Evaluate a comprehensive geriatric assessment service framework targeting frail older people who had high risk of requiring long-term care services in Japan: a community-based pilot study.

BACKGROUND: Frailty has become a key concern in an aging population. A comprehensive geriatric assessment (CGA) service framework was developed and evaluated aiming to target and connect frail older adults who are at high risk of requiring long-term care services. METHODS: A community-based pilot study was conducted in fiscal year 2016 and 2017 in Kure city, Hiroshima, Japan. Participants aged 65 and over living in Kure city, and 393 persons were extracted from the Kihon Check List (KCL) responses. Among the eligible individuals, 101 consented to participate and received CGA and referred to services based on individual health needs. The efficacy was evaluated by referral rate of services, continuity of the service usage, evaluation of participant's health condition and the quality of life (QoL) after the 6-month follow-up. RESULTS: Ninety-nine (98.0%) participants needed support for the instrumental activity of daily living, 97 (96.0%) were categorized as locomotive syndrome, and 64 (63.4%) had a depressive tendency. Afterward, 60 participants (59.4%) subsequently accepted the referral services, however, 34 (33.7%) used the services and the remaining 26 (25.7%) did not use the services. The health condition improvements in the service-uses group were statistically significant (p < 0.001), however, QoL score did not change between the baseline and 6th -month. CONCLUSION: KCL extracted high-risks older people, and CGA revealed related diseases and health conditions. However, the high refusal rate of referral services indicates a necessity to modify the service framework such as by collaborating with community general support centers, which could increase the efficacy of service framework.

Low tongue pressure and depression using Kihon Checklist for assessing frailty status among community-dwelling Japanese older adults: A pilot study.

BACKGROUND: Evaluation of low tongue pressure is used to diagnose oral hypofunction. The pathophysiology of oral hypofunction is hypothesized to be associated with oral dysfunction related to ageing. Depression in older adults is a major problem and is related to handgrip strength, which is related to tongue pressure. We hypothesized that low tongue pressure could indicate depression mood in community-dwelling older adults. OBJECTIVES: This study aimed to measure maximum tongue pressure and compare it to the responses to the Kihon Checklist (KCL), which is used to check mental and physical deterioration of community-dwelling older adults. METHODS: A total of 49 community-dwelling independent older adults with stable dental condition (23 men, 26 women; median age, 79 years) answered the KCL, which contained questions on frailty status, cognitive function, nutritional and sarcopenia status. Oral function was measured to assess oral hypofunction. The relationship between tongue pressure differences and frailty status, cognitive function, nutritional and sarcopenia status was analysed using logistic regression analyses after adjusting for age and sex. RESULTS: Nine participants (6 men and 3 women; median age, 81 years) had a tongue pressure <23.0 kPa, which was the lowest limit of the standard value of maximum tongue pressure in patients aged ≥70 years. Logistic regression analyses showed that only Question 21, which is related to a lack of fulfilment in daily life, was significantly associated with low tongue pressure (p = .027). CONCLUSION: Low tongue pressure may be associated with sociopsychological factors in older adults.

Prevalence and Associated Factors with Frailty Using the Kihon Checklist among Community-Dwelling Older Adults in Taiwan.

Background and Objectives: Frailty in older adults is associated with adverse health outcomes. This study aimed to analyze the frailty status of community-dwelling older adults in Taiwan using the Kihon Checklist (KCL) and explore associations with demographic, physiological, and functional factors. Materials and Methods: In this cross-sectional study, 278 community-dwelling older adults were classified as robust, prefrail, or frail based on their KCL scores. Participants underwent physical fitness assessments including muscle strength and endurance tests, walking speed tests, and flexibility tests. One-way ANOVA and logistic regression analyses were used to examine differences and associations between frailty status and physical fitness indicators. Results: 36% of participants were robust, 47.1% prefrail, and 16.9% frail. The robust group significantly outperformed the prefrail and frail groups in the 30 s sit-to-stand test, 2.44 m sit-to-walk test, and walking speed (p < 0.001). The 2.44 m sit-to-walk test was a significant predictor of prefrailty (OR = 1.18, 95% CI = 1.02-1.36) after adjusting for other physical fitness indicators. Conclusions: Lower limb functional capacity, particularly in the 2.44 m sit-to-walk test, was significantly associated with pre-frailty among community-dwelling older adults in Taiwan. Early screening, the classification of frailty by the Kihon Checklist, and targeted interventions focusing on lower limb strength, endurance, and mobility are crucial for preventing and delaying frailty progression in older populations.

Impact of tailored message notifications for frailty prevention in older adults: a quasi-randomized controlled study using a regression discontinuity design.

[Purpose] This study investigated the potential of tailored message notifications based on municipal health check-up results to improve pre-frailty and frailty in older adults. [Participants and Methods] This study was conducted in Iiyama City, Nagano Prefecture, Japan, by using the Kihon Checklist to assess the health status of older adults. Since 2019, Iiyama City has sent notifications to individuals with pre-frailty (Kihon Checklist score: 4-7) and frailty (Kihon Checklist score: ≥8). A regression discontinuity design was used to estimate the effects of the intervention by comparing the groups with scores just above and below the cutoff points. Data from 6,382 individuals aged ≥65 years from 2019 to 2022 were analyzed. [Results] The intervention slightly improved the Kihon Checklist scores in the pre-frailty group. No statistically significant effects were observed in the frailty group or after multiple imputations for missing data. [Conclusion] The findings suggest that tailored message notifications can improve frailty prevention among pre-frail older adults. However, the limited frequency and content of these messages may have reduced their effectiveness. Therefore, more frequent and targeted messages are needed to address the needs of frail individuals.

Changes in caregiving risk and motor function among older adults participating in community gatherings in Koshigaya city.

[Purpose] This study investigated the changes in caregiving risk and motor function among older adults participating in community gatherings ("Kayoinoba") in Koshigaya. [Participants and Methods] A total of 257 older participants who engaged in the Kayoinoba program for 6 months from its inception were included in the analysis. Caregiving risk and motor function were assessed twice-once at the beginning of the Kayoinoba (first assessment) and again 6 months later (second assessment). The Kihon Checklist was used to evaluate caregiving risk, and the timed up-and-go, one-leg standing, and 30-s chair-stand tests were done to evaluate motor functioning. Participants were divided into pre-frail and healthy groups, and the first and second assessments were compared. [Results] The Kihon Checklist score of the pre-frail group significantly improved from the first to the second assessment. The pre-frail group had lower composite scores for physical function, outdoor activities, and depression mood items based on the Kihon Checklist; the healthy group showed no such differences. Performance on the 30-s chair-stand test was significantly better in the second assessment than in the first assessment in both groups. [Conclusion] The findings of this study emphasize the benefits of participating in Kayoinoba among high-risk older adults and provide the knowledge for developing a healthier community-based symbiotic society.

Exploring the Frailty Components Related to Hospitalization-Associated Disability in Older Patients After Cardiac Surgery Using a Comprehensive Frailty Assessment.

BACKGROUND: We investigated the components of frailty associated with hospitalization-associated disability (HAD) after cardiac surgery.Methods and Results: This retrospective, observational study evaluated 1,446 older patients after elective cardiac surgery at the Sakakibara Heart Institute. We examined the association between HAD and 7 domains of frailty assessed by the Kihon Checklist. HAD was defined as a decline in the ability to perform activities of daily living (ADL) between admission and discharge, as assessed by the Barthel Index. Logistic regression and decision tree analysis were used to identify associations between the number and type of frailty components and HAD. Of the 1,446 patients, 190 were excluded, and 90 (7%) developed HAD. An increase in the number of frailty components was a risk factor for HAD (odds ratio: 1.88, 95% confidence interval: 1.62-2.17). Decision tree analysis identified physical functional decline, depression, and cognitive dysfunction as factors associated with HAD. The incidence of HAD was highest in cases of physical functional decline (21%) and lowest for cases in which the 3 aforementioned factors were absent (2.8%). CONCLUSIONS: An increased number of frailty factors increased the risk of HAD and the findings also reaffirmed the importance of a comprehensive assessment to evaluate the risk of HAD, including evaluation of physical function, cognitive function, and depression.

Relationship between Total Kihon Checklist Score and Age-Specific Deaths among Late-Stage Older Adults in Otawara City (Aged 75 and Older) over a 15-Year Period.

INTRODUCTION: While the Japanese long-term care insurance system supports an ageing society, there are concerns about the shortage of financial resources and labour force. Further, extending healthy life expectancy and narrowing the gap with the average life expectancy are important issues. In this study, we aimed to examine, over a 15-year period, the relationship between the total Kihon Checklist (t-KCL) score and age-specific deaths among late-stage older adults aged 75 and older who were not certified for long-term care insurance. METHODS: The participants were older adults residing in Otawara City, Tochigi Prefecture, who were aged 75 years or older as of 2006. The participants, who were not certified by the long-term care insurance system, were asked to complete the KCL by a community welfare committee member. Based on their t-KCL scores, the participants were classified as robust (0-3 points), pre-frail (4-7 points), and frail (≥8 points). The deaths of those aged 75-89 years who had completed the KCL were investigated. Information on deaths was obtained from local authorities. Statistics were examined for the risk of robust, pre-frail, and frail mortality using a Cox proportional hazards model with age and gender as covariates for the 75-79, 80-84, and 85-89 age groups. RESULTS: Of the 7,924 participants, 3,423 (75-79 years: 1,990, 80-84 years: 1,059, 85-89 years: 374) were ultimately eligible for the study. Of these, 2,450 (75-79 years: 1,238, 80-84 years: 861, 85-89 years: 351) died over the 15-year study period. Hazard ratios for death in frailty as determined by the t-KCL score were 1.337 (95% confidence interval [CI], 1.162-1.540) for the pre-frail group and 2.012 (95% CI, 1.7756-2.305) for the frail group at 75-79 years, respectively, compared with the robust group; 1.511 (95% CI, 1.271-1.797) at 80-84 years only in the frail group; and 1.567 (95% CI, 1.140-2.154) at 85-89 years, also in the frail group. DISCUSSION: The relationship between frailty and mortality weakens after age 80. The results suggest that factors other than frailty may have a stronger influence on mortality risk after the age of 80.

Determining factors that maintain physical function or increase frailty using the Kihon checklist among community-dwelling older adults: a six-year longitudinal study in Agano, Japan.

BACKGROUND: A significant increase in the older adult population in Japan will significantly increase healthcare costs. This study aimed to examine the risk factors contributing to robustness transitioning to frailty in older residents. METHODS: Participants were aged 70 in 2016 and 76 in 2022. Participants were evaluated using the Kihon Checklist (KCL). RESULTS: Participants for this longitudinal study included 444 older persons who completed the KCL surveys in 2016 and 2022. The follow-up rate was 80.6%; therefore, 358 participants were included in the analysis. The median KCL score increased significantly from 2 to 2016 to 3 in 2022 (p < 0.001). The prevalence of robustness significantly decreased from 60.9 to 48.6% (p = 0.042). In a stepwise logistic regression analysis, robustness was independently associated with regular continuous walks for 15 min and a body mass index of above 18.5%. The following variables were associated with the transition to prefrailty: experiencing a fall in the past year and not going out at least once a week. For the transition to frailty, the variables were turned to family or friends for advice, experienced a fall in the past year, and felt helpless in the last two weeks. The independent factor for the transition from prefrailty to frailty was having a BMI of less than 18.5. In contrast, the independent factor for improving from frailty to robustness or prefrailty was going out at least once a week. CONCLUSIONS: We recommend maintaining continuous walking for more than 15 min, maintaining a BMI of at least 18.5, and going out more than once a week to improve being house-bounded and depressive mood, not only to prevent the transition to prefrailty or frailty but also to improve frailty.

The relationship between frailty and motor function among living in the community elderly females.

[Purpose] This study aimed to investigate the prevalence of frailty among community-dwelling elderly females, and to examine its relation to motor function and the main risk factors of frailty. [Participants and Methods] The participants were 67 community-dwelling elderly females, aged 76.2 ± 7.7 years. We performed measurements of physical parameters, motor functions (such as grip strength), timed up and go test (TUG), walking speed, and frailty (measured using the Kihon Checklist [KCL]). [Results] KCL scores were 31.3%, 31.3%, and 37.3% in the frailty, pre-frailty, and robust groups, respectively. The frailty group was older than the pre-frailty and robust groups. Additionally, the different groups showed significant differences in grip strength, TUG, and walking speed. The highest median KCL score was for depression, followed by physical function. As a results, frailty was evident even among health-conscious elderly people. [Conclusion] It is essential to identify frailty at an early stage and identify its preventive factors, in order to extend the healthy life expectancy of the local population.

Cardiac surgery improves the postoperative frailty score of frail patients.

BACKGROUND: Cardiac surgery in frail patients has been reported to be associated with increased mortality and morbidity but may improve functional status of frail patients. Few studies have investigated the impact of cardiac surgery on the trajectory of postoperative frailty. We hypothesized that cardiac surgery in frail patients would improve frailty postoperatively. METHOD: This study included 71 patients over 65 years old who were scheduled for cardiac surgery via sternotomy or thoracotomy. Frailty was prospectively evaluated using the Kihon Checklist (KCL) at 1 and 3 months postoperatively. Patients were divided into three groups based on the preoperative KCL score: nonfrail, prefrail, and frail. The interaction between the degree of preoperative frailty and the trajectory of postoperative KCL scores was assessed. RESULTS: The KCL score changed significantly over time (P < 0.001), and the KCL score trajectory differed significantly according to the degree of preoperative frailty (P for interaction = 0.003). In the frail group, the KCL score was significantly lower 3 months postoperatively than preoperatively (median 8, interquartile range [5, 9] versus median 9, interquartile range (9, 13), P = 0.029). CONCLUSION: The trajectory of postoperative KCL scores differed significantly depending on the degree of preoperative frailty. At 3 months after cardiac surgery, the KCL score of frail patients was significantly improved, while that in nonfrail patients was significantly deteriorated.

Relationship between locomotive syndrome and frailty in rheumatoid arthritis patients by locomotive syndrome stage.

OBJECTIVES: This study aimed to evaluate the association between locomotive syndrome (LS) and frailty in rheumatoid arthritis (RA) patients. METHODS: Subjects were 538 RA patients (female, 72.9%; mean age ± standard deviation, 66.8 ± 13.4 years). LS and frailty were defined as ≥16 points on the 25-question Geriatric Locomotive Function Scale (Stage ≥2) and ≥8 points on the Kihon Checklist (KCL), respectively. RESULTS: There were 214 subjects with Stage ≥2 LS (39.8%) and 213 subjects with frailty (39.6%). Among subjects with Stage 0, 1, 2, and 3 LS, 11.0%, 21.9%, 48.3%, and 84.6% had frailty, respectively. The KCL points for cognitive and psychosocial factors had no significant differences across LS stages. Multivariable logistic regression analysis revealed that the Health Assessment Questionnaire was independently associated with frailty and LS stage, and the Clinical Disease Activity Index was associated with LS stage but not frailty. CONCLUSIONS: As LS worsens in RA patients, the likelihood of developing physical frailty increases. RA patients with a low LS stage can still develop frailty, and suppressing disease activity may not be sufficient to prevent frailty. These findings highlight the need to screen for frailty in RA patients and consider appropriate interventions based on each patient's condition, focusing on nonphysical factors.

[Development of a risk prediction model and a sample risk chart for long-term care certification based on the functional health of older adults].

Objectives　The first aim of this study was to develop risk prediction models based on age, sex, and functional health to estimate the absolute risk of the 3-year incidence of long-term care certification and to evaluate its performance. The second aim was to produce risk charts showing the probability of the incident long-term care certification as a tool for prompting older adults to engage in healthy behaviors.Methods　This study's data was obtained from older adults, aged ≥65 years, without any disability (i.e., they did not certify≥care level 1) and residing in Yabu, Hyogo Prefecture, Japan (n=5,964). A risk prediction model was developed using a logistic regression model that incorporated age and the Kihon Checklist (KCL) score or the Kaigo-Yobo Checklist (KYCL) score for each sex. The 3-year absolute risk of incidence of the long-term care certification (here defined as≥care level 1) was then calculated. We evaluated the model's discrimination and calibration abilities using the area under the receiver operating characteristic curves (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. For internal validity, the mean AUC was calculated using a 5-fold cross-validation method.Results　After excluding participants with missing KCL (n=4) or KYCL (n=1,516) data, we included 5,960 for the KCL analysis and 4,448 for the KYCL analysis. We identified incident long-term care certification for men and women during the follow-up period: 207 (8.2%) and 390 (11.3%) for KCL analysis and 128 (6.6%) and 256 (10.2%) for KYCL analysis, respectively. For calibration, the χ2 statistic for the risk prediction model using KCL and KYCL was: P=0.26 and P=0.44 in men and P=0.75 and P=0.20 in women, respectively. The AUC (mean AUC) in the KCL model was 0.86 (0.86) in men and 0.83 (0.83) in women. In the KYCL model, the AUC was 0.86 (0.85) in men and 0.85 (0.85) in women. The risk charts had six different colors, suggesting the predicted probability of incident long-term care certification.Conclusions　The risk prediction model demonstrated good discrimination, calibration, and internal validity. The risk charts proposed in our study are easy to use and may help older adults in recognizing their disability risk. These charts may also support health promotion activities by facilitating the assessment and modification of the daily behaviors of older adults in community settings. Further studies with larger sample size and external validity verification are needed to promote the widespread use of risk charts.

Predicting incidence of long-term care insurance certification in Japan with the Kihon Checklist for frailty screening tool: analysis of local government survey data.

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

Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study.

BACKGROUND: How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises. METHODS: We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51). RESULTS: The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups. CONCLUSION: Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

[Association between locomotive syndrome and cognitive decline in community-dwelling older adults].

Objectives　Cognitive function is an important component of health and quality of life in older adults. Locomotive syndrome (LS) is associated with cognitive decline, but this has not been sufficiently shown. Therefore, the purpose of this study was to determine the association between LS and cognitive decline in community-dwelling older adults.Methods　Study participants were 3,751 community-dwelling elderly people (1,914 men and 1,837 women; mean age 71.9±5.7 years) who completed the 25-question Geriatric Locomotive Function Scale (GLFS-25) and the Kihon Checklist administered by the local government in Japan between 2014 and 2016. LS stage was assessed using the total score from the GLFS-25 (non-LS: a score of ≤6, Stage 1: a score of ≥7, and Stage 2: a score of ≥16). The risk of cognitive decline was assessed by the applicable number of 3 cognitive-related items on the Kihon Checklist (mild decline: applicable number ≥1, moderate decline: applicable number ≥2). Multinomial logistic regression analysis adjusted for age, BMI, nutritional status, oral function, and homebound status was used to calculate the odds ratios (ORs) of the LS stage for the risk of cognitive decline.Results　In the multinomial logistic regression model, participants in both stages 1 and 2 of LS had significantly higher ORs for mild cognitive decline than those without LS in men and women. Similar results were observed with moderate cognitive decline. The ORs of LS stages for moderate cognitive decline were as follows: in the multinomial logistic regression model, OR was 1.65 (95% CI, 0.97-2.81) in stage 1 of LS and 2.99 (95% CI, 1.56-5.73) in stage 2 of LS in men (P<0.001), and OR was 1.97 (95%CI, 1.11-3.50) in LS stage 1 and 2.43 (95% CI, 1.14-5.19) in stage 2 of LS in women (P<0.01).Conclusion　This study showed that LS stage had a significant positive association with the decline in cognitive function in older adults and it was more remarkable in cases of increased cognitive decline. Our results suggest that LS might be an independent factor of cognitive decline in community-dwelling elderly people. A longitudinal survey is needed to clarify the association between LS and cognitive function.

[Prevalence of frailty and its related factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities in Osaka prefecture].

Objectives　The purpose of this study was to examine the prevalence of frailty and its associated factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities, which are located in the north and south of Osaka prefecture, respectively.Methods　We conducted a mailed, self-administered, questionnaire survey of individuals aged 40 years and older in Settsu city in 2019 and Hannan city in 2020. There are 10 primary school districts in Settsu city and 8 districts in Hannan city, from each of which 1,000 people were selected according to the age and sex structures of the districts. We included 5,134 individuals from Settsu city and 3,939 individuals from Hannan city. We defined frailty using self-reported questionnaires, the Kihon Checklist (KCL), and Simple Frailty Index (SFI). Multivariate logistic regression analysis was performed for each city to examine the association of frailty with age, sex, body mass index (BMI), family structure, subjective health, economic status, subjective physical fitness, sleeping status, smoking history, alcohol use, meal frequency and awareness of the word "frailty."Results　The average age (standard deviation) of participants was 62.7 (12.5) years in Settsu city and 63.4 (12.2) years in Hannan city. The prevalence of frailty by KCL was 18.7% and 17.9% for participants in their 40s, 18.2% and 14.6% for those in their 50s, 17.0% and 15.7% for those in their 60s, 25.4% and 20.8% for those in their 70s, 39.7% and 36.1% for those 80 years and older from Settsu and Hannan cities, respectively. Using SFI, the prevalence of frailty was 16.2% and 13.5% for participants in their 40s, 15.0% and 11.9% for those in their 50s, 12.5% and 10.0% for those in their 60s, 14.6% and 12.3% for those in their 70s, and 24.7% and 22.3% for those aged 80 years and older in Settsu and Hannan cities, respectively. Significant common independent variables associated with frailty as defined using the KCL and SFI in Settsu and Hannan cities were age, subjective health, economic status, subjective physical fitness, sleeping status, and awareness of the word "frailty."Conclusion　This study found some participants to be frail as early as their 40s or 50s. Thus, efforts must be made to prevent frailty in working-age populations, including those aged 40 years and older. Six factors were associated with frailty. Longitudinal or interventional studies are required to examine their causal relationships and public health significance.

[The characteristics of frail elderly patients in acute care hospitals].

AIM: Efforts to improve the treatment of frail elderly patients in acute care hospitals are urgently needed because a low physical activity level due to hospitalization is reported to be associated with a risk of disability. The aim of this study was to clarify the characteristics of frail elderly patients in acute care hospitals. METHODS: We assessed 198 elderly patients who were admitted to acute care hospitals. The factors that were evaluated included the presence of frailty, the age, gender, and nutritional status of the patients, and complications that developed during hospitalization. In this study, frailty was evaluated using the Kihon checklist (KCL), and was defined by a total KCL score of ≥7 points. RESULTS: A total of 87 (43.9%) subjects met the definition of frailty and there was a female predominance (63.2%). The nutritional status of the subjects with frailty was significantly worse than that of the non-frail patients. In comparison to the non-frail subjects, the frail subjects were significantly older and the onset of complications during hospitalization was observed significantly more frequently. Moreover, a large number of frail subjects showed low scores on the KCL items related to their social activity, physical and oral functions, and psychological status. CONCLUSION: These findings suggest that efforts to improve the treatment of frail elderly patients in acute care hospitals are important because of the high incidence of frailty. Multifaceted assessments and the promotion of physical activity to prevent the onset of complications during hospitalization may be needed for frail elderly patients in acute care hospitals.

[The Comprehensive Geriatric Assessment predicts healthy life expectancy better than health checkups in older people: JAGES cohort study].

AIM: In Japan, the Kihon checklist, which a useful part of the Comprehensive Geriatric Assessment (CGA), is performed using questionnaire. On the other hand, specific health checkup screens are available for some basic diseases, such as diabetes and dyslipidemia, which can cause stroke, the largest cause of long-term care need. However, to date, no report has compared CGA and health checkups in older people for their ability to predict healthy life expectancy; therefore, this study was undertaken to do that. METHODS: Data from the Japan Gerontological Evaluation Study (JAGES) 2010, a self-administered mail survey of independent people aged 65 years or older, were used. A total of 9,756 participants in six cities responded to the questionnaire, underwent a health check, and were followed up for 3 years.Cox proportional hazards models were used to estimate hazard ratios (HR) for the eventual need for long-term care level 2 or more or death, adjusting for sex, age, drinking or smoking habits, educational years, and equivalent income. Explanatory variables in the Kihon checklist included seven risks, namely, general frailty, functional disability, malnutrition, oral dysfunction, seclusion, cognitive impairment, and depression, and in specific health checkups, 15 required items including metabolic syndrome. RESULTS: The incident rate of long-term care level 2 or more or death was 19.4/1,000 person-years. All risks in the Kihon checklist, excluding oral dysfunction, were significant (range of HRs: 1.44-3.63). Six items in the specific health checkups (urine protein, low BMI, AST, HDL, FPG, and HbA1c) were significant (range of HRs: 1.37-2.07). Metabolic syndrome was not significant (HR: 1.05). CONCLUSIONS: Therefore, CGA performed using questionnaire predicts healthy life expectancy better than a health checkup based on a blood test.

Prevalence and factors associated with changes in frailty among community-dwelling older adults in Japan during the COVID-19 pandemic: A prospective cohort study from 2020 to 2022.

AIM: This study aimed to ascertain the prevalence of frailty during the pandemic and to determine factors associated with changes in frailty status. METHODS: In May-June of 2020-2022, we assessed the frailty of 549 participants using the Kihon Checklist. Furthermore, we classified participant residences as urban, suburban, and rural and investigated participants' engagement in hobbies and community activities in 2020 and 2022. Cochran's Q test was used to analyze the proportions of frailty status. Subsequently, we conducted a binomial logistic regression analysis with the improvement/deterioration of frailty status from 2020 to 2022 as the dependent variable, and engagement in hobbies and community activities as the independent variables. RESULTS: Significant changes were observed among participants in urban areas, where an increase in pre-frailty and a decrease in robust individuals from 2020 to 2021 were noted. Focusing on item no. 17 (going out), the decreasing frequency had recovered by 2022 in the group of all groups. Continued engagement in only hobbies or only community activities, and continued engagement in both were associated with remained robust/frailty-status improvement. Moreover, not engaging in either hobbies or community activities was associated with remained frail/frailty-status deterioration. CONCLUSIONS: During the early stages, the COVID-19 pandemic impacted the frailty of older adults in densely populated areas. The results also suggest an attenuation in the decline in older adult activity in 2022. Continuous engagement in hobbies and community activities was crucial for improving and preventing deterioration in frailty status during the COVID-19 pandemic. Geriatr Gerontol Int 2024; 24: 40-47.

Impact of frailty on long-term outcomes after liver resection for hepatocellular carcinoma in elderly patients: A prospective study.

BACKGROUND: sFrailty affects short-term outcomes after liver resection in elderly patients. However, frailty's effects on long-term outcomes after liver resection in elderly patients with hepatocellular carcinoma (HCC) are unknown. METHODS: This prospective, single-center study included 81 independently living patients aged ≥65 years scheduled to undergo liver resection for initial HCC. Frailty was evaluated according to the Kihon Checklist, a phenotypic frailty index." We investigated and compared postoperative long-term outcomes after liver resection between patients with and without frailty. RESULTS: Of the 81 patients, 25 (30.9%) were frail. The proportion of patients with cirrhosis, high serum alpha-fetoprotein level (≥200 ng/mL), and poorly differentiated HCC was higher in the frail group than in the nonfrail group (n = 56). Among the patients with postoperative recurrence, the incidence of extrahepatic recurrence was higher in the frail group than in the nonfrail group (30.8% vs. 3.6%, P = 0.028). Moreover, the proportion of patients who underwent repeat liver resection and ablation for recurrence who met the Milan criteria tended to be lower in the frail group than in the nonfrail group. Although there was no difference in disease-free survival between the two groups, the overall survival rate in the frail group was significantly worse than that in the nonfrail group (5-year overall survival: 42.7% vs. 77.2%, P = 0.005). Results of the multivariate analysis indicated that frailty and blood loss were independent prognostic factors for postoperative survival. CONCLUSION: Frailty is associated with unfavorable long-term outcomes after liver resection in elderly patients with HCC.