Prevalence and characteristics of frailty in older adults in Japan: a cross-sectional study using data from the long-term care insurance system.

[Purpose] Owing to rapid population aging, prevention of frailty in older adults and minimizing the burden on the long-term care insurance system are priorities for the Japanese government. However, limited data are available regarding the prevalence and characteristics of frailty among older adults requiring support in Japan. In this study, we investigated the prevalence and characteristics of frailty in older adults requiring support in Japan. [Participants and Methods] The study included 695 new users of preventive long-term care services certified as "requiring support" between 2011 and 2019. In this cross-sectional investigation, we used data obtained from a community comprehensive support center. Frailty prevalence was assessed using the Kihon Checklist, followed by a χ2 test. Logistic regression analysis was performed to identify the characteristics (basic information and service type) associated with frailty. [Results] A significantly large percentage of robust/pre-frail participants (72.7%) belonged to urban areas, although we observed no significant difference in robust participants with regard to residence. Furthermore, we observed significant intergroup differences in age and orthopedic conditions. [Conclusion] It is important to encourage older adults to access the long-term care insurance system and seek support at an early stage.

Association between regional phase angle and level of locomotion among older females requiring long-term care in a health facility.

[Purpose] This study aimed to determine the characteristics of regional phase angles based on locomotion level among older Japanese females requiring long-term care in a health facility. [Participants and Methods] This was a cross-sectional observational study. The participants included 91 residents (mean age ± standard deviation: 90.2 ± 5.6 years) admitted to an older health facility. Based on their indoor locomotion status, the participants were divided into three groups: group I, able to walk with or without walking aids; group II, able to move in a wheelchair without assistance; and group III, able to move in a wheelchair with assistance. The regional phase angle was measured using a bioimpedance device. [Results] Significant differences were observed in the regional phase angle of the upper limbs between groups I and III and between groups II and III; in that of the lower limbs among all groups; and in that of the trunk between groups I and II and between groups I and III. [Conclusion] The level of locomotion may be explained by the regional phase angles of the lower limbs.

Association between Internet Use and Locomotive Syndrome, Frailty, and Sarcopenia among Community-Dwelling Older Japanese Adults.

In the lives of those who are the target of community health nursing, it is important to collaborate with individuals and communities to improve their quality of life. Herein, we aimed to determine the association between Internet use among older individuals and locomotive syndrome (LS), frailty, and sarcopenia. In this cross-sectional study conducted between July 2022 and March 2023, we recruited 105 community-dwelling older Japanese adults who participated in a care prevention project called "Kayoi-no-ba". All participants were divided into Internet and non-Internet user groups according to the classification of a previous study. We assessed LS (standing test, two-step test, and five-question Geriatric Locomotive Function Scale), frailty (through the Questionnaire for Medical Checkup of Old-Old), and sarcopenia (grip strength, normal walking speed, and skeletal muscle mass index) and made group comparisons between Internet users and non-users. Binomial logistic regression analyses were performed with Internet use as the independent variable and sarcopenia or LS as the dependent variables. The Internet and non-Internet user groups had 69 and 36 participants, respectively. The Internet user group comprised 65.7% of all participants, which was similar to that reported in a previous study of the same age group. Between-group comparisons showed significant differences in sarcopenia and LS items, whereas adjusted binomial logistic analysis showed a significant association between sarcopenia and Internet use. In summary, among LS, frailty, and sarcopenia, sarcopenia showed the highest association with Internet use. Older adults without sarcopenia having good physical functions, such as grip strength, walking speed, and skeletal muscle index, more likely used the Internet; while older adults with sarcopenia were less likely to use the Internet. This implied that Internet use may be associated with physical function.

Effectiveness of comparing calf circumference with neck circumference regarding their association with skeletal muscle indices in Japanese nursing home residents.

[Purpose] This study aimed to determine the association between calf and neck circumferences and skeletal muscle indices, including phase angle, among Japanese nursing home residents. [Participants and Methods] A cross-sectional study of a single nursing home was conducted, in which 72 nursing home residents (aged 85.9 ± 8.4 years, mean ± standard deviation [SD]) were enrolled. Calf and neck circumferences were measured using a measuring tape, and body composition assessment was measured using a bioimpedance device. [Results] The age- and sex-adjusted partial correlation coefficient showed that calf circumference exhibited a significantly high correlation with all body composition parameters; however, neck circumference exhibited a significantly low correlation with body fat percentage only. The calf circumference had a higher correlation coefficient than the neck circumference with all body composition items, except for body fat percentage. [Conclusion] This study showed that phase angle and muscle mass were associated with calf circumference, but not with neck circumference, in Japanese nursing home residents. Therefore, calf circumference is important in clinical evaluations as a potential screening tool for nursing home residents with various diseases.

Age and period of ventilator use are related to walking independence at the time of discharge in patients with severe COVID-19 pneumonia: a single-center retrospective observational study.

[Purpose] This study aimed to identify the factors and cutoffs associated with walking independence in patients with severe COVID-19 pneumonia. [Participants and Methods] In total, 112 patients with COVID-19 pneumonia (98 males and 14 females) who were hospitalized between March 2020 and August 2021 and underwent physiotherapy during mechanical ventilation were included in the study. Attributes, respiratory function, physical function, and bed-withdrawal status were compared between two groups of patients, who were classified according to their ability to walk independently at discharge. The independent variables were reduced to four components by principal component analysis. Logistic regression analysis was performed with walking independence at discharge as the dependent variable. Receiver operating characteristic curves for the extracted factors were drawn, and cutoff values were calculated. [Results] At discharge, 76 patients were able to walk independently, while 36 were not. The logistic regression analysis was adjusted according to age and mechanical ventilation time. Cutoffs were an age of 56 years and a ventilation period of 7.5 days. [Conclusion] In cases of patients with severe COVID-19 pneumonia who required ventilators, age and mechanical ventilation time were associated with ambulatory independence at discharge, indicating the importance of reducing the ventilation period by providing respiratory physiotherapy, including expectoration, positioning, and weaning.

Neck circumference is a highly reliable anthropometric measure in older adults requiring long-term care.

The reliability of neck circumference measurement as an assessment tool for older adults requiring long-term care remains unknown. This study aimed to evaluate the reliability of neck circumference measurement in older adults requiring long-term care, and the effect of edema on measurement error. Two physical therapists measured the neck circumference. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to examine the reliability of neck circumference measurement. Correlation analysis was used to evaluate the relationship between edema values (extracellular water/total body water) and neck circumference measurement difference. For inter-rater reliability of neck circumference measurement, the overall ICC (2,1) was 0.98. The upper and lower limits of the difference between examiners ranged from -0.9 to 1.2 cm. There was no association between edema values and neck circumference measurement error. Thus, measurement of the neck circumference in older adults requiring long-term care is a reliable assessment tool, with a low error rate, even in older adults with edema.

Comparison of body composition and muscle mass by age in amateur soccer players.

[Purpose] This study aimed to elucidate the changes in body composition components associated with aging in amateur male soccer players. Specifically, we investigated the alterations in the phase angle and regional muscle mass distribution. [Participants and Methods] The study included a cohort of 163 male participants categorized into three age groups: U15 (12-15 years), U18 (16-18 years), and O19 (≥19 years). Precise body composition assessments were performed, employing the InBodyS10 body composition scale. [Results] The findings revealed substantial age-related disparities in various body composition parameters. Data revealed a consistent trend of increasing basic body composition metrics with age. Notably, the body fat percentage progressively increased with age. Muscle mass and phase angle exhibited age-related increases with nuanced variations in different anatomical regions. [Conclusion] In the general Japanese population, muscle mass tends to decrease with age after 18 years. However, in this study on amateur soccer players, we observed a plateau in the height and lower limb phase angle around the age of 18 years, whereas muscle mass exhibited an increasing trend.

Prevalence and factors associated with changes in frailty among community-dwelling older adults in Japan during the COVID-19 pandemic: A prospective cohort study from 2020 to 2022.

AIM: This study aimed to ascertain the prevalence of frailty during the pandemic and to determine factors associated with changes in frailty status. METHODS: In May-June of 2020-2022, we assessed the frailty of 549 participants using the Kihon Checklist. Furthermore, we classified participant residences as urban, suburban, and rural and investigated participants' engagement in hobbies and community activities in 2020 and 2022. Cochran's Q test was used to analyze the proportions of frailty status. Subsequently, we conducted a binomial logistic regression analysis with the improvement/deterioration of frailty status from 2020 to 2022 as the dependent variable, and engagement in hobbies and community activities as the independent variables. RESULTS: Significant changes were observed among participants in urban areas, where an increase in pre-frailty and a decrease in robust individuals from 2020 to 2021 were noted. Focusing on item no. 17 (going out), the decreasing frequency had recovered by 2022 in the group of all groups. Continued engagement in only hobbies or only community activities, and continued engagement in both were associated with remained robust/frailty-status improvement. Moreover, not engaging in either hobbies or community activities was associated with remained frail/frailty-status deterioration. CONCLUSIONS: During the early stages, the COVID-19 pandemic impacted the frailty of older adults in densely populated areas. The results also suggest an attenuation in the decline in older adult activity in 2022. Continuous engagement in hobbies and community activities was crucial for improving and preventing deterioration in frailty status during the COVID-19 pandemic. Geriatr Gerontol Int 2024; 24: 40-47.

Grip strength as a predictor for home discharge in convalescent rehabilitation patients.

[Purpose] We examined the impact of the assessment items for sarcopenia on discharge destination in convalescent rehabilitation patients. [Participants and Methods] In this study, 174 patients (males; 77, mean age; 72.4 years, females; 97, mean age; 80.1 years) who were admitted and discharged from the convalescent rehabilitation wards of the International University of Health and Welfare, Shioya Hospital, were included. The participants' height, weight, grip strength, and lower calf circumference were measured. Additionally, the number of motor functional independence measure (mFIM) at discharge, length of stay in the wards, and average number of rehabilitation sessions per day were calculated as the convalescent rehabilitation wards index. [Results] Age, weight, grip strength, lower calf circumference, mFIM at discharge, length of stay in the wards, and average number of rehabilitation sessions per day had significant differences between the return-to-home and non-home groups. Binomial logistic regression analysis revealed significant differences in grip strength and mFIM at discharge. [Conclusion] This study adjusted the sarcopenia criteria for sex and age and showed that grip strength significantly affected the outcome destination. Grip strength was shown to be a predictor of home discharge in convalescent rehabilitation patients.

Improvement of frailty prevalence: difference in factors affecting frailty prevalence among 75 year-old individuals between 2006 and 2019.

[Purpose] This study aimed to examine and compare the prevalence of frailty in 75 year-old people sampled in two remote years, namely 2006 and 2019. [Participants and Methods] A total of 910 participants aged 75 years were included (502 people in 2006 and 408 people in 2019). We compared the total score of the Kihon checklist and each question for males and females between the two years. [Results] The prevalence of frailty decreased from 24.3% in 2006 to 15.2% in 2019. The comparison of the 2006 and 2019 Kihon checklists revealed significant differences in activities of daily living, physical function, oral function, outdoor activities, and cognitive function. [Conclusion] Frailty among 75 year-old individuals improved in 2019 compared to that in 2006. Improved activities of daily living, physical function, outdoor activities, and cognitive function were major causes of improved frailty in 2019.

Phase angle as a prognostic factor for one-year mortality in geriatric health service facility residents.

[Purpose] The present study aimed to investigate the association of phase angle with the continuing activities of residents in a geriatric health service facility for one year. We compared the phase angle among current residents in a geriatric health service facility with those who died within one year. [Participants and Methods] This one-year prospective observational study included 149 residents who entered a geriatric health service facility. We divided participants into two groups: an over one-year survival group and a death within one year group. The receiver operating characteristic curves were created to determine the sensitivity and specificity for predicting one-year mortality based on the phase angle. [Results] The phase angle was significantly higher in the one-year survival group than in the death within one year group and was independently and significantly associated with one-year mortality using binomial logistic regression analysis. The phase angle was shown to have predictive power (based on the area under the receiver operating characteristic curve). Based on the calculation for identifying one-year survival, the optimal cut-off value for the phase angle was 2.95° (area under the receiver operating characteristic curve=0.76, sensitivity 55.6%, specificity 83.3%). [Conclusion] The phase angle may contribute to the prognosis of one-year mortality for residents of geriatric health service facilities.

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care.

AIM: Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. METHODS: The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. RESULTS: Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). CONCLUSIONS: Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

Association between the phase angle and muscle-tendon complex function in Japanese athletes: a comparative study.

[Purpose] In this study, we investigated the association between the phase angle and the muscle-tendon complex in Japanese athletes and the effects of aging on this association. [Participants and Methods] The study included 61 adult male high school soccer players. Body composition was evaluated using an analyzer, and grip strength and rebound jump index were measured to evaluate muscle-tendon complex function. Study participants were categorized into two groups, and statistical analyses were performed for intergroup comparison of outcomes and to determine the correlation between the phase angle and muscle-tendon complex function. [Results] We observed significant intergroup differences in the phase angle, total body muscle mass, grip strength, and rebound jump index. Additionally, we observed a significant positive correlation between the phase angle and grip strength in adult soccer players. [Conclusion] Our results showed a correlation between the phase angle and muscle-tendon complex function in mature adult athletes but not in high school athletes. These findings suggest that the phase angle may serve as an indicator of muscle quality and overall physical condition in adult athletes. Further research is warranted to investigate the association between the phase angle and other performance measures to gain a better understanding of soccer players' athletic abilities.

Relationship between Total Kihon Checklist Score and Age-Specific Deaths among Late-Stage Older Adults in Otawara City (Aged 75 and Older) over a 15-Year Period.

INTRODUCTION: While the Japanese long-term care insurance system supports an ageing society, there are concerns about the shortage of financial resources and labour force. Further, extending healthy life expectancy and narrowing the gap with the average life expectancy are important issues. In this study, we aimed to examine, over a 15-year period, the relationship between the total Kihon Checklist (t-KCL) score and age-specific deaths among late-stage older adults aged 75 and older who were not certified for long-term care insurance. METHODS: The participants were older adults residing in Otawara City, Tochigi Prefecture, who were aged 75 years or older as of 2006. The participants, who were not certified by the long-term care insurance system, were asked to complete the KCL by a community welfare committee member. Based on their t-KCL scores, the participants were classified as robust (0-3 points), pre-frail (4-7 points), and frail (≥8 points). The deaths of those aged 75-89 years who had completed the KCL were investigated. Information on deaths was obtained from local authorities. Statistics were examined for the risk of robust, pre-frail, and frail mortality using a Cox proportional hazards model with age and gender as covariates for the 75-79, 80-84, and 85-89 age groups. RESULTS: Of the 7,924 participants, 3,423 (75-79 years: 1,990, 80-84 years: 1,059, 85-89 years: 374) were ultimately eligible for the study. Of these, 2,450 (75-79 years: 1,238, 80-84 years: 861, 85-89 years: 351) died over the 15-year study period. Hazard ratios for death in frailty as determined by the t-KCL score were 1.337 (95% confidence interval [CI], 1.162-1.540) for the pre-frail group and 2.012 (95% CI, 1.7756-2.305) for the frail group at 75-79 years, respectively, compared with the robust group; 1.511 (95% CI, 1.271-1.797) at 80-84 years only in the frail group; and 1.567 (95% CI, 1.140-2.154) at 85-89 years, also in the frail group. DISCUSSION: The relationship between frailty and mortality weakens after age 80. The results suggest that factors other than frailty may have a stronger influence on mortality risk after the age of 80.

Sarcopenia with Depression Presents a More Severe Disability Than Only Sarcopenia among Japanese Older Adults in Need of Long-Term Care.

Background and objectives: The combination of depression and sarcopenia, a condition prevalent worldwide, may cause dis-tinct problems that should not be underestimated. However, to the best of our knowledge, no reports have investigated the combined effects of depression and sarcopenia. In this study, we compared physical function, nutritional status, and daily functioning among older adults with only depression (OD), those with only sarcopenia (OS), and those with sarcopenia with depression (SD) to examine the effects of the combination of depression and sarcopenia. Materials and Methods: The participants were 186 communi-ty-dwelling older individuals who required support or care. The participants were classified into four groups based on the presence or absence of sarcopenia and depression: Control, OD, OS, and SD. The following parameters were evaluated in the four groups: grip strength, walking speed, skeletal muscle mass index (SMI), Mini Nutritional Assessment Short-Form (MNA-sf), and long-term care certification level. In addition, univariate and multivariate analyses of the survey results were performed to identify risk factors leading from OS to SD. Results: We found that 31.2% of older participants who needed support or nursing care had SD, which had more pronounced adverse effects on grip strength, walking speed, SMI, MNA-sf, and level of nursing care than OD or OS. Furthermore, multivariate analysis of SD vs. OS showed that decreased grip strength and worsening MNA-sf were independent risk factors. Conclusions: SD is common among older individuals living in the community. Patients with SD require support and care, and the condition has a greater impact on physical function, nutritional status, and decline in life function compared to OD and OS. Therefore, it is desirable to elucidate the process leading to SD and investigate the risk factors and prognosis. It is expected that sarcopenia with depression will be investigated worldwide in the future.

Leg skeletal muscle mass asymmetry is independently associated with gait speed in older adults requiring long-term care.

AIM: Decreased gait speed in older adults has been associated with incident disability, cognitive impairment, institutionalization, falls, deterioration in level of care, and mortality. Gait speed has been reported to be related to leg asymmetry. However, the relationship between gait speed and leg skeletal muscle mass asymmetry in older adults requiring long-term care has not been clarified. In this study, we examined the association between gait speed and leg skeletal muscle mass asymmetry and the cutoff values of leg skeletal muscle mass asymmetry that may affect gait speed. METHODS: The asymmetry index of leg skeletal muscle mass was measured in 230 older adults under the Japanese long-term care insurance system using bioelectrical impedance analysis. This cross-sectional study used multiple regression analysis and receiver operating characteristic (ROC) curve analysis to determine the relationship between gait speed and the asymmetry index of leg skeletal muscle mass. RESULTS: Multiple regression analysis revealed that the asymmetry index of leg skeletal muscle mass (ß = -0.19, P = 0.002, R2 = 0.261) was independently and significantly associated with gait speed. Furthermore, ROC analysis showed that the cutoff value of the asymmetry index of leg skeletal muscle mass that identified reduced gait speed (<1.0 m/s) was 3.02% (Area under the curve = 0.62, sensitivity 47.3%, specificity 81.0%, P = 0.014). CONCLUSIONS: The asymmetry index of leg skeletal muscle mass was associated with gait speed in older adults requiring long-term care. Future assessment and interventions directed towards symmetry of leg skeletal muscle mass may help to improve gait speed in older adults. Geriatr Gerontol Int 2023; 23: 371-375.

Female athlete triad cross-sectional study of soccer players by level of competition.

[Purpose] To determine the actual status of the Female Athlete Triad (low energy availability, menstrual dysfunction, and bone mineral density loss) in soccer players. [Participants and Methods] The survey was conducted between February 1 and March 1, 2022. It included 115 females between the ages of 12 and 28 registered with the Japan Football Association, from teams at different levels. [Results] Players in the top league did not differ in height and weight but were older and had a better understanding of caloric intake. There were no differences in amenorrhea or history of bone fractures based on league. [Conclusion] Of the female soccer players in the four different levels of competition, only the players in the top league had a better understanding of available energy and took preventive measures against the Female Athlete Triad.