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

OBJECTIVES: Frailty is a significant cause of adverse health events including long-term care and hospitalization. Although information and communication technology (ICT) has become an integral part of modern life, it remains unclear whether ICT use is associated with frailty. DESIGN: A cross-sectional study (Integrated Longitudinal Studies on Aging in Japan, ILSA-J). SETTING AND PARTICIPANTS: Aged 75 and older data from the ILSA-J in 2017 (n = 2893). METHODS: ICT use was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Specifically, the use of mobile phones, ATMs, DVD players, and sending e-mails were rated as "yes" (able to do) or "no" (unable to do), with the first quintile (≤1 point) defined as ICT non-users. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria based on the phenotype model (e.g., weight loss, slowness, weakness, exhaustion, and low activity). Further, multivariate logistic regression analysis analyzed its association with ICT use. Subgroup analyses were stratified according to gender, years of education, and living arrangements. RESULTS: Higher ICT use was not associated with frailty after adjusting for covariates (odds ratio [OR]: 0.53; 95%CI 0.39-0.73). Similar associations were found in the sub-groups of women (OR 0.45, 95%CI 0.30-0.66), <13 years of education (OR 0.48, 95%CI 0.34-0.67), living alone (OR 0.46, 95%CI 0.27-0.79), and living together (OR 0.57, 95%CI 0.38-0.85). No association existed between using ICT and frailty in the sub-groups of men and ≥13 years of education. CONCLUSIONS AND IMPLICATIONS: Higher ICT use is associated with the absence of frailty in individuals 75 years and older. Such benefits may be particularly pronounced in women, those with lower levels of education, and older adults living alone or with others.

Are middle-aged and older adult users of physical activity monitors more physically active and at a lower risk of locomotive syndrome? Cross-sectional Web-based Online Survey.

Background: Physical inactivity is a risk factor for locomotive syndromes and functional limitations in middle-aged and older adults. Therefore, strategies to promote physical activity should be considered. This study investigated whether users of physical activity monitors were more physically active and exhibited a lower risk of locomotive syndrome, compared with non-users. Methods: We analyzed data from 742 Japanese adults aged 60-79 years. The participants were surveyed for their use of physical activity monitors in their daily lives. We also assessed the prevalence of locomotive syndrome. Results: We observed significantly higher physical activity levels in users compared with non-users. Moreover, the use of a physical activity monitor was significantly associated with decreased odds of locomotive syndrome (adjusted odds ratio [aOR] = 0.48). Significantly lower risk of locomotive syndrome were observed in individuals who had used a monitor for >2 years (aOR = 0.42) or had set a personal step goal (aOR = 0.32). Conclusion: Physical activity monitoring may increase engagement in physical activity-associated behavior. Therefore, monitoring could serve as a useful tool to promote physical health in middle-aged and older adults.

Associations of eating out and dietary diversity with mild cognitive impairment among in community-dwelling older adults.

Background: Dementia is a critical later life health issue that occurs among members of aging societies. This study examined the relationships between eating out, dietary diversity, and mild cognitive impairment (MCI) among community-dwelling older adults. Methods: We analyzed data from 597 older adults (median age 73.0 years [interquartile range 69.0-78.0] and 62.6% females). We applied the Food Frequency Score (FFS) to evaluate diet variety and the weekly consumption frequencies of ten food items were determined. The Functional Assessment Tool from the National Center for Geriatrics and Gerontology was used to evaluate MCI. Finally, we asked the participants how often they ate out each month; those who replied 'none' were categorized into the "non-eating out" group. Results: The overall prevalence of MCI was 122 (20.4%), with a higher prevalence in the low dietary diversity group than in the high dietary diversity group (28.6% vs. 18.6%). After adjusting for covariates, the participants who self-described as not eating out were independently associated with low dietary diversity (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.20-3.20), while low dietary diversity was associated with MCI (OR: 1.72, 95% CI: 1.02-2.87). Structural equation models revealed that not eating out had no direct effect on MCI but was associated with MCI via low dietary diversity (root mean square error of approximation = 0.030, goodness-of-fit index=0.999, and adjusted goodness-of-fit index = 0.984). Conclusions: Although non-eating out may not have a direct effect on MCI, an indirect relationship may exist between eating-out habits and MCI via dietary diversity status.

Impacts of Negative and Positive Life Events on Development of Social Frailty among Community-Dwelling Older Adults.

OBJECTIVES: This study aimed to examine the impact of negative and positive life events on the development of social frailty. DESIGN: Population-based longitudinal study. SETTING AND PARTICIPANTS: This study was set in the Japanese community cohort and included 2174 adults aged ≥65 years without social frailty at baseline. METHODS: We assessed the experiences of 6 negative and positive life events (increase in economic difficulties, illness or injury of spouse, death of family or friends, marriage of children or grandchildren, birth of grandchildren or great-grandchildren, and making new friends) in the 15 months after baseline. We followed the social frailty status of the participants and identified the development of social frailty 48 months after the baseline. Social frailty was operationally defined as having 2 or more of Makizako's 5 items (going out less frequently, rarely visiting friends, not feeling helpful to friends or family, living alone, and not talking to someone daily). RESULTS: Among 2174 participants without social frailty at baseline, 161 (7.4%) developed social frailty after 48 months. Multivariate logistic regression models on each life event and development of social frailty showed that illness or injury of spouse was significantly associated with a higher risk of subsequent social frailty [adjusted odds ratio (OR), 1.74; 95% CI, 1.10-2.74] and making new friends was significantly associated with lower risk of subsequent social frailty (adjusted OR, 0.38; 95% CI, 0.27-0.54). No significant ORs of social frailty were found for other life events. CONCLUSIONS AND IMPLICATIONS: Life events in later life have both positive and negative impacts on the development of social frailty, depending on the nature of the event. To prevent social frailty, it may be important to monitor negative life events and promote positive life events in later life.

Association of olfactory and gustatory function with memory among community-dwelling independent older adults.

Background: This study examined the association between memory function and reduced olfactory and gustatory function among independent community-dwelling older adults. Methods: This cross-sectional study included 127 older adults (65.4% women). We assessed their memory, odor, and taste identification skills. Open essence (OE) test and taste strips (TS) were used to identify hyposmia (OE test ≤6) and hypogeusia (TS test ≤8), respectively. Results: Participants with severe hyposmia had significantly poorer memory functions compared to participants without severe hyposmia. After adjusting for covariates, multivariate logistic regression models revealed a significant association between immediate recognition performance and a decreased likelihood of severe hyposmia (odds ratio = 0.65, 95% confidence interval = 0.47-0.90). We observed no significant association between taste function and memory. Conclusions: Memory function may be associated with olfactory impairment but not with gustatory function in older adults.

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

AIM: This study aimed to examine the relationships between levels of competence and impaired physical and cognitive functions in older adults. METHODS: We used a data set of the Integrated Longitudinal Studies on Aging in Japan for 2017 including 5475 community-dwelling older adults. Levels of competence were assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). Grip strength (low grip strength: <28 kg for men and <18 kg for women) and gait speed (slow gait speed: <1.0 m/s for both sexes) were evaluated as physical function measurements, and the Mini-Mental State Examination (cognitive decline: <24 on the Mini-Mental State Examination) was used to assess cognitive function. RESULTS: The JST-IC had areas under the curve estimated from receiver operating characteristic analysis ranging from 0.65 to 0.73 for detecting low function as assessed by these tests. Restricted cubic spline curves showed that the shape of the association between the JST-IC and impaired function depended on sex and the test used. The comparison between perfect and imperfect JST-IC scores showed significant differences in the prevalence of low grip strength in both sexes, slow gait speed in women, and cognitive decline in men. CONCLUSIONS: It may be insufficient to identify those with impaired physical or cognitive function using the JST-IC. The shape of the association with the JST-IC varies across their measurements. Our findings can help interpret JST-IC scores in the context of low physical and cognitive functions. Geriatr Gerontol Int 2024; 24: 352-358.

Relationship between physical activity and cerebral white matter hyperintensity volumes in older adults with depressive symptoms and mild memory impairment: a cross-sectional study.

Introduction: Cerebral white matter hyperintensities (WMHs) are commonly found in the aging brain and have been implicated in the initiation and severity of many central nervous system diseases. Furthermore, an increased WMH volume indicates reduced brain health in older adults. This study investigated the association between WMH volume and physical activity in older adults with depressive symptoms (DS) and mild memory impairment (MMI). Factors associated with the WMH volume were also investigated. Methods: A total of 57 individuals aged over 65 years with DS and MMI were included in this study. The participants underwent magnetic resonance imaging to quantify WMH volumes. After WMH volume was accumulated, normalized to the total intracranial volume (TIV), the percentage of WMH volume was calculated. In addition, all participants wore a triaxial accelerometer for 2 weeks, and the average daily physical activity and number of steps were measured. The levels of blood biomarkers including cortisol, interleukin-6 (IL-6), brain-derived insulin-like growth factor-1, and brain-derived neurotrophic factor were measured. Motor and cognitive functions were also assessed. Results: Faster maximum walking speed and longer time spent engaged in moderate physical activity were associated with a smaller percent of WMH volume, whereas higher serum IL-6 levels were associated with a larger percent of WMH volume. The number of steps per day, time spent engaged in low levels of physical activity, cognitive function, and all other measured biomarkers were not significantly associated with percent of WMH volume. Discussion: Higher blood inflammatory cytokine levels, shorter duration of moderate physical activity, and lower maximum walking speed were associated with a higher percent of WMH volume. Our results provide useful information for maintaining brain health in older adults at a high risk of developing dementia and may contribute to the development of preventive medicine for brain health.

Independent Association between Cognitive Frailty and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults.

INTRODUCTION: Although arterial stiffness has been suggested to be associated with poor physical function and mild cognitive impairment (MCI), its association with cognitive frailty (CF), a comorbidity of both, is unclear. This study aims to examine the association between CF and arterial stiffness in community-dwelling older adults. METHODS: A cross-sectional analysis of 511 community-dwelling older adults aged 65 years or older (mean age 73.6 ± 6.2 years, 63.6% women), who participated in a community cohort study (Tarumizu Study, 2019), was conducted. Poor physical function was defined as either slowness (walking speed <1.0 m/s) or weakness (grip strength <28 kg for men and <18 kg for women). MCI was defined by the National Center for Geriatrics and Gerontology Functional Assessment Tool as a decline of at least 1.5 standard deviation from age- and education-adjusted baseline values in any one of the four cognitive domains (memory, attention, executive, and information processing). CF was defined as the combination of poor physical function and MCI. Arterial stiffness was measured using the Cardio-Ankle Vascular Index (CAVI), and the average of the left and right sides (mean CAVI) was used. RESULTS: Multinomial logistic regression analysis adjusted for covariates was performed with the four groups of robust, poor physical function, MCI, and CF as dependent variables and mean CAVI as an independent variable. Using the robust group as reference, the poor physical function and MCI groups showed no significant relationship with the mean CAVI. The mean CAVI was significantly higher in the CF group (odds ratio 1.62, 95% confidence interval: 1.14-2.29). CONCLUSION: A significant association was found between CF and the higher CAVI (progression of arterial stiffness). Careful observation and control of CAVI, which is also an indicator of arterial stiffness, may be a potential target for preventive interventions for CF.

Association between dietary diversity and chronic kidney disease in community-dwelling older adults.

OBJECTIVE: The present study examined whether dietary diversity is associated with chronic kidney disease (CKD) in community-dwelling older Japanese adults. METHODS: Participants comprised 8,195 older adults (mean age was 74.0 ± 5.6 years; 42.7% were men) in this cross-sectional study. In this study, CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73 m2. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Participants with an FFS of 16 or fewer points were defined as having low dietary diversity. RESULTS: The prevalence of CKD was 376 (4.6%), and the low dietary diversity group had higher prevalence (5.6%) compared with the high and low dietary diversity group (4.3%). Multiple logistic regression analysis revealed low dietary diversity was associated with CKD in older adults (OR 1.30, 95%CI 1.01-1.68). Stratified analysis showed that low dietary diversity was independently associated with CKD (OR 1.43, 95% CI 1.07-1.91) in older adults with hypertension, but not in adults without hypertension (OR 0.94, 95% CI 0.54-1.64). CONCLUSIONS AND IMPLICATIONS: This cross-sectional study revealed that low dietary diversity was associated with CKD among older adults. Furthermore, low dietary diversity was associated with CKD among older adults with hypertension.

Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study.

BACKGROUND: Sarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia. METHOD: Participants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: "eat almost every day" (1 point), or "not eaten almost daily" (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months). RESULTS: The cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47-0.92; p = 0.015), after adjusting for covariates. CONCLUSIONS: This longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

Physical frailty and survival time after the onset of functional disability: Is there a sex difference?

BACKGROUND: Physical frailty accelerates the timing of both subsequent disability and death; however, evidence regarding the impact of frailty on the period from disability onset to death and sex differences of this impact is lacking. The aim of this study was to examine the relationship among physical frailty, disability, death, and sex differences. METHODS: This Japanese cohort study included 10,524 community-dwelling people aged ≥65 years. Physical frailty was operationalized by key phenotypes as per Fried's criteria (slowness, weakness, exhaustion, weight loss, and low activity) at baseline. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for disability onset and post-disability survival according to the frailty status. RESULTS: During a 5-year follow-up, the risk of disability onset for pre-frailty (HR: 1.74, 95% CI: 1.51-2.00) and frailty (HR: 3.27, 95% CI: 2.77-3.87) were significantly higher than that for robust people. Furthermore, among participants who developed disabilities within 5 years (n = 1481), the risk of post-disability death for pre-frailty was not different from that for robust (HR: 1.49, 95% CI: 0.99-2.24), but frailty showed a higher risk of post-disability death than did robust people. (HR: 1.75, 95% CI: 1.13-2.72). In the sex-stratified analysis, although the female group showed no association between frailty status and post-disability death (HR: 1.21, 95% CI: 0.63-2.33 in pre-frailty; HR: 1.24, 95% CI: 0.60-2.57 in frailty), the male group showed higher risk of post-disability death in both pre-frailty (HR: 1.74, 95% CI: 1.03-2.96) and frailty (HR: 2.32, 95% CI: 1.32-4.09). CONCLUSIONS: Physical frailty shortens the period from disability onset to death. Additionally, the impact of frailty on post-disability death is greater for males than for females. Our findings suggest that physical frailty is an important clinical indicator distinct from disability and that interventions to prevent and address frailty in men need further investigation.

Association between dietary diversity and cognitive impairment in community-dwelling older adults.

AIM: The present study aimed to examine whether dietary diversity is associated with cognitive impairment, including mild cognitive impairment (MCI), in community-dwelling older Japanese adults. METHODS: This cross-sectional study was carried out in a general community setting. MCI and global cognitive impairment (GCI) were assessed using the Mini-Mental State Examination and National Center for Geriatrics and Gerontology-Functional Assessment Tool, which are multicomponent neurocognitive tests that include memory attention, executive function and processing speed. Dietary diversity was assessed using the diet variety score. The diet variety score assessed the 1-week consumption frequency of 10 food groups, and either 0 or 1 point was allocated to each category based on the following responses: (i) "eat almost every day" (1 point); and (ii) "not eaten almost daily" (0 points). Older adults with a diet variety score of ≥3 points were defined as having high dietary diversity. RESULTS: Data included 8987 older adults (mean age 73.9 ± 5.5 years; men 44.3%). The overall prevalences of MCI and GCI were 17.1% (n = 1538) and 8.4% (n = 753), respectively. The proportion of patients with a high dietary diversity was 69.9% (n = 6286). Multinomial logistic regression analysis revealed high dietary diversity was associated with MCI (OR 0.83, 95% CI 0.73-0.94) and GCI (OR 0.77, 95% CI 0.65-0.92) after adjusting for covariates. CONCLUSIONS: This study had a large sample size of older Japanese adults, and showed that high dietary diversity was associated with a lower proportion of MCI and GCI among older adults. Geriatr Gerontol Int 2024; 24: 75-81.

Sex differences in age-related differences in joint motion during gait in community-dwelling middle-age and older individuals.

BACKGROUND: Walking is the most important mode of human locomotion; however, the ability to walk often decreases with age. Age-related differences in lower-limb kinematics during gait may differ depending on sex. However, the question of the compounded effects of age and sex on gait kinematics remains unsolved. RESEARCH QUESTION: The present study aimed to clarify the interaction between age and sex in differences in gait kinematics of community-dwelling middle-age and older individuals. METHODS: This study included 836 community-dwelling middle-age and older adults (61.8 % female). Joint motion during comfortable gait was measured using magnetic and inertial measurement units. Hip, knee, and ankle joint angles were calculated in the sagittal plane. Participants were divided into four groups according to age: 50-59, 60-69, 70-79, and 80-89 years. The interaction of sex and age on spatiotemporal gait parameters and the peak value of joint angles was analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Gait speed (F = 43.92, P < 0.001), step length (F = 73.00, P < 0.001), hip extension (F = 12.89, P = 0.002), knee flexion (F = 39.99, P < 0.001), and ankle plantar flexion (F = 27.43, P < 0.001) significantly decreased with age. Significant differences according to sex were observed in all parameters except gait speed. Significant age and sex interaction effects were observed for knee flexion (F = 4.97, P = 0.002) and ankle dorsiflexion (F = 4.04, P = 0.007). SIGNIFICANCE: A significant interaction effect of age and sex was observed for peak angle of knee flexion and ankle dorsiflexion during gait. In particular, the knee flexion angle among females during gait began to decrease from 60 years of age, and the decreasing trend was faster and more prominent than that among males.

Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination.

OBJECTIVES: We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. MATERIALS AND METHODS: This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. RESULTS: Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). CONCLUSIONS: The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.

Changes in Satisfaction with Meaningful Activities and Onset of Depressive Symptoms among Community-Dwelling Japanese Older Adults: A Population-Based Study Before and During the COVID-19 Pandemic.

OBJECTIVES: This study aimed to clarify the association between changes in satisfaction with meaningful activities and the occurrence of depressive symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: A population-based prospective cohort study (Tarumizu Study). SETTING AND PARTICIPANTS: A total of 231 community-dwelling older adults aged ≥65 years without depressive symptoms at baseline. METHODS: The participants completed baseline (June to December 2018, before the COVID-19 pandemic) and follow-up (September to December 2021, during the COVID-19 pandemic) assessments. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, and their satisfaction levels were evaluated. Satisfaction with the most meaningful activities was assessed as to whether it was maintained/improved or decreased at follow-up. RESULTS: In the follow-up survey, 31 (14.3%) participants reported the occurrence of depressive symptoms. Compared with before the COVID-19 pandemic, the rates of meaningful activities during the COVID-19 pandemic decreased for interpersonal interaction and social life and increased for leisure, sports, self-care, and domestic life. Logistic regression analysis revealed that changes in satisfaction with meaningful activity were associated with the occurrence of depressive symptoms after adjusting for demographic variables, baseline GDS scores, cognitive and physical status, and instrumental activities of daily living (odds ratio, 2.78; 95% confidence interval, 1.17-6.59, P = .020). CONCLUSIONS AND IMPLICATIONS: To avoid decreasing satisfaction with meaningful activities, supporting older adults may be protective against the occurrence of depressive symptoms. Our findings highlight the need for health care professionals to not only encourage older adults to participate in activities for their mental health but also consider whether the activities are meaningful or satisfying for them.

Association between the Cognitive-Related Behavioral Assessment Severity Stage and Activities of Daily Living Required for Discharge to Home in Patients with Stroke: A Cross-Sectional Study.

This study aimed to characterize cognitive function examined using Cognitive-related Behavioral Assessment (CBA) in activities of daily living (ADLs). According to CBA severity at discharge, 791 patients were assigned to five groups (most severe, severe, moderate, mild, and normal). The total scores for Functional Independence Measure (FIM) motor items were compared for each group. Multiple logistic regression analysis was performed to clarify the association between CBA severity and independence in ADL items. Independence in each ADL according to CBA severity was 0-4.8%, 26.8-45.0%, 84.3-91.0%, and 97.2-100% for all ADLs in the most severe to severe, moderate, mild, and normal groups, respectively. Significant differences were found in the FIM motor score according to CBA severity between the groups (p < 0.01). A mild or normal CBA was associated with a higher odds ratio (OR) for dressing the upper body (OR = 21.90; 95% confidence interval (CI), 13.50-35.70), bladder management (OR = 11.60; 95% CI, 7.21-18.60), transfers to the bed/chair/wheelchair (OR = 18.30; 95% CI, 11.40-29.40), transfers to the toilet (OR = 18.30; 95% CI, 11.40-29.30), and walking (OR = 6.60; 95% CI, 10.60-26.10). A CBA severity greater than mild (23 points) was associated with independence in ADLs that are important for discharge to home.

Relationship between grave visitation and apathy among community-dwelling older adults.

BACKGROUND: It has been shown that involvement in religious activities has a positive impact on psychological aspects. In this study, the relationship between grave visitation, a standard religious activity in Japan, and depression and apathy symptoms was investigated among older adults in Japan. METHODS: A total of 638 older adults who participated in a community-based health check survey (Tarumizu Study 2019) were interviewed regarding the presence or absence of grave visitation, frequency, travel time, means of transportation, and flower offerings. Apathy and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). The participants were categorised into three grave visitation groups, namely, frequent (more than once per week), occasional (less than once per week), and non-visiting. Outcomes were compared between the frequency groups, and Poisson regression analysis was used to investigate the relationship between grave visitation frequency and apathy and depression. RESULTS: Of the participants, 91.8% reported regular grave visitation. The non-visiting group had a significantly higher prevalence of apathy symptoms (44.2%) than the visiting groups. Furthermore, using the frequent group as the reference, Poisson regression analysis adjusted for potential covariates demonstrated that no grave visitation was significantly related to apathy (prevalence ratio, 1.43; 95% confidence interval, 1.00-2.05, P = 0.049). CONCLUSIONS: Not practising grave visitation was significantly related to apathy among older adults. Helping older adults to visit graves may prevent apathy by facilitating motivation and increasing activity.

Association between dietary diversity and sarcopenia in community-dwelling older adults.

OBJECTIVES: The aim of this study was to examine whether dietary diversity is associated with sarcopenia in community-dwelling older Japanese adults. METHODS: We used a cross-sectional large cohort data set from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Data from 9080 older adults (mean age 74 ± 5.6 y; 44.4% were men) were included in this cross-sectional study. Sarcopenia was assessed using muscle mass, muscle strength, and physical performance represented by gait speed. We assessed 1-wk consumption frequency of food types, including meat, fish/shellfish, eggs, milk, soybean products, green and yellow vegetables, potatoes, fruits, seaweeds, fats, and oil. Consumption frequency was allotted to each category for the following responses: eat almost every day, eat 3 or 4 /wkd, eat 1 or 2 d/wk, and hardly ever eat. Poor dietary diversity was defined as those who responded hardly ever eat for any of the 10 foods. RESULTS: This study revealed that 2647 participants (29.2%) had poor dietary diversity. Poor dietary diversity was associated with confirmed sarcopenia (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08-1.96) and severe sarcopenia (OR, 1.58; 95% CI, 1.08-2.39). Furthermore, poor dietary diversity of low-protein foods was significantly associated with sarcopenia (OR, 1.57; 95% CI, 1.13-2.20) as well as poor dietary diversity of high-protein foods (OR, 1.47; 95% CI, 1.12-1.92). CONCLUSIONS: This cross-sectional study revealed that poor dietary diversity was associated with sarcopenia among older adults. Ingestion of low-protein foods and high-protein foods is infrequently associated with sarcopenia and ingestion of high-protein foods.

Low-intensity resistance training to improve knee extension strength in community-dwelling older adults: Systematic review and meta-analysis of randomized controlled studies.

AIM: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. METHODS: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with <60 % one repetition maximum (1RM) in community-dwelling older adults aged 60 years and older were eligible. RESULTS: In total, 7 studies involving 275 participants were included in the meta-analysis. The results showed significant improvements in knee extension strength with low-intensity resistance training [standardized mean difference (SMD) 0.62, 95 % confidence interval (CI) 0.32 to 0.91]. In subgroup analyses, significant improvements were observed in the group with intensity at 50-60 % 1RM (0.83, 0.46 to 1.19), but not in the group at 40 % or less 1RM (0.30, 95%CI: -0.08 to 0.68). Concerning frequency, there were significant improvements in knee strength for those receiving training three times (0.90, 0.52 to 1.27) and two times (0.36, 0.03 to 0.69) per week, with a significant difference between the groups (p = 0.04). CONCLUSIONS: Low-intensity resistance training should be considered as an effective intervention to improve knee extension strength in community-dwelling older adults. Older adults may show more improvement in knee extension strength if intensity of the training is set at 50-60 % 1RM and frequency of training is three times per week.