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.

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.

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.

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.

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.

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.

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.

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.

Indicators predicting the development and improvement of sarcopenia in older adults requiring long-term care.

[Purpose] This study aimed to identify factors associated with sarcopenia development and improvement among older adults requiring long-term care. [Participants and Methods] This prospective observational study included 118 older adults requiring long-term care in a single facility. Sarcopenia was assessed according to the 2019 diagnostic criteria of the Asian Working Group for Sarcopenia at baseline and after 6 months. Nutritional status was measured using calf circumference and the Mini Nutritional Assessment-Short Form to examine the association between sarcopenia onset and improvement. [Results] Risk of malnutrition and lower calf circumference at baseline were significantly associated with sarcopenia development. The study also showed that a non-risk of malnutrition, higher calf circumference, and higher skeletal muscle mass index were significantly associated with improved sarcopenia. [Conclusion] The Mini Nutritional Assessment-Short Form and calf circumference were able to predict sarcopenia development and improvement in older adults requiring long-term care.

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.

Neck circumference may predict sarcopenia in Japanese older adults requiring long-term care.

Several studies have established the advantage of using anthropometric measurements as indicators of sarcopenia. Nevertheless, no study has explored the association between sarcopenia and neck circumference. In this cross-sectional study, we examined the data of 90 older adults requiring long-term care to evaluate this association and establish cut-off points for individuals at risk of sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) 2019. A significant association was found between sarcopenia and neck circumference using binomial logistic regression and receiver operating characteristic analyses. The optimal cut-off value for neck circumference associated with increased risk for sarcopenia among older adults was 32.8 cm for females and 38.0 cm for males. Given the potential of declining neck circumference as an anthropometric marker of sarcopenia, it has clinical applications in screening for sarcopenia in older adults requiring long-term care.

Association between age and phase angle in "old" and "super-old" nursing home residents.

[Purpose] We aimed to clarify the characteristics of age-related changes based on the body composition data of old and super-old nursing home residents. [Participants and Methods] This cross-sectional study included 53 female nursing home residents aged 75 years and above (mean age: 89.4 years; standard deviation: 5.6 years). They were divided into the old and super-old groups. The old group consisted of 24 participants aged between 75 and 89 years (mean age: 84.4 years; standard deviation: 3.7 years). The super-old group consisted of 29 participants aged 90 years and above (mean age: 93.5 years; standard deviation: 2.7 years). The parameters such as phase angle, skeletal muscle mass index, skeletal muscle mass, body fat percentage, body mass index, and Barthel index were examined in the two groups. The relationship between age and phase angle was determined, and the partial correlation coefficient was analyzed using the items for which a significant difference was found between the two groups as adjustment variables. [Results] The overall phase angle was 3.2 degrees, and that of the super-old group alone was 2.6 degrees. Age-related difference was observed in the phase angle and Barthel index. A significant correlation of -0.53 was observed between age and phase angle. The Barthel index-adjusted partial correlation coefficient between age and phase angle was -0.35. [Conclusion] The results of this study indicated that phase angle is an indicator of physical condition associated with aging in female nursing home residents aged 75 to 100 years.

Changes in physical function in older females over a 5†year period.

[Purpose] The quality of physical functions was evaluated prospectively in older females over a 5 year period to identify the physical functions that are more likely to consistently decline or be maintained in females aged 65‒74 years and more than 75 years. [Participants and Methods] Physical functions, including grip strength, walking speed, and balance, were measured for older females aged 65-74 years group and more than 75 years group from 2015 to 2019. T-scores of the physical performances were calculated to analyze the changes in the physical functions over 5 years. [Results] Based on the T-scores, physical functions in terms of the 5-m walking speed, timed up-and-go test, and functional reach test, improved from 2015 to 2019 in the 65-74 group, whereas all physical functions consistently deteriorated in the older than 75 group. [Conclusion] There was no significant decline of the physical functions in both groups; however, the T-score variations for physical functions during the 5 year observation period differed in each group.

Features of older community-dwelling adults with osteosarcopenia requiring support or care.

[Purpose] This study aimed to investigate the problems associated with osteosarcopenia and its effect on physical performance, nutritional status, and support or care required by older community-dwelling adults. [Participants and Methods] This study investigated 141 older community-dwelling adults requiring support or care using an ambulatory rehabilitation service. The patients were divided into a control, osteopenia only, sarcopenia only, and osteosarcopenia group. We investigated the associations of each condition with the baseline information, grip strength, gait speed, Mini Nutritional Assessment-Short Form score, and support or care level required. [Results] The osteosarcopenia group consisted of 43.3% of the total study participants. Osteosarcopenia was more closely associated with body mass index, support or care level, grip strength, gait speed, skeletal muscle mass index, and Mini Nutritional Assessment-Short Form score than osteopenia or sarcopenia alone. [Conclusion] Osteosarcopenia is highly prevalent in older community-dwelling adults requiring support or care, which may suggest a greater effect on physical performance, nutritional status, and support or care required than that exerted by osteopenia or sarcopenia alone.

Related factors associated with exercise behavior in patients with peripheral arterial disease.

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.

Recent Insights into the Measurement of Carbon Dioxide Concentrations for Clinical Practice in Respiratory Medicine.

In the field of respiratory clinical practice, the importance of measuring carbon dioxide (CO2) concentrations cannot be overemphasized. Within the body, assessment of the arterial partial pressure of CO2 (PaCO2) has been the gold standard for many decades. Non-invasive assessments are usually predicated on the measurement of CO2 concentrations in the air, usually using an infrared analyzer, and these data are clearly important regarding climate changes as well as regulations of air quality in buildings to ascertain adequate ventilation. Measurements of CO2 production with oxygen consumption yield important indices such as the respiratory quotient and estimates of energy expenditure, which may be used for further investigation in the various fields of metabolism, obesity, sleep disorders, and lifestyle-related issues. Measures of PaCO2 are nowadays performed using the Severinghaus electrode in arterial blood or in arterialized capillary blood, while the same electrode system has been modified to enable relatively accurate non-invasive monitoring of the transcutaneous partial pressure of CO2 (PtcCO2). PtcCO2 monitoring during sleep can be helpful for evaluating sleep apnea syndrome, particularly in children. End-tidal PCO2 is inferior to PtcCO2 as far as accuracy, but it provides breath-by-breath estimates of respiratory gas exchange, while PtcCO2 reflects temporal trends in alveolar ventilation. The frequency of monitoring end-tidal PCO2 has markedly increased in light of its multiple applications (e.g., verify endotracheal intubation, anesthesia or mechanical ventilation, exercise testing, respiratory patterning during sleep, etc.).

Minimal detectable change in handgrip strength and usual and maximum gait speed scores in community-dwelling Japanese older adults requiring long-term care/support.

Aging is an important issue in Japan that has led to a large number of older adults requiring long-term care/support. Therefore, we determined the range of measurement error in the measurement of handgrip strength and gait speed which are representative tests. This cross-sectional study included 111 community-dwelling Japanese older adults aged ≥65 years who required long-term care/support and underwent ambulatory rehabilitation. Handgrip strength and usual and maximum gait speed were measured on two days in one single week. Minimal detectable change (MDC) was calculated. The MDC in handgrip strength was 2.9 kg for the overall population, 3.2 kg for the male participants, and 2.4 kg for the female participants. For the overall population, the MDC in usual gait speed was 0.18 m/s and that in maximum gait speed was 0.23 m/s. These MDCs are expected to be suitable for judging clinical changes because this study considered gender and typical tests.