[Association between issues in activities and psychosocial health status in the social positions of older residents' community-based activities: a cross-sectional study].

Objectives　When local governments and community nurses provide support for community-based activities led by older residents, it is imperative to reduce the burden of participants in leadership positions. This study aimed to identify the issues associated with the activities by social position, such as leadership, support, and regular participation, to discuss effective support for community-based activities and to examine the association between social position, relating issues, and psychosocial health.Methods　Participants in community-based activities were recruited by the local government in Tokyo, Japan. Overall, 2,367 people from 155 activity groups from 40 municipalities responded. Social positions in the groups were defined as leaders who manage activities; supporters who support leaders; and regular members who do not have any specific role. The participants chose the issues of community-based activities from 10 items. Psychosocial health was measured by the WHO-5 well-being index (WHO-5) and Lubben social network scale-6 (LSNS-6). The relationship between recognition of issues and social positions were examined by the chi-square test. Interaction effects of social positions and issues (with or without) on the WHO-5 and LSNS-6 were investigated using a two-way analysis of covariance.Results　The final sample comprised 2,096 respondents: 174 leaders, 296 supporters, and 1,626 regular members. There was a significant association between recognition of social positions and issues in the groups: respondents who reported no issues in the activities comprised 8.6% of the leaders, 27.7% of the supporters, and 53.6% of the regular members (P<0.001). There was a large difference in recognition between roles for issues related to group management, such as the lack of management members. There was no significant interaction between these issues and social positions in either WHO-5 or LSNS-6 (P=0.729, P=0.171, respectively). The main effect of the social positions was significant in both analyses (P<0.001). The leaders and supporters showed significantly higher WHO-5 and LSNS-6 scores than regular members.Conclusion　The issues that the participants reported differed by social positions in activities. It may be effective to provide support according to the difficulty of sharing issues within the group. Regardless of whether or not the participants report issues, leaders and supporters had improved psychosocial health than regular members. The study concludes that organizational position in community-based activities may offer health benefits for older adults.

[Effective support based on length of participation for community-based activities led by older residents].

Objectives　Community-based activities led by older residents are important in preventing long-term care and enhancing social participation among older persons in Japan. Local governments and community nurses are required to support these activities. However, there is no knowledge about the issues of residents who participate in community-based activities, which is essential for the effective support of community-based activities. We aimed to examine the association between the length of participation and recognized issues among community-based activities.Methods　Through the local governments in Tokyo, we recruited participants from community-based activity groups; 2,367 people from 155 activity groups from 40 municipalities responded. The presence or absence of 10 items of recognized issues, such as lack of management members and lack of teachers, were examined. The number of years of participation in the activity was divided into four groups: "less than 1 year," "more than 1 year and less than 2 years," "more than 2 years and less than 4 years," and "more than 4 years." Logistic regression analysis was conducted to examine the association between the length of participation and recognized issues.Results　The number of analyzed respondents was 2,194 (14.5% were male and the average age was 76.9 years). Compared to "less than 1 year" group, the "more than 2 years and less than 4 year" group recognized "aging of group" (OR=1.92), "lack of management members" (OR=1.61), and "health condition of participants" (OR=1.47) as issues. In the "more than 4 years" group, "aging of group" (OR=3.24), "lack of management members" (OR=2.63), "lack of participants" (OR=2.12), "health condition of participants" (OR=1.95), "mannerism of activities" (OR=1.62), and "lack of place" (OR=1.48) were recognized as issues.Conclusion　Issues recognized by participants in community-based activities differed depending on the number of years they had been participating in the activity. This suggests that it is necessary to provide appropriate support taking the length of participation into account. For example, the issue of the "health condition of participants" was recognized by participants who had been participating in the activity for approximately two years. Consequently, "lack of participants" may have occurred in participants who have been participating in the activity for four years. Therefore, promoting the health management of participants from the early phase of community-based activity would be effective in preventing dropout.

[School students' greeting behavior and its association with their community attachment and helping behavior].

Objectives　Many local governments and elementary and junior high schools in Japan have conducted a "greeting campaign". This has been done in order to activate communication among local residents, and to instill public spirit and sociability in students' minds. However, few studies have explored the significance of greeting campaigns. The present study investigates greeting in neighborhoods and its relationship with students' spontaneous greeting behavior. The study also seeks to understand the quantity of greeting in daily life and its association with a student's community attachment and helping behavior.Methods　A self-completion questionnaire survey was conducted with 1,346 students studying in the fourth and higher grades at elementary schools, and 1,357 students in the first and second grade at junior high schools. There were 2,692 valid respondents. We performed the following analyses using the data of elementary school students and junior high school students separately. A partial correlation analysis was conducted wherein gender and grade were introduced as control variables. This analysis tested the correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord. A path analysis that tested the relationship between students' greeting behavior, their attachment to residential areas, and helping behavior was also conducted.Results　The results of the partial correlation analysis revealed that there was a positive correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord, regardless of gender and grade. Moreover, the results of the path analysis revealed that the frequency of being greeted was positively associated with community attachment and that the frequency of students' spontaneous greeting behavior was positively associated not only with community attachment but also with helping behavior. The goodness of model fit was high for both the data of elementary school students as well as the data of junior high school students.Conclusion　We found that exchanging greetings with surrounding people in daily life enhanced students' attachment to the community. In particular, we showed that students' spontaneous greeting behavior led to their helping behavior, which supports the significance of recommending greeting at home, school, or in the local community. Since there was a correlation between the frequency of being greeted and the frequency of greeting willingly, we consider that actions of surrounding adults become important to help students acquire spontaneous greeting behavior.

Co-existence of social isolation and homebound status increase the risk of all-cause mortality.

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality. METHODS: The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained. RESULTS: In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04-4.63). CONCLUSION: Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

Preventive effects of an intergenerational program on age-related hippocampal atrophy in older adults: The REPRINTS study.

OBJECTIVES: A growing body of literature indicates that social engagements, such as intergenerational programs, are effective strategies to improve a range of cognitive abilities. The present study examined whether the intergenerational program-REPRINTS-prevents age-related hippocampal atrophy. METHODS: After comprehensive baseline assessment, participants were allowed to decide whether to participate in the REPRINTS intervention or in the control group, which required only completion of assessments. REPRINTS participants engaged in group activities that involved reading picture books to children at kindergarten and elementary schools, once every 1 to 2 weeks. A follow-up assessment was conducted after 6 years. Two MRI scans were performed, one immediately after baseline assessment and the other after 6 years. Volumes of the hippocampus, thalamus, and caudate nucleus were derived from automated segmentation. The analysis included 17 REPRINTS and 42 control-group participants. RESULTS: There was no significant difference in any variable of participants' characteristics at baseline between the REPRINTS and control groups. Hippocampal volume significantly declined in the control group but was maintained in the REPRINTS group. No significant differences between groups in thalamus or caudate nucleus volume were observed. Although cognitive function was unaffected by the program, greater decreases in hippocampal volume were significantly correlated with greater decreases in cognitive performance scores. CONCLUSIONS: Our results suggest that the REPRINTS intergenerational program has protective effects on age-related hippocampal atrophy in older adults. These changes precede improvements in cognitive performance, suggesting the validity of the concept of brain plasticity in later life following social engagement.

Correction to: Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

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Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

BACKGROUND: An association between handgrip strength, hand dexterity and global cognition is suggested; however, it is unclear whether both hand motor functions are associated with executive function, which is important for performing daily activities. Understanding this association will help identify motor risk factors for impairment of executive function in late adulthood. We aim to investigate the relationship of handgrip strength and hand dexterity with executive function in physically and mentally healthy community-dwelling older adults. METHODS: Three hundred and twenty-six older adults (287 women, mean age ± SD, 70.1 ± 5.6) underwent handgrip strength and hand dexterity tests using a hand dynamometer and the Purdue Pegboard Test (PPT), respectively. Executive function was evaluated with the Trail Making Test (TMT)-A, TMT-B and Digit symbol; global cognition was assessed with the Mini-Mental State Examination (MMSE). RESULTS: Age-group differences showed that the younger groups (60-64, 65-69 and 70-74) had a significant better PPT and executive function performance than the oldest group (75 and older), whereas no significant age differences were observed for handgrip strength. Multiple regression analysis adjusted for potential covariates, including MMSE scores, showed that TMT-A, TMT-B, and Digit symbol were significantly associated with PPT scores; however, no significant association was observed between executive function variables and handgrip strength. CONCLUSIONS: Hand dexterity is vulnerable to the effects of aging and, contrary to handgrip strength, it strongly associates with executive function, independent of global cognition. Our results suggest that assessing hand dexterity may help identify individuals at higher risk of impairment of executive function among high-functioning older adults.

[The relationship between intra- and inter-generational exchange and mental health among young and older adults].

Objective　The purpose of this study was to examine the relationship between intra- and inter-generational exchange and mental health among young adults aged 25-49 years and older adults aged 65-84 years.Methods　In 2016, a community-based, cross-sectional survey was conducted. A total of 3,334 young adults (valid response rate: 24.6%), and 3,116 older adults (valid response rate: 46.0%) completed the survey and were included in the analysis. Their mental health was evaluated using the World Health Organization-Five Well-Being Index (WHO-5), and those who scored under 13 or scored less than one on any item were considered to have poor mental health. To evaluate the intra- or inter-generational exchange, participants were asked about their frequency of interaction with people aged 20-49 years or aged ≥70, excluding family and co-workers. Young adults who interacted with people aged 20-49 years or older adults who interacted with people ≥70 were classified as "having intra-generational exchange," while young adults who interacted with people ≥70 years or older adults who interacted with people aged 20-49 years were classified as "having intergenerational exchange." Therefore, individuals who interacted with both generations were classified as "having multi-generational exchange," and those who did not interact with any generation were categorized as "no exchange." We conducted a logistic regression analysis that included mental health as a dependent variable, intra- and inter-generational exchange as independent variables, and gender, age, educational attainment, marital status, living situation, subjective economic status, social participation, employment, self-rated health, and Instrumental Activity of Daily Living as covariates.Results　Of the 3,334 young adults, 61.5% were mentally healthy, 51.3% had intra-generational exchange, 21.9% had inter-generational exchange, 16.5% had multi-generational exchange, and 42.7% did not have any exchange. Of the 3,116 older adults, 65.8% were mentally healthy, 67.9% had intra-generational exchange, 34.3% had inter-generational exchange, 29.9% had multi-generational exchange, and 21.1% did not have any exchange. A logistic regression analysis revealed that "having intra-generational exchange" and "having intergenerational exchange" were significantly related to better mental health in both young adults (intra-generational; Odds ratios (OR) 1.19, 95% confidence intervals (CI) 1.10-1.30: inter-generational; OR 1.13, 95% CI 1.03-1.25) and older adults (intra-generational; OR 1.15, 95% CI 1.02-1.29: inter-generational; OR 1.46, 95% CI 1.30-1.65). Therefore, "having multi-generational exchange" was more strongly related to better mental health compared with "only having intra-generational exchange."Conclusion　Among young and older adults, intra- and inter-generational exchange were related to better mental health, and multi-generational exchange showed the strongest relationship with better mental health.

Neural basis for the relationship between frequency of going outdoors and depressive mood in older adults.

OBJECTIVE: Low frequency of going outdoors (e.g. being homebound) is associated with depressive mood; however, the underlying neural mechanism of this association is unclear. We therefore investigated the neural substrate involved in the relationship between frequency of going outdoors and depressive mood using positron emission tomography (PET), focusing on the frontal lobe and the limbic system. METHODS: One hundred fifty-eight community-dwelling older adults aged 65-85 years underwent PET with 18 F-fluorodeoxyglucose to evaluate regional cerebral metabolic rates of glucose normalized in reference to cerebellar glucose metabolic value (normalized-rCMRglc) in six regions of interest. We also assessed depressive mood, frequency of going outdoors, and potential covariates. Depressive mood was assessed using the Geriatric Depression Scale (GDS). RESULTS: The proportion of participants who reported low frequency of going outdoors (LG, every 2-3 days or less) was 36.1%. The LG group showed significantly higher GDS scores than those who reported high (once a day or more) frequency of going outdoors. A multiple linear regression analysis adjusted for potential covariates showed higher GDS scores were associated with lower normalized-rCMRglc in the ventrolateral prefrontal and orbitofrontal cortices. Adjusting for frequency of going outdoors, the association between GDS score and normalized-rCMRglc in the orbitofrontal cortex was attenuated. CONCLUSIONS: Our results suggest that the orbitofrontal cortex may mediate the relationship between low frequency of going outdoors and depressive mood among community-dwelling older adults. These findings may help disentangle the role of going outdoors in regulating brain function to improve and/or maintain mental health among community-dwelling older adults. Copyright © 2016 John Wiley & Sons, Ltd.

Self-estimation of physical ability in stepping over an obstacle is not mediated by visual height perception: a comparison between young and older adults.

Older adults tend to overestimate their step-over ability. However, it is unclear as to whether this is caused by inaccurate self-estimation of physical ability or inaccurate perception of height. We, therefore, measured both visual height perception ability and self-estimation of step-over ability among young and older adults. Forty-seven older and 16 young adults performed a height perception test (HPT) and a step-over test (SOT). Participants visually judged the height of vertical bars from distances of 7 and 1 m away in the HPT, then self-estimated and, subsequently, actually performed a step-over action in the SOT. The results showed no significant difference between young and older adults in visual height perception. In the SOT, young adults tended to underestimate their step-over ability, whereas older adults either overestimated their abilities or underestimated them to a lesser extent than did the young adults. Moreover, visual height perception was not correlated with the self-estimation of step-over ability in both young and older adults. These results suggest that the self-overestimation of step-over ability which appeared in some healthy older adults may not be caused by the nature of visual height perception, but by other factor(s), such as the likely age-related nature of self-estimation of physical ability, per se.

The effect of intergenerational programs on the mental health of elderly adults.

OBJECTIVES: The aim of this study was to clarify the effect of an intergenerational program on elderly persons' symptoms of depressive mood and in improving their sense of coherence, which is an element for successful coping with stressors. METHOD: We evaluated an intervention research project (Research of Productivity by Intergenerational Sympathy [REPRINTS]), in which volunteers >65 years old read picture books to children in a school setting. The intervention group (REPRINTS) was recruited through intensive weekly training seminars for three months. The no-contact control group members were also recreated to participate in health checks and surveys for data collection purposes. Eventually, 26 participants in the intervention group and 54 in the control group were included for data analysis. RESULTS: The age or gender was not significantly different between the intervention and control groups. A two-way repeated-measures ANOVA shows a time × group significant interaction effects. Analyses of the simple main effects showed that sense of meaningfulness significantly increased for members of the intervention group at all terms, with no changes in the control group over time. Multiple mediation analysis revealed that participation in the intergenerational program was associated with a sense of manageability which was also significantly related to depressive mood. CONCLUSION: Intergenerational programs could serve as key health promoters among elderly people by decreasing the risk of social isolation and loneliness due to the greater sense of meaningfulness. However, given our limited sample size, generalizability was restricted and studies with larger cohorts are required to further validate our findings.

Cognitive intervention through a training program for picture book reading in community-dwelling older adults: a randomized controlled trial.

BACKGROUND: Non-pharmacological interventions are expected to be important strategies for reducing the age-adjusted prevalence of senile dementia, considering that complete medical treatment for cognitive decline has not yet been developed. From the viewpoint of long-term continuity of activity, it is necessary to develop various cognitive stimulating programs. The aim of this study is to examine the effectiveness of a cognitive intervention through a training program for picture book reading for community-dwelling older adults. METHODS: Fifty-eight Japanese older participants were divided into the intervention and control groups using simple randomization (n =29 vs 29). In the intervention group, participants took part in a program aimed at learning and mastering methods of picture book reading as a form of cognitive training intervention. The control group listened to lectures about elderly health maintenance. Cognitive tests were conducted individually before and after the programs. RESULTS: The rate of memory retention, computed by dividing Logical Memory delayed recall by immediate recall, showed a significant interaction (p < .05) in analysis of covariance. Simple main effects showed that the rate of memory retention of the intervention group improved after the program completion (p < .05). In the participants with mild cognitive impairment (MCI) examined by Japanese version of the Montreal Cognitive Assessment (MoCA-J) (n =14 vs 15), significant interactions were seen in Trail Making Test-A (p < .01), Trail Making Test-B (p < .05), Kana pick-out test (p < .05) and the Mini-Mental State Examination (p < .05). CONCLUSIONS: The intervention effect was found in delayed verbal memory. This program is also effective for improving attention and executive function in those with MCI. The short-term interventional findings suggest that this program might contribute to preventing a decline in memory and executive function. TRIAL REGISTRATION UMIN-CTR: UMIN000014712 (Date of ICMJE and WHO compliant trial information disclosure: 30 July 2014).

[A case of postoperative recurrent hilar cholangiocarcinoma in the lower bile duct treated with pancreatoduodenectomy].

When surgery is selected to treat postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct, attention should be paid to the following: 1 ) technical resectability of the lesion, 2) reconstruction, and 3) high risk of complications. Eight cases, including the present case, of pancreatoduodenectomy (PD) for postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct have been reported thus far. In October 2009, a 73-year-old man noticed that his stools were gray and visited a physician. He was diagnosed with cholangiocarcinoma on close examination and underwent left hepatic and caudate lobectomy in January 2010. After the surgery, he was treated with TS-1 (80 mg) and followed up at the outpatient clinic of our hospital. In July 2013, he was diagnosed with cancer of the lower bile duct and was admitted for surgery. The first and second pathological findings were carcinoma of the bile duct and papillary adenocarcinoma, respectively. The findings from the immunostaining were also inconsistent. The histopathological examination result suggested multicentric recurrence. The surgery was highly invasive, increasing the patient's risk of complications, in addition to the presence of postoperative adhesion. Therefore, surgery may be an important option for cases of localized recurrence but not for multicentric recurrence.

Locomotive and non-locomotive activities evaluated with a triaxial accelerometer in adults and elderly individuals.

BACKGROUND AND AIMS: Comparative data on locomotive and non-locomotive physical activity (PA) by age and gender are lacking for Japanese adults. The purpose of this study was to investigate objectively the levels of PA in each intensity in adults and older people by both genders living in Japan with triaxial accelerometry with discrimination between locomotive and non-locomotive PA. METHODS: In 571 women and 315 men aged 18-92 years from the Kanto region, PA was assessed for 6 consecutive days with a triaxial accelerometer (Active style Pro: HJA-350IT), and minutes of light and moderate-to-vigorous physical activity (MVPA) classified by metabolic equivalents were evaluated. RESULTS: Japanese elderly women over 70 years, spent less time in not only locomotive PA (light and MVPA), but also in non-locomotive MVPA. For non-locomotive light activity, however, there was no significant difference between women over 70 years and younger women. In contrast, for men, non-locomotive light activity and MVPA remained constant with age, while elderly men over 70 years spent less time in locomotive activities (light and MVPA). Women spent more time in non-locomotive activity than men, except for MVPA in elderly individuals, and time in non-locomotive MVPA occupied more than half of the total MVPA in all age groups for women. CONCLUSIONS: These findings suggest that the intensity and the type of PA for Japanese were obviously affected by age, while locomotive PA for men and non-locomotive light PA for Japanese women were obviously unaffected by age. The finding also indicates gender differences. Thus, evaluation of both locomotive and non-locomotive activity is important in the overall assessment of PA.

Effects of a comprehensive intervention program, including hot bathing, on physical function in community-dwelling healthy older adults: a pilot randomized controlled trial.

BACKGROUND AND AIMS: To study the effects of a comprehensive intervention program comprising exercise, diet, and hot bathing in community-dwelling older adults by using a randomized controlled trial. METHODS: The program included 61 community-dwelling healthy older adults (mean [SD] age, 69.9 [5.3] years) who were using a hot bath facility. The participants were randomly assigned to four groups as follows: an exercise, diet, and hot bath intervention group (A); an exercise and diet intervention group (B); a hot bath intervention group (C); and a control group (D). Individuals in groups A and B participated in a comprehensive intervention program (including exercise and diet classes) twice a week for 3 months, and those in groups A and C took hot baths. RESULTS: After 3 months, the participants in groups A and B showed a significantly greater improvement in their timed up and go test and stepping test scores than the participants in groups C and D. However, the participants in groups A and C did not show any dependent or independent effects of hot bathing. Three months after the intervention, a follow-up assessment indicated that the group A participants maintained the effect of the intervention and showed improved lower extremity function and health-related quality of life. CONCLUSIONS: The present study suggests that a comprehensive intervention program involving hot bathing may improve lower extremity function and that its effects can be maintained even in healthy older adults. However, the dependent or independent effects of hot bathing may not be expected for healthy older adults.

[Social concern and the present state of intergenerational programs. An analysis of newspaper articles and a survey of organizations].

OBJECTIVES: The objectives of this study were (1) to clarify changes in social concern in intergenerational programs and (2) to determine the current state of and issues affecting intergenerational programs. METHODS: Articles including the words "intergenerational programs" were selected from 3 major Japanese newspapers (Asahi Shimbun, Yomiuri Shimbun, and Mainichi Shimbun) using an online database (399 articles). Content analysis was conducted to check changes in the number and content of articles. A total of 56 cases of intergenerational programs were selected, and a questionnaire survey was conducted with the responsible organization. The problems were classified using cluster analysis. RESULTS: Content analysis revealed that the number of articles relating to this topic increased towards the end of the 1990s, which corresponds with a change in social policy. The questionnaire survey revealed that most of the intergenerational programs were either annual or periodic activities. Furthermore, it was shown that the 4 main issues facing current intergenerational programs were the intergenerational gap, operating problems, activity selection, and lack of participants. CONCLUSION: In summary, social concern regarding the intergenerational programs has increased. However, most intergenerational programs were infrequent and quite time-intensive. Furthermore, the 4 issues mentioned above must be addressed in order to create programs that have wide-ranging benefits for each community. Resolving the problem of compartmentalized administration and appointing local coordinators is necessary to solve these problems.

[Association of confidence in motor function and fear of falling with physical ability in community-dwelling older people].

OBJECTIVE: The objective of this study was to investigate the difference of physical ability depending on the presence or absence of confidence in motor function (CIMF) and fear of falling (FOF) in independently living community-dwelling older adults. METHODS: Participants in this study were 368 community-dwelling older adults (mean age±SD, 72.2±5.7 years) without instrumental activity of daily living (IADL) problems who participated in a comprehensive health check-up. CIMF (existence or non-existence), FOF (existence or non-existence), past medical history, history of a fall within the past year, and self-rated health were assessed by interview. Physical ability [grip strength, one-leg standing (OLS), maximum walking speed (MWS), and timed up & go test (TUG)] was also measured. RESULTS: Our results revealed significantly more older adults with FOF and without CIMF than expected, indicating that CIMF might be a component factor in FOF. Two-way ANOVA adjusted for sex and age showed main effects of the CIMF factor on grip strength, OLS, and TUG, indicating that these physical abilities are reduced in participants without CIMF, regardless of FOF. On the other hand, we found a main effect of the FOF factor on MWS. Logistic regression analysis showed that frequency of going outdoors, self-rated health, arthropathy, and OLS were factors associated with CIMF. CONCLUSIONS: Our results suggest that CIMF is a useful screening tool for older adults with potential problems and evaluation of intervention for health promotion in community-dwelling older adults without IADL problems.

[The influences of exercise fulfillment on mental and physical functions of targeted older adults and the effect of a physical exercise intervention].

OBJECTIVES: To investigate the influence of the differences in exercise fulfillment on mental and physical functions and the effects of exercise intervention on community-dwelling older adults. METHODS: Participants in this study included 260 community-dwelling older adults (mean age +/- SD, 70.4 +/- 6.0 years) who participated in the exercise intervention study (intervention and control groups). Exercise fulfillment levels (low or high), physical activity levels (low or high), mental health (WHO-5 scores), health-related QOL (SF-8 score), and physical abilities of these adults were measured during a baseline health checkup. Based on the status of the 3 exercise fulfillment groups, multivariate analysis of variance (MANOVA), which was adjusted for age, sex, and physical activity levels, was performed to compare the results of the outcome measures among the 3 groups. The intervention group (n = 88, aged 70.3 +/- 6.2 years) was divided into 2 subgroups: the deterioration subgroup (participants with low-exercise fulfillment after the intervention) and the improvement subgroup (participants with high-exercise fulfillment after the intervention). Subsequently, the intervention effects were assessed by repeated measurements of the analysis of variance (ANOVA) between the 2 subgroups. RESULTS: MANOVA analysis revealed that body mass index, grip strength, maximum walking speed, the WHO-5 score, and the SF-8 subscale (8 items) score differed significantly amongst the groups. The high-exercise fulfillment group demonstrated better results for these variables than the low-exercise fulfillment group. Similar results were obtained for each group with respect to the physical activity levels. The repeated-measures ANOVA revealed that time had an important effect on lower physical functions and the SF-8 subscale (1 item) score; it also revealed the important effects of body mass index, the WHO-5 score, the SF-8 subscale (6 items) score, and psychological independence on the group. CONCLUSION: Older adults with higher exercise fulfillment demonstrated better mental and psychological health, regardless of their physical activity levels. Older adults with low-exercise fulfillment could potentially improve their physical abilities; however, their mental and psychological health significantly differed from that of older adults with medium- or high-exercise fulfillment after exercise intervention. These findings provide preliminary evidence, which indicates that exercise can provide sufficient fulfillment and contribute to the promotion and improvement of health in older adults. Moreover, performing adequate tests on exercise fulfillment may aid in assessing the effects of intervention programs in regional healthcare systems.

[The association between foot problems and falls in older adults -a covariance structure analysis-].

AIM: To investigate the manner in which community-dwelling older adults' foot problems affect their history of falls. METHODS: This study included 112 community-dwelling older adults. Foot problems (e.g., inflammation, ingrown nails, and pain while walking), self-rated physical ability (e.g., gait, tripping over, and balance), history of falls within a year, and physical ability (e.g., walking speed, Timed Up & Go test, and one leg balance test) were measured during a routine health checkup. Of these, five subjects were excluded due to incomplete all the measurement. Thus, the subjects eligible for analysis were 107 older adults (mean age±standard deviation=73.0±5.5 years). Covariance structure analysis was used to identify the inter-relationships among all measurements. RESULTS: The covariance structure analysis showed that foot problems negatively influenced participants' self-rated physical ability, and this relationship was also linked to history of falls. The overall fit of this model was judged to be statistically satisfactory (GFI=0.959, AGFI=0.912, CFI=0.981, RMSEA=0.043). CONCLUSIONS: Our model indicated that the association between foot problems and history of falls was affected by self-rated physical ability. Furthermore, in order to prevent falls, the current results suggest that foot care could be an important intervention in older adults to prevent decline in their overall physical ability.

[A randomized controlled trial of the effects of a comprehensive intervention program for community-dwelling older adults].

AIM: The objective of this study was to evaluate the effects of a comprehensive intervention program named SPRING, which utilizes a hot spring facility, in community-dwelling older adults in a randomized controlled trial. METHODS: A total of 60 community-dwelling elderly people (mean age, 72.7±6.0 years) participated in this program. After baseline investigation, participants were randomly assigned to an intervention group (n=31) or a control group (n=29). The intervention group participated in a comprehensive intervention program (including exercise classes, nutrition classes and bathing) twice a week for 3 months. After 3 months and 6 months, we evaluated the effects of the intervention. RESULTS: The attendance rate of the intervention group was 76%, and there were no accidents or injuries associated with this program. After 3 months, grip strength and one-leg standing with eyes-open scores significantly improved among the intervention group, compared with the control group (p=0.028; p=0.003, respectively). On follow-up, grip strength, one-leg standing with eyes-open scores and the World Health Organization Well-Being Index (WHO-5) scores were statistically significantly maintained or had improved in the intervention group (p=0.001; p=0.024; p=0.027, respectively). CONCLUSION: The comprehensive intervention program SPRING may improve physical function among community-dwelling older adults. In addition, SPRING may have long-term beneficial effects for older adults.