Effects of social activity participation and trust in the community on the transition of frailty classification in late-stage older adults: a 4-year prospective cohort study.

OBJECTIVES: In Japan, frailty is a major risk factor for requiring long-term care, especially among older adults aged 75 years or older (ie, late-stage older adults). Both physical and social factors (eg, social activities, social support and community trust) are protective factors against frailty. However, few longitudinal studies have examined reversible change or stage improvement in frailty. This study investigated social activity participation and trust in the community that may affect the transition of late-stage older adults' frailty status. DESIGN: A mail-based survey was used to analyse the improvement or deterioration of frailty status (categorised as frailty, pre-frailty and robust) over a 4-year period. Binomial and multinomial logistic regression analyses were conducted; the transition in frailty classification was the dependent variable, while a change in social activity participation and the degree of trust in the community were the independent variables. SETTING: Ikoma City, Nara Prefecture, Japan. PARTICIPANTS: 4249 community-dwelling older adults, aged ≥75 years, not requiring long-term care who completed a follow-up questionnaire from April to May 2016. RESULTS: Adjusting for confounding factors, no significant social factors were detected regarding improvement in frailty. However, an increase in exercise-based social participation was an improvement factor in the pre-frailty group (OR 2.43 (95% CI 1.08 to 5.45)). Conversely, a decrease in community-based social activity was a risk factor in the deterioration from pre-frailty to frailty (OR 0.46 (95% CI 0.22 to 0.93)). In the robust group, increased community-based social activity (OR 1.38 (95% CI 1.00 to 1.90)) was a protective factor against frailty, whereas decreased community trust was a risk factor (OR 1.87 (95% CI 1.38 to 2.52)). CONCLUSIONS: No social factors had a significant influence on the improvement of frailty in late-stage older adults. However, the promotion of exercise-based social participation was found to be important for improvement in the pre-frailty state. TRIAL REGISTRATION NUMBER: UMIN000025621.

[Relationship between the subjective age, higher-life function, and new certification as needing long-term care in community-dwelling older adults: The KAGUYA project longitudinal survey of older adults].

AIM: To determine the relationship between the subjective age, higher-life function, and new certification for the need for long-term care among older adults in the community. METHODS: A mail survey was conducted in 2016 among community-dwelling older adults, and the 2,323 participants who were available for follow-up in 2019 were included in the analysis. Subjective age was evaluated using the following three items in response to the question "Please answer how old you feel you are": "Same as actual age," "Feel younger," and "Feel older." Other assessments included an evaluation of the higher-life function, Geriatric Depression Scale scores, general self-efficacy, and exercise adherence. In addition, at follow-up, we investigated whether or not participants required new certification for the need for long-term care. RESULTS: At baseline, participants who felt "older than their actual age" had a significantly lower life function and general self-efficacy and were less likely to exercise at least once a week than the other groups. Furthermore, those who felt "older than their actual age" was more likely than the other groups to be newly certified as needing long-term care, while those who felt "younger than their actual age" were less likely to receive new certification. A logistic regression analysis revealed that "feeling older" was a risk factor for being certified as needing long-term care, even after adjusting for other factors (odds ratio= 3.33, 95% confidence interval: 1.02-10.94, p=0.047). CONCLUSIONS: Among community-dwelling older adults, those with a subjective age exceeding their chronological age were expected to show a decreased life function in the future and an increased risk of needing long-term care.

The effect of a buddy-style intervention on physical activity in community-dwelling older adults with disabilities: A 24-week follow-up of a randomized controlled trial.

OBJECTIVE: To assess the sustained effects of a buddy-style intervention aiming to improve physical activity. DESIGN: A parallel-group, open-label, randomized controlled trial. SETTING: Three adult day-care centers. PARTICIPANTS: Sixty-five community-dwelling older adults with disabilities. INTERVENTION: All participants received a 12-week home-based exercise program. An intervention group (n = 33) received a 5-10 min buddy-style intervention once a week at an adult day-care center for older adults. MAIN MEASURES: The primary outcome was the average daily time spent performing "walking outside home" and "muscle strength exercises" at 24 weeks follow-up post-intervention. RESULTS: Of the 65 participants, one participant in each group dropped out before the program began, 4 and 5 in the intervention and control groups by the 12-week assessment, and 4 and 3 by the 24-week assessment, respectively. Analysis of covariance of the 47 participants who were able to be assessed after 24 weeks revealed that outdoor walking time (min/day) was significantly longer in the intervention group (n = 24) than in the control group (n = 23) at 24 weeks (intervention group, 73.5 [66.1]; control group, 42.7 [45.5]; P = 0.030, f = 0.38). There was no significant difference in the duration of muscle strength exercises (min/day) between the two groups at 24 weeks (intervention group, 8.2 [9.7]; control group, 6.5 [9.3]; P = 0.593, f = 0.08). CONCLUSIONS: The buddy-style intervention increased the duration of outdoor walking, with a sustained effect up to 12 weeks after the end of the intervention.

Association between neighborhood walkability and social participation in community-dwelling older adults in Japan: A cross-sectional analysis of the keeping active across generations uniting the youth and the aged study.

AIM: This study investigated neighborhood walkability using Walk Score® and social participation in districts within a city among older Japanese adults. METHODS: This study was a cross-sectional study using baseline data of older adults from the Keeping Active across Generations Uniting the Youth and the Aged study. In total, 2750 participants (1361 men and 1389 women, mean age 72.8 ± 6.4 years) were included in the analysis. The questionnaire included socioeconomic status, self-rated health, medical history, depressive symptoms, instrumental activities of daily living and social participation. We used the Walk Score® as neighborhood walkability and a walk score <50 was categorized as a "car-dependent" area and a score ≥50 as a "walkable" area. A Poisson regression analysis stratified by sex was performed to investigate the association of neighborhood walkability with social participation. Prevalence ratios were calculated and their 95% confidence intervals. RESULTS: We found that dwelling in car-dependent areas (prevalence ratio 0.78, 95% confidence interval 0.64-0.94) had a significant negative effect on women's social participation, unlike men. CONCLUSIONS: Our study showed that neighborhood walkability and social participation were associated with older Japanese women after adjusting for the covariates. These findings might provide helpful information for public health interventions targeted to promote social participation among older adults. Geriatr Gerontol Int 2022; 22: 350-359.

Effect of buddy-style intervention on exercise adherence in community-dwelling disabled older adults: A pilot randomized controlled trial.

OBJECTIVE: To assess the preliminary effects of a buddy-style intervention to improve exercise adherence. DESIGN: A parallel-group, open-label, pilot randomized controlled trial. SETTING: Adult day-care centers. PARTICIPANTS: Sixty-five disabled older adults. INTERVENTIONS: All participants underwent a 12-week home exercise program, and the intervention group received a 5-10 min buddy-style intervention between older adults in the intervention group once weekly at an adult day-care center. MAIN MEASURES: Based on the exercise log calendar, the number of days of exercise was assessed for each of the three phases: 1-4 weeks, 5-8 weeks, and 9-12 weeks. Short physical performance battery was measured at baseline and after 12 weeks. RESULTS: Of the 590 screened older adults, 65 were recruited and 33 were assigned to the intervention group. One participant in each group withdrew before the program began, and four and five patients in the intervention and control groups, respectively, dropped out by the 12-week assessment. Analysis of covariance of the 28 and 26 patients in the intervention and control groups, respectively, for whom exercise log calendars could be retrieved, showed that the intervention group (24.4/28 days) exercised significantly more days than the control group (20.6/28 days) at 9-12 weeks (P = 0.009). In the between-group effect of the intention-to-treat analysis of short physical performance battery, walking and standing test (P = 0.790, P = 0.829) were not significantly different, and balance test (P = 0.049) was significantly better in the control group. CONCLUSIONS: There was a preliminary effect of the buddy-style intervention to improve exercise adherence.

Regional Differences in Disability Incidence among Japanese Adults Aged 75 Years and Older: A 4-Year Prospective Cohort Study.

The present prospective study investigated the regional differences and trajectories of new-onset disabilities among older adults in the districts within a city in Japan. We analyzed data from 5050 Japanese residents aged ≥75 years old (men/women: 2512/2538) who completed the Kihon Checklist (a self-reported questionnaire on frailty) and a questionnaire on medical history and social capital in Ikoma city in 2015. The incidence of disability was determined using the new certification of long-term care insurance and was followed-up on 4 years after the primary outcome. A Cox proportional hazards regression model was used to determine the factors related to the risk of incident disability. During the 4-year follow-up period, 567 participants (11.2%) were newly certified to have a disability. The disability incidence rate ranged from 8.1% to 14.6%, depending on the district. After adjustment for the covariates of: older, women, stroke, prefrail, frail, participation in multiple social activities (hazard ratio [HR] = 0.72, 95% confidence interval [CI] = 0.56-0.91), and one of the districts (HR = 1.67, 95% CI = 1.06-2.61) were significantly associated with disability incidence. The findings of this longitudinal study suggest that there could be a regional difference in disability incidence among older adults in Japan. Thus, community-based approaches should be designed to prevent disability in older adults.

Social factors associated with reversing frailty progression in community-dwelling late-stage elderly people: An observational study.

Frailty is considered to be a complex concept based mainly on physical vulnerability, but also vulnerabilities in mental/psychological and social aspects. Frailty can be reversible with appropriate intervention; however, factors that are important in recovering from frailty have not been clarified. The aim of the present study was to identify factors that help an individual reverse frailty progression and characteristics of individuals that have recovered from frailty. Community-dwelling people aged ≥75 years who responded to the Kihon Checklist (KCL) were enrolled in the study. The KCL consists of 25 yes/no questions in 7 areas: daily-life related activities, motor functions, nutritional status, oral functions, homebound, cognitive functions, and depressed mood. The number of social activities, degree of trust in the community, degree of interaction with neighbors, and subjective age were also evaluated. Frailty was assessed based on the number of checked items: 0-3 for robust, 4-7 for pre-frailty, and ≥8 for frailty. A total of 5050 participants were included for statistical analysis. At the time of the baseline survey in 2016, 18.7% (n = 942) of respondents had frailty, and the follow-up survey showed that the recovery rate from frailty within 2 years (median 24 months) was 31.8% (n = 300). Multiple logistic regression analysis showed that exercise-based social participation (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.2-3.4; P<0.01) and self-rated health (OR 1.2, CI 1.0-1.5; P = 0.02) were related to reversing frailty progression. Principal component analysis indicated that the main factors constituting the first principal component (contribution rate, 18.3%) included items related to social capital, such as interaction with neighbors, trust in the community, and number of social participation activities. Our results demonstrate that exercise-based social participation and high self-rated health have associations with reversing frailty progression. Individuals that recovered from frailty are characterized by high individual-level social capital components (i.e., trust in community, interaction with neighbors, and social participation).

Eating Alone at Each Meal and Associated Health Status among Community-Dwelling Japanese Elderly Living with Others: A Cross-Sectional Analysis of the KAGUYA Study.

This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01-1.61, and 1.26; 1.06-1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (p < 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.

The difference between self-perceived and chronological age in the elderly may correlate with general health, personality and the practice of good health behavior: A cross-sectional study.

BACKGROUND AND OBJECTIVE: For the elderly, maintaining a young self-perceived age has a positive impact on physical and mental health. The purpose of this study was to investigate the impact of the discrepancy between self-perceived age and chronological age in regards to physical activity, instrumental activities of daily living, functional capacity, personality, general self-efficacy, depressive symptoms, and disease burden. METHODS: Participants were 3094 older adults from 2015 baseline data of the Keeping Active across Generations Uniting the Youth and the Aged study. The questionnaire was mailed to 8004 elderly people aged 65 years or older. Of the 3871 people who returned the questionnaire (collection rate, 48.3%), 3094 subjects were analyzed in this study (female, 52%). The questionnaire included aspects of physical activity, instrumental activity of daily living, functional capacity, personality traits, general self-efficacy, depressive symptoms, history of falls, fear of falling, communication with young people, medical history, and self-perceived age, as well as basic characteristics such as age, sex, living alone or not, and educational history. RESULTS: Regression analysis showed that the presence of high self-rated health, personality traits of extraversion and openness to experience, higher general self-efficacy, and the presence of fear of falling were positively associated with a younger self-perceived age. CONCLUSIONS: The results identified personality and psychological factors related to of self-perceived age in community-dwelling elderly people. Therefore, changes in personality traits and subjective health accompanying aging affect the self-perceived age, which may also affect the extension of healthy life expectancy.

Benefits of a novel concept of home-based exercise with the aim of preventing aspiration pneumonia and falls in frail older women: a pragmatic controlled trial.

AIM: To investigate whether home-based exercise with the aim of preventing aspiration pneumonia and accidental falls improves swallowing-related and physical functions in community-dwelling frail older women. METHODS: Participants were 266 community-dwelling frail older women in a long-term care prevention class (mean (SD): age 75 (5) years). Participants were allocated to either an intervention group or a control group. In the intervention group, participants were asked to perform, at least three times a week for 6 months, a home-based exercise programme that was specifically developed to prevent aspiration pneumonia and accidental falls. Control group participants were instructed to perform general stretching exercises only. Voluntary peak cough flow and lip closure force were measured as swallowing-related functions. Static and dynamic balance function, lower limb strength and flexibility were measured as secondary outcomes. Intervention effects were determined using t tests; effect sizes were calculated using Cohen's d. RESULTS: Voluntary peak cough flow in the intervention group was significantly greater than in the control group (p<0.01, d=0.5). However, lip closure force did not differ between groups. Regarding physical function, results of the Timed Up and Go Test (p<0.05, d=0.4), Chair Stand Test (p<0.01, d=0.4), maximal knee extension strength (p<0.05, d=0.4), and Sit and Reach Test (p<0.05, d=0.3) showed greater improvement in the intervention group. CONCLUSIONS: Specifically developed home-based exercise as described in this study is simple and can be performed briefly. Improvements in voluntary peak cough flow and physical function indicate the possible usefulness of such exercise in preventing falls and aspiration pneumonia in community-dwelling frail older adults. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry (UMIN-CTR): UMIN000014880.

Relationships Between Simple Toe Elevation Angle in the Standing Position and Dynamic Balance and Fall Risk Among Community-Dwelling Older Adults.

OBJECTIVE: To investigate the relationships between toe elevation ability in the standing position and dynamic balance and fall risk among community-dwelling older adults. DESIGN: Cross-sectional survey. SETTING: General community. PARTICIPANTS: Community-dwelling older adults (N = 287). MAIN OUTCOME MEASURE: Toe elevation angles in the standing position. RESULTS: Intra-rater and inter-rater reliability of measurements of the toe elevation angle was high (internal coefficient of correlation [ICC] (1,2) = 0.94 for the former and ICC (2,1) = 0.90 for the latter). Significant correlations were found between the toe elevation angle and age (r = -0.20, P < .01), 5-m walking time (r = -0.31, P < .01), Functional Reach Test (r = 0.36, P < .01), Timed Up and Go Test (r = -0.36, P < .01), and Chair Stand Test (r = 0.26, P < .01). Subjects who experienced a fall in the previous 6 months had a significantly lower toe elevation angle compared with subjects who did not experience a fall (t = 2.19, P < .05). Multiple regression analysis revealed that results of the Functional Reach Test (ß = .22, P < .001) and Timed Up and Go Test (ß = -0.74, P < .001) were significantly associated with the toe elevation angle. CONCLUSIONS: Toe elevation angle was an index of dynamic balance ability and appears to be a simple screening test for fall risk in community-dwelling older adults.

Effect of intensive rehabilitation on physical function and arterial function in community-dwelling chronic stroke survivors.

BACKGROUND: Atherothrombosis due to arteriosclerosis is a risk factor for recurrence of stroke. Although exercise therapy is essential to prevent progression of arteriosclerosis and to improve endothelial function, little is known about the effect of rehabilitation in chronic stroke survivors. OBJECTIVE: The purpose of this study was to investigate the effect of intensive rehabilitation on physical and arterial function among community-dwelling stroke survivors. METHODS: Forty-four community-dwelling stroke survivors participated in the study. The experimental group (n = 22) received primarily intensive strengthening exercise and the control group (n = 22) received standard physical therapy consisting mainly of stretching and gait training. Both groups underwent the rehabilitation program for 12 weeks. Physical function was evaluated using 10-m gait velocity, the 30-s chair stand test, Timed Up and Go test, and grip strength. Arterial function of the affected and unaffected sides was evaluated using the cardio-ankle vascular index (CAVI) as an index of arterial stiffness and the ankle-brachial pressure index (ABI) as an index of arterial occlusion. RESULTS: After the 12-week rehabilitation period, improvement in physical function did not differ between the 2 groups; whereas with regard to arterial function, a significant improvement in the CAVI for the affected side was observed in the experimental group (P < .001). Also, the ABI for the unaffected side in the experimental group was significantly improved after intervention (P < .001). No significant differences were found for the unaffected-side CAVI and affected-side ABI between the 2 groups. CONCLUSIONS: These findings suggested that intensive rehabilitation for stroke patients during the chronic stage preserved physical function and improved arterial function.

Effect of a cognitive task during obstacle crossing in hemiparetic stroke patients.

Stroke patients are at a higher risk of falling than the community-dwelling elderly, and many falls are due to contact with an obstacle. This study compared the effects of the simultaneous addition of a cognitive task during obstacle crossing between stroke patients and community-dwelling older adults (control subjects). Participants comprised 20 stroke patients who could walk with or without supervision and 20 control subjects matched for age and height with the stroke patients. Participants were asked to cross a 4-cm-high obstacle while walking at a self-selected speed. The number of failures and the spatial and temporal parameters were compared between a single-task condition (i.e., crossing task only) and a dual-task condition (i.e., verbal fluency task: listing vegetables or animals). Under the dual-task condition, six stroke patients (30%) and three community-dwelling elderly individuals (15%) failed to complete the motor task. Task failure was only due to heel-obstacle contact after toe clearance. In both groups, obstacle-heel distance after clearance was reduced, and the time from heel contact to toe clearance and stride time were significantly increased under dual-task condition versus single-task condition. In addition, group-task interaction for the time from heel contact to toe clearance of the obstacle was significant; this increase in time was significantly greater under dual-task condition in stroke patients than in control subjects. Obstacle crossing in stroke patients involved an increase in crossing performance time and a risk of heel-obstacle contact after crossing. These tendencies appeared stronger under the dual-task condition.

Abnormalities of the first three steps of gait initiation in patients with Parkinson's disease with freezing of gait.

The purpose of this study was to investigate abnormalities of the first three steps of gait initiation in patients with Parkinson's disease (PD) with freezing of gait (FOG). Ten PD patients with FOG and 10 age-matched healthy controls performed self-generated gait initiation. The center of pressure (COP), heel contact positions, and spatiotemporal parameters were estimated from the vertical pressures on the surface of the force platform. The initial swing side of gait initiation was consistent among the trials in healthy controls but not among the trials in PD patients. The COP and the heel contact position deviated to the initial swing side during the first step, and the COP passed medial to each heel contact position during the first two steps in PD patients. Medial deviation of the COP from the first heel contact position had significant correlation with FOG questionnaire item 5. These findings indicate that weight shifting between the legs is abnormal and that medial deviation of the COP from the first heel contact position sensitively reflects the severity of FOG during the first three steps of gait initiation in PD patients with FOG.

Variable initial swing side and prolonged double limb support represent abnormalities of the first three steps of gait initiation in patients with Parkinson's disease with freezing of gait.

This study investigated abnormalities of the first three steps of gait initiation in patients with Parkinson's disease without freezing of gait (PD - FOG) and investigated which abnormalities are related to FOG. Seven PD - FOG and seven age-matched healthy controls performed self-generated or cue-triggered gait initiation. Data for PD patients with FOG (PD + FOG) were cited from a previous study using a procedure similar to that used in the present study. Gait initiation was abnormal, and external cue normalized some abnormalities in PD - FOG. The initial swing side was fairly consistent among the trials in both PD - FOG and in healthy controls, although the initial swing side was inconsistent in PD + FOG. The duration of the first double limb support (DLS) was the only parameter that depends on FOG severity and that was abnormal in PD + FOG but was not abnormal in PD - FOG. The variability of the initial swing side and prolonged first DLS are abnormalities specifically related to FOG.

Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke patients?

OBJECTIVE: To investigate the relationship between errors in perceiving postural limits and falls in hospitalized hemiplegic patients and to determine whether this relationship is useful for identifying patients at high risk of falls. DESIGN: Observational study. SUBJECTS: Seventy-six hemiplegic patients who were admitted to a rehabilitation hospital. METHODS: Error in perceiving postural limits was defined as the difference between the estimated maximum reach and actual reach distances, and its relationship to falls during hospitalization was investigated. Other measurements included Functional Ambulation Category, Brunnstrom's recovery stage, sensory disturbance, fear of falling and the Japanese version of the Montgomery-Asberg Depression Rating Scale (MADRS-J). RESULTS: For the multiple fall group, the error in estimated distance (EED) was significantly greater than that for the zero/single fall group (P < 0.01). Stepwise logistic regression analysis showed that EED (odds ratio 1.2, 95% confidence interval (CI) 1.1-1.4, P < 0.01) and MADRS-J scores (odds ratio 1.1, 95% CI 1.0-1.3, P < 0.05) were correlated with multiple falls. According to the receiver operating characteristic curve for EED, the cut-off value for discriminating multiple fallers was 6.3 cm (sensitivity 81.0%, specificity 78.2%, area under the curve 0.8). CONCLUSIONS: The results suggest that assessing error in perceiving postural limits by measuring the maximum reach of the non-affected side of hemiplegic patients is one way to identify those who are at high risk for falling.

Effects of ultrasound therapy on calcificated tendinitis of the shoulder.

In general, surgery is recommended for calcificated tendinitis of the shoulder if the patients have symptoms after conservative treatments, including needle aspiration and physical therapy. Many researchers agree about the need for adequate physical therapy consisting of range of motion exercise, muscle strengthening exercises and electrophysical agents. Some researchers report that ultrasound (u/s) promotes angiogenesis and calcium uptake to fibroblasts, but there are few studies about u/s effects on calcificated tendinitis of the shoulder. The purpose of this study was to evaluate the u/s therapy effect on calcification, pain during active movement, and to identify factors related to improvement in a randomized controlled fashion. We used the stratified random allocation method to assign 40 consecutive patients to experimental and control groups, so each group consisted of 20 patients. The experimental group was treated by u/s therapy and therapeutic exercises, and the control group was treated with therapeutic exercises only. All patients in both groups came to our department 3 times per week and u/s therapy was performed 3 times per week until the end of the study. First, we classified the calcifications as type I (clearly circumscribed and with dense appearance on radiography), type II (dense or clearly circumscribed appearance) and type III (translucent or cloudy appearance without clear circumscription) according to the classification of Gartner and Heyer. Radiography was performed every one month, and the main outcome measure was the change from the base-line of the calcification on radiography at the end of the treatment. The three point scale of Gartner and Heyer was used, in which a score of 1 indicates no change or a worsening of the condition, a score of 2 a decrease of at least 50 percent in the area and density of the calcification, and a score of 3 a complete resolution of the calcification. We also examined the affected shoulders for presence or absence of pain in active movement at the start and at the end of the study. The calcifications improved significantly and fewer patients had pain during active movement in the experimental group. There was a statistical significant disease duration difference from the first clinical presentation between scores 2 and 3 in the experimental group. The results of this study suggest that u/s therapy helps to resolve calcifications of shorter disease duration. Calcifications of longer disease duration tended to persist in spite of u/s therapy, but we thought treatment of 27-38 times (95% CI), until score 2 was attained, was a desirable strategy.