The relationship between masseter muscle thickness and appendicular skeletal muscle mass in Japanese community-dwelling elders: A cross-sectional study.

PURPOSE OF THE STUDY: Sarcopenia has been identified as a health hazard in elderly people. Although the association between sarcopenia and a decrease in masticatory function has been reported, the mechanism underlying this association has not been widely reported. Therefore, in order to elucidate the relationship between sarcopenia and masticatory function, we examined whether the masseter muscle thickness (MMT), which is a factor influencing masticatory function, in community-dwelling elders is associated with the appendicular skeletal muscle index (SMI), a diagnostic criterion for sarcopenia. MATERIALS AND METHODS: MMT was measured in 774 community-dwelling elders aged 65 years or older at resting state via ultrasonography, and SMI was measured with the bioelectrical impedance method. The relationships were investigated by calculating Pearson's correlation coefficients. Multiple regression analyses adjusted for age and sex, SMI, and oral-related items were performed to determine the association between these factors. RESULTS: There was a significant correlation between the MMT and the SMI. The multiple regression analysis indicated that SMI was significantly associated with a decrease in MMT. CONCLUSIONS: The reduction in whole-body skeletal muscle mass in sarcopenia may be involved in the reduction in MMT. Prevention of sarcopenia may be an important factor for maintaining masticatory function in the elderly.

Assessing competence at a higher level among older adults: development of the Japan Science and Technology Agency Index of Competence (JST-IC).

BACKGROUND AND AIMS: Older adults' ever-improving health and changing lifestyles necessitate the development of a scale that can better measure their competence at a higher level. We developed the Japan Science and Technology Agency Index of Competence (JST-IC) via item analysis and assessed its psychometric properties. METHODS: Participants were 1306 community-dwelling older adults (623 men and 683 women, 74.0 ± 2.8 years old) who completed the 54-item draft JST-IC to determine their level of independence. Three procedures (including item selection, factor analyses, and reliability and validity analyses) were conducted to finalize the JST-IC and evaluate its psychometric properties. RESULTS: The item selection resulted in exclusion of 26 items for the following reasons: (a) 15 because of very high ratios (80% or more) of responders who answered "yes", (b) one because of gender differences (phi coefficient = 0.34), (c) five because of their weak association with the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Pearson correlation coefficient of 0.30 or smaller), and (d) five because of redundancy of meaning with other items. Through factor analyses, we selected 16 items with a four-factor solution for the final version. JST-IC score exhibited a near-normal distribution and significant gender and age differences, and had moderate correlations with size of social network and level of subjective well-being and strong correlations with TMIG-IC score, physical fitness, and health literacy. CONCLUSIONS: The JST-IC is useful for assessing competence at a higher level in community-dwelling older adults.

Association Between Serum ß2 -Microglobulin Levels and Prevalent and Incident Physical Frailty in Community-Dwelling Older Women.

OBJECTIVES: To investigate whether higher serum ß2 -microglobulin (B2M) levels, a kidney function marker, are associated with prevalent and incident frailty in community-dwelling older women. DESIGN: Cross-sectional and longitudinal analyses of a prospective cohort. SETTING: Population-based cohort study in Tokyo, Japan. PARTICIPANTS: Community-dwelling women aged 75 and older with adequate data for assessing frailty status (N = 1,191) and a subset of participants without baseline frailty but with repeated frailty assessment at 2 and 4 years of follow-up. MEASUREMENTS: The primary predictor was B2M level. Outcomes were prevalent and incident frailty during the 4-year follow-up period. Frailty was defined as presence of three of the five Fried criteria: weight loss, exhaustion, weakness, slowness, and low physical activity. Adjusted odds ratios for the main confounders were obtained using logistic regression. Discrete-time Cox proportional hazards models were used to determine the risk of developing frailty. RESULTS: The study included 241 (20.2%) women with prevalent frailty at baseline and 139 (21.1%) with incident frailty during the 4-year follow-up. On multivariate analysis adjusted for multiple potential confounders, the odds of prevalent frailty were 2.5 times as great with B2M levels of 1.9 to 2.1 mg/L as with levels less than 1.6 mg/L and 2.0 times as great with B2M levels of 2.2 mg/L or more. In the unadjusted model, B2M levels of 1.9 to 2.1 mg/L were associated with a greater incidence of frailty than B2M levels of less than 1.6 mg/L (hazard ratio = 1.72, 95% confidence interval = 1.04-2.86). In the multivariate analysis adjusted for potential confounders, no significant association was noted between the highest B2M quartile and incident frailty. CONCLUSION: Higher B2M levels were independently associated with greater frailty at baseline in older adults but only slightly associated with greater risk of incident frailty over 4 years of follow-up.

Physical and psychological characteristics of the community-dwelling elderly with heart disease.

Objectives Although the survival rates of patients with heart diseases, such as myocardial infarction and heart failure, have increased, the incidence of heart disease in elderly individuals has also increased. We compared characteristics of the community-dwelling elderly with heart diseases (heart disease group) and without heart diseases (non-heart disease group).Methods A total of 758 elderly individuals participated in our survey ("Otassha-kensin") in 2014. The heart disease group (47 men, 28 women) and the non-heart disease group (263 men, 420 women) were selected from among these participants. Data on comorbidities, medications, the Kihon check list (KCL), and social background (lifestyle, exercise habits, certification for using long-term care insurance, and Japan Science and Technology Agency Index of Competence [JST-IC]) were obtained through interview. Body composition, grip strength, 5 walking time (usual pace, maximum speed), timed-up and go test (TUG), single-leg standing time, cognitive function, and depression were evaluated to assess physical and psychological function. Frailty was defined by the KCL. For between-groups comparisons, the Student t-test and Mann-Whitney U-test were used. To determine factors related to heart disease with functional decline, we used a multiple logistic regression analysis with the group (the non-heart disease group [0] and the heart disease group [1]) as the dependent variable and the decline in physical and psychological function as the independent variable.Results Men in the heart disease group had less grip strength, worse balance, and lower JST-IC scores than did men in the non-heart disease group. Women in the heart disease group had greater 5 walking times (usual pace, maximum speed) than those in the non-heart disease group. Both men and women in the heart disease group overall used more drugs and statins, and medications for heart disease than did participants in the non-heart disease group. In the multiple logistic regression analysis, 5 walking time (maximum speed) was shown to be associated with heart disease.Conclusions The community-dwelling elderly with heart disease showed declined physical functions. Our results suggested that these functional declines may be induced via medication and/or declines in daily activity.

Classification of frailty using the Kihon checklist: A cluster analysis of older adults in urban areas.

AIM: Frailty is an important predictor of the need for long-term care and hospitalization. Our aim was to categorize frailty in community-dwelling older adults. METHODS: The present study was carried out in 2011-2013, and consisted of 1380 individuals over 65 years of age. Participants completed the Kihon checklist, which is widely used to assess frailty in Japan, and their physical, cognitive and social function was evaluated. Non-hierarchical cluster analysis was used to statistically categorize frailty. The optimum number of clusters was determined as the point at which the external reference values (instrumental activity of daily living score, grip power, 10-m walk time, body mass index, portable fall risk index, occlusal force and Mini-Mental State Examination score) differed. RESULTS: According to the Kihon checklist, 369 (26.7%) of the 1380 study participants were considered frail. When the cluster number was increased from two to six, the scores in each subdomain of the Kihon checklist significantly differed. The estimated minimum number of clusters was five, and each of the five cluster groups had distinct characteristics. The numbers of participants in cluster groups 1-5 were 105, 78, 62, 71 and 53, respectively. CONCLUSIONS: We identified five types of frailty in community-dwelling older adults in Japan: "experience of falling," "pre-frailty," "oral frailty," "housebound" and "severe frailty." Geriatr Gerontol Int 2017; 17: 69-77.

Fear of falling, but not gait impairment, predicts subjective memory complaints in cognitively intact older adults.

AIM: Understanding the risk factors for developing subjective memory complaints (SMC) could help with early screening and treatment for cognitive impairment. The aim of the present study was to explore the risk factors for developing SMC, by focusing on gait-related variables. METHODS: A total of 406 community-dwelling older adults aged 65-85 years without impending cognitive impairment participated in baseline and 1-year follow-up evaluations. A comprehensive evaluation was carried out, and included gait speed and fear of falling (FoF) assessments, and the Montreal Cognitive Assessment test. Logistic regression analyses were carried out to independently evaluate the risk factors at baseline and follow-up evaluations. RESULTS: At baseline, 45.1% of older adults had SMC. The presence of SMC at baseline was associated with being female, subjective hearing loss and FoF. Of 223 participants who did not report SMC at baseline, 48 had newly developed SMC at follow up (21.5%). The significant predictors for developing SMC were being female and FoF, but not gait speed, and were independent of depression symptoms. The Montreal Cognitive Assessment total score at baseline was a marginally significant predictor for developing SMC at follow up (P = 0.06), but a lower score in the language domain was a significant predictor in further analysis. CONCLUSIONS: FoF was a significant risk for future development of SMC, suggesting that FoF might reflect the risk of cognitive impairment at an earlier stage, or that FoF and SMC could share the same basis of anxiety for daily activities. The mechanisms and consequence of this longitudinal relationship require further study. Geriatr Gerontol Int 2017; 17: 1125-1131.

Exome-wide Association Study Identifies CLEC3B Missense Variant p.S106G as Being Associated With Extreme Longevity in East Asian Populations.

Life span is a complex trait regulated by multiple genetic and environmental factors; however, the genetic determinants of extreme longevity have been largely unknown. To identify the functional coding variants associated with extreme longevity, we performed an exome-wide association study (EWAS) on a Japanese population by using an Illumina HumanExome Beadchip and a focused replication study on a Chinese population. The EWAS on two independent Japanese cohorts consisting of 530 nonagenarians/centenarians demonstrated that the G allele of CLEC3B missense variant p.S106G was associated with extreme longevity at the exome-wide level of significance (p = 2.33×10-7, odds ratio [OR] = 1.50). The CLEC3B gene encodes tetranectin, a protein implicated in the mineralization process in osteogenesis as well as in the prognosis and metastasis of cancer. The replication study consisting of 448 Chinese nonagenarians/centenarians showed that the G allele of CLEC3B p.S106G was also associated with extreme longevity (p = .027, OR = 1.51), and the p value of this variant reached 1.87×10-8 in the meta-analysis of Japanese and Chinese populations. In conclusion, the present study identified the CLEC3B p.S106G as a novel longevity-associated variant, raising the novel hypothesis that tetranectin, encoded by CLEC3B, plays a role in human longevity and aging.

Development of an oral health-related self-efficacy scale for use with older adults.

AIM: Self-efficacy is considered to be an important factor influencing behavior change; however, there are no existing tools to measure self-efficacy in the context of oral health among older adults. The purpose of the present study was to develop the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) for use with older adults, and to evaluate its reliability and validity. METHODS: The self-administered questionnaire was completed by 646 Japanese older people. The draft version of the scale consisted of 35 items that were generated to measure the three dimensions of personal beliefs in tooth brushing, observing own oral health status and oral function. We carried out a principal components factor analysis with promax rotation, and investigated the scale's internal consistency and construct validity. RESULTS: The final version of the scale consisted of three dimensions measured with 20 items. Cronbach's alpha of the GSEOH total scale was 0.924. There were significant differences (P < 0.05) in total scores on the GSEOH for the change process of oral health behavior, and in relation to self-rated oral health. CONCLUSIONS: We developed the GSEOH, with three factors and 20 items, and confirmed its reliability and validity. More studies are necessary to investigate the cross-cultural validity and reliability with larger samples from other countries. Geriatr Gerontol Int 2017; 17: 1406-1411.

Relationship between skeletal muscle mass and swallowing function in patients with Alzheimer's disease.

AIM: The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function. METHODS: We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function. RESULTS: Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52-30.20), body mass index < 18.5 (odds ratio 3.18, 95% confidence interval 1.27-8.00), calf circumference <30.5 cm (odds ratio 9.33, 95% confidence interval 2.01-43.27) and poor swallowing function (odds ratio 4.93, 95% confidence interval 1.10-22.04) had a significant effect on decreased skeletal muscle index. CONCLUSIONS: Therefore, decreased skeletal muscle mass in patients with Alzheimer's disease requires strategies to manage swallowing dysfunction. Geriatr Gerontol Int 2016; 17: 402-409.

Association between the nutritional status and the severity of sarcopenia among community-dwelling elderly Japanese people.

AIM: To investigate the association between nutritional evaluation indices (body mass index, albumin, and weight loss) and sarcopenia severity among community-dwelling elderly people in Japan. METHODS: The subjects consisted of 758 community-dwelling elderly people ≥65 years of age, categorized into two groups by based on Operation of long life medical care system (medical care system for elderly in the latter stage of life), the cut-off value for age used was 75. The outcome measures were basic characteristics, anthropometric measures, physical function, and blood biochemistry (five assessments). The appendicular skeletal muscle mass was calculated via a bioelectrical impedance analysis. The subjects were categorized into three groups by the body mass index (BMI) [BMI 3 group]. The cut-off value for albumin used was 3.8 g/dL [A1b 2 group]. Weight loss was assessed using item 11 on the Kihon check list: "Have you experienced more than 2-3 kg weight loss over the past 6 months? Yes=1, No=0." [weight loss 2 group]. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People definition, using the Asian Working Group for Sarcopenia cut-off values. All subjects were then categorized into four groups based on their sarcopenia status: non-sarcopenic (non-), pre-sarcopenic (pre-), sarcopenic (sarco-), or severely sarcopenic (severe-) [sarco4 group]. RESULTS: The prevalence of sarcopenia and severe sarcopenia in men was 5.6% (n=18) and 1.2% (n=4), respectively, and in women was 7.8% (n=34) and 1.6% (n=7), respectively. The analysis showed that, among the people (>75 years of age) with normal BMI (18.5-25.0), 10.4%-15.6% were in the Sarco group. Further, among women over 75 years of age with BMI >25.0, 5.7% (n=2) were in the Sarco group. There was a significant association between weight loss and sarcopenia severity in older men. No significant association between albumin levels and sarcopenia severity was observed. 80.0% of weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL. CONCLUSION: Sarcopenia and severe sarcopenia were prevalent among those with normal BMI, and particularly among obese women over 75 years of age. Weight-loss was presented in above BMI 18.5 kg/m2 and Alb 3.8 g/dL. Our findings indicate that the nutritional evaluation indices, including BMI, albumin, and weight loss, were insufficient in screening for malnutrition and sarcopenia among the elderly.

Alternating Motion Rate to Distinguish Elderly People With History of Pneumonia.

BACKGROUND: Under the hypothesis that elderly people in the community may have deficient oropharyngeal dysfunction, the purpose of this case-control study was to compare oral and physical characteristics in elderly people with and without a history of pneumonia and to identify factors distinguishing them. METHODS: In 2014, we examined 1,311 elderly people who agreed to participate in a longitudinal and intervention study for the community-dwelling elderly. We looked at such physical characteristics as body composition, grip power, gait, and balance and at oropharyngeal characteristics, such as alternating motion rate (AMR) in speech and the repetitive saliva-swallowing test (RSST). The subjects were also asked about past history of pneumonia and other morbid conditions. From that information, we extracted 24 subjects reporting to have had pneumonia within the previous 5 y as well as 172 other subjects who matched the pneumonia subjects with respect to age, sex, and number of other morbidities to form 2 groups for comparisons. We also subjected the data to a logistic regression analysis, with having or not having pneumonia as the dependent variable, oral and physical characteristics as independent variables, and age and sex as covariates. RESULTS: No significant differences were seen in physical characteristics between the 2 groups. Among the oropharyngeal characteristics, AMR was significantly lower in the pneumonia subjects (P = .005, effect size = 0.20), whereas RSST exhibited no significant difference between the 2 groups. Logistic regression revealed AMR to be the only factor related to pneumonia (P = .002, odds ratio 0.169, 95% CI 0.056-0.508). CONCLUSIONS: In community-dwelling elderly people, association of pneumonia with skilled tongue control (AMR) rather than with swallowing (RSST) prompts a reexamination of what constitutes being at risk for pneumonia.

Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effects of exercise and/or nutritional supplementation on body composition, blood components, and physical function in community-dwelling elderly Japanese women with sarcopenic obesity. DESIGN: Randomized controlled trial. SETTING: Urban community in Tokyo, Japan. PARTICIPANTS: Among 1213 community-dwelling elderly women over 70 years of age, 307 were defined with sarcopenic obesity, and 139 women participated in the study. INTERVENTION: Participants were randomly assigned to one of four intervention groups. The exercise and nutrition (Ex + N) and exercise only (Ex) groups attended 60-minute exercise classes twice a week for 3 months. The Ex + N and nutrition only (N) groups were provided with essential amino acid supplementation and tea fortified with catechins to be taken daily for 3 months. Health education classes were provided to the control (HE) group every 2 weeks. MEASUREMENTS: Bioelectric impedance analysis was used to measure body composition. Skeletal muscle mass index was calculated using measures of muscle mass and height. Physical function measures included grip strength, knee extension strength, usual walking speed, and walking parameters (stride, step length, width, walking angles). Blood samples were obtained to analyze levels of albumin, triglycerides, cholesterol, hemoglobin A1c, leptin, cystatin C, vitamin D, interleukin-6, and high-sensitivity C-reactive protein. RESULTS: Significant between-group × time interactions were observed in usual walking speed (P = .012), stride (P = .004), right step length (P = .003), average number of steps (P = .029), and vitamin D (P < .001). Compared to the HE group, the Ex + N intervention significantly decreased total body fat mass (P = .036) and increased stride (P = .038) and vitamin D (P < .001). Significant reductions in trunk fat were observed in the Ex group compared with HE (P = .014). The Ex + N and Ex interventions were over four times as likely (odds ratio [95% confidence interval]) to reduce body fat mass than the HE group (4.42 [1.21-16.19]; 4.50 [1.13-17.9], respectively). Significant odds ratios of the Ex + N intervention improving walking speed (3.05 [1.01-9.19]), vitamin D (14.22 [1.64-123.02]), and leptin (3.86 [1.19-12.47]) were also observed. CONCLUSION: Although exercise and nutrition have beneficial effects on individual variables of body composition, blood components, and physical function, improvements in muscle mass and variable combinations such as percent fat + skeletal muscle mass index or percent fat + physical functions were not observed in this population. Further large-scale and long-term investigation is necessary.

Sarcopenia: Prevalence and associated factors based on different suggested definitions in community-dwelling older adults.

The age-related loss of muscle mass and/or strength and performance, sarcopenia, has been associated with geriatric syndromes, morbidity and mortality. Although sarcopenia has been researched for many years, currently there is a lack of consensus on its definition. Some studies define sarcopenia as low muscle mass alone, whereas other studies have recently combined low muscle mass, strength and physical performance suggested by the European Working Group on Sarcopenia in Older People, as well as the Asian Working Group for Sarcopenia. The arbitrary use of various available sarcopenia definitions within the literature can cause discrepancies in the prevalence and associated risk factors. The application of population-specific cut-off values in any sample population can be problematic, particularly among different ethnicities. Using commonly used cut-off points to define sarcopenia, including solely muscle mass and combined definitions, on a community-dwelling elderly Japanese population, the prevalence of sarcopenia ranged from 2.5 to 28.0% in men and 2.3 to 11.7% in women, with muscle mass measured by dual-energy X-ray absorptiometry, and 7.1-98.0% in men and 19.8-88.0% in women measured by bioelectrical impedance analysis. Body mass index was the most prominent related factor for sarcopenia across the definitions in this Japanese sample. However, other associated hematological and chronic condition factors varied depending on the definition.

Can You Ride a Bicycle? The Ability to Ride a Bicycle Prevents Reduced Social Function in Older Adults With Mobility Limitation.

BACKGROUND: The health benefits of bicycling in older adults with mobility limitation (ML) are unclear. We investigated ML and functional capacity of older cyclists by evaluating their instrumental activities of daily living (IADL), intellectual activity, and social function. METHODS: On the basis of interviews, 614 community-dwelling older adults (after excluding 63 participants who never cycled) were classified as cyclists with ML, cyclists without ML, non-cyclists with ML (who ceased bicycling due to physical difficulties), or non-cyclists without ML (who ceased bicycling for other reasons). A cyclist was defined as a person who cycled at least a few times per month, and ML was defined as difficulty walking 1 km or climbing stairs without using a handrail. Functional capacity and physical ability were evaluated by standardized tests. RESULTS: Regular cycling was documented in 399 participants, and 74 of them (18.5%) had ML; among non-cyclists, 49 had ML, and 166 did not. Logistic regression analysis for evaluating the relationship between bicycling and functional capacity revealed that non-cyclists with ML were more likely to have reduced IADL and social function compared to cyclists with ML. However, logistic regression analysis also revealed that the risk of bicycle-related falls was significantly associated with ML among older cyclists. CONCLUSIONS: The ability and opportunity to bicycle may prevent reduced IADL and social function in older adults with ML, although older adults with ML have a higher risk of falls during bicycling. It is important to develop a safe environment for bicycling for older adults.

Prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people in Japan.

OBJECTIVE: This study investigated the prevalence and factors associated with xerostomia and hyposalivation among community-dwelling older people. BACKGROUND: Xerostomia and hyposalivation are common symptoms in the older population. MATERIALS AND METHODS: This study included with 894 community-dwelling, Japanese older people (355 men, 539 women; age 65-84 years) who participated in a comprehensive geriatric health examination, which included questionnaires and interviews regarding medical history, medications, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), depressive condition. The Zung Self-Rating Depression Scale (SDS) was used to evaluate depression. Resting salivary flow rate was evaluated by the modified cotton roll method. RESULTS: In this study, 34.8% of the participants (mean age, 73.5 ± 5.0 years) complained about xerostomia, while the prevalence of hyposalivation was 11.5%. Multiple regression analysis revealed hypnotics use [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.13-2.61], SDS (OR = 1.05, CI = 1.04-1.07) and TMIG-IC total points (OR = 0.87, CI = 0.76-0.99) to be significantly associated with xerostomia. In contrast, female gender (OR = 2.59, CI = 1.55-4.31) and the use of agents affecting digestive organs (OR = 1.78, CI = 1.11-2.86) were associated with hyposalivation. CONCLUSION: Our findings showed that the prevalence of xerostomia and hyposalivation were approximately 1 in 3 and 1 in 10 respectively. The factors associated with psychological factors and high-level functional competence, while hyposalivation was associated with medications and gender, as well as systemic and/or metabolic differences. It is important to consider these multidimensional factors associated with xerostomia and hyposalivation.

Construct validity of posture as a measure of physical function in elderly individuals: Use of a digitalized inclinometer to assess trunk inclination.

AIM: The first aim of the present study was to determine the construct validity of evaluating posture as a measure of physical function in elderly individuals. The second aim was to determine reference values for sternum inclination in elderly individuals when measured using a digitalized inclinometer. METHODS: We included 834 community-dwelling elderly individuals (350 men and 484 women) in this study. We used a digital inclinometer for measuring sternum inclination angle. We evaluated physical functions, including muscle strength, static balance, gait ability and the functional mobility of our study participants. To assess the construct validity of sternum inclination in elderly people, Pearson's correlation coefficient between sternum inclination and participant characteristics was calculated. To determine a reference value of sternum inclination by age, P for trend was calculated. RESULTS: In men, the sternum inclination angle and sternum inclination index were significantly associated with all anthropometric measures, except static balance. In women, the sternum inclination index was significantly associated with all measures, whereas the sternum inclination angle was associated with all measures except for balance and the Timed Up and Go test. Trend of sternum inclination index by age was significant. CONCLUSIONS: Our results show that the sternum inclination as a measure of physical function in elderly men and women has construct validity. We determined reference values for sternum inclination of which trend by age was considered. Geriatr Gerontol Int 2016; 16: 1068-1073.

Engagement in paid work as a protective predictor of basic activities of daily living disability in Japanese urban and rural community-dwelling elderly residents: An 8-year prospective study.

AIM: To examine whether engaging in paid work is a predictor of maintaining good functional health among Japanese older adults in both urban and rural communities. METHODS: We used the 8-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging with 306 and 675 persons aged 65-84 years from Koganei City (urban) and Nangai Village (rural), respectively, who are independent in basic activities of daily living (BADL). In order to examine the declining patterns in BADL and evaluate the predictive value of working status for future BADL disability, we applied the log-rank test of cumulative proportion curves and the Cox proportional hazard model by sex, controlling for age, research fields, years of education, marital state, chronic medical conditions, pain, instrumental activities of daily living (IADL), smoking status, exercise habits, life satisfaction, usual walking speed and serum albumin for evaluating the predictive value of working status at baseline for future BADL disability. RESULTS: In both areas, participants who were not working were more likely to decline in BADL than those working (P < 0.05), except for women in urban Koganei. Male participants who did not engage in paid work had a higher adjusted hazard ratio of onset of BADL disability, compared with those working, but this was not seen for female participants. CONCLUSIONS: Working might be protective from a decline in BADL only for men, but not for women. Regarding the difference of sex roles in conventional Japanese society, working would be an effective solution especially for men to participate in social activities.

Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: A 4-year follow-up study.

AIM: To determine the long-term effects of interventions carried out for the improvement of muscle mass, strength, walking ability and fall rate, 4 years after the completion of the intervention. METHODS: Out of 304 elderly sarcopenic women aged over 75 years, 155 participated in an intervention and 149 were excluded from the intervention. Those excluded were considered as non-participants and included in the analysis. Follow-up data were available for 259 women (135 intervention participants; 124 non-participants). Muscle mass was determined by bioelectrical impedance analysis. Physical fitness measurements and interview surveys were carried out at baseline and at 4-year follow up. RESULTS: Compared with the non-participants, women in the intervention group had significantly smaller reductions in measures of muscle mass, strength and walking speed from baseline to follow up. The absolute mean difference between the two groups was 3.7% (95% confidence interval -6.5 to -0.8; P = 0.012) for leg muscle mass, 10.7% (-21.0 to -0.3; P = 0.011) for knee extension strength and 8.4% (-16.0 to -0.9; P = 0.029) for usual walking speed. Instrumental activities of daily living disability significantly increased in both participants and non-participants in 4 years. The fall rate of the previous 1 year in intervention participants was 18.5% in 2008 and 23.0% in 2012 (χ(2) = 2.122, P = 0.145), and 17.7% in 2008 and 29.0% in 2012 among non-participants (χ(2) = 15.415, P < 0.001). CONCLUSION: Participation in an intervention could prevent significant declines in lower extremity muscle mass, strength and mobility, even in the long-term, and might be beneficial in suppressing otherwise significant rises in fall rates.