Community-dwelling Elderly People In Japan Research Articles

Association between Subjective Cognitive Complaints and Sleep Disturbance among Community-Dwelling Elderly Individuals in Japan.

Subjective cognitive complaints (SCCs) are a crucial modifiable risk factor for dementia. There is increasing interest in the association between SCC and sleep disturbance; however, the effects of sleep disturbance on SCC development among community-dwelling elderly individuals in Japan remain unclear. We aimed to cross-sectionally investigate the association between SCC and sleep disturbance, with adjustment for multiple factors related to cognitive decline, among 241 community-dwelling elderly persons without cognitive impairment. The measures were SCCs (Kihon Checklist-Cognitive Function, KCL-CF), sleep disturbance (Japanese version of the Athens Insomnia Scale, AIS-J), general cognitive function (Mini-Mental State Examination), and depressive symptoms (five-item version of the Geriatric Depression Scale [GDS-5]). The following data were collected: sex, age, educational history, whether the participants had visited a medical institution for diseases (hypertension, diabetes, hyperlipidemia, heart disease), and the presence/absence of established risk factors (hearing loss, history of head injury, drinking habits, smoking habits, social isolation, and physical inactivity and activity). Based on the KCL-CF, 96 and 145 participants were considered to have and lack SCCs, respectively. On logistic regression analysis, the AIS-J score and smoking history were significantly associated with SCCs. Our findings suggest that sleep disturbance is associated with SCC development among community-dwelling elderly people in Japan. Evaluating and managing sleep disturbances can be important in preventing SCCs and dementia.

Relationship Between Age-Related Changes in Skeletal Muscle Mass and Physical Function: A Cross-Sectional Study of an Elderly Japanese Population.

Skeletal muscle mass and muscle strength are positively correlated, but the relationship between grip strength and global muscle strength is controversial. This study aimed to clarify the changes in site-specific skeletal muscle mass by age group and determine the relationship between site-specific, age-related changes in skeletal muscle mass and physical function in community-dwelling elderly people in Japan. The participants were divided into age groups of five-year intervals (65-69 years, 70-74 years, 75-79 years, and ≥80 years) and were also categorized by sex. The skeletal muscle mass of the upper limbs, lower limbs, and trunk was measured using multifrequency bioelectrical impedance analyzers (InBody 430 (Biospace Co., Ltd., Seoul, Korea) and InBody 470 (InBody Japan Inc., Tokyo, Japan)). For physical function assessment, we measured grip strength, quadriceps strength, sit-up count, sit-and-reach distance, and standing time on one leg with eyes open and performed the timed up and go (TUG) test. The results showed that skeletal muscle mass decreased with age regardless of sex at all measured sites. Furthermore, a partial correlation analysis adjusted for age, physical constitution, and the presence/absence of exercise habits revealed that the highest correlation was between skeletal muscle mass in all sites and grip strength. Thus, monitoring grip strength may be used as a representative of systemic skeletal mass even in Japanese people.

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan.

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Dynapenia and physical performance in community-dwelling elderly people in Japan.

ABSTRACTAging of society has increased the incidence of physical disability. The goal of this study was to examine the physical ability of elderly people classified as having sarcopenia, presarcopenia, or dynapenia (a low muscle function without low muscle mass) in a community in Japan. The subjects were volunteers aged >60 years who were participants in a health checkup in Yakumo, Hokkaido and were in good general health. Demographic data were collected and physical performance tests were performed to measure grip strength, walking speed, back muscle strength, maximum stride length, and 3-m timed-up-and-go (3m TUG) time. A measurement of skeletal muscle mass was used as a basis for calculating the appendicular skeletal muscle index (aSMI). The rates of sarcopenia, presarcopenia, and dynapenia were 10%, 22%, and 8% in males (n=101, age 69.7±5.4 years), and 19%, 23%, and 13% in females (n=112, 68.5±5.9 years). Body mass index in subjects with dynapenia was significantly higher compared to that in subjects with sarcopenia and presarcopenia (p<0.01). Back muscle strength, maximum stride length and 3m TUG were similar in dynapenia and sarcopenia, but differed significantly with those in presarcopenia in both males and females without the influence of age (p<0.05). Further studies are needed to evaluate the benefits of dynapenia intervention programs and to explore the underlying pathophysiology of dynapenia.

Factors associated with the maintenance and decline of Instrumental Activities of Daily Living (IADL) among community-dwelling elderly people in Japan : a systematic review of observational studies

Factors associated with the maintenance and decline of Instrumental Activities of Daily Living (IADL) among community-dwelling elderly people in Japan : a systematic review of observational studies

Epidemiology and effect on physical function of osteosarcopenia in community-dwelling elderly people in Japan

Objective: To determine the prevalence of osteosarcopenia and its relationship with physical function in elderly people in Japan.Methods: The subjects were 427 healthy volunteers over 65 years old (205 males, 222 females, average age 71.4 years) who attended health checkups in 2016 and 2017. Body mass index (BMI), bone mineral density in the calcaneus (%YAM), physical parameters, and skeletal muscle mass were measured. The appendicular skeletal muscle index (aSMI) was calculated as arm and leg skeletal muscle mass/height2. Osteoporosis was defined as %YAM < 70%, sarcopenia as aSMI < 7.0 kg/m2 (males) and <5.8 kg/m2 (females), and osteosarcopenia as the presence of sarcopenia and osteoporosis.Results: Osteoporosis alone was diagnosed in 60 subjects (14%), sarcopenia alone in 55 (13%), and osteosarcopenia in 36 (8%). The prevalence of osteosarcopenia was 8% in all subjects, 12% in females, and 4% in males. BMI and back muscle strength were significantly lower in osteosarcopenia than in sarcopenia alone (p < .05); and weight, BMI, body fat, grip strength, and back muscle strength were significantly lower in osteosarcopenia than in osteoporosis alone (p < .05).Conclusion: Osteosarcopenia was significantly associated with muscle weakness. Further studies to identify other related factors are needed for prevention and treatment of osteosarcopenia.

Gait speed as a predictor of all-cause mortality in community-dwelling elderly people in Japan: The Mima cohort study

Gait speed as a predictor of all-cause mortality in community-dwelling elderly people in Japan: The Mima cohort study

Postcard intervention for depression in community-dwelling older adults: A randomised controlled trial

Depression in older adults erodes their health, quality of life and the economy. Existing interventions are not feasible for broad application at the community. Postcard intervention only requires a few resources, and previous studies have shown its effectiveness for patients following drug overdose, self-harm and hospitalisation for major depression. The purpose of the present study is to evaluate the effectiveness of a postcard intervention. Participants were community-dwelling individuals, aged 65 or older, who eat meals alone and with the score of 4 or higher on the 15-item Geriatric Depression Scale (GDS-15). We enrolled 184 eligible participants, with 93 in the intervention and 91 in the control arm. Postcards were sent to participants once a month for eight months. Primary outcome was the GDS-15 score at post-intervention. Secondary outcomes were quality of life and activities of daily living. There was no significant difference in primary and secondary outcomes between completers of the intervention and the control arm. However, most of the participants who received intervention thought the intervention was effective. The postcard intervention for depression in community-dwelling elderly people in Japan is neither feasible nor effective. However, the descriptive results suggest that the intervention may be effective given different parameters.

Association between risk perception, subjective knowledge, and depression in community-dwelling elderly people in Japan

Risk perception is one of the core factors in theories of health behavior promotion. However, the association between knowledge, risk perception, and depressed mood in depression is unknown. The aim of this study was to clarify the relationships between subjective knowledge, risk perception, and objective scores of depression in community-dwelling elderly people in Japan. A total of 747 elderly participants (mean age: 76.1, female: 59.8%) who completed the 15-item Geriatric Depression Scale (GDS-15) along with items assessing subjective knowledge and risk perception were included in the analysis. We assessed the correlation between subjective knowledge and risk perception, and then compare GDS-15 scores by level of subjective knowledge and risk perception. Subjective knowledge was weakly associated with risk perception and related to lower GDS-15 scores in a dose–response pattern, which did not change after adjusting for age, gender, basic activities of daily living (ADL), instrumental ADL, years of education and history of depression. There was no significant association between risk perception and GDS-15 scores. The relationship between knowledge, risk perception, and depressed mood in younger generations is unclear, but warrants examination.

Factors Influencing the Preferred Place of Death in Community-dwelling Elderly People in Japan

To investigate factors influencing the preferred place of death among community-living elderly people in Japan in relation to personal attributes, health status, self-rated health, and social capital indicators. A self-report questionnaire survey was conducted between July 2009 and September 2009 on a total of 238 elderly people aged ≥65 years living in Nagasaki Prefecture, Japan. Patients were either members of a social club for the elderly, individuals undergoing special health check-ups, or participants of health workshops held by cities. A total of 178 patients who provided complete responses (79 men, 99 women) were analyzed. Half or more of the patients (men: 68.4%, women: 52.5%) indicated home as their preferred place of death. Multiple logistic regression analysis showed that good self-rated health [odds ratio (OR): 2.6, 95% confidence interval (95% CI): 1.2–5.7, p = 0.013], participation in volunteer activities (OR: 2.0, 95% CI: 1.0–3.8, p = 0.038) and the spouse as the preferred caregiver (OR: 2.5, 95% CI: 1.3–4.8, p = 0.007) were associated with home as the preferred place of death. It is necessary to consider individual preferences and public health strategies in order to enable elderly people to receive suitable and comfortable end-of-life care in their preferred location.

The role of health care toward healthy longevity: life style and social relationship among community-dwelling elderly people in Japan.

The role of health care toward healthy longevity: life style and social relationship among community-dwelling elderly people in Japan.

Factor structures of a Japanese version of the Geriatric Depression Scale and its correlation with the quality of life and functional ability

We investigated the 15-item Geriatric Depression Scale (GDS-15) with regard to its factors and, reproducibility, as well as its relationship to activities of daily living, social factors, medical conditions, and quality of life for community-dwelling elderly people in Japan. The study population consisted of 736 community-dwelling elderly participants aged 65 or older. Exploratory factor analysis of the data and correlation coefficients between factors and activities of daily living, quality of life, social factors, and medical conditions were calculated for two consecutive years. The reproducibility of the results was also evaluated. As the result, GDS-15 had three reproducible factors specified as follows: factor I, “energy loss and pessimistic outlook”; factor II, “positive mental status (reversed)”; and factor III, “empty feeling.” Comparing our findings with a review of research in this area, positive items (excluding “feel full of energy”) seem to compose an universal factor. Factor I correlated best with quality of life, factor II with activities of daily living, and factor III with subjective cognitive function. These results suggest the GDS-15 can be used to assess the functional ability and quality of life, as well as depressive mood in older adults.

Relationship Between Depression and Blood Pressure in Community‐Dwelling Oldest‐Old Adults in Japan

To the Editor: “Inverse Relationship Between Depressive Symptoms and Arterial Blood Pressure in Community-Dwelling Oldest-Old Brazilians” by Rosset and colleagues1 attracted our attention because of its important point of view about community-dwelling oldest-old adults. Rosset and colleagues1 showed a relationship between low blood pressure (BP) and depression and discussed measures of controlling hypertension in the very old population, but the relationship between cognitive or mental functions and BP in community-dwelling elderly adults has been controversial.2-4 According to the Canadian National Population Health Survey, major depression is a possible risk factor for new-onset high BP.4 On the contrary, a recent study in France indicates that people with low BP have a higher risk of developing depression, whereas those with high BP were not at greater risk for incident depression.3 Moreover, another study in Norway showed that symptoms of anxiety and depression were correlated with lower BP 11 years later.5 Therefore, the findings on the relationship between depression and BP in elderly adults differ across study populations, although these findings are from Western populations, and there are few reports on this relationship in Asian populations. Thus, to address this important issue, a cross-sectional study was conducted to reexamine the relationship between BP and depression in the oldest-old community-dwelling adults in Japan. The total sample comprised 134 elderly people aged 80 and older living in Tosa, Japan (mean age ± standard deviation 84.5 ± 3.9, male:female = 43:91). Data were collected in the annual health examination program that the town held in 2012. They included sociodemographic characteristics, mean systolic and diastolic BP (in two consecutive measurements with the participant in a sitting position), body mass index (BMI), Mini-Mental State Examination (MMSE) score for the assessment of cognitive functioning, 15-item Geriatric Depression Scale (GDS) score, use of antihypertensive and antidepressant medications, and subjective sense of low economic status. The ethical review board of the Graduate School of Medicine, Kyoto University, approved this study. Data were analyzed using SPSS version 20.0 (IBM Inc., Armonk, NY). Mean number of years of education was 8.8 ± 2.0, mean MMSE score was 26.5 ± 3.2, and mean BMI was 22.5 ± 3.2 kg/m2; 67.9% and 4.8% of participants used antihypertensive and antidepressant drugs, respectively. There were no significant associations between GDS score and systolic BP (correlation coefficient (r = 0.017, P = .84) or GDS score and diastolic BP (r = −0.12, P = .17) in simple (Figure 1) or quadratic regression. Moreover, these relationships remained statistically nonsignificant after controlling for age, sex, years of education, MMSE score, BMI, use of antihypertensive and antidepressant medications, and subjective low economic status. Thus, the relationship between depression and BP that was significant in the Brazilian oldest-old population was not detected in a Japanese sample. The expression and management of depression and BP abnormality may differ depending on community, country, and social and medical situation, which may have led to the different results, although hypertension and depression in elderly adults are an important concern in Asian communities. Several reports have stated that the prevalence of hypertension in community-dwelling elderly people in Japan is greater than 70%.6, 7 At the same time, the prevalence of depression in elderly people in three Asian communities was reported to range from 17.2% to 33.8%.8 In conclusion, we should focus on accumulating and comparing results from samples drawn from different cultures and living environments to obtain new perspectives and insights in ethnogerontology. Conflict of Interest: The authors declare no financial or any other kind of personal conflicts with this paper. Author Contributions: HI, KM, KO, TW, RS, YK: study concept, analysis of data, preparation of manuscript. MF, YI, EF, WC, MT: interpretation of data, critical review of manuscript. All authors made substantial intellectual contributions to this manuscript. Sponsor's Role: None.

Depressive Symptoms and Past Lifestyle Among Japanese Elderly People

In order to develop an effective preventive intervention for depression, this cross-sectional study aimed to analyze the relationship between past lifestyle, social activity, and depressive symptoms among community-dwelling elderly people in Japan (n=887). The Geriatric Depression Scale was used for assessing depressive symptoms. The lifestyle of middle-aged people was assessed using a recall report. The prevalence of depressive symptoms among the subjects was 12.9%. Logistic regression analyses showed that physical exercise, daily intake of well-balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms among both men and women. Among men, avoidance of excess salt and fat was related to the absence of depressive symptoms, while among women, moderate alcohol consumption and good relationships with neighbors were related. Physical exercise, dietary education, and promotion of social activities among middle-aged people were recommended for prevention of depressive symptoms.

3．老年医学からのアプローチ―在宅ケアにおける現状と問題点

3．老年医学からのアプローチ―在宅ケアにおける現状と問題点

COMMUNITY‐DWELLING ELDERLY FALLERS IN JAPAN ARE OLDER, MORE DISABLED, AND MORE DEPRESSED THAN NONFALLERS

To the Editor: We read with interest the article published by Somadder et al.1 The authors document a correlation between depressive symptoms and self-reported numbers of falls in older subjects attending a day hospital in the United Kingdom. They reported that there were no significant differences in age, comorbidities, or performance on activities of daily living (ADLs) between fallers and infrequent fallers in their small population. We reexamined this important issue in community-dwelling elderly people in Japan and found findings different from those of Somadder et al. The study population consisted of 1,261 people aged 65 and older (men 529, women 732, mean age 75.4 ± 7.2) living in T town, Kochi Prefecture, Japan. Fallers were screened using self-reported questionnaires, along with additional tests of ADLs and subjective quality of life (QOL) for community-dwelling older people in 2006. The question “Do you have any history of a fall within the past year?” was used for detecting fallers. Subjects who answered yes to the question were considered to be fallers. For the assessment of basic ADLs, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) to obtain a basic ADL score (0–21). For advanced ADLs, the Tokyo Metropolitan Institute of Gerontology index of competence rating scale of 0 to 13 was used.2 This scale includes instrumental self-maintenance (0–5), intellectual activity (0–4), and social role (0–4). Five indicators of QOL (sense of subjective health, relationship with family, relationship with friends, financial satisfaction, and subjective happiness) were rated on a 100-mm visual analogue scale (worst QOL on the left end of the scale, best to the right).3,4 The 15-item Geriatric Depression Scale (GDS-15)5 was used for the assessment of depression; a score of 10 or more was considered to indicate depression. A fall risk index6,7 with a score ranging from 0 (low risk of fall) to 21 (high risk of fall) was added to those and used for the assessment of risk of falls. Statview version 5.0 (SAS Institute, Inc., Cary, NC) was used for calculating chi-square tests for categorical variables, unpaired t-test for continuous variables, and Spearman correlation (rs) between number of falls and GDS-15 and between fall risk index and GDS-15. The proportion of fallers was 31.6% in this population. Fallers were significantly older (76.9 vs 74.7) and had significantly lower scores for each item of the ADLs and QOLs than nonfallers, even after the adjustment for age (Table 1). The proportion of subjects with depression was significantly higher in fallers (26.8% vs 11.6%, P<.001). Although only 59.6% of the fallers answered the numbers of falls, there was weak but significant correlation between number of falls and GDS-15 scores in those who had fallen (rs=0.17, P=.002). The mean fall risk index score was significantly higher in fallers than nonfallers, and there was significant correlation between fall risk index and GDS-15 (rs=0.53, P<.001) in fallers. We confirmed the higher prevalence of depression in fallers than nonfallers, and there was a significant correlation between the number of falls and GDS-15, as Somadder et al. reported. However, unlike with the findings of Somadder et al., community-dwelling elderly fallers in Japan were significantly older and had lower quantitative ADL and QOL scores, as well as higher GDS-15 scores than nonfallers, even after adjustment for age. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that none of the authors have any financial or any other kind of personal conflicts with this article. Financial support for this study was obtained in part with funds from working group of fall prevention, Japanese Ministry of Health, Labor and welfare. Taizo Wada was supported by Global COE (Centers of Excellence) Program, In search of Sustainable Humanosphere in Asia and Africa (E-04), Japan Society for the Promotion of Science (JSPS). Author Contributions: Taizo Wada: data analysis and writing the manuscript; Masayuki Ishine, Yasuko Ishimoto, Mayumi Hirosaki, Yumi Kimura, and Yoriko Kasahara: data collection; Kiyohito Okumiya, Masanori Nishinaga, Kuniaki Otsuka, and Kozo Matsubayashi: study concept. Sponsor's Role: The sponsors did not participate in the design or data analysis of any aspect of the study or manuscript preparation.

Dental status and satisfaction with oral function in a sample of community-dwelling elderly people in Japan.

The purpose of this study was to determine the influence of dental status on oral function and satisfaction among a group of independently living elderly persons in an urban area of Japan. The study sample consisted of participants of the Senior Citizens' College from 1995 to 1999. Their dental status and oral satisfaction were measured by a questionnaire. The number of usable questionnaires was 3967, or 80.8% of the total sample. The mean age of the subjects was 66.5+/-4.3 years, and 52.2% were male. Twenty-nine percent of them had a natural dentition, and 7.0% were edentulous in both jaws. The prevalence of edentulism in the study sample was significantly lower (p < 0.01) than that for the national survey. Overall, 66.4% of the subjects were satisfied with their ability to chew, 56.2% with the appearance of their teeth, 63.1% with their ability to speak clearly, and 76.5% with their ability to taste food. For complete-denture wearers, the greatest dissatisfaction was with speech (28.5%); however, for the RPD wearers, it was with chewing ability (21.7%). Sixty-one percent of complete-denture wearers reported that they were satisfied with their chewing ability, but only 11% of them could eat all three of the evaluated foods without difficulty. The multiple stepwise logistic regression analyses showed that both dental status and self-assessed general health had a significant association with dissatisfaction with all four oral functions and self-assessed impairment of chewing ability. There were significant associations between the elderly subjects' dental status and oral function.

52 Application of gee procedures for sample size calculations in repeated measures experiments

We investigated the 15-item Geriatric Depression Scale (GDS-15) with regard to its factors and, reproducibility, as well as its relationship to activities of daily living, social factors, medical conditions, and quality of life for community-dwelling elderly people in Japan. The study population consisted of 736 community-dwelling elderly participants aged 65 or older. Exploratory factor analysis of the data and correlation coefficients between factors and activities of daily living, quality of life, social factors, and medical conditions were calculated for two consecutive years. The reproducibility of the results was also evaluated. As the result, GDS-15 had three reproducible factors specified as follows: factor I, “energy loss and pessimistic outlook”; factor II, “positive mental status (reversed)”; and factor III, “empty feeling.” Comparing our findings with a review of research in this area, positive items (excluding “feel full of energy”) seem to compose an universal factor. Factor I correlated best with quality of life, factor II with activities of daily living, and factor III with subjective cognitive function. These results suggest the GDS-15 can be used to assess the functional ability and quality of life, as well as depressive mood in older adults.