Changes in frailty and lifestyle among community-dwelling older adults: A two-point cross-sectional study during and after the COVID-19 pandemic in Japan.

We aimed to verify the characteristics of lifestyles and frailty among older adults during and after the COVID-19 pandemic. This two-point cross-sectional study conducted a baseline survey (BL) in 2020 and a follow-up survey (FU) in 2023 with community-dwelling individuals aged ≥65 years in Japan. The 700 and 572 participants in the BL and FU were analyzed. We compared frailty occurrence and lifestyle characteristics between both surveys. In the BL and FU, 38.3 %, 52.4 %, and 9.3 % and 29.4 %, 59.4 %, and 11.2 % of the individuals were classified as robust, pre-frail, and frail, respectively, showing a significant decrease in the number of robust, and an increase in the number of pre-frail. A significant decrease in dietary intake was observed among robust individuals in the FU, with an overall significant decrease in communication opportunities in the BL. Therefore, lifestyle changes due to infection control measures may have a delayed impact on frailty.

Fall Risk Prediction for Community-Dwelling Older Adults: Analysis of Assessment Scale and Evaluation Items without Actual Measurement.

The frequency of falls increases with age. In Japan, the population is aging rapidly, and fall prevention measures are an urgent issue. However, assessing fall risk during the coronavirus disease pandemic was complicated by the social distancing measures implemented to prevent the disease, while traditional assessments that involve actual measurements are complicated. This prospective cohort study predicted the risk of falls in community-dwelling older adults using an assessment method that does not require actual measurements. A survey was conducted among 434 community-dwelling older adults to obtain data regarding baseline attributes (age, sex, living with family, use of long-term care insurance, and multimorbidity), Frailty Screening Index (FSI) score, and Questionnaire for Medical Checkup of Old-Old (QMCOO) score. The participants were categorized into fall (n = 78) and non-fall (n = 356) groups. The binomial logistic regression analysis showed that it is better to focus on the QMCOO sub-item score, which focuses on multiple factors. The items significantly associated with falls were Q5 (odds ratio [OR] 1.95), Q8 (OR 2.33), and Q10 (OR 3.68). Our results were similar to common risk factors for falls in normal times. During the pandemic, being able to gauge the risk factors for falls without actually measuring them was important.

[Categorization of the health status and its transition of community-dwelling older adults during the coronavirus disease (COVID-19) epidemic].

AIM: The purpose of this study was to categorize and clarify transitions in the health status of older adults living in the community during the coronavirus disease (coronavirus disease 2019: COVID-19) pandemic. METHODS: The participants were older adults (≥65 years of age) who lived in Takasaki City, Gunma Prefecture. The survey items included basic information and subjective health perception (questionnaire for medical checkup of old-old). Latent class analyses were conducted for the first (baseline) and second surveys (6 months). The scores for each item were compared to identify the characteristics of each class at baseline and at 6 months. In addition, transitions in class affiliation from baseline to 6 months were summarized. RESULTS: A total of 434 of 1,953 participants (mean age: 79.1 years, 98 males and 336 females) completed the survey (22.2%). In both time periods, the responses were categorized into four classes: 1) good, 2) poor physical, oral and cognitive function, 3) poor social status and lifestyle, and 4) poor in all except social status and lifestyle. During 6 months of follow-up, a transition from the generally good class to the poor physical, oral and cognitive functions class was observed in many cases. CONCLUSIONS: The health status of the older adults living in the community was classified into four classes, and changes in health status occurred even within a short period of time during the COVID-19 pandemic.

Factors associated with falls during voluntary self-isolation among community-dwelling older people: a longitudinal study.

[Purpose] We aimed to explore the factors that predict falls in community-dwelling older people over 6 months during their voluntary self-isolation for the coronavirus disease (SARS-CoV-2). [Participants and Methods] In this longitudinal study, we surveyed older people aged ≥65 years living in Takasaki City, Gunma Prefecture, using a questionnaire. We investigated the relationship between the frailty screening index and fall rate. [Results] A total of 588 older adults (response rate, 35.7%) filled and returned the questionnaire during the study period. Of these, 391 participants who had not applied for long-term care insurance and had completed the data on the response items were included in the study. Based on their responses in the survey questionnaire, 35 (8.95%) participants were grouped into the fall group and 356 into the non-fall group. Subsequently, the "no" response to "Can you recall what happened 5 minutes ago?" and "yes" response to "Have you felt tired for no reason (in the past 2 weeks)?" were identified as the significant factors associated with falls. [Conclusion] It is important to pay attention to the subjective evaluation of patients' cognitive decline and fatigue to prevent falls owing to the implementation of SARS-CoV-2 countermeasures.

Associated factors of new subjective cognitive decline complaints after a 6-month period among community-dwelling older adults during the COVID-19 pandemic in Japan.

BACKGROUND: The aim of this study was to determine the number of new subjective cognitive decline (SCD) complaints and associated factors in community-dwelling older adults during the COVID-19 pandemic in Japan. METHOD: A prospective cohort study was conducted in two periods: May to June 2020, and November 2020 to January 2021. We mailed a questionnaire to 1953 older adults in the first survey, and received 700 responses in the second. We analysed 534 participants without SCD in the first survey. We collected data on sociodemographic characteristics and administered the Questionnaire for Medical Checkup of Old-Old (QMCOO) to assess respondents' health condition. SCD was operationally defined using the QMCOO as reports of (1) forgetfulness, and (2) difficulty in naming dates. The subjects were divided into two groups by their condition at the second survey: an SCD (new SCD complaints) and a no-SCD (no new SCD complaints) group. RESULTS: A total of 85 (15.9%) participants had new SCD complaints. The Mann-Whitney U-test and chi-squared test showed that the SCD group had significantly more risk factors of SCD: walking speed (P = 0.001), smoking (P = 0.001), and existence of person with whom the patient could consult when disordered (P = 0.002). Multiple logistic regression analysis revealed that walking speed (odds ratio (OR) = 2.115, 95% confidence interval (CI): 1.259-3.553) and the presence of person to consult (OR = 3.619, 95% CI: 1.553-8.433) were significant related factors of new SCD complaints. CONCLUSION: Maintenance of physical condition and social support were associated with new SCD complaints during the COVID-19 pandemic.

Relationship between consistent subjective cognitive decline and occurrence of falls six months later.

PURPOSE: To examine the association between consistent subjective cognitive decline and fall occurrence six months later. METHOD: A cohort study was conducted at two time points in community-dwelling older adults. The first survey was conducted from May to July 2020 and the second from November 2020 to January 2021. Older adults without missing data who had not fallen during the past year were analyzed. The questionnaire included sociodemographic data, a questionnaire for medical checkup of older adults, and a frailty screening index. We divided the participants into three groups according to the occurrence of subjective cognitive decline (SCD): 1) no SCD (did not complain of SCD at both time points), 2) unstable SCD (complained of SCD once), and 3) consecutive SCD (consistently complained of SCD). Multiple logistic regression analysis was used to examine the association between fall occurrence and SCD. Fall occurrences were obtained from the second survey. RESULTS: In total, 322 participants were included in the analysis. The numbers of patients with no SCD, unstable SCD, and consecutive SCD were 226 (70.2%), 61 (19.0%), and 35 (10.9%), respectively. In the second survey, the number of falls was 26 (8.1%). Multiple logistic regression analysis showed that consecutive SCD was associated with fall occurrence, even after adjusting for age, sex, comorbidity, cohabitants, and frailty status (OR:3.143, 95% CI:1.076-9.388); however, unstable SCD was not (OR:2.348, 95% CI:0.816-6.468). CONCLUSION: Consistent complaints of SCD were associated with the occurrence of falls. We highlighted the importance of evaluating SCD over time when considering falls.

Possible Duration of WISH-type Hip Brace Use: Prognostic Value of Timed Up and Go Test.

Objectives: The WISH-type S-form hip brace (WISH brace) has significantly improved hip function and functional mobility in patients with hip osteoarthritis (OA). However, most patients later undergo surgery. The main purpose of this study was to evaluate how long the orthosis can be effectively used by patients with hip OA, and to reveal the associated prognostic factors. Methods: This prospective study examined the survival curve of the equipment by using surgery as an endpoint and investigated how the duration of use affects patients. Harris Hip Score, muscle strength, and the Timed Up and Go test (TUG) were evaluated as prognostic factors. Results: By drawing the survival curves of 26 patients, approximately one third were expected to be still using the brace after 7 years. A rapid decrease in use was observed at around 1 year. A significant difference between patients with and without bracing at 1 year was found for the TUG result with the unaffected leg inside (ULI) at the start of bracing. A cut-off value of 9.5 s for the TUG with ULI significantly differentiated patients with and without bracing at 1 year, suggesting a possible predictor of brace survivorship in the early phase. Conclusions: The TUG with ULI with a cut-off value of 9.5 s, or at most 10 s, may be a possible predictor of persistence of brace use in the early phase.

Factors for the change in frailty status during the COVID-19 pandemic: A prospective cohort study over six- and 12-month periods in Japan.

We aimed to verify the frailty status and the factors associated with the change in frailty status during the COVID-19 pandemic. A three-wave cohort study was conducted every six months, from May to July 2020, November 2020 to January 2021, and again from May to July 2021. The frailty status was assessed using the frailty screening index. Multivariate generalized linear mixed-effects models were used to determine whether changes in frailty status were associated with health conditions and lifestyle. The 404 survey forms were analyzed. Decline in chewing function (beta = 0.552) and leg muscle strength weakness (beta = 0.515) were significantly associated with the change in frailty status over six months, and leg muscle strength weakness (beta = 0.512) was significantly associated over 12 months. Risk factors associated with worsening health should be assessed for appropriate support. It is especially important to assess subjective leg muscle weakness in older adults.

Utility of SARC-F in daycare facilities for older people.

AIM: SARC-F, a sarcopenia screening tool, has limited use but may be beneficial for detecting sarcopenia in frail older people. This study aimed to clarify the validity of the SARC-F questionnaire in older people. METHODS: In this validation study, 74 (36 men; age, 81.9 ± 6.7 years, 38 women; age, 83 ± 6.2 years) community-dwelling older people who attended a daycare facility participated in our study. Participants completed the SARC-F and SARC-calf circumference (SARC-CalF) questionnaires, and their body composition, walk speed and grip strength were measured. Sarcopenia was determined using the Asian Working Group for Sarcopenia criteria, and the participants were divided into non-sarcopenia and sarcopenia groups. SARC-F and SARC-CalF scores were evaluated using receiver operating characteristic curve analysis for sarcopenia considering the area under the curve. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The prevalence of sarcopenia, defined by physical characteristics, was 60.0% in men and 48.1% in women. The area under the curve of the SARC-F for sarcopenia was 0.703 (95% confidence interval [CI]: 0.585-0.821, P = 0.001). Cronbach's alpha was 0.81, and the internal consistency was high. SARC-F had lower sensitivity (0.47; 95% CI: 0.31-0.64) but higher specificity (0.78; 95% CI: 0.60-0.89) than the sensitivity and specificity of SARC-CalF, respectively, and the sensitivity of SARC-F was higher than that reported in previous studies. CONCLUSION: The SARC-F questionnaire is more sensitive in assessing sarcopenia in low-functioning populations and can be used as a screening tool for sarcopenia in long-term daycare facilities for older people rather than in community-based healthcare activities. Geriatr Gerontol Int 2022; 22: 889-893.

Salivary gland polymorphous adenocarcinoma: Clinicopathological features and gene alterations in 36 Japanese patients.

BACKGROUND: Polymorphous adenocarcinoma is a common intraoral minor salivary gland carcinoma in Western countries but is extremely rare in Japan. The current study aimed to characterize the clinicopathological features and status of molecular alterations of polymorphous adenocarcinoma-associated genes, such as PRKD1/2/3, ARID1A, and DDX3X, in a large cohort of Japanese patients with polymorphous adenocarcinoma. METHODS: We examined the cases of 36 Japanese patients with salivary gland polymorphous adenocarcinoma and 26 cases involving histopathological mimics. To detect gene splits, fluorescence in situ hybridization was carried out for polymorphous adenocarcinoma-associated genes. Additionally, we applied a SNaPshot multiplex assay to identify PRKD1 hotspot mutations. RESULTS: This study revealed the indolent clinical course of polymorphous adenocarcinoma with a high 10-year overall survival rate (92.9%), accompanied by occasional local recurrences and cervical lymph node metastasis (23.3%). Twenty cases (55.6%) of polymorphous adenocarcinoma (but none of the mimics) exhibited alterations in at least one polymorphous adenocarcinoma-associated gene. Rearrangement of polymorphous adenocarcinoma-associated genes and PRKD1 E710D were identified in 17 (47.2%) and 4 (11.1%) cases, respectively; one case showed coexisting PRKD3 split and PRKD1 E710D. In the multivariate analysis, high clinical stage (p = 0.0005), the presence of prominent nucleoli (p = 0.0003), and ARID1A split positivity (p = 0.004) were independent risk factors for disease-free survival. CONCLUSION: Japanese patients with polymorphous adenocarcinoma showed clinicopathological features similar to those reported in Western countries. This study disclosed that polymorphous adenocarcinoma-associated genetic alterations were common and specific findings in polymorphous adenocarcinomas. The diagnostic role and possible prognostic significance of polymorphous adenocarcinoma-associated genetic alterations in polymorphous adenocarcinomas were suggested.

[An investigation to discriminate frailty based on the Questionnaire for medical checkup of old-old: A pilot study using the item response theory].

AIM: This study aimed to investigate a method for scoring the questionnaire for medical checkup of old-old (QMCOO) and to clarify a cut-off score for the discrimination of frailty. METHODS: Survey forms were distributed to 2,586 older adults. For old-old adults, the item characteristics of the QMCOO were indicated using the item response theory (IRT). A receiver operating characteristic (ROC) analysis was performed using the total score of the fitting model of QMCOO for suggesting a cut-off score to discriminate frailty. The cross-validity of the cut-off score was verified among young-old adults. RESULTS: Among 1,680 adults who responded, data from 975 old-old and 421 young-old adults were analyzed. The method for scoring zero or one on each item in QMCOO conformed to the IRT model. The item discrimination and difficulty met the criteria. An ROC analysis showed that the area under the curve (AUC) and cut-off score for the discrimination of frailty were 0.871 and 4 points (sensitivity = 0.811, specificity = 0.766, positive likelihood ratio [LR+] = 3.469, and negative likelihood ratio [LR-] = 0.247), respectively. For young-old adults, the AUC and cut-off score were 0.874 and 4 points (sensitivity = 0.741, specificity = 0.817, LR+= 4.053, and LR- = 0.317), respectively. CONCLUSIONS: The method for scoring zero or one on each item of the QMCOO was valid. A cut-off score of 4 for the discrimination of frailty demonstrated the interpretability of the QMCOO, while the usefulness of the QMCOO in young-old adults demonstrated cross-validity.

Risk factors for falls among community-dwelling older adults during voluntary self-isolation: analysis based on frailty screening index subscales.

[Purpose] This study aimed to assess fall-related risk factors among community-dwelling older adults during a period of voluntary self-isolation for preventing the spread of COVID-19. [Participants and Methods] This was a cross-sectional study. Survey questionnaire forms were distributed to 2,586 community-dwelling older adults in Takasaki City, Gunma Prefecture, Japan. Completed questionnaires were returned by mail. [Results] Of the 1,645 people who responded, 1,040 people aged 65 and over who did not apply for long-term care insurance and fully completed the questionnaire were included in this study. Since no in-person measurements were required, we utilized the Frailty Screening Index for the evaluations. We evaluated the relationship between questionnaire responses and fall rates among community-dwelling older adults. Among the results, "yes" responses to "Do you think you walk more slowly than before?" were identified as significantly associated with falls. [Conclusion] One must pay careful attention to subjectively assessing decreases in walking speed as a fall prevention measure during periods of self-restraint to prevent the spread of COVID-19 infection.

[Construct validity in structural perspectives of the Questionnaire for medical checkup of old-old among community-dwelling older adults: A pilot study of a countermeasure against COVID-19].

AIM: This study aimed to clarify the construct validity of the Questionnaire for medical checkup of old-old (QMCOO). METHODS: In this cross-sectional study, questionnaires including the QMCOO were distributed to 1,953 older adults, and responses were returned by mail. We conducted an exploratory factor analysis (EFA) for the QMCOO among older participants (age ≥75 years) and extracted the relevant factors. Next, we structured the model for the QMCOO based on these factors and conducted a confirmatory factor analysis (CFA) using structural equation modeling. We conducted a CFA among young-older participants (age 65 to <75 years) for the same model. RESULTS: Of the 1,110 (53.5%) adults who responded, data from the 994 respondents who provided complete answers were analyzed. Five factors were extracted from the results of the EFA: physical and mental condition, relationship with society, eating and smoking, chance for exercise, and cognitive function. The results of the CFA were as follows: comparative fit index (CFI) = 0.899, adjusted goodness of fit index (AGFI) = 0.965, root mean square error of approximation (RMSEA) = 0.034, and standardized root mean square residual (SRMR) = 0.040. Meanwhile, the results for young-older participants were as follows: CFI = 0.886, AGFI = 0.942, RMSEA = 0.035, and SRMR = 0.048. CONCLUSIONS: The QMCOO assessed health condition and was composed of multiple factors associated with frailty. The CFA results indicated that the model fit was good. The QMCOO showed sufficient structural validity. Therefore, the construct validity of the QMCOO was shown.

Effects of assessment-oriented group action supported by a health professional on the physical function in community-dwelling older adults: a feasibility study.

BACKGROUND: Assessment-oriented group action (AGA) could be used to empower community-dwelling older adults to maintain their health by groups. AGA can be implemented with the support of a health professional to provide feedback to older adults on physical and cognitive function. OBJECTIVE: To evaluate the effects of AGA. METHODS: For this feasibility study, we enrolled 23 and 20 participants in the intervention and control groups, respectively. Thοse in the intervention group received feedback of their assessments and devised exercise plans with professional support. The participants performed their exercises over 12 weeks; the follow-up examination was conducted at 40 weeks. The control group only received feedback. The change in health-related consciousness and behavior was evaluated. Muscle strength and mass were measured and the timed up and go test, and the Brief-balance evaluation system test (BESTest) were performed. RESULTS: There were no significant differences in consciousness or behavior between the groups. The score was higher in the intervention than in the control group at 40 weeks in Section-I of the Brief-BESTest, indicating that the muscle strength contributed to balance function. CONCLUSION: AGA did not show positive changes in consciousness or behaviors but demonstrated significant improvements and lasting effects in balance function.

Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women.

BACKGROUND AND PURPOSE: Walking speed can be used to identify characteristics of frailty in older adults. It has a strong positive correlation with balance abilities. The Brief-Balance Evaluation Systems Test (Brief-BESTest) was developed to assess functions of the 6 balance control systems in a short time. However, for community-dwelling older adults, the relationship between walking speed and the Brief-BESTest needs to be clarified. Even the cutoff scores for each Brief-BESTest section should be indicated for physical therapists to effectively evaluate balance deficits. Our objective was to establish cutoff scores for individual Brief-BESTest sections, determine fast or slow walkers in community-dwelling older adults, and investigate the relationship between balance control systems and walking speed. METHODS: In a cross-sectional study involving 55 participants 77 years and older, the Brief-BESTest was evaluated after grouping the participants based on their walking speeds in public community centers. We compared the age, history of falls, handgrip strength, quadriceps strength, appendicular skeletal muscle mass index, comfortable walking speeds, and the Brief-BESTest scores between the fast- and slow-walking groups by using the independent t test, Fisher exact test, or Mann-Whitney U test. We also determined the receiver operating characteristic curves, and calculated the cutoff, area under the curve (AUC), sensitivity, and specificity of each section. RESULTS: All sections of the Brief-BESTest, except Section 1 (Biomechanical Constraints) were able to differentiate between fast and slow walkers in community-dwelling older women. Section VI (Stability in Gait) showed the highest AUC (0.83) and the cutoff score for the fast- and slow-walker groups was 3.0 points (sensitivity = 0.85, specificity = 0.81). Sections III, IV, and V (Anticipatory, Reactive, and Sensory Orientation, respectively) had moderate AUC (0.71-0.72). Sections I and II (Stability Limits) showed weak correlations with the walking speed. CONCLUSIONS: Three sections (III, anticipatory postural adjustments; IV, reactive postural responses; and VI, stability in gait) could differentiate between fast and slow walkers. Section VI was a particularly important balance function measurement that differentiated the walking speed with the highest accuracy. Therefore, it should be a primary focus when physical therapists treat community-dwelling older adults.

Ability of the Brief-Balance Evaluation Systems Test to evaluate balance deficits in community-dwelling older adults: a cross-sectional study.

BACKGROUND: A method for assessing balance that differentiates between balance deficit can help guide effective interventions for preventing falls in older adults. OBJECTIVE: This study aimed to clarify the relationship between balance control systems and falls, and to examine the ability of the Brief-Balance Evaluation Systems Test (BESTest) to evaluate balance deficits in older adults. METHODS: Overall, 109 community-dwelling older adults participated in this study. The history of falls in the last year was investigated. Balance deficits were assessed using the Brief-BESTest, the functional reach test, the Timed up and Go Test, and the one leg balance test. We analyzed the difference between the fallers and non-fallers across two different age groups. RESULTS: Among younger-older group participants (age < 75 years), there were no significant differences between fallers and non-fallers across all variables. Among older-older group participants (age ≥ 75 years), there were significant differences in the Brief-BESTest total (p= .011; fallers, 13.5 versus non-fallers, 17.0) and section IV scores (postural responses of the Brief-BESTest; p= .026, 2.0 versus 5.0). There was no significant difference in other balance measurements. CONCLUSIONS: The postural responses assessed by the Brief-BESTest may serve important functions and may be associated with falls in older adults.

Transition to frailty in older Japanese people during the coronavirus disease 2019 pandemic: a prospective cohort study.

BACKGROUND: Globally, lifestyles have changed to prevent the spread of coronavirus disease 2019 (COVID-19). Therefore, we aimed to understand health and lifestyle conditions associated with frailty transition over 6 months and devise a method for identifying frailty among community-dwelling older people during the COVID-19 pandemic. METHOD: This community-based prospective cohort study was conducted from May to July 2020 (baseline) and November 2020 to January 2021 (follow-up) in Japan, with 1,953 community-dwelling older people (≥65 years) at baseline. To identify transition from non-frailty at baseline to frailty at follow-up, the Frailty Screening Index was used. For predicting frailty transition, two self-reported questionnaires assessing health and lifestyle conditions were employed. RESULTS: Overall, 706 individuals returned the baseline and follow-up questionnaires. Among the 492 non-frail older people at baseline, there was a 9.8% increase in frailty transition. The adjusted model for frailty transition by age, sex, multimorbidity, and living arrangements indicated that forgetfulness (odds ratio [OR] 2.74, 95% confidence interval [CI]: 1.00 to 7.51), falls in the past year (OR 2.26, 95% CI: 1.08 to 4.74), and subjective leg muscle weakness (OR 1.83, 95% CI: 1.05 to 3.21) were predictors of frailty transition. The combination of age ≥75 years and subjective leg muscle weakness showed moderate sensitivity, specificity, and % accuracy (0.688, 0.696, and 69.5%, respectively). CONCLUSIONS: Approximately 10% of older people showed new transitions to frailty over 6 months during the COVID-19 pandemic. A combination of age and subjective leg muscle weakness is a feasible measure to optimally identify frailty transition.

Construct validity of the Questionnaire for Older Senior Citizens based on a confirmatory factor analysis: A study during the period of self-restraint to prevent the spread of coronavirus disease 2019.

AIM: This study aims to clarify the construct and criterion-related validity of the Questionnaire for Older Senior Citizens (QO) during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted in Japan between November 11, 2020 and January 10, 2021. Of the 1645 (63.5%) older adults who responded, data from 900 participants were analyzed. First, we conducted an exploratory factor analysis (EFA) among older-older adults (aged ≥75 years) and extracted the factors. Next, we conducted a confirmatory factor analysis (CFA) using structural equation modeling. We also conducted this analysis among younger-older adults (aged ≥65 and <75 years) using the same model. Moreover, we compared each item of the QO with frailty status. RESULTS: Results of the EFA revealed six factors: social conditions and lifestyle, subjective conditions, cognitive functions, physical activity, oral functions, and physical functions. The results of the CFA were as follows: comparative fit index (CFI) = 0.971, adjusted goodness of fit index (AGFI) = 0.978, root mean square error of approximation (RMSEA) = 0.018, and standardized root mean square residual (SRMR) = 0.030. The results among the younger-older adults were as follows: CFI = 0.880, AGFI = 0.940, RMSEA = 0.037, and SRMR = 0.048. Many QO items were significantly associated with frailty (P < 0.05). CONCLUSIONS: Among the older-older adults group, the model used for the QO has sufficient suitability and construct validity; among the younger-older adults group, there also is sufficient questionnaire suitability. Moreover, the QO has criterion related validity with frailty. Geriatr Gerontol Int 2021; 21: 1018-1025.