Decline In Higher-level Functional Capacity Research Articles

Changes in higher-level functional capacity during the COVID-19 pandemic among older adults living in Japan.

To evaluate change in higher-level functional capacity of older Japanese individuals during the COVID-19 pandemic. Four hundred older Japanese individuals completed an online questionnaire in early May 2021. Participants were asked retrospectively about their higher-level functional capacity and lifestyle before and during the COVID-19 pandemic. Higher-level functional capacity was determined as total score on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Total TMIG-IC score ranges from 0 to 13. A decline in higher-level functional capacity was defined as a decrease in TMIG-IC score of more than 2 points during the COVID-19 pandemic. Changes in higher-level functional capacity during the COVID-19 pandemic were assessed by paired t-test and a general linear model. Decreased TMIG-IC scores were found in 43 (21.5%) men and 61 (30.5%) women. Among those with higher-level functional capacity, scores for total TMIG-IC and Social Role decreased significantly in both sexes (all p<0.005). The findings suggest an association of the COVID-19 pandemic with a decrease in higher-level functional capacity, especially in Social Role, among older adults living in Japan. J. Med. Invest. 71 : 66-74, February, 2024.

Incidence of sarcopenic obesity in older patients with diabetes and association between sarcopenic obesity and higher-level functional capacity: evaluation based on a consensus statement.

We used a consensus statement to diagnose sarcopenic obesity, evaluated incidence of sarcopenic obesity in older patients with diabetes, and examined whether sarcopenic obesity was associated with their higher-level functional capacity. Outpatients with diabetes (age, ≥65 years) undergoing treatment at Ise Red Cross Hospital were included. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC)-a self-administered questionnaire-was used to assess their higher-level functional capacity. Sarcopenic obesity was evaluated based on the consensus statement diagnostic criteria-i.e., presence or absence of decreased skeletal muscle mass was evaluated based on appendicular skeletal muscle mass/body weight and obesity was assessed based on body fat mass percentage. To calculate the adjusted β coefficient of sarcopenic obesity for higher-level functional capacity, multiple regression analyses were performed using TMIG-IC scores as the dependent variable and four categories (non-sarcopenia/non-obesity was used as a reference) that included sarcopenia and obesity as the predictor and moderator variables. Among the 310 patients included, the sarcopenic obesity incidence was 13.1% and 14.2% in men and women, respectively. When the non-sarcopenia/non-obesity group was used as a reference, the adjusted β coefficient of sarcopenic obesity for scores of the TMIG-IC was -2.09 (p = 0.014) in men. However, the women showed no relationship between sarcopenic obesity and TMIG-IC scores. In older men with diabetes, sarcopenic obesity was associated with a decline in higher-level functional capacity.

Association between dynapenia and decline in higher-level functional capacity in older men with diabetes.

The present study aimed to investigate an association between dynapenia or sarcopenia and higher-level functional capacity in older diabetes patients. Diabetes outpatients aged ≥65 years were prospectively enrolled. Dynapenia and sarcopenia were defined by criteria of the Asian Working Group for Sarcopenia, and higher-level functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Multiple regression analysis included TMIG-IC scores as the dependent variable and dynapenia or sarcopenia as the explanatory variables. The present study included 204 patients. The regression coefficient of the relationship between dynapenia and covariance-adjusted TMIG-IC in men was -1.26 (95% confidence interval -2.35 to -0.17, P = 0.024), and that of sarcopenia and TMIG-CI adjusted for covariates was 0.65 (95% confidence interval -1.26 to 2.58, P = 0.500). We observed no significant correlation between TMIG-IC scores and dynapenia or sarcopenia in women. A statistically significant association was found between dynapenia and decline of higher-level functional capacity in older men with diabetes. Geriatr Gerontol Int 2018; 18: 1393-1397.

The effect of modifiable healthy practices on higher-level functional capacity decline among Japanese community dwellers.

This study aimed to clarify the effects of the accumulation of 8 modifiable practices related to health, including smoking, alcohol drinking, physical activity, sleeping hours, body mass index, dietary diversity, ikigai (life worth living), and health checkup status, on higher-level functional capacity decline among Japanese community dwellers. Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Subjects comprised 1269 men and women aged 40 to 79 years at baseline (1997–2000) who participated in a follow-up postal survey (2013). Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (total score and 3 subscales: instrumental self-maintenance, intellectual activity, and social role). The odds ratio (OR) and 95% confidence interval (CI) for a decline in higher-level functional capacity in the follow-up study according to the total number of healthy practices were analyzed using the lowest category as a reference. Multivariate adjusted ORs (95% CIs) for the total score of higher-level functional capacity, which declined according to the total number of healthy practices (0–4, 5–6, 7–8 groups) were 1.00 (reference), 0.63 (0.44–0.92), and 0.54 (0.31–0.94). For the score of social role decline, multivariate adjusted ORs (95% CIs) were 1.00 (reference), 0.62 (0.40–0.97), and 0.46 (0.23–0.90), respectively (P for trend = 0.04). Having more modifiable healthy practices, especially in social roles, may protect against a decline in higher-level functional capacity among middle-aged and elderly community dwellers in Japan.

Tooth Loss and Decline in Functional Capacity: A Prospective Cohort Study from the Japan Gerontological Evaluation Study.

To describe associations between tooth loss and changes in higher-level functional capacity. Prospective cohort study. Twenty-four Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling persons aged 65 and older (N=62,333). Self-reported number of teeth was used as an exposure variable. The outcome was changes in higher-level functional capacity measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which consists of three domains: instrumental activities of daily living, intellectual activity, and social roles. The TMIG-IC score ranges from 0 (lowest function) to 13 (highest function). All covariates were chosen from baseline demographic, socioeconomic, health behavior, and health variables based upon evidence from previous studies. Inverse-probability weighting (IPW) with propensity score and multiple linear regression, estimating nonstandardized coefficients (β) and 95% confidence intervals (CIs), were used. The baseline response rate was 65.2%, and the follow-up rate was 70.1%. During the follow-up period, participants' TMIG-IC score declined by an average of 0.247 points (standard deviation: 1.446). The results showed a significant dose-response association between tooth loss and decline in higher-level functional capacity in multiple linear regression models. IPW models estimated the increment in TMIG-IC score (β=0.170, 95% CI=0.114 to 0.227) if edentulous participants gained 20 or more natural teeth. Tooth loss is associated with future decline in higher-level functional capacity. IPW models suggest that treatment for tooth loss attenuates decline in higher-level functional capacity.

Dietary diversity and 14-year decline in higher-level functional capacity among middle-aged and elderly Japanese

ObjectivesThis study aimed to clarify the effects of dietary diversity on a decline in higher-level functional capacity among middle-aged and elderly subjects in Japan. MethodsData were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Subjects comprised 1317 men and women aged 40 to 79 at baseline (1997–2000) who participated in a follow-up postal survey (2013). Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology index of competence (total score and 3 subscales). Dietary intake was assessed using a 3-d dietary record, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The odds ratios and 95% confidence intervals (CI) for a decline in higher-level functional capacity in the follow-up study according to quartiles of QUANTIDD at baseline were estimated, controlling for age, sex, higher-level functional capacity scores at baseline, body mass index, alcohol consumption, physical activity, depressive score, household income, education, smoking, and disease history. ResultsA total of 214 (16%), 145 (11%), 70 (5%), and 136 (10%) subjects showed a decline in total score for higher-level functional capacity (≥2), instrumental self-maintenance (≥1), intellectual activity (≥2), and social role (≥2), respectively. Multivariate-adjusted odds ratios (95% confidence intervals) for the score for intellectual activity decline according to the lowest through highest quartiles of QUANTIDD were 1.00 (reference), 0.47 (0.23–0.95), 0.44 (0.22–0.90), and 0.41 (0.20–0.83), respectively (P for trend = 0.06). ConclusionsDaily intake of various foods may protect against a decline in intellectual activity among middle-aged and elderly community dwellers in Japan.

Self-Reported Hearing Loss Predicts 5-Year Decline in Higher-Level Functional Capacity in High-Functioning Elderly Adults: The Fujiwara-Kyo Study.

To clarify the relationship between self-reported hearing loss (HL) and 5-year decline in higher-level functional capacity in high-functioning elderly adults. Population-based, prospective cohort study. The Fujiwara-Kyo Study, Nara, Japan. Community-dwelling individuals aged 65 and older with a perfect baseline and valid follow-up instrumental activity of daily living (IADL) (n = 3,267), intellectual activity (IA) (n = 2,925), and social role (SR) (n = 2,698) scores. Self-reported HL was evaluated using a single question: "Do you feel you have hearing loss?" IADLs, IA, and SR were measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) subscales. Geriatric syndromes (depressive symptoms, cognitive impairment, sleep disturbance, falls, urinary incontinence, visual impairment) were self-reported at baseline. Blood tests were performed to measure cardiovascular risk factors. During 5-year follow-up, new declines developed for 213 participants in IADLs, 272 in IA, and 327 in SR. After adjustment for all covariates, including geriatric syndromes, using multiple logistic regression analysis, self-reported HL at baseline was associated with a decline in IA (odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.04-1.86) and SR (OR = 1.34, 95% CI = 1.02-1.76) but not IADLs (OR = 1.07, 95% CI = 0.76-1.48). Self-reported HL was found to be a significant predictor of decline in IA and SR. Preventive intervention against age-related HL may contribute to maintaining high-level functional capacity in independent elderly adults.

Higher gait speed and smaller sway area decrease the risk for decline in higher-level functional capacity among middle-aged and elderly women

ObjectiveThis study assessed whether physical function can indicate a risk of decline in higher-level functional capacity. MethodsData were derived from the National Institute for Longevity Sciences—Longitudinal Study of Aging. Subjects comprised 466 men and 495 women aged 40–79 years at baseline (1997–2000), whose total score for the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) at baseline was ≥11 and who participated in the follow-up survey. Baseline physical function examination included grip strength, comfortable gait speed, and sway area with eyes open. A decline in higher-level functional capacity was defined as a ≥2-point decrease in the TMIG-IC score after 14 years. The odds ratios (OR) and 95% confidence intervals (CI) for decline in the TMIG-IC score for 14 years according to a 1-standard deviation (SD) increase in physical function measurements at baseline were estimated. ResultsSubjects with decreased TMIG-IC scores included 78 (16.7%) men and 80 (16.2%) women. In women, the multivariate-adjusted OR (95% CI) for a TMIG-IC score decrease with a 1-SD increase in comfortable gait speed was 0.68 (0.50–0.92; p=0.013), and that with a 1-SD increase in sway area with eyes open was 1.49 (1.17–1.90; p=0.001). Grip strength was not associated with TMIG-IC score decline. None of the physical performance measures affected TMIG-IC score declines in men. ConclusionThese results suggest that gait speed decreases and sway area increases might predict a risk of decline in higher-level functional capacity among middle-aged and elderly women.

Animal Protein Intake Is Associated with Higher‐Level Functional Capacity in Elderly Adults: The Ohasama Study

To determine the association between protein intake and risk of higher-level functional decline in older community-dwelling adults. Prospective. Ohasama Town, Japan. Residents (N = 1,007; mean age 67.4 ± 5.5) free of functional decline at baseline; follow-up was conducted for 7 years. Nutrient and food intakes were determined using a validated 141-item food frequency questionnaire. Participants were divided into quartiles according to intake levels of total, animal, and plant protein. Subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence subscales were used to assess higher-level functional decline. Logistic regression analysis was used to examine the future risk of higher-level functional decline in relation to protein intake, with lowest protein intake as reference. During the study period, 24.4% of eligible participants reported declines in higher-level functional capacity. After adjustment for putative confounding factors, men in the highest quartile of animal protein intake had significantly lower risk of higher-level functional decline than those in the lowest quartile (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.20-0.83; P for trend .01). These associations were not seen in women (OR = 0.76, 95% CI = 0.41-1.34; P for trend .37). No consistent association was observed between plant protein intake and future higher-level functional decline in either sex. Higher protein, particularly animal protein, was associated with lower risk of decline in higher-level functional capacity in older men. Animal protein intake may be a modifiable indicator for early detection and prevention of higher-level functional decline in elderly adults.

Personality traits as predictors of decline in higher-level functional capacity over a 7-year follow-up in older adults: the Ohasama study.

Numerous factors that affect functional decline have been identified, and personality traits are considered to be an important factor in functional decline risk. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG) was developed to measure three higher-level functional capacities, instrumental activities of daily living, intellectual activity, and social roles, in Japanese elderly, which were previously not assessed adequately with existing scales of functional decline. The objective of this study was to explore the effect of personality traits as predictors of higher-level functional decline over a 7-year follow-up in a rural Japanese community. Data on 676 participants (mean 67.1 years) who were free of functional decline and had completed questionnaires at baseline and 7 years later, were analyzed. Demographic characteristics, lifestyle and personality characteristics were obtained from a self-administered questionnaire at baseline. Higher-level functional decline was examined using the subscales of the TMIG at baseline and at a 7-year follow-up examination. Over the 7-year study period, 21.7% of eligible participants reported decline in higher-level functional capacity. After adjustment for putative confounding factors, the traits that were significant predictors of decline in higher-level functional capacity at the 7-year follow-up had higher psychoticism scores [odds ratio (95% confidence interval) 2.12 (1.23-3.66)] and lower extraversion scores [1.89 (1.01-3.56)]. The personality traits of higher psychoticism and lower extraversion were significantly associated with a risk of future functional decline. A better understanding of these personality traits may help identify of at-risk individuals and could help reduce functional decline in older adults.

Health Behaviors as Predictors for Declines in Higher-Level Functional Capacity in Older Adults: The Ohasama Study

To determine the characteristics of health behaviors related to higher-level functional decline in older community-dwelling adults. Prospective. Ohasama Town, Japan. One thousand fifty residents (mean age: 67.5) free of functional decline at baseline. Health behaviors including smoking status, alcohol consumption, frequency of exercise, sleep duration, dietary habits (supplement use, breakfast, late-night snacking, eating regularly, and eating out), and self-rated health were obtained from a self-administered questionnaire at baseline. Higher-level functional decline was examined using the subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence. During the 7-year follow-up, 27.5% of eligible participants reported decline in higher-level functional capacity. After adjustment for putative confounding factors, health behaviors that were significant predictors for declines in higher-level functional capacity at the 7-year follow-up were current smoking (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 1.06-2.36), sleep duration of 9 hours or longer (OR = 2.15, 95% CI = 1.49-3.11), and poor self-rated health (OR = 1.93, 95% CI = 1.40-2.67). Several modifiable health behaviors contribute to higher-level functional decline.