Serum levels of vitamin D and periodontal inflammation in community-dwelling older Japanese adults: The Otassha Study.

AIM: To evaluate the association between vitamin D status and periodontal inflammation as determined by the periodontal inflamed surface area (PISA) in community-dwelling older adults. MATERIALS AND METHODS: This cross-sectional study included 467 Japanese adults (mean age = 73.1 years) who underwent full-mouth periodontal examinations and measurements of serum levels of 25-hydroxyvitamin D (25(OH)D). We used linear regression and restricted cubic spline models to analyse the association between exposure (serum 25(OH)D) and outcome (PISA). RESULTS: The linear regression model showed that, after adjusting for potential confounders, participants in the lowest quartile of serum 25(OH)D had 41.0 mm2 more PISA (95% confidence interval [CI]: 4.6-77.5) than the reference group (the highest quartile of serum 25(OH)D). The spline model showed that the association between serum 25(OH)D and PISA was non-linear and restricted to the low 25(OH)D range. PISA initially sharply decreased as serum 25(OH)D increased, and then the decreasing trend slowed and plateaued. The inflection point with the minimum PISA value was a serum 25(OH)D level of 27.1 ng/mL, above which there was no decreasing trend in PISA with increasing serum 25(OH)D levels. CONCLUSIONS: Low vitamin D status had an L-shaped association with periodontal inflammation in this cohort of Japanese adults.

Initial symptoms of early-onset dementia in Japan: nationwide survey.

AIM: The aim of this study was to investigate initial symptoms of early-onset dementia (EOD) for each dementia subtype. METHOD: We conducted a nationwide, population-based EOD prevalence study in Japan. Data were collected through service providers for people with EOD. Initial symptoms were assessed in six domains: loss of memory, difficulty in word generation, irritability, loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed. RESULTS: Participants were 770 people with EOD. Characteristic initial symptoms were observed for each EOD subtype. Loss of memory was more common in early-onset Alzheimer's disease (75.7%, P < 0.001), difficulty in word generation was more common in early-onset vascular dementia (41.3%, P < 0.001), and loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed were more common in early-onset frontotemporal dementia (34.9%, P < 0.001; 49.4%, P < 0.001; 34.9%, P < 0.001, respectively). In addition, we observed gender differences whereby loss of memory was more common among women and irritability was more common among men. More than half of the participants were employed at symptom onset, and 57.2% of those who were employed at the onset had initial symptoms of increased mistakes in the workplace or domestically. CONCLUSION: This report reveals differences in the frequency of initial symptoms by EOD subtype. The results contribute to increasing public awareness of the initial symptoms of EOD, which will facilitate early diagnosis and social support.

[Classification of community-dwelling older people based on their physical, mental, cognitive, and oral functions and comorbidities and its relationship with the fall history].

AIM: To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups. METHODS: Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed. RESULTS: A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference. CONCLUSIONS: We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Promoting cultural change towards dementia friendly communities: a multi-level intervention in Japan.

BACKGROUND: Effective strategies to develop dementia-friendly communities (DFCs) are needed in aging societies. We aimed to propose a strategy to develop DFCs from a Japanese perspective and to evaluate an intervention program that adopted the strategy. METHODS: This study implemented a multi-level intervention that emphasized nurturing community social capital in a large apartment complex in the Tokyo metropolitan area in 2017. We offered an inclusive café that was open for extended hours as a place to socialize and a center for activities that included monthly public lectures. Individual consultation on daily life issues was also available for free at the café. Postal surveys were sent out to all older residents aged 70 years and older in 2016 and 2019. With a one-group pre-test and post-test design, we assessed changes in the proportion of older residents who had social interaction with friends and those who were confident about living in the community, even if they were living with dementia. RESULTS: Totals of 2633 and 2696 residents completed the pre and post-intervention surveys, respectively. The mean age of the pre-intervention respondents was 77.4 years; 45.7% lived alone and 7.7% reported living with impaired cognitive function. The proportion of men who had regular social interaction and were confident about living in their community with dementia increased significantly from 38.8 to 44.5% (p = 0.0080) and from 34.1 to 38.3% (p = 0.045), respectively. Similar significant increases were observed in the subgroup of men living with impaired cognitive function, but not in the same subgroup for women. CONCLUSIONS: The intervention benefitted male residents who were less likely to be involved in the community's web of social networks at baseline. A strategy to create DFCs that emphasizes nurturing community social capital can form a foundation for DFCs. TRIAL REGISTRATION: This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Clinical Trial Registry (registry number: UMIN000038193 , date of registration: Oct 3, 2019).

Oral hypofunction and malnutrition among community-dwelling older adults: Evidence from the Otassha study.

OBJECTIVE: This study investigated the association between oral hypofunction and malnutrition among community-dwelling older adults. BACKGROUND: Oral hypofunction, a 7-component phenotype of the clinical features of oral health, has been described in Japan. Data about its association with nutritional status are limited. MATERIALS AND METHODS: This cross-sectional study enrolled 715 adults (mean age, 73.5 years; range, 65-91 years) from the Otassha Study. Oral hypofunction was defined as the presence of ≥3 of the following 7 components: poor oral hygiene; oral dryness; low occlusal force; low articulatory oral motor skill; low tongue pressure; low masticatory performance; and compromised swallowing function. The Mini Nutritional Assessment® -Short Form (MNA® -SF) was used to assess the nutritional status. Malnutrition was defined as having an MNA® -SF score of seven or less. The association between oral hypofunction and nutritional status was evaluated using ordinal logistic regression analyses. RESULTS: The prevalence rates of oral hypofunction and malnutrition were 42.7% and 4.1%, respectively. Multivariable Poisson regression analyses revealed that oral hypofunction was associated with malnutrition. The adjusted relative risk of malnutrition in the study participants with oral hypofunction was 3.00 with a 95% confidence interval of 1.29-6.98. CONCLUSION: Community-dwelling older adults whose oral functions were compromised in multiple aspects had poor nutritional status.

Association between dry mouth and physical frailty among community-dwelling older adults in Japan: The Otassha Study.

OBJECTIVE: To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan. BACKGROUND: Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. MATERIALS AND METHODS: This cross-sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. RESULTS: Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. CONCLUSION: Xerostomia is associated with physical frailty among community-dwelling older adults in Japan. CLINICAL TRIAL REGISTRATION: Not applicable.

Factors associated with inability to attend a follow-up assessment, mortality, and institutionalization among community-dwelling older people with cognitive impairment during a 5-year period: evidence from community-based participatory research.

BACKGROUND: The aim of the present study was to explore factors associated with (i) the inability to attend a follow-up assessment in the community-based participatory research (CBPR) framework; (ii) mortality; and (iii) institutionalization, across a 5-year period among older people with cognitive impairment identified via an epidemiological survey. METHODS: The participants were 198 older people whose score on the Mini-Mental State Examination was below 24, and who were living in our CBPR region in the Tokyo metropolitan area. Baseline data included sociodemographic factors, health-related factors, social factors, and assessments by healthcare professionals. Over the following 5 years we observed what happened to the subjects within the CBPR framework. Bivariate and stepwise multiple logistic regression analyses were performed to explore the factors associated with the inability to attend a follow-up assessment, 5-year mortality, and institutionalization. RESULTS: Participants who did not attend a follow-up assessment tended to live alone. Being older (>80), living with others, frailty, and the need for rights protection and daily living support were associated with increased mortality. Long-term care insurance certification was strongly associated with institutionalization as a natural consequence of the health-care system. Having dementia and low access to doctors were also positively associated with institutionalization. CONCLUSIONS: Older people with cognitive impairment who are living alone are at higher risk of being overlooked by society. To move toward more inclusive communities, the following are recommended: (i) more interventions focusing on older people living alone; (ii) social interventions to detect daily life collapse or rights violations; and (iii) more support to help people with dementia continue living in the community.

Living on the edge of the community: factors associated with discontinuation of community living among people with cognitive impairment.

BACKGROUND: As Japanese society continues to age, the isolation of older people is increasing, and community living for people with cognitive impairment is becoming more difficult. However, the challenges faced by people with cognitive impairment living in the community have not been fully explored because of methodological difficulties. This study re-accessed people with cognitive impairment identified in a previous epidemiological survey to explore their current situation and the risk factors associated with all-cause discontinuation of community living. METHODS: Under a community-based participatory framework, we examined a high-risk approach for people with cognitive impairment and a community action approach in parallel, to build a dementia-friendly community. For the high-risk approach, we achieved stepwise access to 7614 older residents, which enabled us to select and visit the homes of 198 participants with a Mini-Mental State Examination score < 24 in 2016. In 2019, we re-accessed these individuals. For the community action approach, we built a community space in the study area to build partnerships with community residents and community workers and were able to re-access participants using multiple methods. RESULTS: We found that 126 (63.6%) participants had continued living in the same community, but 58 (29.3%) had discontinued community living. Of these, 18 (9.1%) had died, 18 (9.1%) were institutionalized, 9 (4.5%) were hospitalized, and 13 (6.6%) had moved out of the community. A multiple logistic regression analysis identified the following risk factors associated with discontinuation of community living: being certified under long-term care insurance, needing housing support, and needing rights protection. CONCLUSIONS: Three years after the baseline survey, 29.3% of people with cognitive impairment had discontinued community living. Despite having cognitive impairment or living alone, older people were able to continue living in the community if their needs for housing support and rights protection were met. Both social interventions and medical interventions are important to build age-friendly communities. TRIAL REGISTRATION: UMIN, UMIN000038189, Registered 3 October 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521.

Interrelationships among whole-body skeletal muscle mass, masseter muscle mass, oral function, and dentition status in older Japanese adults.

BACKGROUND: Generalized loss of skeletal muscle mass (SMM) may modulate or otherwise affect the loss of masseter muscle mass and be responsible for low masseter muscle performance and strength (i.e., low oral function). Moreover, dentition status can affect oral function independent of the muscle state. This cross-sectional study aimed to simultaneously investigate the relationships among whole-body SMM, masseter muscle mass, oral function (masseter muscle performance and strength), and dentition status in 1349 Japanese adults (mean age = 73.6 years). METHODS: We determined the estimated masseter muscle mass (e-MMM) based on morphological measurements of the masseter muscle. Masseter muscle performance was assessed via masticatory performance evaluation scores using gum, and strength was assessed as the maximal occlusal force. Dentition status was assessed as the number of functional teeth. SMM was measured by bioelectrical impedance analysis. Structural equation modeling stratified by sex was employed to investigate associations among SMM, e-MMM, gum score, occlusal force, and number of functional teeth. RESULTS: The direct path from SMM to e-MMM was statistically significant, as was the direct path from e-MMM to oral function (gum score and maximum occlusal force) for both sexes. We additionally confirmed that SMM indirectly affected gum score and maximum occlusal force via e-MMM (men; standardized coefficient [95% CI] = 3.64 [1.31 to 5.96] for maximum occlusal force and 0.01 [0.01 to 0.02] for gum score, women; 2.01 [0.38 to 3.81] for maximum occlusal force and 0.01 [0.002 to 0.01] for gum score). The number of functional teeth had direct effects on e-MMM, gum score, and maximum occlusal force. CONCLUSIONS: Low SMM was significantly indirectly associated with poor oral function through a low masseter muscle mass, and dentition status was independently associated with oral function.

The effect of multimodal comprehensive care methodology training on oral health care professionals' empathy for patients with dementia.

BACKGROUND: The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS: This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS: The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS: The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.

Depressed mood and frailty among older people in Tokyo during the COVID-19 pandemic.

BACKGROUND: The study aim was to identify depressed mood and frailty and its related factors in older people during the coronavirus disease 19 pandemic. METHODS: Since 2010, we have conducted questionnaire surveys on all older residents, who are not certified in the long-term care insurance, living in one district of Tokyo municipality. These residents are divided into two groups by birth month, that is those born between April and September and those born between October and March, and each group completes the survey every 2 years (in April and May). Study participants were older residents who were born between April and September and who completed the survey in spring 2018 and in spring 2020, the pandemic period. Depressed mood and frailty were assessed using the Kihon Checklist, which is widely used by local governments in Japan. We had no control group in this study. RESULTS: A total of 1736 residents responded to both surveys. From 2018 to 2020, the depressed mood rate increased from 29% to 38%, and frailty increased from 10% to 16%. The incidence of depressed mood and frailty was 25% and 11%, respectively. Incidence of depressed mood was related to subjective memory impairment and difficulty in device usage, and incidence of frailty was related to being older, subjective memory impairment, lack of emotional social support, poor subjective health, and social participation difficulties. CONCLUSIONS: Older people with subjective memory impairment may be a high-risk group during the coronavirus pandemic. Telephone outreach for frail older people could be an effective solution. We recommend extending the scope of the 'reasonable accommodation' concept beyond disability and including older people to build an age-friendly and crisis-resistant community.

[The oral function of community-dwelling older adults complaining of an oral function deterioration: An examination using the oral function-related items of the Questionnaire for Latter-stage Elderly People].

AIM: The oral function-related items of the newly developed "Questionnaire for Latter-stage Elderly People" are based on two items of the Kihon checklist assessing the masticatory and swallowing functions. In this study, we estimated the questionnaire's application rate and investigated the oral function of the respondents. METHODS: Included were 699 older adults (274 men/425 women, average age, 73.4±6.6 years old). Those who responded positively to the related items were considered to have decreased swallowing and masticatory functions. The specific oral function was assessed based on the number of present and functional teeth; oral hygiene; oral moisture; occlusal force; oral diadochokinesis /pa/, /ta/, /ka/; tongue pressure; mixing ability; shearing ability; and Eating Assessment Tool (EAT)-10 (reference, score ≥3). RESULTS: The rates of decreased masticatory and swallowing functions were 21.5% and 26.6%, respectively, while 7.4% of participants had both. Those with a decreased masticatory function showed fewer present teeth; a lower occlusal force, oral diadochokinesis /pa/, mixing ability, shearing ability, and higher EAT-10 scores.Those with a decreased swallowing function only had higher EAT-10 scores. In the early- and latter-stage elderly, the decreased masticatory function rates were 15.6% and 29.4%, respectively, the decreased swallowing function rates were 27.8% and 25.0%, respectively, and the rates of both decreased masticatory and swallowing functions were 6.0% and 9.5%, respectively. CONCLUSION: The older adults who responded positively to the related questionnaire items, especially for items related to masticatory function, had a decreased oral function in multiple respects. The items related to the oral function in the Questionnaire for Latter-stage Elderly People are considered useful for identifying older adults with a decreased oral function.

[Relationship between the rate of a decreased oral function and the nutrient intake in community-dwelling older persons: An examination using oral function-related items in a questionnaire for latter-stage elderly people].

AIM: To determine the rate of a decreased oral function using questions from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People and to clarify nutrient intake in older persons. METHODS: This study targeted 511 older people (217 men, 294 women, average age 73.1±5.6 years old). Their oral function was evaluated using questions on the masticatory function and swallowing function from the Kihon checklist, corresponding to questions on the oral function in the Questionnaire for Latter-stage Elderly People. Participants who had at least one symptom measured were defined as the applicable group (AG). In addition, to evaluate the nutrient intake of the participants, interviews were conducted using the Food Frequency Questionnaire Based on Food Groups. RESULTS: The rate of inclusion in the AG was 32.9% for the total sample, 28.2% for early-stage elderly people, and 40.1% for latter-stage elderly people. The AG rates did not differ significantly between men and women. For latter-stage elderly people, the protein-energy ratio and intakes of total energy, protein, pantothenic acid, folic acid, vitamin B6, niacin, vitamin K, copper, zinc, phosphorus, magnesium, potassium, and total dietary fiber were significantly lower in the AG than in the non-AG. CONCLUSION: The evaluation of placement in the AG through questions on the oral function from the Kihon checklist corresponding to the Questionnaire for Latter-stage Elderly People demonstrated that the rate of a decreased oral function was higher in latter-stage elderly people than in early-stage elderly people. In addition, the latter-stage elderly people in the AG had a lower nutrient intake.

Association between anorexia and hyposalivation in community-dwelling older adults in Japan: a 6-year longitudinal study.

BACKGROUND: Hyposalivation is associated with the nutritional status. Anorexia of ageing, defined as an age-related decrease in appetite and food intake, presents even in healthy adults and is considered an independent predictor of malnutrition, frailty, and mortality. However, the relationship between anorexia and hyposalivation of ageing is unclear. Thus, the present longitudinal study aimed to investigate the incidence of hyposalivation and its relationship with anorexia in community-dwelling older people in Japan. METHODS: The study population comprised 220 individuals (80 men and 140 women) aged 65-86 years at baseline. The participants underwent comprehensive health check-ups, including dental examinations and anthropometry, and face-to-face interviews in 2013 and 2019. Hyposalivation was determined on the basis of the unstimulated salivary flow rate measured using the modified cotton roll method. Anorexia was defined as a score of ≤29 in the Japanese version of the Council on Nutrition Appetite Questionnaire. Logistic regression analyses were used to test whether the presence of anorexia at baseline was an independent predictor of hyposalivation. RESULTS: Hyposalivation developed at a rate of 19.5% during the 6-year observation period. Anorexia was observed in 95 (43.2%) participants at baseline. After adjusting for potential confounding factors, anorexia (adjusted odds ratio [AOR], 2.65; 95% confidence interval [CI], 1.26-5.57) and polypharmacy (AOR, 3.29; CI, 1.06-10.19) were significant predictors of hyposalivation. CONCLUSION: Loss of appetite is independently correlated with and a risk factor for hyposalivation in older adults. Anorexia of ageing may have negative effects on the salivary flow rate in such settings. Salivation should be a standard feature in clinical assessments of the older adults.

Everyday challenges facing high-risk older people living in the community: a community-based participatory study.

BACKGROUND: Considering the real-world experiences of those with cognitive impairments is important in building a positive community for older people. Community-based participatory research is an important methodology for investigators focused on improving community health. The aim of this study was to 1) investigate factors associated with the continuation of community dwelling among high-risk older people and 2) to create a model of an inclusive community space for older people in the largest housing complex district in Tokyo. METHODS: From 198 residents who completed all three steps (mail, face-to-face, and home-visit) of a previous large-scale epidemiological survey, we identified 66 residents who were at high-risk of moving out of the community. These participants underwent 6 months of regular assessments by experienced researchers to identify the factors associated with continuing to live in the community. We also employed a community action approach to develop a community space for residents in the study district where more than two researchers who were medical professionals served as staff. The services offered by the space were continuously improved according to user feedback. The function of this center was evaluated during interdisciplinary research meetings. RESULTS: After 6 months, among the 66 high-risk residents, 49 people were living in the community and 12 people had moved out of the community. Those who could not continue to live in the community had greater unmet needs in terms of social support, especially daily living support and housing support. In addition, their families perceived a heavier burden of care. Interestingly, dementia diagnosis via the DSM-5, clinical dementia rating, physical health, mental health, and long-term care usage did not predict the outcome. Through discussions with guests, we equipped the space with various services such as coordination of community care and networking with existing organizations. CONCLUSIONS: Merely providing healthcare and long-term care might not be sufficient to support community living in people with cognitive impairments. Daily living support and housing support should be provided in the context of a broad health services package. For this purpose, creating a comfortable community space for residents and community workers is essential.

Development of a simple method to measure masseter muscle mass.

OBJECTIVE: To develop a simple method to estimate masseter muscle mass. BACKGROUND: The masseter muscle is important for optimal oral function. A decrease in the masseter muscle mass may affect the oral and physical function of the whole body; therefore, it is an important entity to measure. However, to date, no easy measurement method has been developed for the same. Herein, we devised a simple method to estimate masseter muscle mass. In addition, we compared our method with magnetic resonance imaging (MRI) and skeletal muscle mass (SMM) to verify its validity. MATERIALS AND METHODS: We recorded the age, sex, masseter muscle mass (by MRI), number of retained natural teeth, number of functional teeth, length and thickness of masseter muscle, and skeletal muscle mass in 53 community-dwelling elderly people (21 men and 32 women, average age 72.9 ± 4.5 years). The estimated masseter muscle mass was calculated by multiplying the length, width and thickness of the muscle. RESULTS: The correlation coefficient between masseter muscle mass and estimated masseter muscle mass was r = .903; thus, a strong correlation was recognised. The correlation coefficient between the estimated masseter muscle mass and SMM was r = .279, considering age and sex. CONCLUSION: We obtained substantial results using our method for estimating the masseter muscle mass and verified its validity by comparing it with masseter muscle mass measured by MRI and SMM. We believe that our proposed technique is simple and useful for estimating masseter muscle mass.

Prevalence and subtype distribution of early-onset dementia in Japan.

AIM: People living with early-onset dementia (EOD) have specific social needs. Epidemiological studies are needed to obtain current information and provide appropriate service planning. This study aimed to clarify the current prevalence and subtype distribution of EOD, as well as the services frequently used by individuals with EOD. METHODS: A multisite, population-based, two-step study was conducted. Questionnaires were sent to 26 416 candidate facilities in 12 areas with a target population of 11 630 322 to inquire whether any individuals with EOD had sought services or stayed during the last 12 months (step 1). When "yes" responses were received, additional questionnaires were sent to the facilities both to complete and to distribute to the target individuals with EOD to obtain more detailed information, including the dementia subtype (step 2). RESULTS: In step 1, valid responses were obtained from 16 848 facilities (63.8%), and 4077 cases were identified. In step 2, detailed information was obtained for 1614 cases (39.6%) from the facilities and 530 cases (13.0%) from the individuals. The national EOD prevalence rate was estimated to be 50.9/100 000 population at risk (95% confidence interval: 43.9-57.9; age range, 18-64 years). The number of individuals with EOD was estimated to be 35 700 as of 2018. Alzheimer-type dementia (52.6%) was the most frequent subtype, followed by vascular dementia (17.1%), frontotemporal dementia (9.4%), dementia due to traumatic brain injury (4.2%), dementia with Lewy bodies/Parkinson's disease dementia (4.1%), and dementia due to alcohol-related disorders (2.8%). Individuals with EOD were most frequently identified at medical centers for dementia. CONCLUSION: The prevalence rate estimated in this study was comparable to those in previous studies in Japan. However, the subtype distribution differed, with Alzheimer-type dementia being the most prominent. Based on the case identification frequencies, medical centers for dementia are expected to continue to function as the primary special health service by providing quality diagnosis and post-diagnostic support for individuals with EOD.

[Protecting dignity: Reviewing the decision-supporting process for an isolated elderly individual living in a large housing complex].

AIM: To clarify the conditions under which dignity is maintained by reviewing the decision-supporting process for a case. METHODS: We conducted both a longitudinal epidemiological survey and action research in parallel in a large housing complex district in Tokyo, Japan, using the community-based participatory research framework. Through collaboration with community professionals, we supported an isolated elderly man who refused medical intervention for three years until his death. After his passing, we re-examined all of his records, conducted in-depth interviews with the community professionals, and held a conference to review the process of managing this individual. RESULTS: Concerning support for the decision-making, three conclusions were obtained from the data: 1) a decision is not always stated explicitly; 2) a decision should be supported by the team, because mind sometimes changes; and 3) supporting decision-making is a process in itself. For the maintenance of dignity in the medical setting, the following were kept in mind: medical context is not all that is important; supporters should wait for the right moment to intervene, and support should be provided to help the patient keep in touch with other people and the community. CONCLUSIONS: While precisely defining dignity can be difficult, we explored the conditions under which dignity could be maintained by reviewing the decision-supporting process for a single case. Geriatricians may encounter difficult and complex cases such as this in the clinical setting, but guidelines cannot cover such diverse cases.

The Differential Effects of Age on the Association Between Childhood Socioeconomic Disadvantage and Subjective Symptoms of Dementia Among Older Japanese People.

BACKGROUND: Despite increasing evidence of an association between childhood socioeconomic disadvantage and cognitive outcomes, such as dementia and cognitive decline, in Western countries, there are no studies on this association from non-Western societies. We investigated the relationship between childhood socioeconomic status (SES) and subjective symptoms of dementia among community-dwelling older Japanese people and examined age and sex variations in this association. METHODS: Data were derived from a cross-sectional survey for all community-dwelling individuals aged 65 years and over in Adachi, Tokyo (n = 132,005). We assessed subjective dementia symptoms using a self-administered dementia checklist, which was validated by comparison with the Clinical Dementia Rating scale. RESULTS: Data from 75,358 questionnaires were analyzed. After adjusting for potential covariates, lower childhood SES was associated with greater likelihood of subjective dementia symptoms. We found a significant interaction between childhood SES and age on subjective dementia symptoms but no interaction between childhood SES and sex. Age-stratified analysis indicated that the association between lower childhood SES and subjective dementia symptoms was stronger in the ≥75 years subgroup than in the 65-74 years subgroup, indicating an effect modification of age on this association. CONCLUSIONS: Our findings suggested that low SES in childhood might have a long-term influence on dementia symptoms in late life and that this influence varied by age. This differential association might be explained by the social and historical context in Japan (ie, World War II, postwar chaos, and high economic growth) that has shaped participants' early experiences.

Qualitative analysis of the vocabulary used in work logs of a preventive programme for elderly oral function and nutrition.

BACKGROUND: In Japan, day care services for elders include programmes aimed at improving nutrition and oral and motor functions. Few studies have qualitatively assessed these interventions. OBJECTIVE: To qualitatively search for the characteristic words used in the work logs of a preventive programme on oral function and nutrition for elders by intervention period and intervention type． METHODS: We included 83 participants (81.3 ± 8.2 years) from four day care services in Japan and divided them into the following groups randomly: those who received oral function intervention only, nutritional intervention only and those who received combined oral function plus nutritional intervention. The interventions were conducted twice per month for 24 months. Data from handwritten work logs were entered into a computer as text files. Monitoring of frequently appearing words, co-occurrence analysis and cross-tabulation by intervention period and intervention types was conducted using text mining analysis. RESULTS: Correspondence analysis revealed that the words used during 1-6 months and 7-12 months were similar in participants' subjective content, and those used in objective content in 13-18 months and 19-24 months were similar. These results indicate that subjective improvements increased after 13 months, and it was maintained within 24 months. The combined intervention type is ideal for oral and nutrition problems. CONCLUSION: Because this text mining approach revealed the changes in the words used and could be used to monitor any subjective improvement, this approach may help evaluate the effects of preventive care.