Combined Impacts of Physical Activity, Dietary Variety, and Social Interaction on Incident Functional Disability in Older Japanese Adults.

BACKGROUND: This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults. METHODS: Participants were 7,822 initially non-disabled residents (3,966 men and 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database. RESULTS: During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (95% CI, 0.59-0.78), 0.87 (95% CI, 0.77-0.99), and 0.90 (95% CI, 0.79-1.03), respectively. Incident disability HRs gradually reduced with increased frequency of satisfying these behaviors (any one: HR 0.82; 95% CI, 0.65-1.03; any two: HR 0.65; 95% CI, 0.52-0.82; and all three behaviors: HR 0.54; 95% CI, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (95% CI, -0.2 to 7.9%), 9.6% (95% CI, 4.8-14.1%), and 16.0% (95% CI, 8.7-22.8%), respectively. CONCLUSION: Combining physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Improving insufficient behavior elements through individual habits and preexisting social group activities may be effective in preventing disability in the community.

[Development and evaluation of a modified version of the dietary variety score for community-dwelling older adults].

Objectives　The dietary variety score (DVS) was developed as an index to assess the variety of food intake among older Japanese adults and has been widely used in epidemiological studies and public health settings. However, this index has not been reviewed since its development in the 1990s and may not adequately reflect the current dietary habits of the older Japanese population. In this study, we developed a modified version of the DVS (MDVS) and examined its validity.Methods　We conducted a cross-sectional study of 357 community-dwelling adults aged ≥65 years (mean age: 76.2±4.6, men: 61.1%) who participated in the 2016 survey of the Hatoyama cohort study. The DVS and MDVS were assessed by the number of food groups eaten almost every day based on the weekly frequency of consumption. The DVS was calculated based on ten components: meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruits, seaweed, and fats/oils. The components of the MDVS were determined by calculating the contribution of each food group to the total and nutrient intakes from the food groups comprising the main dish, side dish, and soup, based on the data from older adults aged ≥65 years who participated in the 2017 National Health and Nutrition Survey in Japan. Based on the contribution of each food group, we added "other vegetables" and "dairy products" in the MDVS. Dietary intake was assessed using a validated, self-administered diet history questionnaire. We calculated the probability of adequacy for each of the fourteen nutrients selected as per the estimated average requirement in the Dietary Reference Intake for Japanese 2020 and the mean probability of adequacy for all fourteen nutrients. In addition, we assessed the correlation between the DVS, MDVS, and each indicator and the significance of the difference between correlation coefficients.Results　The MDVS was significantly positively correlated with the energy ratios of protein and fat, dietary fiber, potassium, and the modified diet score based on the Japanese Food Guide Spinning Top (r=0.21-0.45) and negatively correlated with the carbohydrate energy ratio (r=-0.32). The MDVS was also correlated with the mean probability of nutrient adequacy (r=0.41). The correlation coefficients between the MDVS and each indicator were not significantly different from those of the DVS.Conclusions　Validity in terms of nutrient intake and diet quality was comparable between the DVS and MDVS. To revise the DVS, it is necessary to conduct nationwide studies based on highly accurate dietary surveys.

Effectiveness of a community-wide intervention for population-level frailty and functional health in older adults: A 2-year cluster nonrandomized controlled trial.

This cluster nonrandomized controlled trial examined the effectiveness of a 2-year community-wide intervention (CWI) on population-level frailty and functional health among older adults. We allocated 18 districts in Ota City, Tokyo, Japan, to intervention (3 districts, A-C) and control (15 districts) groups. Of the 15,500 stratified randomly sampled residents aged 65-84 years, 11,701 (6009 in intervention and 5692 in control groups) gave valid responses to the baseline survey and were followed for 2 years. Using participatory action research framework, we developed an evidence-based CWI to promote frailty prevention. The outcomes were changes in frailty (primary), functional health (secondary, i.e., physical, nutritional, and psychosocial variables), and awareness. Primary analyses showed no significant group by time interactions in frailty prevalence (difference in multivariate-adjusted change between groups, 1.8 percentage points [PP] [95% CI, -0.1, 3.6]). Although changes in functional health were similar between groups, prespecified subgroup analyses showed a benefit for ≥150 min/week of walking (3.9 PP [1.9-5.8]) in district A, and for exercise ≥1 time/week (2.1 PP [0.1-4.0]), Motor Fitness Scale (0.10 points [0.01-0.20]), Dietary Variety Score (DVS) (0.10 points [0.01-0.18]), DVS of ≥7 (2.0 PP [0.01-4.1]), and going outdoors ≥1 time/day (2.1 PP [0.1-4.1]) in district C. Awareness of our CWI was significantly higher in the intervention group (multivariate-adjusted difference between groups, 5.8 PP [3.9-7.8]). This CWI increased awareness in intervention group and improved population-level functional health in intervention subgroups in the short term but was not effective for population-level frailty prevention at 2 years. Trial registration: UMIN-CTR (UMIN000026515).

Development of risk prediction models for incident frailty and their performance evaluation.

There is currently no tool to predict incident frailty despite various frailty assessment tools. This study aimed to develop risk prediction models for incident frailty and evaluated their performance on discrimination, calibration, and internal validity. This 2-year follow-up study used data from 5076 non-frail older adults (51% women) living in Tokyo at baseline. We used the Kaigo-Yobo checklist, a standardised assessment instrument, to determine frailty. Twenty questionnaire-based variables that include sociodemographic, medical, behavioural, and subjective factors were entered into binary logistic regression analysis with stepwise backward elimination (p < 0.1 for retention in the model). Discrimination and calibration were assessed by area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. For the assessment of internal validity, we used a 5-fold cross-validation method and calculated the mean AUC. At the follow-up survey, 15.0% of men and 10.2% of women were frail. The frailty risk prediction model was composed of 10 variables for men and 11 for women. AUC of the model was 0.71 in men and 0.72 in women. The P-value for the Hosmer-Lemeshow test in both models was more than 0.05. For internal validity, the mean AUC was 0.71 in men and 0.72 in women. Probability of incident frailty rose with an increasing risk score that was calculated from the developed models. These results demonstrated that the developed models enable the identification of non-frail older adults at high risk of incident frailty, which could help to implement preventive approaches in community settings.

[The effects of the "Tabepo Check Sheet," which lists 10 food groups, on the dietary variety of older adults in a metropolitan area].

Objectives　This study examined the effects of checking the "Tabepo Check Sheet," which has 10 food groups, on changes in dietary variety among older adults living in Japanese metropolitan areas.Methods　We used baseline and two-year follow-up data from a community-wide intervention to prevent frailty in Ota City, Tokyo. A total of 8,635 non-disabled residents (4,145 men and 4,490 women) aged 65-84 years who responded to the self-administered questionnaire surveys in 2016 and 2018, were included in the two analyses. In 2018, we asked about their experience with the "Tabepo Check Sheet," which had been distributed among participating communities from three districts in Ota City since July 2017. The "checked group" consists of those who answered "habitually check" or "have checked." Dietary variety was assessed using the Dietary Variety Score (DVS). We performed propensity score matching with a 1:1 ratio (checked group vs. non-checked group) for the following variables: demographic, socioeconomic, physical, medical, and lifestyle variables, and DVS. After propensity score matching, 876 participants from the checked and non-checked groups were selected. We used a two-way ANOVA to examine the changes in DVS over two years. We also compared the rates of DVS ≤3 and ≥7 points in 2018 using multivariate adjusted logistic regression analysis.Results　In 2018, 11.9% of the respondents had checked the "Tabepo Check Sheet." The DVS mean±standard deviation in the checked and non-checked groups were 3.9±2.2 points and 3.9±2.3 points in 2016, respectively, and 4.5±2.4 points and 4.1±2.4 points in 2018, respectively. The DVS showed a significant interaction between checking experience and time (p<0.001). The rates of DVS ≤3 points in 2018 were 35.2% and 43.8% among the checked and non-checked groups, respectively. The multivariate adjusted odds ratio (OR) of DVS ≤3 points was 0.68 (95% confidence interval [95% CI] 0.56-0.83) in the checked group versus the non-checked group. The rates of DVS ≥7 points in 2018 were 21.7% and 16.8% among the checked and non-checked groups, respectively. The multivariate adjusted OR (95% CI) of DVS ≥7 points was 1.40 (1.10-1.78) in the checked versus the non-checked group.Conclusions　These results suggest that checking the "Tabepo Check Sheet" may improve dietary variety. However, the effects of dietary variety improvement may be weakened by the incidence of skipped meals, social isolation, frailty, and lack of social participation.

[A Case of Rheumatoid Arthritis Caused by Pembrolizumab Treatment for Non-Small Cell Lung Cancer].

A man in his 40s underwent a transbronchial lung biopsy and received a diagnosis of adenocarcinoma of the right upper lobe of the lung(cT4N0M0, Stage Ⅲ)with no EGFR gene mutation, no ALK fusion gene, no ROS1 fusion gene, and a tumor proportion score(TPS)of 50-74%. During the postoperative follow-up period, enlarged right supraclavicular lymph nodes and right upper and lower paratracheal lymph nodes were detected, diagnosed as recurrence by positron emission tomography-computed tomography. Although a positive rheumatoid factor test, as the patient had no symptoms of rheumatoid arthritis(RA), treatment with pembrolizumab was initiated. Before the second treatment course, a pharmacist conversing with the patient observed that the patient was experiencing pain in his fingers. After discussing the possibility of treatment continuation and test items with the attending physician, the patient underwent tests and received a diagnosis of RA.

[Trajectories of Dietary Variety Score among community-dwelling older Japanese and their related factors].

AIM: To categorize the age-related trajectories of dietary variety score (DVS) in the community-dwelling elderly and to examine the associated factors. METHODS: The study population included 1,195 people who underwent a medical checkup for the elderly in Kusatsu-town, Gunma Prefecture in 2012 to 2017. A multinomial logistic regression analysis was performed to examine the factors associated with the age-related trajectories of DVS. The dependent variables were sex, age, family structure, years of education, BMI, subjective chewing ability, TMIG-IC, GDS-15, MMSE, smoking, alcohol consumption, and history of hypertension, dyslipidemia, diabetes mellitus, and stroke. RESULTS: The adjusted odds ratio (95% confidence intervals) of the low trajectory group in comparison to the medium trajectory group were 2.69 (1.02-7.08) for subjective chewing ability (no chewing), 1.11 (1.06-1.17) for GDS-15, 1.76 (1.14-2.73) for current smoking, and 1.70 (1.19-2.43) for past smoking. In contrast, the adjusted odds ratio of the high trajectory group in comparison to the medium trajectory group were 0.61 (0.37-1.00) for men, 1.04 (1.01-1.07) for age, 0.58 (0.38-0.89) for subjective masticatory ability (difficult to chew), 0.88 (0.82-0.96) for GDS-15, and 0.55 (0.37-0.83) for a history of hypertension. CONCLUSIONS: The age-related trajectory patterns of DVS in the community-dwelling elderly can be categorized into three types. In order to maintain a high quality of food intake, it was shown that, in addition to subjective masticatory ability and mental health factors, such as depression, we should pay attention to the control of hypertension, which is a risk factor for lifestyle diseases, and lifestyle habits such as smoking.

[Effects of a multifactorial intervention for improving frailty on risk of long-term care insurance certification, death, and long-term care cost among community-dwelling older adults: A quasi-experimental study using propensity score matching].

Objectives　To examine the effects of a multifactorial intervention for improving frailty-comprising resistance exercise and nutritional and psychosocial programs-on the risk of long-term care insurance (LTCI) certification, death, and long-term care (LTC) cost among community-dwelling older adults.Methods　Seventy-seven individuals (47 in 2011 and 30 in 2013) from the Hatoyama Cohort Study (742 individuals) participated in a multifactorial intervention. Non-participants were from the same cohort (including people who were invited to participate in the multifactorial intervention but declined). We performed propensity score matching with a ratio of 1 : 2 (intervention group vs. non-participant group). Afterward, 70 individuals undergoing the multifactorial intervention and 140 non-participants were selected. The risk of LTCI certification and/or death and the mean LTC cost during the follow-up period (32 months) were compared using the Cox proportional hazards model and generalized linear model (gamma regression model).Results　The incidence of new LTCI certification (per 1,000 person-years) tended to be lower in the intervention group than in the non-participant group (1.8 vs. 3.6), but this was not statistically significant as per the Cox proportional hazards model (hazard ratio=0.51, 95% confidence interval [CI]=0.17-1.54). Although the incidence of LTC cost was not significant, the mean cumulative LTC cost during the 32 months and the mean LTC cost per unit during the follow-up period (1 month) were 375,308 JPY and 11,906 JPY/month, respectively, in the intervention group and 1,040,727 JPY and 33,460 JPY/month, respectively, in the non-participant group. Cost tended to be lower in the intervention group than in the non-participant group as per the gamma regression model (cumulative LTC cost: cost ratio=0.36, 95%CI=0.11-1.21, P=0.099; LTC cost per unit follow-up period: cost ratio=0.36, 95%CI=0.11-1.12, P=0.076).Conclusions　These results suggest that a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs is effective in lowering the incidence of LTCI certification, consequently saving LTC cost, although the results were not statistically significant. Further research with a stricter study design is needed.

[Awareness of the term "frailty" and its correlates among older adults living in a metropolitan area].

Objectives　This study aimed to examine the awareness of the term "frailty" and its correlates among older adults living in a Japanese metropolitan area.Methods　We used baseline and 2-year follow-up data from a community-wide intervention on preventing frailty in Ota City, Tokyo. In July 2016, we conducted a self-administered questionnaire survey via mail to investigate the lifestyle and health status of 15,500 non-disabled residents aged 65-84 years from all 18 districts. In July 2018, we investigated the awareness of the term "frailty" in the same sample using a different questionnaire, and 10,228 people (4,977 men and 5,251 women) were included in the analyses. In addition, 9,069 people (4,347 men and 4,722 women) who responded to both 2016 and 2018 surveys were analyzed for correlates of awareness of the term "frailty." We categorized the responses "I know the meaning" or "I have heard of it but do not know the meaning" as awareness of the term. Decision tree and multilevel Poisson regression analyses were performed to examine the association of the following with awareness of "frailty": age, marital status, living situation, education, equivalent income, body mass index, number of chronic diseases, alcohol consumption, smoking status, Dietary Variety Score (DVS), and presence or absence of lower back and knee pains, depressive mood, exercise habits, social activity, social isolation, and frailty.Results　Awareness of the term "frailty" was estimated as 20.1% in total (15.5% in men and 24.3% in women). The subgroup with the highest "frailty" awareness was women who exercised, were socially active, and had a DVS of 4 or more (awareness of 36.3%). Significant independent correlates of "frailty" awareness were age (as per year: multivariate-adjusted prevalence ratio=1.03, [95% confidence interval=1.02-1.04]), sex (women: 1.35 [1.21-1.51]), educational attainment (high school: 1.27 [1.11-1.45], higher than junior college/vocational schools: 1.47 [1.28-1.70]), equivalent income (more than 2.5 million yen/year: 1.12 [1.01-1.25]), exercise habits (presence: 1.26 [1.11-1.43]), DVS (6 points or more: 1.37 [1.21-1.55]), social activity (presence: 1.33 [1.20-1.49]), social isolation (presence: 0.75 [0.67-0.85]), and frailty (presence: 0.72 [0.62-0.84]).Conclusions　Although many policies refer to "frailty," the level of awareness of the term among older adults was low. Older adults, especially women, who had higher socioeconomic status, better exercise and dietary habits, and stronger social connections, were significantly more aware of the term. In contrast, individuals who were socially isolated and/or frail did not know the term. Thus, it is crucial to develop specific measures to promote frailty prevention among high-risk individuals.

[Impact of lifestyle-related diseases and frailty on the incidence of loss of independence in Japanese community-dwelling older adults: A Longitudinal Study on Aging and Health in Kusatsu].

Objectives　This study aimed to determine risk factors for frailty and lifestyle-related diseases impacting the incidence of loss of independence among Japanese community-dwelling older adults, and to measure the magnitude of these associations.Methods　We conducted an 8.1-year prospective study involving 1,214 residents of the town of Kusatsu, aged 65 years and over, who were initially free of disability and underwent the comprehensive geriatric assessment between 2002 and 2011. Loss of independence was defined as the incidence of disability or having died before the occurrence of disability was certified by the Long-Term Care Insurance program in Japan. Risk factors for lifestyle-related diseases and health status comprised hypertension, diabetes mellitus, overweight, chronic kidney disease, current smoking, past history of stroke, heart disease and cancer, frailty, underweight, anemia, hypoalbuminemia, and cognitive decline. Frailty was defined as the presence of three or more of the following criteria: Weight loss, weakness, exhaustion, slowness, and low levels of physical activity. Prefrailty was defined as the presence of one or two of these same criteria. Cox proportional-hazard regression model was used to estimate hazard ratios (HR) and the population attributable fraction (PAF) of loss of independence.Results　During the follow-up, 475 cases, including 372 disabilities and 103 deaths, were identified as having experienced loss of independence. The multivariable HRs for the loss of independence were 1.3 to 2.2-fold higher for the presence of frailty, past history of stroke, cognitive decline, prefrailty, and smoking. The PAF of loss of independence was the greatest for prefrailty (19%), followed by frailty (12%). The PAF was relatively large for prefrailty (19%) and smoking (11%) in men, and frailty (18%), prefrailty (18%), and chronic kidney disease (11%) in women. Stratified by age category, participants aged 65-74 years having frailty and several lifestyle-related diseases showed significantly higher HRs for loss of independence and greater PAFs for prefrailty (18%), frailty (13%), and smoking (11%).Conclusions　Loss of independence among Japanese community-dwelling older adults who underwent screening examinations was largely attributed to frailty and prefrailty. Our findings suggest that the screening and the intervention for frailty and lifestyle-related diseases in the early stages of old age might be beneficial in prolonging healthy life expectancy of Japanese community-dwelling older adults.

Frequency of Balanced-Meal Consumption and Frailty in Community-Dwelling Older Japanese: A Cross-Sectional Study.

BACKGROUND: Although meals that combine a staple food, main dish, and side dish (balanced meals) are recommended in Japan, the health effects of such meals are unclear. We investigated the association of frequency of eating balanced meals with frailty among community-dwelling older Japanese. METHODS: We analyzed data from 912 persons aged 65 years or older who participated in the Hatoyama Cohort Study or Kusatsu Longitudinal Study. The frequency of eating two or more balanced meals daily was self-reported as ≤1 day/week, 2 or 3 days/week, 4 or 5 days/week, and daily. Frailty was defined as the presence of at least three, and pre-frailty as the presence of one or two, of the following criteria: weight loss, muscle weakness, exhaustion, slowness, and low physical activity. Adjusted logistic regression was used to study associations of frequency of balanced-meal consumption with frailty (prefrailty and frailty combined) and frailty criteria. RESULTS: Participants reporting a frequency of balanced-meal consumption of ≤2 or 3 days/week had a higher prevalence of frailty (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.21-2.64) than did those reporting a frequency of daily. Lower frequency of balanced-meal consumption was also associated with higher prevalences of weight loss (OR, 4.10; 95% CI, 1.90-8.85), exhaustion (OR, 6.35; 95% CI, 2.49-16.17), and low physical activity (OR, 1.92; 95% CI, 1.22-3.01). CONCLUSIONS: Our findings suggest that more frequent twice daily consumption of meals with a staple food, main dish, and side dish decreases the risks of prefrailty and frailty.

A Community-Wide Intervention Trial for Preventing and Reducing Frailty Among Older Adults Living in Metropolitan Areas: Design and Baseline Survey for a Study Integrating Participatory Action Research With a Cluster Trial.

BACKGROUND: Preventing and reducing frailty is an important challenge for Japan in the next decade, especially in metropolitan areas. We launched a community-wide intervention trial (the Ota Genki Senior Project) in 2016 to develop effective community-based strategies for frailty prevention in metropolitan areas. This report describes the study design and baseline survey. METHODS: This study is a community-wide intervention trial that integrates participatory action research into a cluster non-randomized controlled trial for adults aged 65 years or older living in Ota City, Tokyo. We allocated 3 of 18 districts to an intervention group and the other 15 to a control group. Using a mailed self-administered questionnaire, we conducted a baseline survey of 15,500 residents (8,000 and 7,500 in the intervention and control groups, respectively) from July through August 2016. In addition to socioeconomic status and lifestyle variables, we assessed frailty status (primary outcome) and physical, nutritional, and psychosocial variables (secondary outcomes). Based on the baseline findings, an intervention to improve outcomes will be implemented as participatory action research. Follow-up surveys will be conducted in the same manner as the baseline survey. RESULTS: A total of 11,925 questionnaires were returned (76.9% response rate; 6,105 [76.3%] and 5,820 [77.6%] in the intervention and control groups, respectively), and 11,701 were included in the analysis (mean age, 74.3 [standard deviation, 5.5] years; 48.5% were men). CONCLUSIONS: This study is expected to contribute to development of a prototype of a community-wide frailty prevention strategy, especially in metropolitan areas in Japan. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN000026515).

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.

[Process and outcome evaluation of community-based strategies for frailty prevention in the elderly with the help of the senior workforce at Silver Human Resources Centers in Yabu City, Japan].

Objectives　Preventing frailty is a crucial issue in aging societies such as Japan. In 2011, we launched an action research project in Yabu City, Hyogo Prefecture, to develop effective community-based strategies to prevent frailty in the elderly. We attempted to introduce community-based frailty prevention classes in every administrative district with the help of the senior workforce at Silver Human Resources Centers. This study aimed to evaluate the effectiveness and the applicability to different communities of this strategy, which will be called the "Yabu model."Methods　Using PAIREM (Plan, Adoption, Implementation, Reach, Effectiveness, Maintenance) framework, we evaluated the effectiveness and the applicability to different communities of the Yabu model. To evaluate its effectiveness, we conducted a baseline and follow-up survey of residents aged 65 years or older in 2012 (n=7,287, 90.7% response rate) and 2017 (n=8,157, 85.7%), using a mailed self-administered questionnaire.Results　(1) Plan: The idea was to establish a frailty prevention class (60 min/session, once a week) consisting of resistance exercises and nutritional or psychosocial programs (standard course, six months, 20 sessions/course; short course, one and a half months, 6 sessions/course; after the course, residents continued with the activities themselves). We planned to launch three classes in the first year (2014) and then to increase the number of classes by ten each year after the second year. (2) Adoption: Out of 154 administrative districts, 36 (23.4%) held frailty prevention classes between 2014 and 2017. (3) Implementation: The median attendance rate for the standard or short course (number of times each participant attended/number of frailty prevention class sessions held) was 75.0%. (4) Reach: A total of 719 older people participated in the standard or short course. The participation rate in the administrative districts, where each frailty prevention class was held, was 32.8%, while at the city level it was 8.1%. (5) Effectiveness: Propensity score matching after multiple imputations were performed. While the prevalence of frailty in non-participants increased by 13.7% in the five years from 2012 to 2017, it only increased by 6.8% in participants. Compared to non-participants, program participants had a significantly lower prevalence odds ratio of frailty at the time of the follow-up survey (OR=0.65, 95% confidence interval 0.46-0.93). (6) Maintenance: After the standard or short course, 25 out of 26 communities (96.2%) continued the frailty prevention activities once a week.Conclusion　The frailty prevention classes were adopted across many districts and lowered the participants' risk of frailty. Moreover, participants continued to engage in frailty prevention activities even after the course. These results indicate the Yabu model's effectiveness and its applicability for a different community.

Individual- and community-level neighbor relationships and physical activity among older Japanese adults living in a metropolitan area: a cross-sectional multilevel analysis.

BACKGROUND: Informal neighbor relationships (NRs) are considered a structural aspect of social relationships. Although NRs might affect physical activity (PA), no previous study has simultaneously examined compositional and contextual associations of NRs with PA. In this study, we examined whether individual- and community-level NRs were independently associated with PA. METHODS: We analyzed cross-sectional data from 8592 (4340 men and 4252 women) non-disabled residents aged 65-84 years from all 18 districts of Ota City, Tokyo. PA was assessed by using the International Physical Activity Questionnaire-Short Form. In addition, we calculated moderate-to-vigorous PA (MVPA), its components (vigorous PA [VPA], moderate PA [MPA], and walking time [WT]), and sitting time (ST). Individual-level NRs were categorized as "visiting each other," "standing and chatting," "exchange of greetings," or "none." Community-level NRs were defined as the proportions of residents with active NRs (i.e., those in the categories visiting each other and standing and chatting) in the 18 districts. Using multilevel regression analyses, we examined independent associations of individual- and community-level NRs with PA variables and adjusted for important confounders. RESULTS: Individual-level NRs were consistently positively associated with MVPA and its components (VPA, MPA [in men], and WT) in both sexes, and the dose-response relationships were significant (all P < 0.041 for trend). In men, community-level NRs (by 1% estimation) were positively associated with individual MVPA (2.1 metabolic equivalent-hours/week, 95% confidence interval: 0.7-3.4), VPA (8.6 min/week, 2.7-14.4), and WT (11.6 min/week, 2.2-20.9), regardless of the degree of individual-level NRs. Significant cross-level interactions of NRs with MVPA and VPA were observed among men, and the dose-response relationships were significant (both P < 0.037 for trend). Neither individual- nor community-level NRs were associated with ST in either sex. CONCLUSIONS: Men and women with inaccessible neighbors engaged in less MVPA, while men living in communities with active NRs engaged in more MVPA, regardless of individual-level NRs. NRs at the individual and community level might help prevent physical inactivity among men.

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.

[Relationship between eating alone and dietary variety among urban older Japanese adults].

Objectives　This study aimed to investigate the practice of eating alone, including its frequency, among urban older Japanese adults and to clarify its association with dietary variety.Methods　In June 2016, self-reported questionnaires were mailed to 15,500 men and women aged 65 years or older living in Ota City, Tokyo without nursing care certification. Of these, 11,925 questionnaires were returned (a 76.9% response rate), and responses from 8,812 subjects were analyzed (a 56.9% valid response rate). The frequency of eating alone, defined as the number of days per week eating alone for each meal, was reported as zero, one to three, four to six, or seven days. A Dietary Variety Score (DVS) was obtained based upon consumption frequencies per week of 10 food groups. Total points were calculated, and three or fewer points indicated low dietary variety. The association between eating alone and low dietary variety was analyzed by binomial logistic regression, with adjustments for potential confounding variables including age, body mass index (BMI), location, educational history, equivalent income, employment, living alone, medical history, and smoking and drinking habits.Results　The results indicated that 47.1% of men and 48.5% of women ate alone at least one day per week, and 14.9% of men and 16.9% of women ate alone every day. For men, after adjusting for potential confounders (ORs=1.51-2.00), the odds ratios (ORs) of low DVSs were significantly higher among those who ate alone one to three days, four to six days, or seven days per week compared to those who ate with others. For women, adjusted ORs were not significant among those who ate alone every day (OR=1.15, 95% CI=0.92-1.43). Men and women who ate alone had significantly lower ORs of eating green or yellow vegetables, fruits, and fats/oils almost every day compared to those who ate with others.Conclusion　Among urban Japanese older adults, about 50% of subjects reported eating alone. Eating alone was associated with lower dietary variety scores regardless of age, income, and family status. Therefore, the present findings might be useful for developing strategies for addressing undernutrition among urban older adults eating alone.

[Impact of frailty and metabolic syndrome on the incidence of loss of independence in community-dwelling older Japanese: the Kusatsu-town study].

Objectives　To investigate the relationship between frailty, metabolic syndrome (MetS), and loss of independence leading to the onset of disability or death among community-dwelling older Japanese.Methods　Between 2002 and 2011, we conducted a 7-year prospective study involving 1,453 residents aged 65 years and over, initially free of disability, who underwent a comprehensive geriatric assessment in Kusatsu town. Statistical analysis was conducted for those with complete values, resulting in a variable number of subjects for each data point. Frailty was defined for 1,335 subjects as three or more of the following criteria: weight loss (>2-3 kg in the past six months), weakness (grip strength was <26 kg for men and <18 kg for women), exhaustion (answer of "no" to the question "Do you feel full of energy?" on the Geriatric Depression Scale), slowness (usual gait speed<1.0 m/s), and low physical activity (answer of "less than once a week" to the question "How often do you usually go outdoors?"). MetS was defined for 1,450 subjects from the Japanese definition. The Cox proportional-hazard regression model was used to estimate hazard ratio (HR) of loss of independence for 1,217 subjects.Results　During the follow-up, 494 cases of loss of independence, including 376 disabilities and 118 deaths were identified. In men and women, the incidence of the loss of independence showed a significant linear trend according to the severity classification of frailty. By contrast, there was no relationship between MetS and the loss of independence. Subjects classified as prefrail and frail had an increased risk of loss of independence compared with robust participants, with sex- and age-adjusted HRs (95% CIs) of 1.5 (1.2-1.9) and 2.4 (1.8-3.3), respectively. After adjusting for sex, age, the presence of MetS, low serum total cholesterol, chronic kidney disease, anemia, low serum albumin, cognitive impairment, and past history of stroke, the respective multivariable HRs (95% CIs) of loss of independence were 1.5 (1.2-1.9) and 2.1 (1.5-2.9). The magnitude of the risk of loss of independence incidence for frailty was greater among the subjects aged 65-74 years than those aged ≥75 years.Conclusions　Frailty was significantly associated with incident loss of independence among elderly Japanese. The presence of MetS had no effect on subsequent onset of disability and mortality in elderly Japanese. Our findings suggest screening and intervention for frailty in the early stage of aging are beneficial to prolong healthy life expectancy of elderly Japanese.