The Relationship Between Neighborhood Environment, Health-Related Behaviors, and Self-Rated Health in Community-Dwelling Older Adults in Japan.

Background: Falls in older adults are a major barrier to healthy longevity. Recent studies suggest that muscle quality is associated with fall risk. This study aimed to determine whether a functional muscle quality index (MQI) using the 5-repetition sit-to-stand test (5R-STS) reflects fall risk in community-dwelling older adults. Methods: This cross-sectional study included 137 community-dwelling older adults (≥65 years) in Japan. Lower limb skeletal muscle mass (SMM) was measured using the BIA method, and muscle function was assessed using the 5R-STS. The MQI was calculated as "(5R-STS (s)/SMM (kg)) × 10". Fall history was collected using a self-administered questionnaire, and binary logistic regression analysis including gait speed and physical frailty was performed. Results: Participants were divided into fallers (n = 36; age = 78.2 ± 5.6) and non-fallers (n = 101; age = 76.9 ± 5.3). Significant differences were found between the groups in gait speed (p = 0.01), TUG (p < 0.01), 5R-STS (p < 0.01), and MQI (p < 0.01). Binary logistic regression identified MQI (OR = 1.28; p < 0.01) and gait speed (OR = 0.14; p = 0.02) as explanatory variables for fall history. The results of the evaluation using the receiver operating characteristic (ROC) curve showed that the cutoff value for MQI to distinguish fall history was 8.04 s/kg, and the cutoff value for gait speed was 1.21 s. Conclusions: The MQI using the 5R-STS shows promise as an indicator of fall risk in older adults. Further longitudinal studies are needed to clarify the causal relationship.

To elucidate the relationship between physical frailty and dry mouth among community-dwelling older adults in Japan. Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. This cross-sectional study included 643 individuals (mean age, 73.9years) from the Otassha Study in 2019. Xerostomia was assessed using the 5-item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre-frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. Among the participants, 4.5% and 49.8% had physical frailty and pre-frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one-point increase in SXI, 1.12; 95% confidence interval, 1.06-1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. Xerostomia is associated with physical frailty among community-dwelling older adults in Japan. Not applicable.

This study examines the relationship between living arrangements and depressive symptoms among community-dwelling older adults in Japan, with a particular focus on gender differences. A cross-sectional survey was conducted in Ayase City, Kanagawa Prefecture, using mailed questionnaires, and the analysis was conducted on data from 1409 participants aged 65 and older. Logistic regression analysis was performed to assess the associations between living arrangements, social networks, social participation, and depressive symptoms, adjusting for sociodemographic and health-related factors. The findings indicate that older adults living alone and those co-residing with their children are particularly vulnerable. Those living alone were more likely to be women aged 75 and older, with economic difficulties, and exhibited higher rates of depressive symptoms and care needs. Similarly, older adults living with their children had a higher prevalence of depressive symptoms and care requirements despite experiencing fewer economic hardships. This group was also characterized by lower educational attainment. Additionally, gender-specific factors were identified in the relationship between social relationships, including living arrangements, and depressive symptoms. These results underscore the necessity of interventions that consider both living arrangements and gender-specific social factors to mitigate mental health risks among older adults.

ObjectivesTo investigate the trajectories of social networks and interactions among older Japanese individuals during the COVID-19 pandemic. Study designWe used data from a cohort of community-dwelling older individuals from the Otassha study's 2019–2022 survey. Participants comprised 606 older individuals who participated in the 2019 survey and were followed up at least once. Main outcome measuresSocial networks were assessed using the Lubben Social Network Scale-6 (LSNS-6), whereas social interactions were assessed by the frequency of face-to-face or non-face-to-face contact with non-resident family members and friends. Trajectories of the LSNS-6 and face-to-face and non-face-to-face interactions were identified using group-based semiparametric mixture modeling. The trajectories of change in the LSNS-6 from 2019 were also identified. The factors associated with the changes in trajectory patterns were examined using logistic regression analysis. ResultsThree LSNS-6 trajectories were identified, with slightly decreasing patterns over time. Specifically, face-to-face interactions tended to decrease over time, whereas non-face-to-face interactions exhibited almost no change. The reduction in LSNS-6 in the decreased pattern failed to recover to its pre-pandemic level. The group of participants with the decreased pattern had a significantly higher proportion of people participating in group activities [odds ratio (95 % confidence interval): 2.27 (1.12–4.59)] and performing calisthenics twice a week than the group with the maintained pattern [2.08 (1.18–3.68)]. ConclusionsDuring the three years of the pandemic, no changes were observed in the social networks of community-dwelling older Japanese individuals.

The purpose of this study was to examine the effects of simplified reminiscence practice using olfactory stimuli on depression and cognitive function in community-dwelling older adults in Japan. Accordingly, 61 individuals were randomly divided into two groups. In the intervention group, 12 sessions of reminiscence were performed using olfactory cards. In the control group, reminiscence sessions were similarly performed, but with language cards. The Geriatric Depression Scale-15 (GDS-15) was used to measure mental health status and the Five Cognitive Test was used to measure cognitive function at baseline and after completion of the intervention. The final sample included 27 participants in the intervention group and 23 participants in the control group. Basic characteristics of the participants at baseline were compared and a significant difference was observed between the two groups in age (p = 0.029). Repeated-measures analysis of covariance with age as the covariate revealed a significant interaction between time and group on the GDS-15 (p = 0.04). Furthermore, a before and after comparison using a paired t-test showed a significant difference only in the intervention group (p = 0.01). The results of this study suggest that simplified reminiscence practice using olfactory cards could serve as an intervention to help maintain the mental health of community-dwelling older adults.

BackgroundMost studies on interventions using social robots to reduce loneliness have been conducted in facilities in Western countries.ObjectiveThis study evaluated the effectiveness of digital social robot interventions in reducing loneliness among community-dwelling older Japanese adults using a randomized controlled trial and qualitative analysis.MethodsIndividuals aged ≥65 years who lived alone in Tokyo and neighboring areas and experienced loneliness were recruited. In total, 73 eligible participants were randomly assigned to either an intervention or a control group. The 4-week intervention involved a humanoid social communication robot (BOCCO emo), which facilitated conversations with human operators and family members and reminded participants of daily tasks. The primary outcome was loneliness, with mental health (psychological well-being, depression, and self-rated health), the frequency of laughter in daily life, health competence, and interpersonal relationships (social network and generalized trust) as secondary outcomes. Participants were evaluated at baseline and follow-up using a self-administered questionnaire. In the follow-up survey, participants in the intervention group provided open-ended responses regarding their experiences using the social robot.ResultsIn total, 68 participants completed both the baseline and follow-up surveys (34 in each group). The average age of the participants was 82.3 (SD 6.5) years, and 64 (N=68, 94%) participants were women. A linear mixed-effects model with a random intercept indicated that loneliness decreased more in the intervention group than in the control group (difference-in-difference −3.1, 95% CI −5.9 to −0.4). Psychological well-being also improved in the intervention group (difference-in-difference 1.9, 95% CI 0.1 to 3.7). We identified 4 categories through content analysis: emotional support and psychological connection, lifestyle assistance, enrichment of social interaction, and cognitive and mental stimulation.ConclusionsSocial robots can reduce loneliness among community-dwelling older adults in non-Western societies. Information and communication technology appears to be an effective approach for alleviating loneliness and enhancing well-being among older adults in community settings.

To investigate the associations between periodontal inflammation-as determined by the periodontal inflamed surface area (PISA)-and serum inflammatory markers in community-dwelling older adults in Japan. This cross-sectional study included 470 adults (mean age: 73.1 years). The composite inflammatory marker z-score (CIMZ) was calculated as the sum of the participants' individual z-scores for C-reactive protein (CRP), interleukin-1beta (IL-1β), IL-6 and tumour necrosis factor-α (TNF-α). The associations of PISA (quartiles) with individual biomarkers (continuous, log-transformed) and CIMZ (dichotomized, highest quartile or not) were assessed using linear or Poisson regression models. Compared with participants in the lowest PISA quartile (Q1), those in Q3 and Q4 had significantly (p < 0.05) higher CRP and IL-6 levels. Statistically significant linear trends (p trend < 0.05) across the PISA quartiles were observed for CRP and IL-6. The multivariable adjusted prevalence ratios (95% confidence intervals) of high CIMZ (reference: Q1) were 1.20 (0.68-2.14), 1.66 (0.96-2.88) and 1.90 (1.08-3.34) (p trend = 0.01) in individuals in PISA Q2-Q4. Older adults with high periodontal inflammation had high serum CRP and IL-6 concentrations and composite summary inflammatory indicator values. Periodontal inflammation is a potential modifiable factor of elevated inflammatory status among older adults in Japan.

This study investigated neighborhood walkability using Walk Score® and social participation in districts within a city among older Japanese adults. This study was a cross-sectional study using baseline data of older adults from the Keeping Active across Generations Uniting the Youth and the Aged study. In total, 2750 participants (1361 men and 1389 women, mean age 72.8± 6.4 years) were included in the analysis. The questionnaire included socioeconomic status, self-rated health, medical history, depressive symptoms, instrumental activities of daily living and social participation. We used the Walk Score® as neighborhood walkability and a walk score <50 was categorized as a "car-dependent" area and a score ≥50 as a "walkable" area. A Poisson regression analysis stratified by sex was performed to investigate the association of neighborhood walkability with social participation. Prevalence ratios were calculated and their 95% confidence intervals. We found that dwelling in car-dependent areas (prevalence ratio 0.78, 95% confidence interval 0.64-0.94) had a significant negative effect on women's social participation, unlike men. Our study showed that neighborhood walkability and social participation were associated with older Japanese women after adjusting for the covariates. These findings might provide helpful information for public health interventions targeted to promote social participation among older adults. Geriatr Gerontol Int 2022; 22: 350-359.

The present study explored the association between comprehensive health literacy and frailty level in community-dwelling older adults in Japan. This was a cross-sectional study. We enrolled 517 community-dwelling older adults (mean age 73.2 ± 6.3 years; 410 women). We divided the cohort into two groups, non-frail and any-frail, based on Fried Frailty Index scores. We assessed comprehensive health literacy using a 14-item health literacy scale, and classified the participants as having high or low health literacy. We carried out multivariate logistic regression analysis in which the dependent variable was the presence of non-frailty and the independent variable was the presence of high health literacy. The analysis was adjusted for age, sex, body mass index, educational history and cognitive function. There were 132 (25.5%) and 385 (74.5%) participants in the non-frail and any-frail groups, respectively. The analysis showed that high health literacy was independently associated with the non-frail group (odds ratio 1.64, 95% confidence interval 1.03-2.61). The results showed that high health literacy was associated with non-frailty. This result implies that comprehensive health literacy might play a salient role in maintaining good health status in community-dwelling older adults in Japan. Geriatr Gerontol Int 2017; 17: 804-809.

Studies involving the 30 s chair-stand test (CS-30) have shown that subjects’ movements can vary during the test, and that these variations may follow several patterns. The present study aimed to define these different patterns and their respective incidences among a population of community-dwelling older adults in Japan. We also investigated, among the patterns identified, potential associations with physical and mental characteristics. The study population comprised 202 community-dwelling older adults. Subjects were classified into four groups based on how their CS-30 performance (defined through sit–stand–sit cycle count) changed over three successive 10 s segments: “steady-goers,” “fluctuators,” “decelerators,” and “accelerators.” Several other measures were also evaluated, including sit-up count, knee-extension strength, toe-grip strength, and Mini-Mental State Examination score. We found that steady-goers and decelerators comprised 70% of the sample. Fluctuators and steady-goers showed comparable physical function. Decelerators exhibited significant correlations between CS-30 score (total cycles) and tasks involving persistence and repetitive actions (p < 0.05). In addition, accelerators showed significantly stronger knee extension than steady-goers (p < 0.01). Differences in temporal patterns of CS-30 performance corresponded to differences in certain dimensions of physical and mental function. Our findings may be useful for planning and evaluating intervention programs aimed at long-term-care prevention among community-dwelling older adults.

It is estimated that 7.2% of community-dwelling older adults worldwide have major depression. Therefore, this study aimed to investigate the relationship between geriatric syndromes and depressive symptoms. Data were obtained from the Kaizuka Dementia Prevention Study 2018 and 2019, which was a community-based health check conducted in collaboration with the Osaka Kawasaki Rehabilitation University (Kaizuka City Office) and Cognitive Reserve Research Center in Osaka, Japan. The participants comprised 363 older adults (mean age 73.6±6.6years; women=75.8%) who participated in a community-based health check. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Depressive symptoms were defined as a GDS-15 score of≥5. Furthermore, geriatric syndromes in participants-such as frailty, sarcopenia, and locomotive syndrome-were assessed. There was a 28.1% prevalence of depressive symptoms. In a logistic regression analysis with depressive symptoms as the dependent variable, both pre-frailty (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.09-3.01) and frailty (OR 5.45, 95% CI 2.23-13.31) were found to be significantly higher in the depressive group. There were no significant differences in sarcopenia and locomotive syndrome between the depressive groups. Our findings suggest that depressive symptoms are associated with frailty and pre-frailty in community-dwelling older adults in Japan. Physical frailty should be evaluated in depressed individuals and may contribute to the prioritization of clinical evaluation of geriatric syndromes.

This study aimed to examine the relationship between one’s physical status related to non-communicable diseases (NCDs) and social isolation, and to identify lifestyle behaviors for the prevention of NCDs associated with social isolation among community-dwelling older adults in Japan. A cross-sectional study was conducted to investigate lifestyle behaviors for NCD prevention associated with social isolation in Japanese adults aged 60 years and above in a community setting. Out of 57 participants, 17.5% were not socially participative, 66.7% hardly ever, 29.8% sometimes, and 3.5% often felt loneliness. Non-social participation and loneliness were negatively related to the frequency of vegetable and fruit intake. Additionally, loneliness was positively associated with one’s duration of smoking and current smoking habits, and negatively associated with the frequency of moderate-intensity activities, with marginal significance. Those with non-social participation or loneliness were less likely to eat a healthy diet and live a smoke-free lifestyle. The findings of this study suggest that a mutual health support system in the community and the development of community-based approaches for the prevention of NCDs among Japanese older adults are needed.

Tri-axial accelerometer-derived sedentary time and its correlates among community-dwelling older adults in Japan

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01–1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.

We examined correlating clinical biomarkers for the physical aspect of frailty among community-dwelling older adults in Japan, using Japanese Gerontological Evaluation Study (JAGES). We used information from the JAGES participants (N = 3,128) who also participated in the community health screening in 2010. We grouped participants' response to the Study of Osteoporotic Fracture (SOF) Frailty Index into robust (=0), intermediate frail (=1), and frail (=2+) ones to indicate physical aspect of frailty. Independent of sex and age, results from multinomial logistic regression showed above normal albumin and below normal HDL and haemoglobin levels were positively associated with intermediate frail (RRR = 1.99, 95% CI = 1.22–3.23; RRR = 1.36, 95% CI = 1.33–1.39; RRR = 1.36, 95% CI = 1.23–1.51, resp.) and frail cases (RRR = 2.27, 95% CI = 1.91–2.70; RRR = 1.59, 95% CI = 1.51–1.68; RRR = 1.40, 95% CI = 1.28–1.52, resp.). Limited to women, above normal Hb1Ac level was similarly associated with intermediate frail and frail cases (RRR = 1.18, 95% CI = 1.02, 1.38; RRR = 2.56, 95% CI = 2.23–2.95, resp.). Use of relevant clinical biomarkers can help in assessment of older adults' physical aspect of frailty.