[Methods of coping with musculoskeletal pain among community-dwelling elderly individuals].

Objectives　Musculoskeletal pain impairs vital function and results in a requirement for long-term care. According to studies in other countries, a program that aims at reducing pain through instructions for pain-coping should be implemented. In Japan, a study on pain-coping has recently been initiated; however, the methods of coping with pain that are implemented by community-dwelling elderly individuals have not been evaluated. This study aimed to clarify the methods currently used for coping with musculoskeletal pain and to examine their association with the state of pain among community-dwelling elderly individuals.Methods　A survey was performed by sending questionnaires by mail to 2,281 community-dwelling elderly individuals. Responses were obtained from 1,835 people. The survey items consisted of questions about basic attributes and pain. A total of 16 questionnaire items regarding the methods of coping with pain were used for measuring pain-coping that community-dwelling elderly individuals use. The methods of coping with pain were classified into various types by factor analysis. The scores were calculated by type and their association with the state of pain was analyzed using one-way analysis of variance.Results　As a result of the factor analysis, methods of coping with pain were classified into five categories: "treatment in hospitals," "daily active coping," "restriction of daily behavior," "self-therapy," and "rest." From one-way analysis of variance for the site of pain, there was a significant difference between the "treatment in hospitals" and "restriction of daily behavior" categories. Among both scores, a higher score was observed in subjects with pain in both the lower back and the knee, compared to those with only pain in the lower back or the knee. Among the number of the sites, there was a significant difference between the "treatment in hospitals," "restriction of daily behavior," and "self-therapy" categories; subjects exhibiting two or more sites of pain showed a higher score than those exhibiting one site of pain. For pain duration, there was a significant difference between the "treatment in hospitals," "restriction of daily behavior," and "self-therapy" categories; subjects who had experienced pain for 5 years or longer had a higher score than those who had experienced pain for less than 6 months.Conclusion　We found that five types of methods of coping with pain ("treatment in hospitals," "daily active coping," "restriction of daily behavior," "self-therapy," and "rest") were used by community-dwelling elderly individuals and that "treatment in hospitals" and "restriction of daily behavior" were the most common strategies among elderly individuals with pain.

The Impact of Japan's Soft Lockdown on Depressive Symptoms among Community-Dwelling Older Adults.

This study investigated the impact of stay-at-home orders on depressive symptoms among community-dwelling older adults during the early stages of the COVID-19 pandemic. A questionnaire was administered to older adults living in Ayase City, Kanagawa Prefecture, in July 2020, after the Japanese government declared its first COVID-19 state of emergency and stay-at-home order. In a sample of 1056 people, 69.1% were stay-at-home, and 30.9% were not. Those in the first group were more likely to be women, young-old, or non-workers. In addition, the patients tended to have more diseases. Of the participants, 39.3% had depressive symptoms and 60.7% did not. Multivariate analysis revealed that depressive symptoms were associated with increased frequency of being alone during the daytime (OR = 1.27; 95% CI = 1.07, 1.51), less face-to-face contact with friends or acquaintances (OR = 0.78; 95% CI = 0.65, 0.94), increased contact with friends or acquaintances through email/LINE app (OR = 1.29; 95% CI = 1.03, 1.60), and refraining from going out (OR = 1.54; 95% CI = 1.12, 2.09). These results suggest that quarantine measures related to soft lockdowns may aggravate the mental health of community-dwelling older adults. Therefore, it is necessary to consider macro-level policies.

The predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability.

BACKGROUND AND AIMS: To compare the predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability in community-dwelling elderly persons. METHODS: Prospective cohort study. Participants were 813 aged 70 years and older, elderly Japanese residing in the community, included in the Tsurugaya Project, who were not disabled at the baseline in 2003. Physical function was assessed by the questionnaire of "Motor Fitness Scale". Physical performance measures consisted of maximum walking velocity, timed up and go test (TUG), leg extension power, and functional reach test. The area under the curve (AUC) of the receiver operating characteristic curve for disability was used to compare screening accuracy between Motor Fitness Scale and physical performance measures. Incident disability, defined as certification for long-term care insurance, was used as the endpoint. RESULTS: We observed 135 cases of incident disability during follow-up. The third or fourth quartile for each measure was associated with a significantly increased risk of disability in comparison with the highest quartile. The AUC was 0.70, 0.72, 0.70, 0.68, 0.69 and 0.74, for Motor Fitness Scale, maxi- mum walking velocity, TUG, leg extension power, functional reach test, and total performance score, respectively. CONCLUSIONS: The predictive power of physical function assessed by the Motor Fitness Scale was equivalent to that assessed by physical performance measures. Since Motor Fitness Scale can evaluate physical function safely and simply in comparison with physical performance tests, it would be a practical tool for screening persons at high risk of disability.

[Association between physical function and musculoskeletal pain in community-dwelling elderly people].

AIM: To examine the associations among the presence, level, and the duration of pain, the number of painful areas and physical function in elderly patients. METHODS: The participants in this study were 351 men and women aged 75 years orolder who were living in the community. Participants were interviewed about the presence, level, number of painful areas and duration of pain. Physical function was self-assessed using a questionnaire. RESULTS: The presence of pain was higher in women than men. No significant differences in the level, number of affected areas and duration of pain were observed between men and women. Physical function was significantly associated with the presence of pain (odds ratio[OR]: 1.75), presence of pain in the upper and lower extremities (OR: 5.15), pain in more than 3 areas of the body (OR: 11.56), presence of strong pain (OR: 4.65), and pain with a duration of over 5 years (OR: 3.35). CONCLUSION: It is insufficient to assess the association between physical function and pain solely by the presence of pain. These findings suggest that it is necessary to assess the association between physical function and pain by the presence and level of pain, number of painful areas and duration of pain.

[Relationships between participation in community activities and psychosocial and physical health of community-dwelling elderly].

OBJECTIVE: The aim of this study was to clarify relationships between participation in community activities and psychosocial and physical health of community-dwelling elderly. METHODS: The participants of the present study were 413 people selected on the basis of a random 1/3 extraction of people aged 65 or older and living in a rural community in Miyagi prefecture. The baseline survey was conducted in February 2008. One year later, we conducted a follow-up survey to clarify how participation in community activities influenced the elderly. Finally, we analyzed data for 218 people, focusing on influences on psychosocial and physical health using the logistic regression model. The state of community activity was treated as a dependent variable, and mental and physical health indicators were assessed as the independent variables. RESULTS: Of the elderly sample, 63 persons were found to be frequent participants in community activities, 60 were infrequent participants, and 95 did not participate. The frequently participating individuals displayed significantly better results for declines in depression (OR = 0.34, 95% CI: 0.13-0.89), and social participation (OR = 0.12, 95% CI: 0.05-0.29), as well as the TMIG index of competence (OR = 0.26, 95% CI: 0.08-0.78) as compared with those who did not participate. CONCLUSION: These results suggest that community activities prevent deterioration of mental health, improve social health, and maintain higher-level functional capacity among community-dwelling elderly individuals.

[Community participation is associated with life satisfaction in elderly people with diabetes mellitus].

METHODS: Comprehensive questionnaires encompassing physical, psychological, and social aspects were administered by interview to 56 elderly outpatients with diabetes mellitus. Life satisfaction was assessed using the Life Satisfaction Index K (LSIK) . We also assessed the emotional and instrumental social support provided by the families living along with the participants or living separately from the participants. The Index of Social Interaction (18 items) was used to assess the social relationships and the environmental social resources, which were classified into 5 domains: 1) independence, 2) social curiosity, 3) relationships with other people, 4) participation in the community, and 5) feelings of safety. RESULTS: In a univariate analysis, the presence of diabetic neuropathy and pain in the lower back or knee joints were associated with low LSIK scores. Community participation, social curiosity, relationships with other people, and instrumental support from families living together with the participants positively correlated with high LSIK scores. The LSIK scores of the leaders of the diabetes patient group were higher than the scores of those who only participated in the diabetes patient group. In a multiple linear regression analysis, community participation, instrumental support from families living along with the participants, and the absence of neuropathy were independently associated with high LSIK scores. CONCLUSION: Community participation is an important factor associated with life satisfaction in elderly people with diabetes mellitus.

[Relationships between volunteerism and social-physical health and QOL with community-dwelling elderly participating in a long-term care prevention programme].

OBJECTIVE: The aim of this study was to clarify the influence of volunteerism as part of a long-term care prevention program on social and physical health indicators and QOL, as compared with non-participation among elderly people. METHODS: The baseline survey was conducted in 2003 among elderly people (age, 70-84 years) living in a rural community in Miyagi Prefecture. We recruited elderly volunteer leaders for long-term care prevention from among the 1,503 elderly people participating in the baseline survey. Of these, 77 individuals were registered as volunteer leaders. One year later, we conducted a follow-up survey to clarify the influence of volunteerism. Finally, we analyzed data for 69 volunteer leaders and 1,207 non-leaders, focusing on influences of volunteerism on social and physical health and QOL using a logistic regression model. State of volunteer activity was treated as a dependent variable, and social and physical health indicators and QOL indices as independent variables. RESULTS: Non-participating individuals had significant declines in Intellectual Activity (OR: 4.51, 95% CI: 1.60-12.74), Social Role (OR: 2.85, 95%CI: 1.11-7.21), Self-efficacy for ADL (OR: 4.58, 95%CI: 1.11-18.88), Satisfaction with Economic State (OR: 2.83, 95%CI: 1.11-7.21), and Contact with Neighbors (OR: 3.62, 95%CI: 1.29-10.16), as compared with volunteers. CONCLUSION: These results suggest that volunteerism prevents lowering of higher-level functional capacity and social networking among community-dwelling elderly individuals.

[Production of a fall prevention exercise programme considering suggestions from community-dwelling elderly].

OBJECTIVES: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people. METHODS: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls. RESULTS: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants. CONCLUSIONS: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.

[Effectiveness of ability grouping in structured fall prevention exercise program for frail elderly people].

AIM: To assess the effectiveness of ability grouping in a fall prevention structured exercise program for elderly people. METHODS: We enrolled 124 subjects from among 2,582 elderly people aged 70 to 84 years living in the Tsurugaya district in Sendai City. Exclusion criteria were 1) motor fitness scale (MFS) score 9 points or more, 2) severe sensory, cognitive, or 3) physical disorders, and 4) nursing care grade 2 or more. Those ranked in the lower fourth and in the upper 3 fourths of the timed up and go test (TUGT) were each randomly assigned to 3 groups. Subjects in groups A and B had an exercise program for lower and higher fitness subjects separately, whereas all subjects in group C underwent a single exercise program. The exercise program, once a week for 12 weeks, consisted of strength and stability training. TUGT, lateral reach (LR), leg power per body weight and MFS were measured after the intervention and compared with the baseline values. RESULTS: There were no difference in the baseline characteristics among the groups. For group A, no significant changes in physical fitness measures, for group B a small but significant deterioration in LR, and for group C a small but significant deterioration in LR and TUGT were observed. MFS score improved significantly in all groups. CONCLUSION: Ability grouping appeared to be effective for a short-term exercise program in maintaining the physical ability, but the effectiveness did not reach statistical significance in the randomized controlled design.

[Characteristics of elderly leaders volunteering to participate in a fall prevention programme].

OBJECTIVES: This study was conducted to assess characteristics of elderly leaders volunteering to participate in a fall prevention programme. METHODS: We surveyed 1,503 individuals (75 elderly leaders volunteering to participate in a fall prevention programme and 1,428 non-leader elderly) among the elderly population living in a rural community, Miyagi Prefecture. Subjects were aged 70-84 years. The questionnaire covered socio-demographic factors, as well as physical, psychology and social variables. To analyze the characteristics of the elderly leaders volunteering to participate in this programme, the relationships of socio-demographic, physical, psychology and social factors to whether the elderly were leaders in the programme were analyzed using logistic regression. RESULT: As a result of multiple logistic regression analysis, the characteristics of elderly leaders volunteering to participate in the fall prevention programme were as follows; 1) being male (OR = 0.25, 95%CI 0.14-0.44); 2) young age (OR=0.43, 95%CI 0.25-0.73); 3) having a high intellectual activity (OR = 2.72, 95%CI 1.65-4.48); 4) being well satisfied with their health (OR = 1.45, 95%CI 1.02-2.07), and 5) having a high IKIGAI (OR = 1.06, 95%CI 1.01-1.13). CONCLUSION: Only elderly individuals capable of high-level intellectual activities can fill the roles of elderly volunteer group leaders discussed in this study.

Longitudinal changes in higher-level functional capacity of an older population living in a Japanese urban community.

This study examined the present state and longitudinal changes in higher-level functional capacity in a Japanese urban community. Persons aged 65-84 years living in a suburb of central Tokyo participated in a baseline survey held in 1991 (n = 814) and followed-up for 8 years. Outcome measures were disabilities in: instrumental self-maintenance (IADL), the intellectual activity scale (intellectual activity) and the social role scale (social role), as measured by subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-index of competence). At baseline among the three subscales, both older men and women had the highest prevalence of disability in social role, followed in turn by intellectual activity and IADL disability. The 8-year longitudinal survey on subjects who had no initial disability (229 men and 235 women) in all three subscales of TMIG-index of competence demonstrated that they were most likely to lose social role function with advancing age, followed in turn by intellectual activity and IADL. The Cox proportional hazard model analysis for all 814 participants revealed that baseline level of social role and intellectual activity significantly predicted the new onset of IADL disability during the 8-year follow-up period even after controlling for gender, age, and chronic medical conditions. In summary, disability in social role and intellectual activity do not only likely precede IADL disability, but also predict significantly the future onset of IADL disability in a Japanese urban community older population.

[The effects of daily physical activity on QOL in the elderly].

OBJECTIVE: To ascertain the meaning and the influence of daily physical activity on QOL among the elderly, we surveyed their lifestyle exercise habits, cross-sectionally and longitudinally. METHODS: The subjects of this study were all residents living in a certain suburb of Nagoya-city, aged 63, 68, 73, 78, 83 years of age. They answered questionnaires regarding their exercise, physical activity, and QOL with six categories. The same questionnaire survey was conducted again 3 years later, and 958 people who answered both of them were examined in this study. The three-year-trend for physical activities, exercise habits and QOL scores, were analyzed and a comparison of QOL was made between the first and third year data based on the primary physical-activity-scores. In addition we applied logistic regression analysis to investigate the influence of physical activity changes (independent variable) on maintaining or improving of QOL scores (dependent variable). RESULTS: Daily physical activities were well maintained, but the percentage of feasible activities decreased by 5-10% as the sample population aged. On the other hand, 20 to 30% of the subjects increased their physical activity. The more people moved, the higher the QOL scores they had in both cross-sectional and longitudinal analyses. According to the logistic regression analysis, baseline physical activity habits positively contributed to most QOL change, increase in exercise tending to maintain or improve the QOL scores. CONCLUSIONS: Daily physical activity was relatively well maintained among the sample population, and some increased their physical activity scores over the period studied. Those with high values had better physical conditions and a consistently high QOL. These results suggest that maintaining or increasing physical activity positively influences QOL in the elderly.

[Test-retest variation in the Tokyo Metropolitan Institute of Gerontology Index of Competence in community-dwelling older people independent in daily living toward individual assessment of functional capacity].

OBJECTIVES: To assess individual variation in the functional capacity of community-dwelling older people who are almost independent in daily living, using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-Index of Competence). METHODS: Out of 74 elderly outpatients showing a total score of TMIG-Index of Competence above 10 points at baseline, 61 who remained stable during subsequent two months in terms of medical and social aspects were assessed for their functional capacity with the test-retest method using the TMIG-Index of Competence. We assessed individual variation between the tests of one month interval with correspondence rate. RESULTS: The ranges for score differences within which correspondence rates of 95% and over applied were as follows: within 1 point for the total score of the Index (95.1%), 0 point in the Instrumental Self-Maintenance subscale (IADL) (95.1%), and 1 point in the Intellectual Activity subscale (Intellectual Activity) (98.4%) and the Social Role subscale (Social Role) (98.3%). CONCLUSIONS: The variation of 1 point for the total score of the Index, and subscales of Intellectual Activity and Social Role was regarded as a possible measurement error. In other words, variations of 2 points and over for total score, subscales of Intellectual Activity and Social Role, and variations of 1 point and over for IADL should not be ignored in screening of functional capacity among older people.

[Effects of dietary variety on declines in high-level functional capacity in elderly people living in a community].

OBJECTIVE: The purpose of the investigation was to assess effects of dietary variety on declines in high-level functional capacity in community dwelling elderly, based on a 5-year longitudinal study (from 1992 to 1997). SUBJECTS AND METHOD: Subjects were a representative sample comprising 235 men (mean age 70.8 years) and 373 women (71.7 years) aged 65 years and above, living in Nangai village in Akita prefecture. Baseline and follow-up surveys were undertaken by the interview method. For assessing dietary variety, we introduced the dietary variety score (DVS), counting the number of 10 food-groups consumed daily from food frequency questionnaires: meat, fish and shellfish, eggs, milk, soybean products, potatoes, green yellow vegetables, fruits, seaweed, and fat and oil. The DVS ranged from 0 to 10 with higher score indicating a higher dietary variety. We also evaluated higher-level functional capacity using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence). Effects of dietary variety on declines in TMIG Index of Competence were analyzed by multiple logistic regression analysis. RESULTS: The average TMIG Index of Competence score for men and women were 12.1 and 10.8 at baseline, respectively. The mean baseline DVS was 6.3 for men, and 6.2 for women. Relative to the reference groups with DVS in 1-3, the groups with 4-8 and 9-10 scores had lower risks for decrease in TMIG Index of Competence scores over the study period. Relative risks (95% confidence interval) of the groups with a DVS of 4-8 and 9-10 were 0.92 (0.50-1.67) and 0.71 (0.34-1.48) regarding instrumental self maintenance, 0.50 (0.29-0.86) and 0.40 (0.20-0.77) for intellectual activities, and 0.44 (0.26-0.75) and 0.43 (0.20-0.82) for social roles of sub-scales of TMIG Index of Competence, adjusting for age, sex, educational attainment, and the baseline TMIG Index of Competence scores. CONCLUSION: Higher dietary variety is associated with a reduced risk of higher-level functional decline in community dwelling elderly.

Effect of exercise, aging and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age.

BACKGROUND: Age-associated decline in immune function and regulation, referred to as immunosenescence, brings about an increased incidence of infectious diseases in the aged; however, there are few data on the effect of aging and exercise on mucosal immune function in elderly people. Moreover, there is no evidence on whether the change in functional capacity affects mucosal immunity in elderly people. Therefore, the aim of the present study was to examine the effects of exercise, aging and functional capacity on mucosal immune function in elderly people over 75 years of age. METHODS: The subjects were 92 community-dwelling elderly women aged over 75 years who lived in a rural community in Miyagi Prefecture. The subjects periodically performed approximately 20 min of low intensity exercise. Saliva samples were collected before and after exercise, and saliva flow (SF), secretory immunoglobulin A (SIgA) concentration (SIgA-C) and SIgA secretion rate (SIgA-SR) were determined. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to measure functional capacity. RESULTS: In comparison with before exercise, SF, SIgA-C and SIgA-SR were significantly increased after exercise in elderly subjects. In addition, when low and high value groups of resting SIgA levels were compared, acute SIgA responses were observed only in the low value group; however, there was no significant effect of aging and decline in functional capacity on exercise-induced SIgA response. CONCLUSION: These results suggest that resting SIgA levels influence the mucosal immune function response to exercise in elderly people over 75 years of age.