Pet ownership-related differences in medical and long-term care costs among community-dwelling older Japanese.

This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services.

Physical, social, and dietary behavioral changes during the COVID-19 crisis and their effects on functional capacity in older adults.

BACKGROUND: This two-year follow-up study aimed to identify factors associated with unhealthy behaviors during the COVID-19 pandemic and examine their impact on functional capacity in older adults. METHODS: Altogether, 536 adults aged ≥65 years participated in this study. The frequency of going out, exercise habits, face-to-face and non-face-to-face interactions, social participation, and eating habits were examined as behavioral factors before and after the first declaration of a state of emergency in Japan. Functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. RESULTS: Using latent class analysis considering changes in the six behaviors, the participants were divided into healthy (n = 289) and unhealthy (n = 247) behavior groups. The male sex was associated with 2.36 times higher odds, diabetes with 2.19 times higher odds, depressive mood with 1.83 times higher odds, poor subjective economic status with 2.62 times higher odds, and living alone with 44% lower odds of being unhealthy. The unhealthy behavior group showed significantly decreased functional capacity (B =-1.56 [-1.98, -1.14]) than the healthy behavior group. For each behavior, negative changes in going out (B =-0.99 [-1.60, -0.37]), face-to-face interaction (B =-0.65 [-1.16, -0.13]), and non-face-to-face interactions (B =-0.80 [-1.36, -0.25]) were associated with a decline in functional capacity. CONCLUSION: Our results showed four factors associated with engaging in unhealthy lifestyle behaviors and how behavioral changes affect functional capacity decline during the COVID-19 pandemic, which will help to develop public health approaches.

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

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

Pathway from gait speed to incidence of disability and mortality in older adults: A mediating role of physical activity.

OBJECTIVES: To determine whether physical activity mediates the association of gait speed with incident disability and mortality in older adults. STUDY DESIGN: Prospective cohort data from 782 community-dwelling Japanese older adults were analyzed. The median follow-up periods for incident disability and mortality were 4.4 and 4.5 years, respectively. MAIN OUTCOME MEASURES: Physical activity was assessed with the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire, gait speed was calculated from 5-m walking time, and incident disability was defined as long-term care insurance certification during follow-up. RESULTS: There were 247 cases of incident disability and 202 deaths during follow-up. After adjusting for potential confounders, faster gait speed was associated with decreased risk of incident disability (hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.82-0.93), but physical activity level was not associated with incident disability (HR = 0.98, 95% CI = 0.95-1.01). Gait speed was associated with mortality risk in the model without physical activity (HR = 0.93, 95% CI = 0.88-1.00). When gait speed and physical activity were both included in the model, gait speed was not associated with mortality (HR = 0.95, 95% CI = 0.89-1.02) but physical activity was associated with mortality (HR = 0.95, 95% CI = 0.92-0.99). Physical activity was a mediating factor in the association between gait speed and mortality (Sobel test p = .025). CONCLUSIONS: Gait speed is directly associated with incident disability and is indirectly related to mortality through physical activity in older adults.

Is unwilling volunteering protective for functional decline? The interactive effects of volunteer willingness and engagement on health in a 3-year longitudinal study of Japanese older adults.

AIM: The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study. METHODS: We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period. RESULTS: During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers. CONCLUSION: Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

Background: Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. Methods: 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). Results: We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. Conclusions: People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

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).

[Prospective study of cognitive decline assessed using the mini-mental state examination and the risk of incident long-term care insurance among community-dwelling older Japanese].

AIM: We examined the longitudinal association between the change in the Mini-Mental State Examination (MMSE) score per year and the incidence of a certified need for care in the long-term care insurance system among community-dwelling older Japanese subjects. METHODS: A total of 773 adults 65 years of age or older who participated in a baseline survey (2002 to 2007) underwent MMSE reevaluation at least once until Wave-1 (2003 to 2008). The incidence of a certified need for care in the long-term care insurance system until Wave-2 (Wave-1 to 2013) was examined in all subjects. RESULTS: During an average follow-up of 1,195 days (baseline survey to Wave-1), the change in the MMSE score per year was greater than 0 in 511 (66.1%) participants, 0 to -0.5 in 94 (12.2%) participants, -0.5 to -1 in 66 (8.5%) participants, -1 to -2 in 56 (7.2%) participants, and less than -2 in 46 (6.0%) participants. During an average follow-up of 1,802 days (Wave-1 to Wave-2), 104 participants (13.5%) were newly certified with a need for care in the long-term care insurance system. After controlling for important confounders, elders with a change in the MMSE score of 0 to -0.5, -0.5 to -1, -1 to -2 and less than -2 per year were 1.73 (95% confidence interval, 0.93-3.23), 1.94 (1.01-3.45), 1.95 (1.02-3.76) and 3.16 (1.68-5.98) times as likely to be newly certified with a need for care in the long-term care insurance system, respectively, compared those with a change in the score greater than 0. CONCLUSIONS: The extent of change in the MMSE score per year independently predicted the incident certified need for care in the long-term care insurance system in a general population of older Japanese subjects. A decrease of greater than 0.5 points per year may be a useful cutoff value for clinically evaluating elders.

Predictors of improvement or decline in instrumental activities of daily living among community-dwelling older Japanese.

BACKGROUND: To explore predictors of functional improvement or decline in instrumental activities of daily living (IADL) among community-dwelling older people. METHODS: Of all the residents (>or=65 years, n = 1,673) living in Yoita town, Niigata prefecture, Japan, in 2000, 1,544 subjects who participated in the baseline interview survey (T1) were followed up until 2002 (T2). A wide range of variables obtained in T1 was entered into the model predicting functional improvement or decline in IADL. RESULTS: Among 1,274 individuals who participated in both T1 and T2, 105 subjects showed improvement, 194 decline, and the remaining 975 showed stability in IADL. Multiple logistic regression analyses indicated that good self-rated health and cognitive function (MMSE >or=24) at T1 were good predictors of both improvement and protection against decline in IADL. Independence in basic activities of daily living predicted improvement in IADL. Advanced age and poor walking ability predicted decline in IADL. CONCLUSIONS: Good self-rated health and cognitive function predicted both improvement and protection against decline in IADL. Thus, intervention programs aiming at maintaining both good self-rated health and cognitive function should be able to improve IADL.

[Economic evaluation of disability prevention programs for community-dwelling elderly secular trend analyses of medical and care expenses comparing participants and non-participants in the programs].

OBJECTIVE: This study was conducted to evaluate disability prevention programs for community-dwelling elderly in terms of the cost/benefit balance. METHODS: Out of all residents aged 65 years and over who lived in Yoita Town, Niigata Prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline survey conducted in November, 2000 (response rate, 92.2%). Based on the results, Yoita town then launched several kinds of disability prevention programs for community-dwelling elderly, e.g., preventive programs for falls, dementia and homeboundness. The subjects for the present study included only those aged 70 years and over who responded to the baseline survey and were alive as of March 2004. During 2001 to 2003, 146 persons had participated at lease once in one of disability prevention programs (denoted as the participant group), whereas 846 persons had not participated in any of the programs (denoted as the non-participant group). We compared medical and care expenses (sum of national and employment health insurance benefits, and long-term care insurance) between the two groups during 2000-2003, and determined whether participating in program affected subsequent medical and care expenses independent of key confounders [sex, age, and baseline medical and care expenses or health indicator (TMIG-Index of Competence or Generic Mobility Index)], using general linear models. RESULTS: The mean medical expenses per capita and per month slightly decreased over the period of the study in the participant group (51,606 yen for 2000 to 47,539 yen for 2003), while those in non-participant group steadily increased (41,888 yen, to 51,558 yen, respectively). During the same period, the mean care cost per capita and per month increased in both groups, but the increase was much more moderate in the participating group (507 yen to 5,186 yen vs. 8,127 yen to 27,072 yen for non-participant group). Summed cost reduction through the program participation accounted for 49 million yen during the three years (2001-2003). After adjustment for sex, age and baseline medical and care expenses or health indicator, it was estimated as 12 million yen per year. Given that the expenses for the disability prevention programs summed 2.3 million yen per year, the net benefit of disability prevention programs was estimated to be approx. 10 million yen per year. CONCLUSION: Disability preventive programs for the community-dwelling elderly are economically efficient in terms of the cost/benefit balance. Future research is needed to examine how such programs lead to cost reduction.

[Physical activity level and physical, mental and social factors in community-dwelling elderly people].

PURPOSE: This study was conducted to examine the relationship between physical activity level (PAL) and physical, mental and social factors in community-dwelling elderly people. METHODS: The subjects comprised 428 residents aged 70 or over living in Kusatsu-machi, Gunma, who took part in an interview and tests of physical fitness as part of the "NIKKORI-KENKOSODANJIGYO". Data for 330 out of the 428 residents were adopted for this study. The PAL was evaluated with a questionnaire developed by Naito et al. (2003). Subjects were interviewed on physical, mental and social functioning including the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence and cognitive function (Mini Mental State Examination: MMSE). Physical fitness tests included assessment of handgrip strength, usual and maximal walking speed, and one-leg standing balance with eyes open. RESULTS: Correlations between PAL and the TMIG Index of Competence, physical (e.g. physical fitness), mental (e.g. depression) and social (e.g. roles at home) factors, and smoking status were significant by ANCOVA adjusted for age and sex. Analysis using a general linear model indicated that smoking status, usual walking speed, depression, roles at home, frequency of going outdoors and visual impairment all together explained 13.5% of the PAL variance. CONCLUSION: The findings indicate that PAL in the community-dwelling elderly aged 70 years or over is associated with physical, mental and social factors.

[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].

OBJECTIVE: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community. METHODS: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification. RESULTS: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females. CONCLUSIONS: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

[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.