MCI after two years. The participants in the MCI group were significantly older. They had lower maximal gait speed, baseline MMSE scores, subtest Z-scores, and total Z-scores than those in the robust group. The area under the ROC curve was 0.79 (95% confidence interval: 0.70-0.87; P <0.01). The sensitivity was 0.76, and the specificity was 0.75. The logistic regression analysis showed an odds ratio of 1.34 (95% confidence interval: 1.18-1.52; P <0.01). This study showed that CompBased-CAT can detect MCI, which is an early stage of dementia. Thus, CompBased-CAT can be used in future community health checkups and events for older adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Takahashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: To develop a rapid and easy screening tool to detect sarcopenia., Methods: In total, 683 community-dwelling older adults who participated in our cohort study, the "Otassha Study," in 2019, completely responded to a questionnaire, and were diagnosed with sarcopenia were included. Participants responded to a nine-item questionnaire, including candidate items for a new sarcopenia screening tool named rapid sarcopenia screening, based on items of the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire. To select appropriate items for the new screeening tool, multiple logistic regression analyses were performed, with sarcopenia as the dependent variable and questionnaire responses as independent variables. The area under the curve using 10 000 bootstraps was used to assess the rapid sarcopenia screening diagnostic ability for detecting sarcopenia., Results: Responses to question nos 2 (how much can you squeeze a wet towel?), 5 (how much muscle strength do you think you have compared with that of people of your age and sex?), 7 (how fast do you usually walk?), and 9 (age-related item) were related to sarcopenia in multiple logistic regression analysis. The area under the curve of the total score of rapid sarcopenia screening was 0.82, 0.80, and 0.81 for men, women, and overall, respectively. At a cut-off value of 14/15, the sensitivity and specificity for sarcopenia detection were 0.73 and 0.73, respectively., Conclusions: The newly developed sarcopenia screening tool has a better diagnostic ability for sarcopenia than the SARC-F. Rapid sarcopenia screening does not require physical function measurements, making it a useful and accessible tool among older adults to detect sarcopenia. Geriatr Gerontol Int 2023; 23: 945-950., (© 2023 Japan Geriatrics Society.)

Background: The frequency of combined declines in domains of multi-faceted frailty and their impact on adverse health outcomes have not been adequately investigated. We aimed to examine the association between combined subscale declines in higher-level functional capacity and 8-year all-cause mortality among community-dwelling older Japanese individuals and the impact of multi-faceted frailty on mortality., Materials and Methods: We administered a questionnaire to 7015 community-dwelling older adults aged 65-85 years. The higher-level functional capacity of the 3381 respondents was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Subscale decline was defined as (1) none, (2) only social role (SR), (3) only intellectual activity (IA), (4) SR and IA, (5) only instrumental activities of daily living (IADL), (6) IADL and SR, (7) IADL and IA, and (8) all. Associations between combined subscale declines and mortality were examined using adjusted Cox proportional hazards models. Follow-up was conducted from October 1, 2012, to death or November 1, 2020., Results: The mortality rate was 16.7/1000 person-years. Moreover, 44% of respondents had declined SR, and half of them had multiple declines. Compared with no decline, SR (adjusted hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.14-1.93), SR and IA (HR: 1.59, 95% CI: 1.16-2.17), IADL and SR (HR: 1.97, 95% CI: 1.31-2.99), and all-domain (HR: 2.72, 95% CI: 1.98-3.74) declines were significantly associated with higher mortality risks., Conclusions: Overlapping SR and IADL declines increased mortality risk, suggesting the importance of measuring social frailty and overlapping physical and social frailty., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)