Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study.

BACKGROUND: The clinical effect of enteral administration of sleep-promoting medication (SPM) in mechanically ventilated patients remains unclear. This study aimed to investigate the relationship between enteral SPM administration and the intravenous sedative dose and examine the safety and cost of enteral SPM administration. METHODS: This single-center retrospective cohort study was conducted in a Japanese tertiary hospital intensive care unit (ICU). The exposure was enteral SPM administration during mechanical ventilation. The outcome was the average daily propofol dose per body weight administered as a continuous sedative during mechanical ventilation. Patients were divided into three groups based on the timing of SPM administration at ICU admission: "administration within 48 hours (early administration [EA])," "administration after 48 hours (late administration [LA])," and "no administration (NA)." We used multiple linear regression models. RESULTS: Of 123 included patients, 37, 50, and 36 patients were assigned to the EA, LA, and NA groups, respectively. The average daily propofol dose per body weight was significantly lower in the EA group than in the LA and NA groups (ß -5.13 [95% confidence interval (CI) -8.93 to -1.33] and ß -4.51 [95% CI -8.59 to -0.43], respectively). Regarding safety, enteral SPM administration did not increase adverse events, including self-extubation. The total cost of neuroactive drugs tended to be lower in the EA group than in the LA and NA groups. CONCLUSIONS: Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.

Effect of financial incentives for participation in dementia prevention and support activities: results of a web survey with persons aged 60 and older.

BACKGROUND: This study aims to elucidate the impact of financial incentives on the motivation to participate in dementia prevention activities and to provide support to people with dementia. METHODS: An online survey was completed by 1500 men and women, aged 60 or above, from the general community in Japan. When responding to questions regarding motivation for participating in dementia prevention activities and providing support to people with dementia, respondents were randomly assigned different incentive conditions. Two incentive options were used for dementia prevention activities (no incentives, and a small number of reward points). Three incentive options were used for support activities (no incentives, a small cash reward, or an in-kind time reward that allowed respondents or their family members to use similar services at a later time (time credits)). RESULTS: Financial incentives decreased motivation for participating in dementia prevention activities, while time credits significantly increased motivation to participate in providing support to people with dementia for going out of their home, when receiving a cash reward was compared with receiving no reward. No significant differences by incentive were found for participating in daily living support for those with dementia or for providing support at a dementia café where people with dementia and their families interact. CONCLUSIONS: The adverse influence of financial incentives on motivation to participate in dementia prevention suggested that financial incentives may reduce intrinsic motivation for dementia prevention activities. The positive effects of time credits in providing support to people with dementia in going out suggested that time credits might be effective for some support activities for people with dementia. Different incentive measures should be considered to raise awareness of dementia prevention and dementia support activities.

Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS.

INTRODUCTION: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. OBJECTIVE: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. METHODS: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. RESULTS: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were ¥6,434 ($63.1) for robust, ¥19,324 ($189.5) for pre-frail, and ¥147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. DISCUSSION/CONCLUSION: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

Assessment of eldecalcitol and alendronate effect on postural balance control in aged women with osteoporosis.

INTRODUCTION: Older people aged over 75 are more prone to falls because physical functions become deteriorated along with aging, and also fracture risk is strongly correlated with age. We evaluated the effects of anti-osteoporosis agents, eldecalcitol (ELD) and alendronate (ALN) on physical functions by assessing dynamic and static postural balance in aged patients with osteoporosis. MATERIALS AND METHODS: A randomized, open-label, controlled clinical trial has been conducted with 124 female patients aged 65 or over with osteoporosis. Patients were randomly assigned to receive either 0.75 µg of ELD once-a-day or 35 mg of ALN once-a-week for 24 weeks. The primary endpoint was the change in a postural balance index, adjusted composite equilibrium score (CES) of sensory organization test (SOT). The SOT equilibrium scores, leg muscle strength, and other physical functions were also evaluated. RESULTS: The Adjusted CES increased from baseline by 6.10% in the ELD group and 6.28% in the ALN group. There was no statistically significant difference between the two groups. The static postural balance at fixed platform were maintained in the ELD group, but declined in the ALN group. The dynamic postural balance at swaying platform and knee extension power increased from baseline in both groups. CONCLUSIONS: These results suggest that ELD and ALN treatments may each be beneficial to improve postural balance control in older patients with osteoporosis via different mechanisms of action.

Promoting dementia-friendly communities to improve the well-being of individuals with and without dementia.

A community is the totality of human relationships, in which individuals live with and for others. This article discusses promoting dementia-friendly community from the perspective of human relationships within a community. Improving the social well-being of aging people is important; it is especially important for people with dementia, as dementia is a life-changing syndrome that affects all aspects of one's life, including human relationships. Dementia-friendly community requires support from the community in improving the social adaptation of people with dementia, as they experience greater difficulties in social interaction as a result of cognitive decline, especially deterioration of social cognition. They need to be empowered to stay motivated for the opportunity to maintain an active and meaningful life, despite dementia. Flexible provisions of such tailored support can be effective to improve the support network in the community to meet the individual's needs. As social and human resources are limited, it is also necessary to discuss how to share socioeconomic burdens to meet both social sustainability demands and the welfare of aging adults. More discussions that include people with dementia and their family members are required to achieve the purpose of dementia-friendly community. This is important to enhance the well-being of individuals with and without dementia, as well as the society as a whole, through dementia support and dementia prevention activities. Geriatr Gerontol Int 2020; ••: ••-••.

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.

Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions.

AIM: The present study aimed to: (i) examine the reliability and validity of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items for classifying patients to the appropriate categories for glycemic targets in older patients; and (ii) develop a short version of the tool and examine its reliability and validity. METHODS: A total of 410 older individuals were recruited for this multicenter cross-sectional study. We classified them into three categories used for determining the glycemic target in older patients in Japan based on cognitive functions and activities of daily living. Exploratory factor analyses were used to select the eight items of the shorter version. The reliability and validity of the assessment tools were assessed using Cronbach's alpha coefficients and receiver operating characteristic analyses, respectively. RESULTS: The Dementia Assessment Sheet for Community-based Integrated Care System 21-items had three latent factors: cognitive function, instrumental activities of daily living and basic activities of daily living. The Dementia Assessment Sheet for Community-based Integrated Care System 8-items was developed based on each factor load quantity and was confirmed to have a strong correlation with the original version (r = 0.965, P < 0.001). Both tools significantly discriminated older adults belonging to category I from those belonging to category II or III, and category III from category I or II. CONCLUSIONS: Both tools had sufficient internal consistency and validity to classify older patients into the categories for determining the glycemic target in this population based on cognitive and daily functions. Geriatr Gerontol Int 2018; 18: 1458-1462.

[Construction of a Platform for the Development of Pharmaceutical and Medical Applications Using Transgenic Silkworms].

　We have been constructing a platform for the development of pharmaceutical and medical applications using the domesticated silkworm, Bombyx mori, as a new animal model for drug development and evaluation. Because silkworm larvae originally have the capacity to synthesize up to 0.5 g of silk proteins, genetically modified silkworms (transgenic silkworms) are expected to have high potential in the production of recombinant silks/proteins. An innovative method for generating transgenic silkworms was established in 2000, and ever since this epoch-defining technological development, longstanding efforts have succeeded in developing novel silks that enable the manufacture of new textile materials for regenerative medical uses. Furthermore, we have succeeded in developing a new system of recombinant protein production. This recombinant protein production system is currently capable of producing a maximum of approximately 15 mg recombinant protein per silkworm larva. Transgenic silkworms have also been shown to produce a wide variety of useful proteins, including antibodies and membrane proteins. Some of these recombinant proteins have been in commercial use since 2011. In addition, we have been developing transgenic silkworms as a novel animal model for testing medicines based on metabolic similarities between silkworms and mammals. These applications show the suitability and potential of transgenic silkworms for medical use. Here, we will describe the challenges faced in creating a transgenic silkworm-based platform for pharmaceutical and medical applications.

Distance to screening site and older adults' participation in cognitive impairment screening.

AIM: To develop intervention strategies that promote screening for cognitive impairment, it is essential to identify the modifiable predictors for participation in screening. The present study aimed to examine whether a shorter distance to the screening site predicted participation in screening for cognitive impairment, and whether interactive effects of the distance and psychological factors on the participation would be observed among community-dwelling older adults. METHODS: The study used a prospective design. After a baseline questionnaire survey, participation in screening for cognitive impairment was followed for 6 months (n = 9616). The distance to the screening site was measured by road distance from each residential address and categorized into four groups (<1 km, 1-1.99 km, 2-2.99 km, ≥3 km). The questionnaire measured psychological factors (behavioral intention and perceived benefits of screening), driving status and demographic factors. RESULTS: A logistic regression analysis showed that compared with the <1 km group, the 2-2.99 km (adjusted odds ratio 0.62, P = 0.040) and ≥3 km (adjusted odds ratio 0.54, P = 0.015) groups did not participate in screening after adjusting for psychological and demographic factors, and driving status. The interaction of the distances and psychological factors on participation were not significant. CONCLUSIONS: The distance to the screening site predicted participation in cognitive impairment screening among older adults regardless of their psychological status. This finding shows that improving access to screening sites would be effective for promoting screening for cognitive impairments among both low and highly motivated older adults. Geriatr Gerontol Int 2018; 18: 146-153.

Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study.

OBJECTIVE: To examine the relationship between physical frailty and risk of disability, and to identify the component(s) of frailty with the most impact on disability in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: A Japanese community. PARTICIPANTS: 4341 older adults aged ≥65 living in the community participated in a baseline assessment from 2011 to 2012 and were followed for 2 years. MAIN OUTCOME MEASURES: Care-needs certification in the national long-term care insurance (LTCI) system of Japan, type of physical frailty (robust, prefrail, frail) and subitems (slowness, weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics, analysed with Kaplan-Meier survival curves for incidence of disability by frailty phenotype. RESULTS: During the 2-year follow-up period, 168 participants (3.9%) began using the LTCI system for incidence of disability. Participants classified as frail (HR 4.65, 95% CI 2.63 to 8.22) or prefrail (2.52, 1.56 to 4.07) at the baseline assessment had an increased risk of disability incidence compared with robust participants. Analyses for subitems of frailty showed that slowness (2.32, 1.62 to 3.33), weakness (1.90, 1.35 to 2.68) and weight loss (1.61, 1.13 to 2.31) were related to increased risk of disability incidence. In stratified analyses, participants who were classified as frail and who had lower cognitive function had the highest percentage (30.3%) of disability incidence during the 2 years after baseline assessment. CONCLUSIONS: Physical frailty, even being prefrail, had a strong impact on the risk of future disability. Some components of frailty, such as slowness, weakness and weight loss, are strongly associated with incident disability in community-dwelling older adults.

Cognitive functioning and walking speed in older adults as predictors of limitations in self-reported instrumental activity of daily living: prospective findings from the Obu Study of Health Promotion for the Elderly.

Our aim was to determine whether baseline measures of cognitive functioning, walking speed, and depressive status are independent predictors of limitations in instrumental activities of daily living (IADL) in older adults. The cross-sectional study involved 1329 community-dwelling adults, aged 75 years or older. At baseline, the Mini-Mental State Examination (MMSE), Symbol Digit Substitution Test (SDST), Geriatric Depressive Scale (GDS), and a word list memory task were completed, and self-reported IADLs and walking speed were recorded. The longitudinal study involved 948 participants without baseline IADL limitation, which was assessed at baseline and 15-month follow up, using the three Kihon Checklist subitems. In cross-sectional analyses, participants with IADL limitation demonstrated greater GDS scores, slower walking speeds, and lower MMSE, word list memory task, and SDST (only for women) scores relative to those without IADL limitation. In the longitudinal analyses, baseline walking speed (men: OR 0.98; women: OR 0.97, p<0.05) and word list memory task scores (men: OR 0.84; women: OR 0.83, p<0.05) in both sexes and SDST scores in women (OR 0.96, p=0.04) were independent predictors of subsequent IADL limitation. Walking speed, memory, and processing speed may be independent predictors of IADL limitation in older adults.

Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the Obu Study of Health Promotion for the Elderly.

OBJECTIVE: The purpose of this study was to determine whether frailty is an important and independent predictor of incident depressive symptoms in elderly people without depressive symptoms at baseline. DESIGN: Fifteen-month prospective study. SETTING: General community in Japan. PARTICIPANTS: A total of 3025 community-dwelling elderly people aged 65 years or over without depressive symptoms at baseline. MEASUREMENTS: The self-rated 15-item Geriatric Depression Scale was used to assess symptoms of depression with a score of 6 or more at baseline and 15-month follow-up. Participants underwent a structural interview designed to obtain demographic factors and frailty status, and completed cognitive testing with the Mini-Mental State Examination and physical performance testing with the Short Physical Performance Battery as potential predictors. RESULTS: At a 15-month follow-up survey, 226 participants (7.5%) reported the development of depressive symptoms. We found that frailty and poor self-rated general health (adjusted odds ratio 1.86, 95% confidence interval 1.30-2.66, P < .01) were independent predictors of incident depressive symptoms. The odds ratio for depressive symptoms in participants with frailty compared with robust participants was 1.86 (95% confidence interval 1.05-3.28, P = .03) after adjusting for demographic factors, self-rated general health, behavior, living arrangements, Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale scores at baseline. CONCLUSIONS: Our findings suggested that frailty and poor self-rated general health were independent predictors of depressive symptoms in community-dwelling elderly people.

The combined status of physical performance and depressive symptoms is strongly associated with a history of falling in community-dwelling elderly: cross-sectional findings from the Obu Study of Health Promotion for the Elderly (OSHPE).

The purpose of this study was to examine whether the combined factors of physical performance, depressive symptoms and cognitive status are significantly associated with a history of falling in community-dwelling elderly. We performed a cross-sectional community-based survey, the OSHPE, from August 2011 to February 2012. In total, 5104 community-dwelling older adults aged 65 years and older (mean age 72.0) participated in the OSHPE. Participants underwent a grip strength (GS) test, chair stand test (CST), Timed Up & Go (TUG) test, Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Of the 4481 participants who met our requirements, 645 (14.4%) participants reported falling at least once in the past year. In a signal detection analysis (SDA), we found that the combination of GDS (≥6 points) and TUG (≥10.6 s) had the highest fall rate (36.4%), and the combination of GDS (<6 points) and CST (<11.1 s) had the lowest fall rate (11.7%). The highest fall rate group had a significantly higher odds ratio (OR) compared with the lowest fall rate group after adjusting for other potentially confounding variables [OR 3.12 (95% confidence interval (CI) 2.08-4.68) p<0.001]. The combination of depressive symptoms, TUG, and CST performance was strongly associated with a history of falling in community-dwelling elderly.

Association of physical activities of daily living with the incidence of certified need of care in the long-term care insurance system of Japan: the ROAD study.

BACKGROUND: The present study aimed to investigate association of physical activities of daily living with the incidence of certified need of care in the national long-term care insurance (LTCI) system in elderly Japanese population-based cohorts. METHODS: Of the 3,040 participants in the baseline examination, we enrolled 1,773 (699 men, 1,074 women) aged 65 years or older who were not certified as in need of care-level elderly at baseline. Participants were followed during an average of 4.0 years for incident certification of need of care in the LTCI system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used assess function. Associated factors in the baseline examination with the occurrence were determined by multivariate Cox proportional hazards regression analysis. Receiver operating characteristic curve analysis was performed to evaluate cut-off values for discriminating between the occurrence and the non-occurrence group. RESULTS: All 17 items in the WOMAC function domain were significantly associated with the occurrence of certified need of care in the overall population. Cut-off values of the WOMAC function score that maximized the sum of sensitivity and specificity were around 4-6 in the overall population, in men, and in women. Multivariate Cox hazards regression analysis revealed that a WOMAC function score ≥4 was significantly associated with occurrence with the highest hazard ratio (HR) for occurrence after adjusting for confounders in the overall population (HR [95 % confidence interval (CI)] 2.54 [1.76-3.67]) and in women [HR (95 % CI) 3.13 (1.95-5.02)]. A WOMAC function score ≥5 was significantly associated with the highest HR for occurrence in men [HR (95 % CI) 1.88 (1.03-3.43)]. CONCLUSIONS: Physical dysfunction in daily living is a predictor of the occurrence of certified need of care. Elderly men with a WOMAC function score ≥5 and women with a score ≥4 should undergo early intervention programs to prevent subsequent deterioration.

Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: the ROAD study.

AIM: To examine the incidence of certified need of care in the national long-term care insurance (LTCI) system, and to determine its risk factors in the elderly of Japanese population-based cohorts of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. METHODS: Of the 3040 participants in the baseline examination of the ROAD study, we enrolled 1773 (699 men, 1074 women) aged 65 years or older who were not certified as in need of care level elderly at baseline. Participants were followed for incident certification of need of care in the LTCI system. Associated factors in the baseline examination with occurrence were determined by multivariate Cox proportional hazards regression analysis. Muscle dysfunction was defined in accordance with the European Working Group on Sarcopenia in Older People algorithm for screening sarcopenia. RESULTS: A total of 54 men and 115 women were certified as in need of care level elderly during the average 4.0-year follow up. The incidence was 2.0 and 2.5 per 100 person-years in men and women, respectively. Identified risk factors were region, age, body mass index <18.5 or ≥ 27.5 kg/m(2), grip strength, knee extension torque, usual gait speed, chair stand time and muscle dysfunction. CONCLUSIONS: Both underweight and obesity, as well as low muscle strength and physical ability, are risk factors for certification of need of care. Considering muscle dysfunction is a risk factor for occurrence, screened individuals are recommended to receive early intervention programs regardless of muscle volume.

[Fall risk and fracture. Fall risk assessment].

For the prevention of fall and its associated injuries including various fractures among the elderly, some simple and clinical screening tools for prediction of falls for the community-dwelling elderly have been developed. In Japan, Toba et al. (2005) explored a portable Fall Risk Index (FRI) consisting of 22items for the elderly living in the community. Among these 22 items, selected seven items which were revealed as independent risk factors for previous falls, are also now considered as good predictor for future falls with the sensitivity and specificity of 0.65 and 0.72, respectively. Thus, FRI is considered as useful screening tools to identify high risk elderly people of falls in the community in Japan.

[Prognostic prediction of the functional capacity and effectiveness of functional improvement program of the musculoskeletal system among users of preventive care service under long-term care insurance].

OBJECTIVE: The purpose of this study was to examine the effectiveness of the Functional Improvement Program of the Musculoskeletal System among users of Preventive Care Service under Long-Term Care Insurance. METHODS: A total of 3,073 subjects were analyzed. We used the prediction formula to estimate the predicted value of the Kihon Checklist after one year, and calculated the measured value minus the predicted value. The subjects were divided into two groups according to the measured value minus predicted value tertiles: the lowest and middle tertile (good-to-fair measured value) and the highest tertile (poor measured value). We used a multiple logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of the good-to-fair measured values of the Kihon Checklist after one year, according to the Functional Improvement Program of the Musculoskeletal System. RESULTS: In potentially dependent elderly, the multivariate adjusted ORs (95% CI) of the good-to-fair measured values were 2.4 (1.3-4.4) for those who attended the program eight times or more in a month (vs those who attended it three times or less in a month), 1.3 (1.0-1.8) for those who engaged in strength training using machines (vs those who did not train), and 1.4 (1.0-1.9) for those who engaged in endurance training. CONCLUSIONS: In this study, among potentially dependent elderly, those who attended the program eight times or more in a month and those who engaged in strength training using machines or endurance training showed a significant improvement of their functional capacity.

[Activities in daily life and changes in care level among users of Preventive Care Service under Long-Term Care Insurance].

OBJECTIVES: The aim of this study was to investigate the association between social roles (engaged in working outside or house work) or hobbies and changes in care level among users of Preventive Care Service under Long-Term Care Insurance. METHODS: A total of 8,734 Preventive Care Service users were analyzed. The assessment was conducted between February 2007 and December 2008. The improvement, maintenance, and aggravation in care level were defined by changes in care level from the beginning to the end. To assess their activities in daily life, the participants were asked, "Which is the major activity in your daily life? Please select one from the following: working outside, house work, hobbies, watching television, others, or none." We used the multiple logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of the maintenance or improvement in care level according to the category of activity. RESULTS: As compared with subjects who answered none, the multivariate adjusted ORs (95% CI) of the maintenance or improvement in care level were 2.0 (1.4-2.9) for those who answered working outside, 1.5 (1.2-1.8) for those who answered house work, and 1.5 (1.2-1.9) for those who answered hobbies. However, those who answered watching television or others did not show a significant association with the maintenance or improvement in care level. CONCLUSIONS: In this study, compared with subjects who answered none, those who answered that they were engaged in working outside, house work, or hobbies were associated with having significantly higher ORs of the maintenance or improvement in care level.

Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people.

BACKGROUND: Objective measurements can be used to identify people with risks of falls, but many frail elderly adults cannot complete physical performance tests. The study examined the relationship between a subjective risk rating of specific tasks (SRRST) to screen for fall risks and falls and fall-related fractures in frail elderly people. METHODS: The SRRST was investigated in 5,062 individuals aged 65 years or older who were utilized day-care services. The SRRST comprised 7 dichotomous questions to screen for fall risks during movements and behaviours such as walking, transferring, and wandering. The history of falls and fall-related fractures during the previous year was reported by participants or determined from an interview with the participant's family and care staff. RESULTS: All SRRST items showed significant differences between the participants with and without falls and fall-related fractures. In multiple logistic regression analysis adjusted for age, sex, diseases, and behavioural variables, the SRRST score was independently associated with history of falls and fractures. Odds ratios for those in the high-risk SRRST group (≥ 5 points) compared with the no risk SRRST group (0 point) were 6.15 (p < 0.01) for a single fall, 15.04 (p < 0.01) for recurrent falls, and 5.05 (p < 0.01) for fall-related fractures. The results remained essentially unchanged in subgroup analysis accounting for locomotion status. CONCLUSION: These results suggest that subjective ratings by care staff can be utilized to determine the risks of falls and fall-related fractures in the frail elderly, however, these preliminary results require confirmation in further prospective research.

[Exercise for prevention of osteoporosis and other lifestyle-related diseases].

The prevalence of lifestyle-related diseases including hypertension, dyslipidemia (hyperlipidemia) and diabetes increases with aging, and all these conditions are risk factors of arteriosclerotic diseases such as cerebrovascular event (stroke) and myocardial infarction. The term "metabolic domino" has been used to describe the collective concept of the development and progression of these lifestyle-related diseases, the sequence of events, and the progression process of complications. Like the first tile of a domino toppling game, undesirable lifestyle such as overeating and underexercising first triggers obesity, and is followed in succession by onset of an insulin resistance state (underlied by a genetic background indigenous to Japanese) , hypertension, hyperlipidemia, and further postprandial hyperglycemia (the pre-diabetic state) , the so-called metabolic syndrome, at around the same time. On the other hand, apart from the other lifestyle-related diseases, the prevalence of osteoporosis also increases rapidly accompanying aging. Osteoporosis is known to be strongly related to disorders due to the metabolic domino such as arteriosclerosis and vascular calcification, and a new disease category called "osteo-vascular interaction" has attracted attention recently. Regarding "osteo-vascular interaction" , a close relation between bone density loss or osteoporotic changes and vascular lesion-associated lifestyle-related diseases such as hypertension, dyslipidemia and diabetes has been reported. Therefore, as a common preventive factor for bone mass loss or osteoporosis and lifestyle-related diseases including hypertension, dyslipidemia and diabetes (osteo-vascular interaction) , exercise has been recognized anew as an important non-pharmaceutical therapy that should take top priority. This article overviews the evidence of exercise therapy for the prevention of osteoporosis and other lifestyle-related diseases, from the viewpoint of health promotion, especially of the skeletal system (motor system) .