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IntroductionSocial 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.MethodsThis 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.ResultsA 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).ConclusionRegular 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.

IntroductionSocial 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.MethodsWe 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.ResultsOf 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 conclusionLiving 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.

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.

Summary: Background & Aims: Depression is receiving increase attention for its relation to lifestyle-related diseases. We aim to assess differences in blood biomarkers and dietary habit between individuals with typical and atypical depression. Methods: We gathered data from 804 older Japanese individuals. Participants with diagnosed depression were further grouped into typical or atypical subtypes. Dietary habits were measured by a dietary variety score. Considering the small sample size, descriptive analysis and logistic regression analysis adjusted by propensity score were used to evaluate the associations of blood biomarkers and dietary habits with typical and atypical depression. Results: Via interviews, 777 participants were confirmed to not be depressed, with the remaining 27 individuals having either typical (n = 18) or atypical (n = 9) depression. Weight, BMI, HbA1c levels, and the proportion of never drinkers were higher in the depressed group than in the non-depressed group (P = 0.04, P = 0.02, P = 0.04, P < 0.01, respectively). The habit of fruit intake was lower in the depression group (P = 0.01). Atypical depression was positively associated with weight and BMI (odds ratio: OR 1.06, P = 0.02, OR 1.20, P = 0.01), while typical depression had a positive relation to HbA1c (OR 1.76, P = 0.01). As for eating habit, atypical depression was negatively associated with fruit intake (OR 0.38, P < 0.01). Conclusions: Depression in older individuals was positively associated with weight (atypical type), BMI (atypical type), HbA1c (typical type), and low fruit intake (atypical type).

Introduction: Since soy isoflavones compensate for age-related estrogen reduction, adequate intake of soy products may prevent the decline in activities of daily living (ADL) due to estrogen reduction in women. However, it is unclear whether regular soy product intake prevents ADL decline. This study examined the effects of soy product consumption on basic/instrumental ADL (BADL/IADL) in Japanese women 75 years or older for 4 years. Materials and Methods: The subject population consisted of 1289 women aged 75 years or older living in Tokyo who underwent private health examinations in 2008. For 1114 (or 1042) participants without baseline BADL (or IADL) disability, we examined the association between baseline soy product consumption frequency and the BADL (or IADL) disabilities 4 years later using logistic regression analyses. The models were adjusted for baseline age, or further for dietary variety for food groups other than soy products, exercise and sport participation, smoking, pre-existing disease number, and body mass index. Results: Regardless of adjustment for potential confounding factors, less frequent soy product consumption was associated with higher BADL or IADL disability incidence. In the fully adjusted models, the trend toward a higher incidence of disabilities with less frequent soy product consumption was statistically significant for both BADL (p?=?0.001) and IADL (p?=?0.007). Conclusions: Those who consumed soy products more frequently at baseline were less likely to develop BADL and IADL disabilities after 4 years than those who did not. The results show that daily soy product consumption may prevent functional ADL decline in older Japanese women.

Abstract Background Few studies have examined the state of oral function in older adults with sarcopenia. We assessed the oral functions of community‐dwelling older adults with sarcopenia from multiple perspectives to clarify their potentially low oral function. Methods A total of 1517 (86.2%; 990 women, 527 men; mean age 76.1 ± 7.6 years) participants were included in this study. Grip strength, gait speed and skeletal muscle mass index were assessed, and sarcopenia was evaluated according to the criteria of the Asian Working Group for Sarcopenia 2019. The degree of tongue coating, oral moisture, occlusal force, tongue–lip motor function, tongue pressure, masticatory function and swallowing function were assessed. The criteria for oral hypofunction (a disease that is a combination of multiple low oral functions) were used to assess oral function. Statistical analyses were performed using Kolmogorov–Smirnov test, unpaired t‐test, Mann–Whitney U test, χ2 test, and univariate and multivariable logistic regression analyses, with each oral function as the dependent variable and sarcopenia as one of the independent variables. The significance level was set at P

IntroductionThis longitudinal study aimed to identify aging trajectory patterns of social interaction by sex and determine the association between these patterns and all-cause mortality.MethodsParticipants were 4,065 community-dwelling older adults (1849 men) in Japan, aged 65–89 years, who responded twice or more to a mail survey conducted between 2012 and 2020. Social interaction was examined through the frequency of face-to-face and non-face-to-face contact with non-resident family and friends. The aging trajectories of the social interaction scores were identified using group-based trajectory modeling.ResultsTwo groups were identified among both men and women. Among men with high-frequency interaction, a rapid decrease in the frequency of social interaction was observed after 80 years of age. Conversely, among women, the frequency tended to remain the same, even after 80 years of age. The social interaction score among those aged 65 years in the low-frequency group was approximately 4 points for men and 6 points for women. Among men, no decrease was observed; however, it tended to decline after 85 years of age among women. Among men, the factors associated with the low-frequency group were instrumental activities of daily living score, perceived financial status, and social participation, while among women, they were self-rated health and social participation. The adjusted hazard ratio in the low-frequency group for all-cause mortality was 1.72 (95% confidence interval, 1.27–1.72) for men and 1.45 (95% confidence interval, 0.98–2.14) for women.DiscussionIn the low-frequency group, men had a higher risk of all-cause mortality than women. Daily social interaction from mid-age is important to reduce the risk of social isolation and all-cause mortality in later life.

Abstract This study examined the impact of disengagement on health status and mortality among community-dwelling older adults in Japan. Disengagement from society was operationally defined as dropping out of a longitudinal survey. A follow-up mail survey was conducted, in 2014, among respondents (n = 3696) of the baseline mail survey. Step-by-step follow-up surveys (FLs), including simplified mail, postcard, and home-visit surveys, were sent to participants who did not respond. Disengagement levels were defined according to the response to the FLs as zero (mail survey), low (simplified mail survey), middle (postcard survey), high (home-visit survey), and highest (non-responders to the home-visit survey). After adjusting for health status at baseline, the proportion of respondents self-rated as “not healthy” during FLs was significantly higher in the high-level than in the zero-level group. The proportion of respondents reporting a “once a week or less” frequency of going outdoors during FLs was significantly higher in the low-, middle-, and high-level groups than in the zero-level group. Mortality rates were significantly higher in the high and highest levels than in the zero-level group. Higher disengagement levels increased the risk of lower health status and mortality, suggesting an urgent need to prevent societal disengagement among older adults.

Abstract Mood and anxiety disorders are frequent in the elderly and increase the risk of frailty. This study aimed to identify novel biomarkers of major depressive disorder (MDD) and anxiety in the elderly. We examined 639 participants in the community-dwelling Otassha Study (518 individuals considered healthy control, 77 with depression, anxiety, etc.), mean age 75 years, 58.4% of female. After exclusion criteria, we analyzed VOCs from 18 individuals (9 healthy control, 9 of MDD/agoraphobia case). Urinary volatile and semi-volatile organic compounds (VOCs) were profiled using solid-phase microextraction and gas chromatography-mass spectrometry. Six urinary VOCs differed in the absolute area of the base peak between participants with MDD and/or agoraphobia and controls. High area under the receiver-operating characteristic curve (AUC) values were found for phenethyl isothiocyanate (AUC: 0.86, p = 0.009), hexanoic acid (AUC: 0.85, p = 0.012), texanol (AUC: 0.99, p = 0.0005), and texanol isomer (AUC: 0.89, p = 0.005). The combined indices of dimethyl sulfone, phenethyl isothiocyanate, and hexanoic acid, and texanol and texanol isomer showed AUCs of 0.91 (p = 0.003) and 0.99 (p = 0.0005) and correlated with the GRID-HAMD and the Kihon Checklist (CL score), respectively. These VOCs may be valuable biomarkers for evaluating MDD and/or agoraphobia in the elderly.

IntroductionA prior study showed an association between diversity in daily activities (type, frequency, evenness) and frailty in older adults. However, the causality of this relationship is unclear. Therefore, this study aimed to clarify the relationship between activity diversity and frailty through a 2-year longitudinal study conducted among community-dwelling older adults.MethodsWe evaluated data from the 2018 and 2020 waves of the Otassha Study. Frailty was assessed using the Cardiovascular Health Study criteria, with pre-frail and frail participants defined as frail and the other participants categorized into the robust group. We enrolled a total of 207 participants who were not frail at baseline. Activity type, frequency, and evenness scores were calculated using an Activity Diversity Questionnaire. The association between each activity diversity score and the incidence of frailty was evaluated using logistic regression modeling (each diversity score was entered the model after Z-transformation).ResultsOf the 207 enrolled participants (median age, 73 years; age range, 65–91 years; 60.4% women), 64 (30.9%) had incident frailty during the follow-up period. A logistic regression analysis adjusting for sociodemographic and psychosomatic factors revealed odds ratios for activity type and evenness scores of 0.64 and 0.61, respectively (P < 0.05). These factors were significantly associated with the incidence of frailty.DiscussionActivity type and evenness (except frequency) within daily activities were predictors of frailty during 2 years of follow-up. Engagement in diverse activities appears to be more effective in preventing frailty than does engagement in a few activities.

Objectives To assess whether frailty can be assessed using a smartphone and whether daily walking speed (DWS) is associated with frailty.Design Cross-sectional study.Setting Three prefectures (Kanagawa, Saitama and Tokyo) in Japan.Participants The study enrolled 163 participants (65 in the robust group, 69 in the prefrailty group and 29 in the frailty group) by sending letters to house owners aged≥55 years.Primary and secondary outcome measures The participants downloaded the DWS measurement application on their smartphones, which measured the daily walking (DW) parameters (DWS, step length and cadence) and the Kihon checklist for frailty assessment. The differences in the DW parameters between the robust, prefrailty and frailty groups were examined using one-way analysis of variance. We conducted logistic regression analysis for the Crude model (each DW parameter), model 1 (adjusted for the number of steps) and model 2 (model 1+age, sex and the number of chronic diseases).Results DWS was marginally significantly slower in the frailty group than in the prefrailty and robust group (robust 1.26 m/s vs prefrailty 1.25 m/s vs frailty 1.19 m/s, p=0.060). Step length was significantly smaller in the frailty group than in the robust group (robust 66.1 cm vs prefrailty 65.9 vs frailty 62.3 cm, p

This study aims to identify the trajectory of psychological well-being during the COVID-19 pandemic among community-dwelling older adults and to clarify the association between coping behavior in the early stage of the pandemic and the trajectory of psychological well-being. The study was based on a cohort study, known as “the Otassha Study.” We administered three follow-up surveys to 720 older adults who participated in the survey in October 2019 (T0): T1: June 2020, T2: October 2020, and T3: October 2021. Furthermore, we assessed coping behavior in T1 via a self-developed questionnaire comprising 10 items. Psychological well-being was assessed by the WHO-5 Well-Being Index (score range: 0 to 25) in all surveys. The trajectories of psychological well-being were identified by group-based trajectory modeling. The association between coping behaviors and trajectory patterns was assessed using multinomial logistic regression analysis. Furthermore, among the 508 participants who participated in the follow-up survey two times or more, three patterns of the trajectory of psychological well-being were identified: heavily decreased group (n = 39), decreased group (n = 352), and increased group (n = 39). “Walking” as a coping behavior had a significantly higher odds ratio (OR) to be in the increased group (OR = 2.32, 95 % confidence interval (CI) 1.06–5.05, p = 0.035) compared to the heavily decreased group. “Conversations with family living together” had a slightly higher OR to become an increased group (OR = 1.96, 95 % CI: 0.87–4.41, p = 0.106), and “actively gathering information on COVID-19” had a slightly lower OR to become the decreased group (OR = 0.53, 95 % CI: 0.26–1.06, p = 0.072) compared to the heavily decreased group. The results of this study suggest how maintaining health in the early stage of the pandemic had a great influence on the long-term health status.

Abstract Aims Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age‐related decline has yet to be developed. We aimed to define an event‐driven cut‐off for the relative decline in gait speed against age‐adjusted reference values derived from the general population and evaluate its prognostic implications. Methods and results Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age ≥ 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology‐Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event‐driven optimal cut‐off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE‐HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE‐HF data, the optimal SGS ratio cut‐off was determined as 0.527. In the Kitasato cohort, SGS ratio

Abstract Background Generalized loss of skeletal muscle mass (SMM) may modulate or otherwise affect the loss of masseter muscle mass and be responsible for low masseter muscle performance and strength (i.e., low oral function). Moreover, dentition status can affect oral function independent of the muscle state. This cross-sectional study aimed to simultaneously investigate the relationships among whole-body SMM, masseter muscle mass, oral function (masseter muscle performance and strength), and dentition status in 1349 Japanese adults (mean age = 73.6 years). Methods We determined the estimated masseter muscle mass (e-MMM) based on morphological measurements of the masseter muscle. Masseter muscle performance was assessed via masticatory performance evaluation scores using gum, and strength was assessed as the maximal occlusal force. Dentition status was assessed as the number of functional teeth. SMM was measured by bioelectrical impedance analysis. Structural equation modeling stratified by sex was employed to investigate associations among SMM, e-MMM, gum score, occlusal force, and number of functional teeth. Results The direct path from SMM to e-MMM was statistically significant, as was the direct path from e-MMM to oral function (gum score and maximum occlusal force) for both sexes. We additionally confirmed that SMM indirectly affected gum score and maximum occlusal force via e-MMM (men; standardized coefficient [95% CI] = 3.64 [1.31 to 5.96] for maximum occlusal force and 0.01 [0.01 to 0.02] for gum score, women; 2.01 [0.38 to 3.81] for maximum occlusal force and 0.01 [0.002 to 0.01] for gum score). The number of functional teeth had direct effects on e-MMM, gum score, and maximum occlusal force. Conclusions Low SMM was significantly indirectly associated with poor oral function through a low masseter muscle mass, and dentition status was independently associated with oral function.

Abstract Background Walking speed is an important measure associated with health outcomes in older individuals, such as dependency and death. This study aimed to examine whether the walking speed of community-dwelling older adults varies between time periods within a day, as measured outdoors in daily life. We aimed to determine the types of walking speed variations and examine the factors associated with them. Methods Daily life outdoor walking speed was measured in 92 participants (average age 71.9 years±5.64) using a GPS smartphone app for 1 month. Average walking speeds for five time periods were analyzed with a linear mixed model. Intra-day walking speed variation patterns were classified by latent class analysis. Factors associated with the class were identified by logistic regression analysis. Results A statistically significant difference in average walking speed was found between early morning (1.33 m/s), and afternoon (1.27 m/s) and evening (1.26 m/s) (p

Objectives: Eating alone is associated with an increased risk of depression symptoms. This association may be confounded by poor social networks. The present study aimed to determine the role of poor social networks in the association of eating alone with depression symptoms, focusing on cohabitation status. Methods: Seven hundred and ten community-dwelling older adults were categorized according to their eating style and social network size, evaluated using an abbreviated version of the Lubben Social Network Scale, with poor social network size (defined as the lowest quartile). Living arrangements and depression symptoms, detected using the Zung Self-Rating Depression Scale, were also assessed. Results: A mixed-design two-way analysis of covariance (eating style and social network size factors) for the depression scale score, adjusted by covariates, yielded significant effects of social network size and eating style without interaction. Greater depression scores were observed in eating alone and poor social network size. Analysis of participants living with others showed the same results. However, among older adults living alone, only a significant main effect of social network size was observed; poor social network size resulted in greater depression scores irrespective of eating style. Conclusions: Poor social network size, and not eating alone, was associated with greater depression symptoms among older adults living alone, whereas both factors may increase depression symptoms among older adults living with others. Poor social network size may show a stronger influence on depression than eating alone in older adults living alone; thus, social network size is an important health indicator.

Abstract Background Predicting incidence of long-term care insurance (LTCI) certification in the short term is of increasing importance in Japan. The present study examined whether the Kihon Checklist (KCL) can be used to predict incidence of LTCI certification (care level 1 or higher) in the short term among older Japanese persons. Methods In 2015, the local government in Tokyo, Japan, distributed the KCL to all individuals older than 65 years who had not been certified as having a disability or who had already been certified as requiring support level 1–2 according to LTCI system. We also collected LTCI certification data within the 3 months after collecting the KCL data. The data of 17,785 respondents were analyzed. First, we selected KCL items strongly associated with incidence of LTCI certification, using stepwise forward-selection multiple logistic regression. Second, we conducted receiver operating characteristic (ROC) analyses for three conditions (1: Selected KCL items, 2: The main 20 KCL items (nos. 1–20), 3: All 25 KCL items). Third, we estimated specificity and sensitivity for each condition. Results During a 3-month follow-up, 81 (0.5%) individuals required new LTCI certification. Eight KCL items were selected by multiple logistic regression as predictive of certification. The area under the ROC curve in the three conditions was 0.92–0.93, and specificity and sensitivity for all conditions were greater than 80%. Conclusions Three KCL conditions predicted short-term incidence of LTCI certification. This suggests that KCL items may be used to screen for the risk of incident LTCI certification.

Abstract Background Diet is a modifiable factor affecting sarcopenia, and accumulating evidence links dietary factors to muscle mass, strength, and function in older adults. However, few studies have examined the association of dietary patterns with sarcopenia. This study examined the association of dietary patterns derived by reduced-rank regression (RRR) with sarcopenia and its components in community-dwelling older Japanese. Methods We conducted a cross-sectional study of 1606 community-dwelling adults aged 65 years or older. Dietary intake was assessed by a validated, self-administered diet history questionnaire. Nutrient-derived dietary patterns were identified by using RRR, with sarcopenia-related nutrients (protein, vitamin D, vitamin C, vitamin E, folate, vitamin K, magnesium, iron, and calcium intakes) as response variables. Sarcopenia was defined by using the algorithm of the Asian Working Group for Sarcopenia 2019. Multivariate regression and logistic regression were used to examine the association of dietary patterns with sarcopenia and its components. Results The first RRR dietary pattern was characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruit and a low intake of rice and was associated with decreased prevalence of sarcopenia: the multivariable-adjusted odds ratio of sarcopenia was 0.57 (95% confidence interval, 0.34–0.94; p for trend=0.022) in the highest versus the lowest tertile of dietary pattern. This dietary pattern was also significantly positively associated with usual gait speed (β: 0.02, p=0.024). Conclusions A dietary pattern characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruits and low rice intake was inversely associated with sarcopenia in community-dwelling older Japanese.

Participation in sports groups has health benefits for older adults, such as preventing functional limitations and social isolation. Encouraging participation in sports groups may be an important means of health promotion in older adults. However, there is insufficient research on the determinants of new participation in sports groups to consider effective interventions to promote participation in these groups. We investigated this using data from a 1-year prospective study. Data were obtained from "The Otassha Study" that assessed a cohort of community-dwelling older adults living in an urban area of Japan. Of 769 older adults who participated in a baseline health survey in 2018, 557 participated in a follow-up survey in 2019. We excluded 184 individuals who already participated in sports groups at baseline and 36 with missing data. Participation in sports groups was defined as that occurring more than once a week. Logistic regression analysis was used to identify the determinants of new participation in sports groups, with sociodemographic factors, lifestyle habits, physical functions, cognitive functions, psychological factors, and social factors as independent variables. Forty-one (12.2%) individuals participated in sports groups at follow-up. In the multiple adjusted logistic regression model, new participation in sports groups was significantly associated with female sex (odds ratio [OR] = 5.57, 95% confidence interval [CI]: 1.61‒19.26), engagement in regular exercise (OR = 2.23, 95%CI: 1.03‒4.84), and having a large social network (OR = 1.12, 95%CI: 1.04‒1.20). Physical functions were not associated with new participation. Determinants of new participation were lifestyle habits and social factors, rather than physical functions. Intervention through social networks may be effective in encouraging new participation in sports groups, which, in turn, may facilitate healthy aging.

Background: Considering the rate of growth of the older population in several countries, accidental falls in older cyclists are expected to increase. However, the prevalence and correlates of bicycle-related falls (BR-falls) are unknown. The aim of the present study was to explore the characteristics of BR-falls, focusing on the risk factors. Methods: Seven-hundred and ninety-one older adults participated in a comprehensive baseline assessment that included questions on bicycle use, BR-falls, lifestyle, and physical and cognitive evaluations. A cyclist was defined as a person who cycled at least a few times per month. The incidence of BR-falls in participants who did not report BR-falls at baseline was again ascertained 3 years later. Logistic regression analyses examined the predictors of BR-falls incidence. Results: At baseline, 395 older adults were cyclists and 45 (11.4%) of them had experienced BR-falls. Adjusted regression analysis showed that slower gait velocity, shorter one-leg standing time, and experience of falls (ie, non-BR-falls) were associated with BR-falls. Among the 214 cyclists who did not report BR-falls at baseline and who participated in both baseline and follow-up assessments, 35 (16.4%) cyclists experienced BR-falls during the 3-year follow-up. Adjusted regression analysis revealed that higher body mass index and non-BR-falls were predictors of future incidence of BR-falls, independent of physical function. Conclusions: Our results showed that experience of falls, irrespective of bicycling, is an independent correlate and risk factor of BR-falls. This suggests that experience of falls and BR-falls may share the same risk factors.

ObjectiveTo assess the relationship of serum brain-derived neurotrophic factor (BDNF) levels with the subsequent short-term decline in cognitive functioning in community-dwelling older adults.DesignTwo-year prospective, observational study.Setting and ParticipantsThe study included 405 adults aged 65–84 years, initially free of a dementia diagnosis who were living in Tokyo, Japan.MethodsParticipants underwent health assessments at baseline (2011) and follow-up (2013). Serum BDNF levels and scores from the Montreal Cognitive Assessment-Japanese version (MoCA-J) were systematically measured. Logistic regression was used to estimate the odds of cognitive decline between baseline and follow-up assessments in the full MoCA-J scale (operationally defined as a decrease of two or more points), as well as in MoCA-J subscales (decline of one or more points in a specific subscale), as a function of serum BDNF level, adjusting for baseline demographics, prevalent chronic diseases, and baseline cognitive scores.ResultsAmong individuals who performed worse on the full MoCA-J at baseline (i.e., scores in the bottom quartile [≤21], which is consistent with a mild cognitive impairment status), but not among those who performed better (top 3 quartiles), those with highest baseline serum BDNF levels (top quartile) had lower odds of subsequent decline in the full MoCA-J scale than those with lowest (bottom quartile); i.e., odds ratio (OR): 0.10 (95% confidence interval [CI]: 0.02–0.62; p = 0.013). Regarding MoCA-J subscales, adjusted odds of decline in the executive function subscale, but not in the other five subscales, were substantially low among those with highest baseline serum BDNF levels (top quartile), as compared to those with the lowest (bottom quartile), i.e., OR: 0.27 (95% CI:0.13–0.60; p < 0.001).Conclusion and ImplicationsHigher serum BDNF levels were associated with a lower risk of decline in cognitive function in a sample of community-dwelling older Japanese adults. Risk varied across cognitive subdomains and according to baseline cognition. This warrants further research to evaluate the added-value of serum BDNF in health promotion initiatives directed toward cognitive decline prevention in community-dwelling older adults.

PURPOSE:To investigate the association between different stages of posterior vitreous detachment (PVD) and macular microvasculature in the elderly. METHODS:Swept-source optical coherence tomography (OCT), OCT angiography, and color fundus images of 490 eyes without retinal pathologies of 322 participants aged ≥65 years were evaluated. PVD was classified using enhanced vitreous visualization mode as no apparent PVD (stage 0/1), vitreous adhesions at the fovea and optic disc (stage 2), adhesion at the optic disc (stage 3), or complete PVD (stage 4). Microvascular parameters, including foveal avascular zone (FAZ) and vessel density (VD), were analyzed for their associations with complete PVD. Additionally, the association between PVD and central retinal thickness (CRT) was also addressed. RESULTS:Overall, 80, 31, 31, and 349 eyes were categorized into stages 0/1, 2, 3, and 4, respectively. Using multivariate mixed-effects model, the mean superficial FAZ area was smaller in stage 4 compared with stages 0-3 (0.29 vs. 0.32 mm2; P = 0.014), and the mean superficial VD was lower in stage 4 compared with stages 0-3 (34.96% vs. 35.24%; P = 0.0089). However, PVD was not significantly associated with deep macular microvascular parameters or CRT. CONCLUSIONS:Complete PVD was associated with smaller FAZ area and lower VD in superficial macular microvasculature, while it was not associated with central retinal thickness.

This study aims to clarify the factors associated with the gradual withdrawal from society in older adults. We defined the stages of follow-up difficulty based on four follow-up surveys on non-respondents of longitudinal mail surveys in community-dwelling older adults to examine the main factors associated with the stages of follow-up difficulty. We conducted a follow-up mail survey (FL1) with respondents of a baseline survey, and three more follow-up surveys with the non-respondents of each previous survey: simplified mail (FL2), postcard (FL3), and home visit surveys (FL4). The respondents of each follow-up survey were defined as a stage of follow-up difficulty; their characteristics concerning social participation and interaction at baseline in each stage were analyzed. The number of respondents in the FL1, FL2, FL3, and FL4 stages and non-respondents (NR) were as follows: 2,361; 462; 234; 84; and 101, respectively. Participation in hobby groups in FL2 and FL3, sports groups in FL4, and neighborhood association and social isolation in NR were significantly associated with the stage of follow-up difficulty. Based on these results, we conclude that the following factors are associated with each stage of follow-up difficulty: 1) a decline in instrumental activities of daily living in the FL2 and FL3 stages, 2) dislike for participating in physical activity such as sports in the FL4 stage, and 3) social isolation, not even belonging to a neighborhood association due to low social interaction in the NR group.

ObjectivesSocial isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study.MethodsA mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL.ResultsAt FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender.ConclusionsParticipation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life.

The association between dietary diversity and frailty remains unknown in older people. We evaluated whether a limited dietary variety is associated with frailty in older adults with diabetes mellitus (DM). This cross-sectional investigation included 1357 adults (median age: 77 years, women: 61.3%). DM was determined by self-reporting, the Dietary Variety Score (DVS) was used to evaluate dietary variety, and the revised Japanese version of the Cardiovascular Health Study criteria evaluated frailty. Participants were divided into 4 groups: no DM/high DVS (non-DMHV), no DM/low DVS (non-DMLV), DM/high DVS (DMHV), and DM/low DVS (DMLV). The prevalence of frailty in each group was 3.6%, 6.7%, 6.7%, and 12.2%. After adjusting for covariates, logistic regression analysis revealed the highest odds ratio (OR) of frailty in the DMLV (non-DMLV, OR = 2.18 (95% confidence interval (CI): 1.25–3.83); DMHV, OR = 1.87 (95% CI: 0.63–5.52); DML, OR = 5.03 (95% CI: 2.05–12.35)). Another logistic regression analysis revealed that a low DVS and DM were independently associated with frailty. Both a low dietary variety and DM were independently related to frailty in older people and the combination increased the prevalence of frailty. These findings suggest that high dietary variety could be important for the prevention of frailty in people with DM.

Sarcopenia is associated with instrumental activities of daily living (IADL) and basic activities of daily living (BADL) disabilities. We developed an index for assessing sarcopenia degree (sarcoscore) and compared it to the Asian Working Group for Sarcopenia (AWGS) criteria. Principal component analyses of walking speed, handgrip strength, and skeletal muscle index were performed to develop a sarcoscore using 3088 Japanese population-based cross-sectional data. During the nine-year follow-up, 278 of 2571 and 88 of 2341 participants developed IADL and BADL disabilities, respectively. Adjusted Cox proportional hazards regression models showed that the sarcoscore criteria, defined as proportional to the sarcopenia prevalence diagnosed by the AWGS criteria, had higher hazard ratios (HRs) and 95% confidence interval (CI) for disability onset than the AWGS criteria (IADL disability: 2.19 (1.64−2.93) vs 1.79 (1.32−2.43), BADL disability: 4.28 (2.63−6.96) vs 3.22 (1.97−5.27)). The adjusted HRs for IADL and BADL disabilities were reduced by 4% and 8% per point increase in the sarcoscore, respectively. The sarcoscore assessed the degree of sarcopenia and had a satisfactory performance for predicting functional disabilities in older Japanese adults, suggesting its usefulness as a complementary composite marker for clinical diagnosis.

This cross-sectional and 4-year longitudinal cohort study aimed to clarify how various lifestyle-related variables affect knee extension strength in elderly Japanese women. The participants were community-dwelling women (n = 575) living in the Itabashi Ward of Tokyo, Japan aged 75-85 years at baseline (in 2008) who returned for a follow-up examination 4 years later (in 2012). Maximum isometric knee extension strength in the dominant leg was measured during comprehensive medical check-ups at baseline and follow-up. Interviews with participants included questions on their history of 11 diseases and lifestyle-related factors such as physical activity as well as dietary, smoking, and drinking habits. Cross-sectional and longitudinal analyses yielded inconsistent results regarding the associations between lifestyle-related factors and knee extension strength. While going out more frequently and regular physical exercise positively affected baseline knee extension strength, they did not affect knee extension strength in the longitudinal analysis. The longitudinal analysis revealed that more frequent intake of soy products or green and yellow vegetables at baseline decreased age-related knee extension strength decline. The inconsistent results from the cross-sectional and longitudinal analyses indicate that conducting both types of analyses is crucial for researching this type of subject. The present study demonstrates that the age-related decline in muscle strength is lower in those who frequently eat soy products or green and yellow vegetables. Thus, recommending higher intake of soy products, and green and yellow vegetables for the elderly might help maintain their muscle health.

To determine age- and sex-specific body composition reference values and investigate age differences in these parameters for community-dwelling older Japanese men and women, using direct segmental multi-frequency bioelectrical impedance analysis.We conducted a pooled analysis of data collected in four cohort studies between 2008 and 2012: Kusatsu Longitudinal Study, Hatoyama Cohort Study, Itabashi Cohort Study, and Kashiwa Cohort Study. The pooled analysis included cross-sectional data from 4478 nondisabled, community-dwelling adults aged 65-94 years (2145 men, 2333 women; mean age: 72.9 years in men and 72.6 years in women). Body weight, fat mass (FM), percentage FM, fat-free mass (FFM), and appendicular lean soft tissue mass were measured using the InBody 720 and 430 (Biospace Co. Ltd, Seoul, Korea). The values were then normalized by height in meters squared to determine body mass index (BMI), FM index (FMI), FFM index (FFMI), and skeletal muscle mass index (SMI).Simple means (standard deviation) of BMI, percentage FM, FMI, FFMI, and SMI were 23.4 (2.9) kg/m(2), 24.9 (6.3)%, 5.96 (2.09) kg/m(2), 17.4 (1.5) kg/m(2), and 7.29 (0.76) kg/m(2), respectively, in men and 22.7 (3.3) kg/m(2), 31.7 (7.1)%, 7.40 (2.61) kg/m(2), 15.3 (1.2) kg/m(2), and 5.86 (0.67) kg/m(2), respectively, in women. We then calculated quartiles and quintiles for these indices after stratifying for sex and 5-year age group. FFMI and SMI decreased significantly with age in both sexes (P < 0.001 for trends), but FFMI remained constant among the women with only a 1% decrease up to age 84 years. Percentage FM increased significantly, with age (P < 0.001 in men and P = 0.045 in women for trends), but FMI was unchanged in both sexes (P = 0.147 in men and P = 0.176 in women for trends).The present data should be useful in the clinical evaluation of body composition of older Japanese and for international comparisons. The small age-related decrease in FFMI may be a noteworthy characteristic of body composition change in older Japanese women.

OBJECTIVES: To determine age- and sex-specific reference values for six physical performance measures, i.e. hand-grip strength, one-legged stance, and gait speed and step length at both usual and maximum paces, and to investigate age and sex differences in these measures among community-dwelling older Japanese adults. METHODS: We conducted a pooled analysis of data from six cohort studies collected between 2002 and 2011 as part of the Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging. The pooled analysis included cross-sectional data from 4683 nondisabled, community-dwelling adults aged 65 years or older (2168 men, 2515 women; mean age: 74.0 years in men and 73.9 years in women). RESULTS: Unweighted simple mean (standard deviation) hand-grip strength, one-legged stance, usual gait speed, usual gait step length, maximum gait speed, and maximum gait step length were 31.7 (6.7) kg, 39.3 (23.0) s, 1.29 (0.25) m/s, 67.7 (10.0) cm, 1.94 (0.38) m/s, and 82.3 (11.6) cm, respectively, in men and 20.4 (5.0) kg, 36.8 (23.4) s, 1.25 (0.27) m/s, 60.8 (10.0) cm, 1.73 (0.36) m/s, and 69.7 (10.8) cm, respectively, in women. All physical performance measures showed significant decreasing trends with advancing age in both sexes (all P

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To assess the validity of self-reported articulatory oral motor skill against objectively measured repetitive articulatory rate (oral diadochokinesis [oral-DDK]) as a gold standard index for articulatory oral motor skill in community-dwelling older Japanese adults. Methods: This cross-sectional study included 607 Japanese adults (mean age = 73.9 years). A single-item self-report questionnaire for articulatory oral motor skill was developed. Study participants completed a 1-month-interval test-retest protocol to assess reliability of the questionnaire, and the protocol was tested by the kappa statistic. Oral-DDK with/ta/(i.e., the number of repetitions of the monosyllable/ta/per second) was measured during the on-site examination. Low oral-DDK performance was defined as <5.2 times/s in men and <5.4 times/s in women. Oral-DDK performance, oral functions other than articulatory oral motor skill, and physical frailty were compared in the groups with and without self-reported low articulatory oral motor skill as determined by the response to the questionnaire. Results: Self-reported low articulatory oral motor skill was identified in 18.5% of the study population. The self-report questionnaire had good test-retest reliability, with a kappa statistic of 0.71. Self-reported low articulatory oral motor skill was significantly associated with a lower value of oral-DDK with/ta/and a higher proportion of low oral-DDK performance, difficulties in chewing and swallowing, dry mouth, and physical frailty. Self-report had high specificity (83.1%) but low sensitivity (42.1%) for detecting low oral-DDK performance. Conclusions: A single-item self-report questionnaire for articulatory oral motor skill had acceptable test-retest reliability and was associated with objectively measured articulatory oral motor skill. [ABSTRACT FROM AUTHOR]