Dose-response associations between physical activity and sedentary time with functional disability in older adults with or without frailty: a prospective cohort study.

Purpose: Evidence regarding the dose-response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with/without frailty. We examined the dose-response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with/without frailty. Methods: We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65-84 years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried's frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose-response curves were examined using restricted cubic splines. Results: During 3.6 years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)■min/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51-0.74) was reached at around 3,000-4,000 METs■min/week. Although the shape of this association was consistent regardless of with/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300 min/day) of ST, the HRs for FD increased linearly as ST reached approximately 600 min/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01-1.71) for 1,080 min/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults. Conclusion: Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose-response manner. A significant positive nonlinear dose-response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults.

Associations between information and communication technology use and frailty in community-dwelling old-old adults: results from the ILSA-J.

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.

Japan-Multimodal Intervention Trial for the Prevention of Dementia: A randomized controlled trial.

INTRODUCTION: We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS: Participants aged 65-85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS: Of 531 participants, 406 completed the trial. The between-group difference in composite score changes was 0.047 (95% CI: -0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. HIGHLIGHTS: This trial evaluated the efficacy of multidomain intervention in individuals with MCI. The trial did not show a significant difference in preplanned cognitive outcomes. Interventions had positive effects on a wide range of secondary health outcomes. Those with adequate adherence or high risk of dementia benefited from interventions.

A Study of the Risk Factors for 402 Patients with Esophageal Squamous Cell Carcinoma - A Retrospective Comparison with Health Checkup Participants.

Objective Esophageal cancer is a gastrointestinal cancer with a poor prognosis. However, it is curable and can be treated endoscopically if it is detected at an early stage. The objective of this study was to identify the factors that contribute to early detection. Methods From April 2011 to December 2019, we retrospectively investigated consecutive patients diagnosed with esophageal squamous cell carcinoma (ESCC) through upper gastrointestinal endoscopy at two hospitals of Kawasaki Medical University based on medical records. The factors contributing to the early detection of ESCC were investigated by comparing patients with ESCC with those undergoing health checkups in whom no organic lesions were found in the upper gastrointestinal tract on endoscopy (controls). Patients Factors contributing to early detection were examined in 402 ESCC cases and 391 sex- and age-matched controls, and early and advanced cancers were compared along with the risk factors for ESCC. Results A multivariate analysis showed that alcohol consumption and smoking, concomitant cancer of other organs, and a low body mass index (BMI) were factors associated with ESCC (odds ratio [OR], 4.65; 95% confidence interval [CI], 2.880-7.520, OR,3.63; 95% CI, 2.380-5.540, OR, 2.09; 95% CI, 1.330-3.270, OR, 6.38; 95% CI, 3.780-10.800), whereas dyslipidemia was significantly less common in patients with ESCC (OR, 0.545; 95% CI, 0.348-0.853). Comparing early and advanced cancers, a history of endoscopic screening was the only factor involved in early detection (OR, 7.93; 95% CI, 4.480-14.00). Conclusion The factors associated with ESCC include alcohol consumption, smoking, concomitant cancer of other organs, and a low BMI. Endoscopy in subjects with these factors may therefore be recommended for the early detection of ESCC.

[A framework for promoting and evaluating "Kayoi-no-ba" initiatives according to the Plan-Do-Check-Action cycle: The ACT-RECIPE framework].

Objective　In 2019, the Ministry of Health, Labour and Welfare emphasized the importance of promoting "Kayoi-no-ba" (or "places to go") initiatives according to the Plan-Do-Check-Action (PDCA) cycle. However, it proposed no specific promotion measures or standardized evaluation frameworks. This study is intended to propose a framework for local government officials to promote and evaluate "Kayoi-no-ba" initiatives according to the PDCA cycle.Methods　The working group (WG) conducted a narrative review of research and extracted evaluation models and indicators that could be used to create the framework. The co-researcher review committee discussed a draft framework prepared by the WG, and the WG revised it based on the discussion; this process was repeated four times. Using the completed framework, we calculated the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and conducted regional correlation analyses on the relationship between the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and the number of "Kayoi-no-ba" per 1,000 older persons.Results　The completed framework (named "ACT-RECIPE" by rearranging the underlined characters below) comprised the following six evaluation phases: (1) Comprehension: understanding the key lessons around disability and frailty prevention, and the necessity for "Kayoi-no-ba"; (2) Research and Planning: clarifying the current status of "Kayoi-no-ba," the strengths of the community, and the issues to be addressed through a community assessment, and developing a plan to resolve the issues; (3) Team Building and Collaboration: building a team by collaborating with organizations to solve problems; (4) Implementation: implementing the initiatives necessary to solve problems; (5) Evaluation: verifying changes in output and outcome indicators from the initiatives; and (6) Adjustment and Improvement: re-examining plans, teams, content, and goals based on the evaluation results. In these six phases, we designated 10 core items and accompanying subitems. The median score rate of the ACT-RECIPE framework in 50 municipalities was 75% for "Comprehension," 61% for "Research and Planning," 69% for "Team Building and Collaboration," 64% for "Implementation," 31% for "Evaluation," and 56% for "Adjustment and Improvement," and the mean ACT-RECIPE score rate was 57%. A significant positive correlation (rs=0.43, P=0.002) was observed between the ACT-RECIPE mean score rate and the number of "Kayoi-no-ba" per 1,000 older persons.Conclusion　We proposed the ACT-RECIPE as a framework for promoting and evaluating "Kayoi-no-ba" initiatives according to the PDCA cycle. We hope that this framework will lead to further progress in "Kayoi-no-ba" initiatives and facilitate evaluation of their effectiveness according to the PDCA cycle.

[Examination of the relationship between tasks in geriatric health service facilities and benefits of working for older assistant care workers].

Objective　In this study, we clarified the characteristics of tasks performed by older assistant care workers at geriatric health services facilities, by individual characteristics and work status. Additionally, we examined the relationship between the tasks and benefits of working for older assistant care workers.Methods　A self-administered questionnaire survey was provided to 2,571 elderly care facilities employing assistant care workers aged ≥60.　A total of 1,606 responses were obtained, and personal characteristics, working conditions, tasks, and benefits of working for older care assistants were surveyed. Thirteen work tasks were established and categorized into four broad categories; user transfer assistance, facility maintenance, meal-related assistance, and managing and talking to users. Seven benefits of working as care assistants were "contribution to society," "social connection," "purpose of life," "income," "learning from caregiving," "health maintenance and promotion," and "time utilization."Results　Most of the respondents were women and relatively young workers. Among tasks, men, younger workers, and those working >5 days weekly represented a high proportion of those performing user transfer assistance tasks. Tasks on managing and talking to users were not correlated with sex, age, and number of days worked, but those with more flexible work patterns were more likely to be engaged in such tasks. Logistic regression analysis showed that user transfer assistance was correlated with benefits of working, such as "contribution to society," "social connection," and "learning from caregiving." Moreover, facility maintenance was associated with "income," "health maintenance and promotion," and "time utilization" and meal-related assistance was associated with "learning from caregiving." Managing and talking to users was associated with "contribution of society," "social connection," "purpose of life," and "learning from caregiving."Conclusion　The tasks of the workers were associated with individual characteristics and work status. The perception of benefits between the working tasks that involved frequent contact with users and those that did not were considerably different.

Feasibility, Acceptability, and Potential Efficacy of a Mobile Health Application for Community-Dwelling Older Adults with Frailty and Pre-Frailty: A Pilot Study.

Smartphone applications aimed at enhancing physical, cognitive, and social activities through mobile health (mHealth) technology are of increasing interest. Their feasibility and acceptability, alongside impacts on frailty phenotype scores and step counts among older adults with frailty, remain to be fully validated. This study presents a 13-week preliminary intervention trial assessing an mHealth app's feasibility in a cohort of 34 eligible older adults, including 5 frail and 29 pre-frail participants. The intervention entailed a 6-week course on app usage, followed by 7 weeks of observation, with four participants withdrawing early. Feasibility was determined by login and active use rates, with a target login rate of 60% or higher. Post-intervention, 100% session attendance and a median login rate of 88.4% were observed. Acceptability was high, with 73% affirming the app's health benefits. Notably, frailty scores and step counts improved post-intervention, underscoring the app's potential for supporting older adults with frailty.

Social isolation, regardless of living alone, is associated with mortality: the Otassha study.

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.

Association Between Ego-Resilience and Social Isolation Among Urban Older People.

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.

Three-year trajectories of social networks, face-to-face interactions, and non-face-to-face interactions among community-dwelling older adults in Japan during the COVID-19 pandemic: Otassha study.

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.

Higher-level competence: Results from the Integrated Longitudinal Studies on Aging in Japan (ILSA-J) on the shape of associations with impaired physical and cognitive functions.

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.

[Association between the change in the job facilitating and inhibiting factors of care staff due to the employment of older assistant workers and the emotional exhaustion among care staff].

Objectives　The mental health condition of care staff in Japan is becoming problematic. Older assistant workers are currently being employed to assist care staff with their jobs and alleviate their job burden. This employment of older assistant workers is drawing attention; however, their influence on the job facilitating and inhibiting factors of care staff and the association with the care staff's emotional exhaustion remains unclear. In this study, we aim to examine how the employment of older care assistant workers relates to the job-facilitating and job-inhibiting factors of care staff and explore that association with the care staff's emotional exhaustion.Methods　Data from a mail survey of geriatric health services facilities with older assistant workers were analyzed. Among the answers obtained from the care staff, answers from 5,185 who reported working in facilities that employ older assistant workers (over the age of 60) were analyzed. The Emotional Exhaustion subscale of the Japanese Version of the Burnout Questionnaire was used as the dependent variable. The change in job-facilitating and job-inhibiting factors of care staff due to the employment of older assistant workers (improve, maintain/exacerbate) was explored for nine contents.Results　Care staff reported a decrease in the total volume of the task (63.6%), less stress during daily tasks (39.8%), and more concentration on the tasks that require expert care knowledge (38.0%). The results of multiple regression analysis showed that the emotional exhaustion score of care staff was low when the total volume of tasks decreased (ß=－0.383, 95%CI=－0.719, －0.047), when less stress was perceived during daily tasks (ß=－0.432, 95%CI=－0.796, －0.068), when concentration on tasks that required expert care knowledge increased (ß=－0.574, 95%CI=－0.937, －0.210), and when human relationships among staff improved (ß=－0.871, 95%CI=－1.263, －0.480). Conversely, an increase in tasks requiring work with regional personnel and organizations (ß=0.800, 95%CI=0.162, 1.437) was associated with a high emotional exhaustion score.Conclusion　The employment of older care workers was related to the job-facilitating or job-inhibiting factors of care staff, and the change in these factors was associated with lower emotional exhaustion. The employment of older personnel may lower the risk of burnout among care staff.

Effects of fear of COVID-19 on older volunteers' willingness to continue their activities: REPRINTS cohort study.

AIM: This study examined the effects of fear of COVID-19 on older volunteers' willingness to continue activities that required face-to-face interactions. METHODS: From September to November 2020, a self-administered questionnaire survey was conducted with 481 older adult volunteers. A total of 423 responses were collected; 343 had no missing items and were included in the analysis. Analysis items included willingness to continue volunteer activities, fear of COVID-19, mental and physical health, and a group of items related to factors influencing the continuation of volunteer activities. RESULTS: The structural analysis of covariance indicated that volunteer orientation, which included items considered to be factors for continuing volunteer activities, had a significant positive influence on the willingness to continue activities. Fear of COVID-19 had a significant negative effect on the latent variable mental and physical health, which consisted of a subjective sense of health, but fear of COVID-19 and physical and mental health had no significant effect on the willingness to continue volunteering. CONCLUSIONS: Our results suggest that the willingness of older adults to continue volunteer activities during the COVID-19 pandemic is influenced by their volunteer orientation and is not affected by their fear of COVID-19. Geriatr Gerontol Int 2024; 24: 370-376.

Serum Growth Differentiation Factor 15 Levels Predict the Incidence of Frailty among Patients with Cardiometabolic Diseases.

INTRODUCTION: Frailty is a crucial health issue among older adults. Growth differentiation factor 15 (GDF15) is associated with inflammation, oxidative stress, insulin resistance, and mitochondrial dysfunction, which are possible pathogeneses of frailty. However, few longitudinal studies have investigated the association between GDF15 and the incidence of frailty. Therefore, we investigated whether high serum GDF15 levels are associated with the incidence of frailty. METHODS: A total of 175 older adults (mean age: 77 ± 6 years; 63% women) with cardiometabolic diseases and no frailty out of the two criteria at baseline participated. Individuals with severe renal impairment or severe cognitive impairment were excluded. Serum GDF15 levels were measured at baseline. Patients were asked to assess frailty status at baseline and annually during follow-up using the modified version of the Cardiovascular Health Study (mCHS) and the Kihon Checklist (KCL). We examined the association between GDF15 tertiles and each frailty measure during follow-up (median 38-39 months). In the multivariate Cox regression analysis, with the GDF15 tertile groups as the explanatory variables, hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were calculated after adjusting for covariates and using the lowest tertile group as the reference. RESULTS: During the follow-up period, 25.6% and 34.0% of patients developed frailty, as defined by the mCHS and KCL, respectively. The highest GDF15 tertile group had a significantly higher incidence of mCHS- or KCL-defined frailty than the lowest GDF15 tertile group. Multivariate Cox regression analysis revealed that the adjusted HRs for incident mCHS- and KCL-defined frailty in the highest GDF15 tertile group were 3.9 (95% CI: 1.3-12.0) and 2.7 (95% CI: 1.1-6.9), respectively. CONCLUSION: High serum GDF15 levels predicted the incidence of frailty among older adults with cardiometabolic diseases and could be an effective marker of the risk for frailty in interventions aimed at preventing frailty, such as exercise and nutrition.

Predicting the incidence of mild cognitive impairment with a computer-based cognitive assessment tool in community-dwelling older adults: The Otassha study.

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.

Association between dynapenia and cognitive decline in community-dwelling older Japanese adults: The IRIDE Cohort Study.

AIM: Muscle mass and strength correlate with cognitive function; however, it remains unclear whether dynapenia (i.e., muscle weakness with preserved muscle mass) is relevant. This study aimed to explore whether dynapenia is associated with global cognitive function in community-dwelling older Japanese adults. METHODS: This cross-sectional study used data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which pooled data from five community-based geriatric cohorts. Dynapenia was defined as muscle weakness without muscle mass loss according to the Asian Working Group for Sarcopenia criteria. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). An ordered logistic regression analysis was conducted with dynapenia as the exposure and with cognitive decline stages, defined as an MMSE score of 27-30 for normal cognition, 24-26 for possible cognitive decline, and <24 for cognitive decline, as the outcome, stratified by sex and adjusted for age, muscle mass, education, alcohol consumption, smoking habits, living alone, and non-communicable diseases. RESULTS: We analyzed data for 3338 participants (2162 female) with preserved muscle mass. Of these, 449 (13.5%) had dynapenia, and 79 (2.4%) exhibited cognitive decline. Multivariate odds ratios (95% confidence interval) for cognitive decline among those with dynapenia, compared with those without dynapenia, were 1.51 (1.02-2.24) for males and 2.08 (1.51-2.86) for females. CONCLUSIONS: Muscle weakness is associated with cognitive decline, even in individuals with preserved muscle mass. Further studies are needed to better understand the association between muscle weakness and cognitive decline over time in order to develop dementia prevention strategies for those with dynapenia. Geriatr Gerontol Int 2024; 24: 123-129.

[Current conditions and challenges of employing older assistant care workers based on geriatric health services facilities' scale].

Objectives　To support care workers, some care facilities employ older individuals as care assistants for peripheral, non-professional tasks. However, the size of the facilities influences their employment needs and support systems for older care workers. Therefore, this study examined the rationale for employing older assistant care workers; the challenges they face; educational systems; and the efforts to facilitate continued employment based on facility size.Methods　Initially, a fax survey was conducted with 3,591 facilities associated with the National Association of Geriatric Health Services Facilities to determine the proportion of older assistant care workers employed. Thereafter, a questionnaire survey was administered to gather more information. Out of 3,591 facilities, 2,170 responded to the survey, and 1,261 responded to the questionnaire. In this study, care assistants aged ≥60 years were classified as older care assistants. The facilities were categorized based on admission capacity into two groups: "small/medium facilities" (≤99 residents) and "large facilities" (≥100 residents). A chi-square test was conducted for data analysis.Results　Of the all geriatric health services facilities, 31.7% employed older assistant care workers. Moreover, the questionnaire survey responses showed they are employed by 687 facilities. Further analysis revealed that larger facilities employed a higher number of older care assistants than small/medium facilities. Small/medium facilities tended to have fewer training systems for older care assistants than larger facilities (30.0% for small/medium facilities vs. 21.6% for large facilities; P=0.014). Furthermore, the work of older care assistants in small/medium facilities was more susceptible to family circumstances than those in larger facilities (15.7% for small/medium facilities vs. 10.2% for large facilities; P=0.033). Compared to small/medium facilities, larger facilities were more likely to state that their employment objective was to reduce the risk of care accidents (19.8% for small/medium facilities vs. 26.3% for large facilities; P=0.046) and provide psychological support, such as periodic interviews, to older care workers to ensure continued employment (24.1% for small/medium facilities vs. for large facilities 37.3%; P<0.001).Conclusion　Larger facilities employeda higher number of older care assistants than small/medium facilities. Furthermore, small/medium facilities were less likely to provide psychological support and had a less structured training system, compared to larger facilities. Additionally, the work of older care assistants in small/medium facilities was more susceptible to family circumstances and other factors, which could affect their work performance. Thus, developing adequate support systems in small/medium facilities is crucial to promoting the employment of older care assistants.