Sensory impairment, loneliness, and the discordance between subjective and objective cognitive function among older adults: A multi-cohort study.

OBJECTIVES: This study aimed to examine the association between sensory impairment and the discordance between subjective/objective cognitive function among older adults and test the mediating effect of loneliness. METHODS: We used data from four cohort studies conducted in 16 countries (N = 19,119). Sensory impairment and subjective cognitive impairment were self-reported. Objective cognitive impairment was measured in three dimensions. Generalized estimating equations were conducted to examine the association between sensory impairment and discordance in subjective/objective cognitive function. Cross-lagged panel model and a bootstrap method with 2,000 samples were employed to verify the mediating effect. RESULTS: Sensory impairment was related to an increased risk of subjective cognitive impairment (OR = 4.70, 95 % CI 4.33-5.10), objective impairment (OR = 1.51, 95 %CI 1.31-1.74), as well as the discordance in subjective/objective cognitive function (OR = 1.35, 95 %CI 1.06-1.71 for older adults with normal subjective cognitive function). In contrast, sensory impairment was associated with a decreased risk of discordant subjective/objective cognitive function among those with subjective cognitive impairment (OR = 0.79, 95 %CI 0.66-0.94). Moreover, loneliness mediated the association between sensory impairment and subjective cognitive impairment (standardized indirect effect = 0.002, 95 %CI 0.001-0.004), objective cognitive impairment (standardized indirect effect = 0.005, 95 %CI 0.003-0.007) as well as the discordance in subjective/objective cognitive function (standardized indirect effect = 0.001, 95 %CI 0.001-0.003 for older adults with normal subjective cognitive function). CONCLUSIONS: Significant association between sensory impairment and discordance in subjective/objective cognitive function and the mediating role of loneliness were revealed, varying by subjective cognitive function. Early screening on sensory impairment and targeted interventions on loneliness should be considered in future policies on cognitive impairment.

Economic effects of healthy ageing: functional limitation, forgone wages, and medical and long-term care costs.

This study aims to estimate the potential economic benefits of healthy ageing by obtaining estimates of the economic losses generated by functional limitations among middle-aged and older people. Utilising two data sources retrieved from nationally representative samples of the Japanese people, we analysed the association between functional limitation and economic indicators, including labour market outcomes, savings, investment, consumption, and unpaid activities among individuals aged ≥ 60. Using the estimated parameters from our micro-econometric analyses and the official statistics by the Japanese government and a previous study, we calculated the financial costs that can be averted if healthy ageing is achieved as foregone wages and formal medical/long-term care costs incurred by functional limitations. Our micro-econometric analyses found that functional limitation was associated with a 3% point increase in retirement probability, with a stronger association among those aged 60-69. Moreover, functional limitation was linked with higher total health spending and less active involvement in domestic work. Foregone wages generated by functional limitation were estimated to be approximately USD 266.4 million, driven mainly by individuals in their 60s. Long-term care costs, rather than medical care costs, for older people aged ≥ 85 accounted for most of the additional costs, indicating that the estimated medical and long-term costs generated by functional limitations were approximately USD 72.7 billion. Health interventions can yield economic benefits by preventing exits from the labour market due to health issues and reducing medical and long-term care costs.

Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study.

BACKGROUND: Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association. METHODS: We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores. FINDINGS: The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, ß=-0·15 [95% CI -0·17 to -0·13]; two diseases, ß=-0·37 [-0·40 to -0·34]; three diseases, ß=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (ß=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888). INTERPRETATION: These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people. FUNDING: Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

Living Alone and Depressive Symptoms Among Older Japanese: Do Urbanization and Time Period Matter?

OBJECTIVES: Previous research has suggested cross-national differences in the association between living alone and well-being among older adults. This study examined whether the association varied across social contexts within the country, Japan, in terms of varying degree of urbanization and differential time periods. METHODS: Data were obtained from a nine-wave nationwide longitudinal survey with a probability sample of Japanese adults aged 60 years and over. Respondents belonged to one of the three periods (around 1990, 2000, and 2015) according to the year they commenced participation. As many as 4,655 individuals from 575 municipalities provided 9,016 observation sets of two consecutive waves (t - 1 and t). Within a framework of the Hierarchical Generalized Linear Model, depressive symptoms at t were predicted based on changes in living arrangements from t - 1 to t and their cross-level interactions with gender, level of urbanization, and time period, controlling for various covariates at t - 1. RESULTS: In general, older adults living alone continuously as well as those who started living alone between the waves showed more depressive symptoms than those coresiding with someone continuously. However, this tendency was more prominent among rural residents than their urban counterparts, especially for men. Moreover, the effect of continuously living alone on depressive symptoms became smaller in Period 2015 than that in Period 1990, because of the increase in depressiveness in coresident older adults. DISCUSSION: Our findings indicate that living alone has a differential effect on older adults' well-being depending on the social context where residents' preferences for living arrangements and availability of formal services could vary.

Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip-fracture surgery.

OBJECTIVE: This study examined trajectories of social support and their relationships with health outcomes over 2 years post hip-fracture surgery for older adults with diabetes mellitus (DM). METHODS: This was a secondary analysis of data derived from a clinical trial, which included 158 hip fractured older adults with DM who had completed the Medical Outcomes Study Social Support Survey at 1-, 12-, 18-, and 24-months following hospital discharge. Health outcomes for self-care, physical and nutritional status, mental health, and depression were assessed at 3-month intervals up to 24-months after hospital discharge. Trajectories of social support were derived with latent class analysis while hierarchical linear models were employed to assess the associations of social-support trajectory with health outcomes. RESULTS: Four social-support trajectories were derived for persons with DM following hip-fracture surgery: poor and declining (n = 18, 11.4%), moderate and stable (n = 29, 18.4%), high but declining (n = 34, 21.5%), and high and stable (n = 77, 48.7%). Relative to those in the poor and declining group, participants in the high and stable trajectory group performed better in Activities of Daily Living and quadriceps muscle power, had better mental Health-Related Quality of Life and nutritional status, and had fewer depressive symptoms. These differences persisted over the 2 years following hospital discharge. CONCLUSIONS: These results suggest social support for persons with DM should be continually assessed following hip-fracture surgery.

Better nutrition trajectory improves recovery following a hip fracture surgery for older persons with diabetes mellitus.

BACKGROUND: Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. AIMS: To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. METHODS: A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. RESULTS: Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. DISCUSSION: Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. CONCLUSIONS: Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.

Retention in Community Health Screening among Taiwanese Adults: A 9-Year Prospective Cohort Study.

Largely conducted in Western developed nations, research on community health screening has mainly been of limited duration. This study aims to ascertain the predictors of retention in a community health screening program, involving multiple admission cohorts over a 9-year period in Taiwan. Retention is defined as the participation in subsequent waves of health screening after being recruited for an initial screening. Data came from a prospective cohort study, named "Landseed Integrated Outreaching Neighborhood Screening (LIONS)", in Taiwan. This research retrieved 5901 community-dwelling Taiwanese adults aged 30 and over from LIONS and examined their retention in three follow-ups during 2006-2014. Generalized estimating equations were employed to evaluate retention over time as a function of social determinants, health behaviors, and health conditions. Being middle-aged, higher education, and regular exercise were positively associated with retention. Conversely, smoking, betel-nut chewing, psychiatric disorder, hypertension, type 2 diabetes mellitus, stroke, and a longer time interval since enrollment were negatively associated with retention. Furthermore, retention rates varied substantially across admission cohorts with more recent cohorts having a lower rate of retention (aOR = 0.33-0.83). Greater attention needs to be directed to retention over time and variations across admission cohorts. Additionally, those who are in either younger or older age groups and have chronic diseases or unhealthy behaviors should be targeted with greater efforts.

Defining Childlessness Among Middle-Aged and Older Americans: A Research Note.

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2% to 13.6% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

Smart clothes-assisted home-nursing care program for family caregivers of older persons with dementia and hip fracture: a mixed-methods study.

BACKGROUND: The purpose of this preliminary study was to explore whether a smart clothes-assisted home-nursing care program could benefit family caregivers and their care recipients. METHODS: Family caregivers in charge of a care recipient's living situation participated in this convergent parallel, mixed methods study. We recruited older persons with dementia (n = 7) and those discharged following hip-fracture surgery (n = 6) from neurological clinics and surgical wards of a medical center, respectively, along with their family caregivers: three spouses, eight sons, one daughter, and one daughter-in-law. Care recipients were asked to wear a smart vest at least 4 days/week for 6 months, which contained a coin-size monitor hidden in an inner pocket. Sensors installed in bedrooms and living areas received signals from the smart clothing, which were transmitted to a mobile phone app of homecare nurses, who provided caregivers with transmitted information regarding activities, emergency situations and suggestions for caregiving activities. Outcomes included changes from baseline in caregivers' preparedness and depressive symptoms collected at 1- and 3-months, which were analyzed with Friedman's non-parametric test of repeated measures with post-hoc analysis. Transcripts of face-to-face semi-structured interview data about caregivers' experiences were analyzed to identify descriptive, interpretative, and pattern codes. RESULTS: Preparedness did not change from baseline at either 1- or 3-months for family caregivers of persons with dementia. However, depressive symptoms decreased significantly at 1-month and 3-months compared with baseline, but not between 1-months and 3-months. Analysis of the interview data revealed the smart clothes program increased family caregivers' knowledge of the care recipient's situation and condition, informed healthcare providers of the care recipient's physical health and cognitive status, helped homecare nurses provide timely interventions, balanced the care recipient's exercise and safety, motivated recipients to exercise, helped family caregivers balance work and caregiving, and provided guidance for caregiving activities. CONCLUSIONS: Experiences with the smart clothes-assisted home-nursing care program directly benefited family caregivers, which provided indirect benefits to the care recipients due to the timely interventions and caregiving guidance from homecare nurses. These benefits suggest a smart-clothes-assisted program might be beneficial for all family caregivers.

Retirement and Social Activities in Japan: Does Age Moderate the Association?

Although retirement age is increasing in aging societies, its impact on individuals and communities is unclear. This study examined how age moderates the linkage between transition into retirement and participation in productive and non-productive social activities after retirement, using a nationwide longitudinal survey with a probability sample of Japanese aged 60 and over (n = 3,493). Multinomial logistic regression analyses were performed to predict changes in volunteering and hobbies/learning during 3-5 years of follow-up and their participation level at the follow-up. The significant interactions between change in work status (remained working as reference, full/partial retirement, remained not-working) and age at baseline showed that fully retired persons were more likely to increase these activities than remained workers only when they retired by their early seventies. Thus it is important to encourage engagement in social activities before retirement and remove psychological and environmental barriers that hinder starting new activities at old age.

Later-Life Living Arrangements of Americans With and Without Children: A Life Table Approach.

OBJECTIVES: This study describes living arrangement-specific life expectancy for older Americans with and without children, by sex and race/ethnicity. METHOD: We use life tables from the Human Mortality Database and data from the Health and Retirement Study over a 17-year period (2000-2016) to calculate living arrangement-specific life expectancy at age 65 using Sullivan's method. Results describe the lives of older Americans aged 65 and older with and without children in terms of the number of expected years of life in different living arrangements. RESULTS: With the exception of Hispanic men, older Americans without children spend over half of their remaining life living alone. Among the childless, it is White women and Black men who spend the largest percent of remaining life living alone (65% and 57%, respectively). Relative to parents, childless older Americans have an overall life expectancy at age 65 that is 1 year lower and spend 5-6 years more living alone and fewer years living with a spouse (8 years less for men and 5 years less for women). Childless older Americans spend more time in nursing homes, but average expected duration in this living arrangement is short and differences between those with and without children are small. DISCUSSION: This descriptive analysis demonstrates the fundamental ways in which children shape the lives of older Americans by showing that later-life living arrangements of childless Americans differ markedly from their counterparts with children. These results provide a valuable empirical foundation for broader efforts to understand relationships between childlessness, living arrangements, and well-being at older ages.

Physician distribution across China's cities: regional variations.

BACKGROUND: Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. METHODS: Data came from National Census Surveys and China statistical yearbooks, 2000-2003, and 2010-2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. RESULTS: Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. CONCLUSION: Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics.

A family care model for older persons with hip-fracture and cognitive impairment: A randomized controlled trial.

BACKGROUND: Dementia and hip fracture are both associated with substantial disability and mortality. However, few studies have explored the effects of intervention programs on post-operative recovery of older persons with hip fracture and cognitive impairment. OBJECTIVE: To examine the effects of a family-centered care model for older persons with hip fracture and cognitive impairment and their family caregivers. DESIGN: Single-blinded clinical trial. SETTING: A 3000-bed medical center in Taiwan. PARTICIPANTS: Older persons hip fracture and cognitive impairment (N = 152); 76 in the intervention group, and 76 in the usual-care control group. METHODS: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care. Outcomes were assessed 1-, 3-, 6- and 12-months following hospital discharge for older persons with hip fracture and cognitive impairment. Assessed outcomes were self-care ability (performance of activities of daily living and instrumental activities of daily living), nutritional status, self-rated health, health-related quality of life and self-efficacy, and competence of the family caregivers. RESULTS: Relative to patients who received usual care, those who received the family-centered care intervention had a greater rate of improvement in self-rated health (ß = 1.68, p < .05) and nutritional status (ß = 0.23, p < .05), especially during the first 6 months following hospital discharge. Relative to family caregivers who received usual care, those who received family-centered care had a higher level of competence (ß = 7.97, p < .01), a greater rate of improvement in competence (ß = 0.57, p < .01), and a greater rate of improvement in self-efficacy (ß = 0.74, p < .05) 3 months following hospital discharge. CONCLUSIONS: A family-centered care model enhanced family caregivers' self-efficacy and competence but did not improve the physical recovery of the participants with hip fracture and dementia. We suggest adding an educational component to include geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care and assessing family caregiver outcomes in interventions for older persons with hip fracture and cognitive impairment. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT03894709) Tweetable abstract: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care of older persons with hip fracture and cognitive impairment enhanced family caregivers' self-efficacy and competence.

Age trajectories of disability development after 65: A comparison between Japan and Taiwan.

INTRODUCTION: Disability development using age as the axis was void in the literature. Identification of the age trajectory of disability development across populations enables preparation for aging-related policies when conducting cross-national comparisons. This study compared three indicators of the development of physical disability in populations of Taiwan and Japan. METHODS: Data comprised two nationally representative panel surveys (1) the Taiwan Longitudinal Study on Aging (N = 3,037) in 1996-2011 and (2) the National Survey of the Japanese Elderly in 1996-2012 (N = 1,974). Older adults (65+) were examined longitudinally. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility disability development during aging were analyzed using multilevel models. RESULTS: After age standardization, Japan reported higher prevalence rate of ADL disability (14.95% vs. 9.65%) but lower IADL (19.30% vs. 30.36%) and mobility disability (36.07% vs. 49.82%) as compared with Taiwan. ADL limitation occur (ADL limitation>=1) at the age of 77.9 and 77.2 for populations in Japan and Taiwan, respectively. Populations reached three ADL limitations at the age of 86.7 and 85.0 in Japan and in Taiwan, respectively. IADL limitation occur (IADL limitation>=1) at the age of 79.1 and 74.5 for populations in Japan and Taiwan, respectively. Mobility limitation occur (Mobility limitation>=1) at the age of 70.7 and 65.3 for populations in Japan and Taiwan, respectively. CONCLUSIONS: Older adults generally do not report ADL limitation until 77 and do not face serious disability until 85 or 86 in Taiwan or Japan, respectively. Mobility limitation occurs at a various age in different countries.

Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans.

Objectives: This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Methods: Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Results: Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Discussion: Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.

Short-, Medium-, and Long-term Weight Changes and All-Cause Mortality in Old Age: Findings From the National Survey of the Japanese Elderly.

BACKGROUND: Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people. METHODS: Data were obtained from the National Survey of the Japanese Elderly, which included 4869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered 3 indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥ 5%, loss 2.5%-4.9%, stable (±2.4%), gain 2.5%-4.9%, and gain ≥ 5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category. RESULTS: Weight loss ≥ 5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all 3 intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline. CONCLUSIONS: These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.

Decomposition of gender differences in cognitive functioning: National Survey of the Japanese elderly.

BACKGROUND: It is well known that females generally live longer than males, but women tend to suffer from more illnesses and limitations than men do, also for dementia. However, limited empirical evidence is available why this 'male-female health-survival paradox' is observed. This study aimed to investigate factors which account for gender differences in health, particularly cognitive functioning and decline among older adults. METHODS: Data were retrieved from the National Survey of the Japanese Elderly, which is a longitudinal survey of a nationwide representative sample of Japanese adults aged 60 or over. Gender differences in cognitive functioning and decline in three-year follow-ups were decomposed using Blinder-Oaxaca decomposition analysis, regarding demographic, socioeconomic, and health-related factors into the 'explained' component, by differences in individual attributes listed above, and the 'unexplained' component. RESULTS: Empirical analyses showed that women's lower cognitive functioning was partly explained by the endowment effect. Moreover, a shorter duration of formal education and a larger proportion with their longest occupation being domestic worker accounted for steeper cognitive decline and more prevalent mild cognitive impairment in women than in men. CONCLUSION: This empirical study suggested that gender differences in cognitive functioning and decline account for different individual attributes of social determinants among men and women. Particularly, men seem to be more engaged in activities which accumulate intellectual experiences through education and occupation, as suggested by the cognitive reserve hypothesis.

National prevalence of frailty in the older Japanese population: Findings from a nationally representative survey.

BACKGROUND: Japan has the largest aging population in the world, thus, a focus on frailty is important in clinical geriatric practice. Using a nationally representative sample, this study provided national estimates of the prevalence of frailty among community-dwelling older Japanese people. We also examined variations in the prevalence by sociodemographic characteristics, health conditions, and geographical regions. METHODS: Data came from the National Survey of the Japanese Elderly in 2012. The data were collected using a home visit and face-to-face interviews with trained interviewers. The sample consisted of 2206 adults aged ≥65 years. We used the widely accepted definition of physical frailty phenotype and calculated weighted estimates of the prevalence of frailty. RESULTS: Overall estimated prevalence was 8.7 % (7.5 %-9.9 %) for frail, 40.8 % (38.7 %-42.9 %) for prefrail, and 50.5 % (48.4 %-52.6 %) for robust. Frailty was more prevalent in older groups, women, and those with lower socioeconomic status, which was measured by education and household income. Frail people tended to have worse health. We also observed a regional variation: frailty prevalence tended to be higher in eastern than western Japan. CONCLUSIONS: This study provides important evidence on the prevalence of frailty in older Japanese people and found substantial disparities by sociodemographic characteristics, health conditions, and geographical regions.

Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study.

OBJECTIVES: There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese. DESIGN: Longitudinal panel study with 8 observation points from 1987 to 2012. SETTING AND PARTICIPANTS: The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline. METHODS: Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis. RESULTS: Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years. CONCLUSIONS AND IMPLICATIONS: We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.

Falls in community-dwelling older adults with heart failure: A retrospective cohort study.

BACKGROUND: While heart failure (HF) in older adults is associated with fall risk, little is known about this in the U.S. OBJECTIVE: To examine the independent effect of functional impairments related to HF on falls among community-dwelling older adults in the U.S. METHODS: A retrospective cohort study was conducted with 17,712 community-dwelling older adults aged 65 and above with (n = 1693) and without HF, using mixed-effects logistic regression to examine the association between HF and falls. RESULTS: HF patients had 14% greater odds of falling than those without HF. Moreover, HF patients with functional difficulties in mobility, large muscle difficulty, instrumental activities of daily living difficulty, poor vision, and urinary incontinence demonstrated an increased likelihood of falling. CONCLUSION: Community-dwelling older adults with HF and functional difficulties have a higher fall risk than those without HF, indicating that fall prevention programs should be developed, tested, and implemented for this population.