Proposal and validation of an equation to identify sarcopenia using bioelectrical impedance analysis-derived parameters.

OBJECTIVE: This study aimed to develop a simpler approach for diagnosing sarcopenia by using only bioelectrical impedance vector analysis parameters. METHODS: The study design was a cross-sectional study. The research was conducted based on the Itabashi Longitudinal Study on Aging, a community-based cohort study, with data collected from the 2022 and 2023 surveys in Itabashi Ward, Tokyo, Japan. The development cohort consisted of 1146 participants from the 2022 survey, and the validation cohort included 656 participants from the 2023 survey. Both cohorts were comprised of community-dwelling older adults with similar inclusion criteria. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The logistic model utilized height divided by impedance at 50 kHz and phase angle to establish a new regression equation to identify sarcopenia. Regression equations were generated for the development cohort and validated for the validation cohort. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) for men and women. RESULTS: The prevalence of sarcopenia was 20.7% and 14.8% in the development and validation cohort, respectively. The AUC (95% confidence interval) of the logistic model in discriminating sarcopenia was 0.92 (0.88, 0.95) for men and 0.82 (0.78, 0.86) for women in the development cohort and 0.85 (0.78, 0.91) for men and 0.90 (0.86, 0.95) for women in the validation cohort. CONCLUSION: The study demonstrated that a simple formula using bioelectrical parameters at 50 kHz proved useful in identifying sarcopenia in the older adult population.

Sex-specific factors associated with acceptance of smartwatches among urban older adults: the Itabashi longitudinal study on aging.

Smartwatches (SW) are wearable devices that support daily life and monitor an individual's health and activity status. This information is utilized to promote behavior modification, which could help prevent chronic diseases and manage the health of older adults. Despite being interested in SWs, older adults tend to decrease their SW usage as they age. Therefore, understanding the acceptance of SWs among older individuals can facilitate individual health management through digital health technology. This study investigated the factors associated with the acceptance of SWs among older adults in Japan and the variations in the factors by sex. This study utilized data from the 2022 Itabashi Longitudinal Study on Aging, an ongoing cohort study conducted by the Tokyo Metropolitan Institute for Geriatrics and Gerontology. We included 899 eligible individuals aged ≥65 years. Participants were classified into three groups: possessing SW (possessor group), not possessing SW but interested in possession in the future (interest group), and not interested in possession in the future (non-interest group) using a self-administered questionnaire. The level of SW acceptance was operationally defined as follows: low (non-interest group), medium (interest group), and high (possessor group). Further, we evaluated the association of acceptance and purchase intentions of SWs with sociodemographic variables, technology literacy, and health variables. Among the participants, 4.2% possessed SWs, with no significant sex difference (men, 4.2%; women, 4.3%). Among men, age < 75 years, obesity, diabetes, and dyslipidemia were significantly associated with SW acceptance level. Contrastingly, among women, age < 75 years, living alone, higher household income, and a high score for new device use in the technology literacy category were significantly associated with SW acceptance level. Health-related factors were associated with SW acceptance in men, while technology literacy and sociodemographic factors were associated with SW acceptance in women. Our findings may inform the development of sex-specific interventions and policies for increasing SW utilization among older adults in Japan.

Associations of polypharmacy with frailty severity and each frailty phenotype in community-dwelling older adults: Itabashi Longitudinal Study on Aging.

AIM: Although polypharmacy and frailty are concerns in older adults, there is limited understanding of their association, particularly regarding frailty severity and its phenotypes within this population. This study aimed to examine the association between polypharmacy and frailty severity or frailty phenotypes in community-dwelling older Japanese adults. METHODS: This cross-sectional study included 1021 older adults from the Itabashi Longitudinal Study on Aging. Men accounted for 45.4%, and the mean age (standard deviation) was 77.9 (5.1) years. Participants were classified into frail (n = 67), pre-frail (n = 543), and robust (n = 411) groups using the revised Japanese Cardiovascular Health Study criteria. Polypharmacy was defined as using five or more self-reported prescription drugs. Ordinal and binomial logistic regression analyses examined the association between polypharmacy and frailty severity or frailty phenotypes (weight loss, weakness, exhaustion, slowness, and low activity). These models were adjusted for age, sex, body mass index, number of comorbidities, living status, employment status, years of education, as well as drinking and smoking habits. RESULTS: The prevalence of frailty in participants with and without polypharmacy was 10.1% and 5.0%, respectively. Participants with polypharmacy were more likely to have frailty (adjusted odds ratio [95% confidence interval], 1.89 [1.40-2.57]), weight loss (1.81 [1.00-3.27]), weakness (1.50 [1.08-2.09]), and slowness (2.25 [1.29-3.94]) compared with the no-polypharmacy group. CONCLUSIONS: Polypharmacy was associated with frailty severity and three frailty phenotypes. Longitudinal studies are required to investigate whether polypharmacy can predict the development and progression of frailty. Geriatr Gerontol Int 2024; 24: 196-201.

Questionnaire for Medical Checkup of Old-Old is non-inferior to the Kihon Checklist in screening frailty among independent older adults aged 75 years and older: The Itabashi Longitudinal Study on Aging.

AIM: The Questionnaire for Medical Checkup of Old-Old (QMCOO) is a 15-item dichotomous questionnaire developed for the early detection and intervention of frailty in a nationwide health checkup program targeting the old-old (i.e. aged ≥75 years). The Kihon Checklist (KCL) is a 25-item questionnaire widely used for screening and self-monitoring frailty status in administrative settings. With fewer items than the KCL, the QMCOO might expedite the frailty screening process. This study tested whether the QMCOO shows noninferiority in detecting frailty compared with the KCL. METHODS: Overall, 645 participants aged ≥75 years in the Itabashi Longitudinal Study on Aging were assessed for their frailty status according to the revised Japanese version of the Cardiovascular Health Study criteria. They also completed the QMCOO and the KCL simultaneously. We compared the discriminative performance of the two questionnaires using non-inferiority testing with an operationally defined non-inferiority margin of 10% of the area under the receiver operating characteristic curve computed from the KCL. RESULTS: The prevalence of frailty was 8.8%. The area under the receiver operating characteristic curve for the QMCOO in determining frailty was 0.76 (95% CI 0.70, 0.82), and the corresponding area under the receiver operating characteristic curve for the KCL was 0.77 (95% CI 0.69, 0.84). The QMCOO was not inferior to the KCL for frailty discrimination (P for non-inferiority = 0.006). CONCLUSIONS: The accuracy of the QMCOO for determining frailty was not inferior to that of the KCL. The QMCOO might be more acceptable and useful, as it can be applied in a shorter time with fewer questions than the KCL. Geriatr Gerontol Int 2024; 24: 176-181.

Relationship between phase angle and lower-extremity function in older adults: Itabashi Longitudinal Study on Aging.

OBJECTIVE: Evaluating muscle quality instead of its mass has gained attention in diagnosing sarcopenia. The aim of this study was to examine whether phase angle (PhA) as a bioelectrical impedance analysis (BIA)-derived muscle quality indicator is associated with overall lower extremity function better than appendicular skeletal muscle mass index (ASMI) in community-dwelling older adults. METHODS: This cross-sectional study used data from the Itabashi Longitudinal Study on Aging, a community-based cohort study. A sex-stratified multivariate logistic regression analysis was conducted using PhA and ASMI as exposures, and low physical function defined as short physical performance battery score <10 as the outcome, adjusted for age, being overweight, knee pain, and non-communicable diseases. Discrimination of low physical function was compared using the receiver operating characteristic curve. RESULTS: This study included 1464 participants (age 76 [73-80] y; 757 women), with 58 men (8%) and 66 women (9%) exhibiting low physical function. The multivariate odds ratio (OR; 95% confidence interval [CI]) for low physical function among the highest quartile, compared with the lowest quartile were significant in PhA in multiple sites (e.g., OR, 0.09; 95% CI, 0.03-0.32] for men and 0.12; 95% CI, 0.04-0.33 for women in the left leg) but not in ASMI (OR, 0.51; 95% CI, 0.19-1.34 for men and 0.56; 95% CI, 0.21-1.47 for women). Legs and whole-body PhA outperformed the ASMI in discriminating low physical function (P < 0.001). CONCLUSION: PhA reflected physical function better than ASMI; using PhA instead of ASMI in BIA-based morphometric evaluation may add information on low physical function and enhance the diagnostic value of sarcopenia.

Inaccessibility, unresponsiveness, inconsistency, and invisibility of informal caregivers of older persons with cognitive impairment: community-based participatory research.

BACKGROUND: Studies on informal caregivers in Japan have been limited to family caregivers and largely conducted where family caregivers generally gather. Family caregivers who do not visit such places or non-family caregivers are generally overlooked, and data on these informal caregivers remains scant. Consequently, a framework is needed through which healthcare professionals can approach the informal caregivers of community-dwelling older persons. Therefore, this study approaches such informal caregivers and proposes a classification system for them from the starting point of older persons living in the community with cognitive impairment. METHODS: In 2016, we conducted an epidemiological survey of 7000 + community-dwelling older persons and identified 198 residents with Mini-mental state examination scores less than 23. A team of healthcare professionals contacted them regularly. By 2022, 92 people were still living in the community, and we systematically asked them about their informal caregivers. After approaching the caregivers and obtaining informed consent, we mailed separate questionnaires to older persons and informal caregivers. RESULTS: Among the caregivers, 59%, 34%, and 3% were the child, spouse, and sibling of the older person, while the remaining 4% were non-family caregivers. Except for two daughters-in-laws, all children were biological children of the older person. Male caregivers (46%) tended to have full-time jobs, whereas female caregivers (54%) tended to face financial difficulties. Only 3% of the caregivers had joined a family caregivers' association. Caregivers' reason for not joining such organizations was a lack of time and knowledge. A 3-tiered classification system was developed for these informal caregivers: (1) the household form, (2) accessibility, and (3) the reciprocal awareness of caregiving. Furthermore, family caregivers who lived with the older person or visited them more than once a week with reciprocal awareness of caring and being cared, or "traditional caregivers," accounted for 68% of the caregivers in this study. CONCLUSION: Core family caregivers can be easily approached at places where such caregivers generally gather. However, there also exists a group of informal caregivers who are sometimes inaccessible, unresponsive, and invisible to healthcare professionals. Moreover, their awareness of caregiving is sometimes inconsistent.

Peer support meeting of people with dementia: a qualitative descriptive analysis of the discussions.

BACKGROUND: Dementia cafés for people with dementia and their caregivers are promoted in national dementia policies. The effect of dementia cafés on people with dementia has been reported through narratives of caregivers who participated the dementia cafés. However, evidence derived from the data, which included only people with dementia, is sparse. The aim of this study is to analyze the narratives of people with dementia in peer support meetings in Tokyo where only people with dementia participate, i.e., caregivers were not present. METHODS: People with dementia and older people with subjective cognitive impairment were recruited in our community-based participatory research centre. Based on the qualitative descriptive approach, we conducted a thematic analysis of the field notes, which was made through ethnographical observation of the meetings. RESULTS: Twenty-five meetings were held from November 2018 to March 2020. The cumulative total number of participants was 196. First, the symptomatic problems related to living with dementia were mentioned, which were collectively named under the overarching category of 'Experience of living with dementia.' Second, questions and solutions to the various symptoms were discussed, which were named the 'Quest of Symptoms.' Third, we noted the narrative that reflected on daily life, feelings, and the life that one has led, which were named 'Life story.' Fourth, we noted narratives of how symptoms have improved and their world has expanded, which were named 'Hope.' Fifth and most importantly, narratives about compassion for people with dementia in the past and future, as well as for people of the same generation, were discussed, which were named 'Compassion.' CONCLUSIONS: The lived experiences of people with dementia were revealed. Participants noted they were not just being cared for but exchanging information and exploring the symptoms; in other words, they were resilient. Furthermore, more positive aspects concerning living with dementia were discussed, such as 'Hope' and 'Compassion.' Further research concerning the discourse of people around the participants is necessary to evaluate the situation from multiple perspectives.

The Relationship Between Cognitive Decline and All-Cause Mortality Is Modified by Living Alone and a Small Social Network: A Paradox of Isolation.

OBJECTIVES: Although cognitive decline is a well-known mortality risk, it has not been adequately investigated, whether social relationships modify the relationship between cognitive decline and mortality. We examined the modifying effects of social relationships (household composition, social network [frequency of social contact with individuals outside the household], and social participation) on the association between cognitive decline and all-cause mortality in older Japanese people. METHODS: In 2015, a baseline questionnaire was distributed to all 132,005 independent community-dwelling individuals aged ≥65 years resident in Adachi Ward of the Tokyo Metropolitan area. The final sample analyzed comprised 74,872 participants (men: 44.9%; mean age: 73.7 ± 6.0 years). Cognitive decline was assessed using a self-administered dementia checklist that was validated using the Clinical Dementia Rating Scale. RESULTS: A Cox proportional hazard model with an average follow-up of 1,657 days revealed that cognitive decline was associated with higher mortality (hazard ratio [HR]: 1.37, 95% confidence interval [95% CI]: 1.25-1.50). We identified significant associations among household composition, social networks, and cognitive decline. Stratified analyses indicated that the cognitive decline-mortality association was stronger among participants with low contact frequency (HR = 1.60, 95% CI: 1.39-1.85) than high frequency (HR = 1.24, 95% CI: 1.11-1.39). Conversely, the association was weaker among individuals living alone (HR = 1.13, 95% CI: 0.90-1.40) than among cohabiting individuals (HR = 1.43, 95% CI: 1.29-1.57). CONCLUSIONS: Although living alone and having a small social network represent an isolated status, their modifying effects were the opposite. These findings indicate that the isolation type should be considered when implementing support strategies for older adults with cognitive decline or dementia.

Encouraging death communication in a death-avoidant society: analysis of interviews with death café organizers.

BACKGROUND: Post-war Japanese tend to avoid discussion of death, resulting in a lack of death communication within clinical settings. However, with the aging of society, the significance of conversations and decisions related to end-of-life issues has grown. In 2007, the government established guidelines for decision-making in end-of-life care. Nonetheless, death communication remains a challenge for healthcare professionals in clinical settings. In contrast, death cafés have spontaneously emerged within communities as informal gatherings to openly discuss and explore death. Learning from death café organizers may help healthcare professionals encourage death communication in a death-avoidant society. Therefore, a qualitative study was conducted to describe death cafés by examining the underlying motivation and practices through interviews with death café organizers. METHODS: Individual in-depth interviews were conducted with death café organizers. Two key aspects were explored: 1) the underlying motivations of organizers; and 2) the practices and challenges encountered in running death cafés. The interviews were transcribed verbatim and analyzed using a qualitative descriptive approach. Thematic analysis was used. RESULTS: The study identified two themes representing the underlying motivation of death café organizers: individually-oriented and community-oriented. These themes exhibited contrasting orientations and were collectively termed "individual-community orientation". Regarding the practice of death cafés, the focus was on the "attitude towards having attendees with and without grief in the same session." Participants' attitudes towards this aspect fell into two categories with opposing orientations: "purification" and "inclusion." The "purification-inclusion orientation" was more prevalent among organizers who initiated death cafés due to their personal experiences. A matrix was created to categorize death cafés based on their underlying motivations (individual vs. community-oriented) and practices (purification vs. inclusion). This classification resulted in quadrant 1 (community-oriented, inclusive) and quadrant 3 (individually-oriented, purification). Notably, death cafés in quadrant 1 were often held in temples. CONCLUSIONS: Japanese death cafés can be classified into two categories: individually and purification-oriented and community and inclusive-oriented categories. Healthcare professionals can learn valuable insights from death café organizers, particularly in promoting death communication. Specifically, temple death cafés, with their inclusive practices and orientation towards community, can be particularly beneficial in fostering inclusivity and community engagement.

Characteristics of people seeking consultation after progressing to severe dementia: A mixed-method analysis.

OBJECTIVES: This explores the characteristics of patients with worsening dementia who did not receive a specialized medical examination or care. METHODS: This study utilized a mixed methods analysis. Of the 2712 people who received the Mini Mental State of Examination (MMSE) at the Community Consultation Center for Citizens with MCI and Dementia between December 2007 and December 2019, 1413 people who scored 23 points or less were included. Participants were categorized into mild, moderate, and severe groups, based on their MMSE scores. Participants' characteristics-gender, age, presence or absence of an escort, demographics, family type, and presence or absence of a family doctor-were compared between the groups. To further understand the severe group's characteristics, clinical psychologists recorded consultation forms were categorized. RESULTS: More than 80% of the patients in each group had a family doctor. Moreover, all the severe groups had escorts, and the role of family members and supporters was important for the consultation. In the severe group, 29 patients had never received specialized medical care. Their characteristics were coded "non-existence" (fewer people or opportunities to notice their needs), "connection failure" (a lack of access or connections to consultations), and "evaluation failure" (not recognized as a problem requiring consultation). CONCLUSIONS: It is necessary to improve primary physician education, disseminate knowledge, and raise awareness about dementia, besides building and strengthening networks to alleviate the isolation of dementia patients and their families. The psychological aspects of family members' denial regarding their family members with dementia must be addressed through intervention.

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.

GO Revisited: Qualitative Analysis of the Motivating Factors to Start and Continue Playing GO.

PURPOSE: To explore the motivating factors for starting and continuing to play GO among older adults, as well as to examine the effect of GO activities in helping people to live well with, as well as to prevent, dementia. DESIGN: Qualitative descriptive research. METHODS: Semi-structured interviews were conducted. FINDINGS: The participants reportedly started playing GO for dementia prevention, and to cope with their anxieties about aging. They described feeling relaxed while playing GO. They also felt that playing GO fostered human relationships. CONCLUSIONS: GO is effective in assisting older adults to cope with aging issues, cultivate peace of mind and encourage interaction with peers. CLINICAL EVIDENCE: GO is effective in assisting older adults to cope with aging issues, cultivate peace of mind and encourage interaction with peers.

Population-based reference values for tongue pressure in Japanese older adults: A pooled analysis of over 5,000 participants.

PURPOSE: To establish age- and sex-specific population reference values for tongue pressure (TP) in community-dwelling Japanese older adults. METHODS: For this analysis, we pooled four population-based studies on community-dwelling adults aged ≥65 years that measured TP using a JMS tongue pressure measuring device. We calculated the means and deciles of TP per 5-year age group for each sex. We also estimated age trends in TP for men and women. RESULTS: In total, 5,083 individuals (2,150 men and 2,933 women, with a mean [standard deviation] age of 75.2 [6.5] years) were included in the present analysis. In male participants, the mean (standard deviation) TPs for ages 65-69, 70-74, 75-79, 80-84, and ≥85 years were 34.0 (8.4), 32.2 (8.1), 30.8 (8.3), 28.4 (8.9), and 24.4 (8.2) kPa, respectively. In female participants, the corresponding values were 31.5 (7.1), 30.5 (7.5), 29.6 (7.3), 28.4 (8.0), and 26.4 (7.6) kPa, respectively. For both sexes, there were significant declining trends in TP with advanced age. In addition, the interaction between age and sex had a significant effect on TP (regression coefficient [95% confidence interval] = -0.18 [-0.25 to -0.11] when age was modeled as a continuous variable and sex was modeled as a categorical variable [coded as 0=women, 1=men]). CONCLUSIONS: This study determined age- and sex-specific reference values for TP, presented as means and deciles, in community-dwelling Japanese older adults aged ≥65 years. This study also demonstrated sex differences in age-related declines in TP.