Higher-level Functional Capacity Research Articles

Relationship between Oral Hypofunction and Sarcopenia in Community-Dwelling Older Adults: The Otassha Study.

Oral hypofunction, resulting from a combined decrease in multiple oral functions, may affect systemic-condition deterioration; however, few studies have examined the association between oral hypofunction and general health among older adults. In this cross-sectional study, we examined the relationship between oral hypofunction and sarcopenia in community-dwelling older adults. We included 878 adults (268 men and 610 women, mean age 76.5 ± 8.3 years). Tongue coating index, oral moisture, occlusal force, oral diadochokinesis (/pa/,/ta/,/ka/), tongue pressure, mas-ticatory function, and swallowing function were evaluated as indicators of oral hypofunction. Grip strength, gait speed, and skeletal muscle mass index were measured as diagnostic sarcopenia parameters. The association between oral hypofunction and sarcopenia was examined via logistic regression using sarcopenia as the dependent variable. Oral hypofunction prevalence was 50.5% overall, 40.3% in men, and 54.9% in women. The prevalence of sarcopenia was 18.6% overall, 9.7% in men, and 22.5% in women. A logistic regression showed oral hypofunction, age, body mass index, higher-level functional capacity, and serum albumin level were significantly associated with sarcopenia. Sarcopenia occurred at an increased frequency in patients diagnosed with oral hypofunction (odds ratio: 1.59, 95% confidence interval: 1.02–2.47); accordingly, oral hypofunction appears to be significantly associated with sarcopenia.

Comprehensive Geriatric Assessment Using the Yoitoko Check-Up, a Novel Health Check-Up Providing Positive Feedback to Older Adults: A Before-After Study.

PurposeThe Yoitoko check-up, a novel health check-up providing positive feedback, has been developed to promote health among older adults, and consists of several comprehensive geriatric assessment items. This report aimed to describe the details of the Yoitoko check-up and to explore the future possibility of the check-up by evaluating the participants’ short-term behavioral changes in terms of comprehensive functioning, using a before-after study design.Patients and MethodsFour Yoitoko check-ups were conducted, at 3-month intervals, between December 2018 and September 2019. Study participants aged ≥65 years included those who had undergone ≥2 Yoitoko check-ups. The results of each visit after the second check-ups were retrospectively compared with those of the baseline, and the mean changes and the odds ratios were calculated using a paired t-test or a McNemar test, respectively.ResultsOf 84 participants, the results of 16 (19.0%) participants were analyzed. The mean (standard deviation) age was 75.3 (4.7) years. The mean Tokyo Metropolitan Institute of Gerontology Index of Competence score, a measure of high-level functional capacity, increased 0.9 (95% confidence interval; range, 0.2–1.5) points between the first and second visits.ConclusionWe developed the Yoitoko check-up and introduced the details of it. Our study findings suggested that the Yoitoko check-up may further motivate older adults to improve their health and promote positive behavioral changes. Future studies are needed to evaluate the effectiveness of this novel assessment method.

Depressed Mood Screening from the Kihon Checklist and Higher-Level Functional Capacity in Community-Dwelling Older Adults

Depressed Mood Screening from the Kihon Checklist and Higher-Level Functional Capacity in Community-Dwelling Older Adults

Higher-Level Functional Capacity Associated with Social Frailty in Community-Dwelling Older Adults

Higher-Level Functional Capacity Associated with Social Frailty in Community-Dwelling Older Adults

Dentition status and 10-year higher-level functional capacity trajectories in older adults.

The effect of dentition status on higher-level functional capacity patterns over time remains unclear. We aimed to identify distinct higher-level functional capacity trajectories in individuals aged 70-80 years, and examine whether dentition status at 70 years predicted the trajectory. The study included 551 community-dwelling adults aged 70 years at baseline. Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) up to the age of 80 years. A higher TMIG-IC score indicated a higher level of competence. Group-based trajectory modeling was used to identify distinct TMIG-IC trajectories. The number of teeth, use of dentures, sex and education were added as baseline group membership predictors. Dental visits, health behaviors, body mass index and comorbidities during observation were added as time-varying covariates. Three TMIG-IC trajectories were identified: "high/stable" (65.3%), "middle/decline" (24.5%) and "low/decline" (10.2%). A lower number of teeth and non-denture use were associated with increased odds of a low/decline trajectory relative to a high/stable trajectory (odds ratio 1.09, 95% confidence interval 1.04-1.14 [per one decrease] and odds ratio 3.96, 95% confidence interval 1.54-10.16, respectively). Older adults with fewer teeth and those without dentures at the age of 70 years were more likely to follow a trajectory toward functional decline with low baseline TMIG-IC scores, which further declines by the age of 80 years. These findings suggest that preserving natural teeth later in life, as well as using dentures, could contribute toward maintaining a higher-level functional competence. Geriatr Gerontol Int 2021; 21: 48-53.

Factors associated with social isolation and being homebound among older patients with diabetes: a cross-sectional study

ObjectiveWe aimed at investigating factors associated with social isolation and being homebound in older patients with diabetes.DesignCross-sectional study.SettingsThose undergoing outpatient treatments at Ise Red Cross Hospital, Mie Prefecture.ParticipantsPatients with diabetes...

Frequency of Social Isolation and Homeboundness and Their Relationships with High-Level Functional Capacity in Elderly Diabetic Patients.

PurposeTo determine the frequency of social isolation (hereinafter, isolation) and homeboundness in elderly diabetic patients and to investigate their relationships with high-level functional capacity.Patients and MethodsSubjects were diabetic outpatients aged 65 years and older who were visiting the Japanese Red Cross Ise Hospital. Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate high-level functional capacity. Isolation was defined as having less than one interaction per week with someone other than co-habiting family members. Homeboundness was defined as leaving the house less than once a day. Multiple regression analysis was performed with the TMIG-IC score as the dependent variable and isolation and homeboundness as independent variables.ResultsFour hundred fifty-one patients were included in the analysis. The frequency of isolation and homeboundness affected 37% and 13.3% of men and 28.9% and 20.6% of women, respectively. The adjusted partial regression coefficient of the TMIG-IC scores of isolated, homebound, and isolated+homebound men was −0.94 [95% confidence interval (CI), −1.68 to −0.21; P = 0.012], −0.27 (95% CI, −1.93 to 1.39; P = 0.746), and −4.03 (95% CI, −5.37 to −2.68; P < 0.001) in relation to that of the non-isolated and non-homebound group as reference. In women, the respective coefficients to the reference were −1.33 (95% CI, −2.93 to 0.25; P = 0.099), −0.65 (95% CI, −2.56 to 1.26; P = 0.501), and −3.01 (95% CI, −4.92 to −1.1; P = 0.002), respectively.ConclusionThe frequency of isolation was high in both female and male elderly diabetic patients. In men, there was a significant relationship between isolation and decline in high-level functional capacity. In both men and women, there was a significant relationship between isolation+homeboundness and decline in high-level functional capacity.

Working for only financial reasons attenuates the health effects of working beyond retirement age: A 2-year longitudinal study.

The health benefits of paid employment in late life are understood, but they might vary according to work motives. We examined the health effects of employment among older adults, focusing on motivation. We carried out a 2-year longitudinal survey from 2013 (baseline) to 2015 (follow up). Among 7608 older adults, the analysis included 1069 who completed both surveys and were employed at baseline. Work motives were assessed using a questionnaire. Participants were assigned to groups based on their responses: (i) financial reasons; (ii) motivation other than financial reasons; and (iii) both financial and non-financial reasons. Self-rated health, mental health and higher-level functional capacity were evaluated as health outcomes. There were group differences in baseline demographic variables and health status; those with financial reasons had lower socioeconomic status and worse mental health. Multivariable logistic regression analysis showed that compared with older workers with non-financial reasons, those with financial reasons were more likely to decline in self-rated health (OR 1.42; 95% CI 1.00-2.03) and higher-level functional capacity (OR 1.55; 95% CI 1.16-2.07), which was independent of potential covariates, including socioeconomic status. However, no differences were evident between those with only non-financial reasons and those having both financial and non-financial reasons. We found that the participants who worked only for financial rewards had reduced health benefits through working in old age. A prolonged working life among older workers can contribute to maintaining health and can be enhanced by non-financial reasons, such as finding meaning in life and social contact. Geriatr Gerontol Int 2020; 20: 745-751.

Factors related to removable denture use in independent older people: A cross-sectional study.

Denture use for recovery of major tooth loss can reduce the need for care, and thus, it is important for dentists to identify the types of patients who use removable dentures. To identify factors associated with removable denture use in independent older Japanese people. This cross-sectional study investigated the oral condition; demographics; lifestyle; dental visit behaviour; and higher-level functional capacity, as assessed using the Tokyo Metropolitan Institute of Gerontology index of competence (TMIG index), of independent older people aged 65-74years. Participants were divided into four groups based on sex and condition of the posterior occluding pairs (POPs). Multivariate-adjusted logistic regression analyses were performed for each group, with denture use or non-use as the dependent variable and the other items as independent variables. Denture use or non-use was significantly associated with only dental consultation behaviour (regular dental visits and time since the last dental visit) in all groups. Subsequent analyses excluding dental consultation behaviour demonstrated that denture use or non-use was significantly associated with educational background in female participants with decreased POPs, with the type of household in male participants with lost POPs and with the TMIG index (social role) in female participants with lost POPs. Denture use was associated with dental consultation behaviour. We revealed factors related to denture use or non-use in females with decreased POPs and both males and females with lost POPs.

Food diversity and its relationship with nutrient intakes and meal days involving staple foods, main dishes, and side dishes in community-dwelling elderly adults

Objectives One of the diversity indicators of food intake in the elderly Japanese population is the Dietary Variety Score (DVS). Studies on elderly people have reported the relationship of food intake with health outcomes, such as body function, higher-level functional capacity, fall risk, and sarcopenia. However, the index have not been studied enough whether it is suggestive of nutrients and the characteristics of the meal by various food intakes. The purpose of this study was to clarify the DVS and its relationship with nutrient intakes and meal days consisting of staple foods, main dishes, and side dishes among elderly adults.Methods The participants were 182 community-dwelling elderly adults (65-84 years) in Itabashi city, Tokyo. For the food diversity indicator, we used the DVS developed by Kumagai et al. and classified the patients as follows: the low score group (0-3 points), the medium score group (4-6 points), and the high score group (7-10 points). Dietary intakes were assessed using a 3-day dietary record. The daily amounts from foods and nutrients, and days of balanced diet with staple foods, main dishes, and side dishes greater than twice a day (hereafter "balanced meal days") were calculated. The relationships between the DVS classification and each dietary index were evaluated by the general linear model adjusted for sex, age, and energy levels. Additionally, we calculated the percentage of people with intakes below the estimated average requirement (EAR) of each nutrient and estimated the risk of below the EAR in the groups by multiple logistic regression analysis.Results The low DVS group had significantly fewer balanced meal days (low 1.4 [1.2-1.6] days, medium 1.8 [1.6-1.9] days, high 1.9 [1.7-2.1] days, p for trend=0.001) than the high DVS group. The low DVS group showed significantly low energy ratios of protein and fat, as well as lower intakes of protein, dietary fiber, phosphorus, magnesium, potassium, vitamin K, and vitamin B12. In contrast, the low DVS group showed significantly higher energy ratios of carbohydrates and grains and higher carbohydrate intake. Compared to the high DVS group, the odds ratio for inadequate vitamin C intake (below the EAR) was significantly high in the low DVS group, and the odds ratios for inadequate intakes of magnesium, zinc, and vitamin B6 were significantly high in the middle DVS group.Conclusion The high DVS group had significant associations with increased intake of protein and micronutrients, as well as balanced meal days. DVS can be a dietary indicator that leads to the intake of a desirable variety of food and nutrients in old age.

The interaction effect between physical and cultural leisure activities on the subsequent decline of instrumental ADL: the Fujiwara-kyo study

BackgroundMaintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown.MethodsWe prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index).ResultsThe mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004).ConclusionsWe found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.

Rotating savings and credit association, its members' diversity, and higher-level functional capacity: A 3-year prospective study from the Japan Gerontological Evaluation Study.

AimA rotating savings and credit association – an informal local microfinance group – provides community‐dwelling older adults with cohesive social capital. This study examined whether participation in mujin, a traditional Japanese rotating savings and credit association, affected the maintenance of higher‐level functional capacity in older adults.MethodsWe studied 10 991 older adults living in 24 municipalities in Japan who were aged ≥65 years, and physically and cognitively independent. We carried out a baseline survey in 2013 and a follow‐up survey in 2016. Higher‐level functional capacity, consisting of instrumental activities of daily living, intellectual activity and social role, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. To address potential reverse causation, we used stabilized inverse probability weights to balance characteristics at baseline between mujin participants and non‐participants.ResultsIn our analytic sample, 406 out of 10 991 older adults (3.7%) participated in mujin at the baseline. Our weighted logistic regression showed that mujin participants were more likely to maintain higher‐level functional capacity (i.e. full marks in the Tokyo Metropolitan Institute of Gerontology Index of Competence) 3 years later compared with non‐participants (odds ratio 1.75, 95% confidence interval 1.29–2.39). Furthermore, independent social role functioning and intellectual activity were associated with participation in mujin for an equal number of both sexes, as well as people of high social standing.ConclusionsThe present study suggests that rotating savings and credit associations can help older adults maintain their independence in a higher‐level functional capacity. Furthermore, the members' diversity might add to these beneficial effects. Geriatr Gerontol Int 2019; 19: 1268–1274.

The influence of types of living alone on 2-year health changes according to elderly adults' marital status: Based on the Comprehensive Regional Studies for Preventing Isolation of the Elderly Who Live in Metropolitan Area (CAPITAL Study)

Objectives The aim of this research is to classify elderly adults who live alone by their marital status type and to clarify how those types affect their higher-level functional capacity and mental health with a 2-year follow-up survey.Methods This research is based on the results from a survey in 2013. The base-line scores were from 757 participants who completed a survey by mail, carried out in B area of A ward, Tokyo, within the jurisdiction of community general support centers, with people who were not at nursing care levels 4 or 5 and who were not residents of welfare facilities. This study analyzed data for 517 of 527 participants, who answered all questions in the 2015 survey and indicated their marital status. This research categorized the respondents into 4 types of marital status: separation, divorce, bereavement, and unmarried groups. This study adopted the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) as the index of higher-level functional capacity, and the WHO-Five Well-Being Index (WHO-5-J) as the mental health index. In the analysis of the causes of 2-year variations in TMIG-IC total scores and WHO-5-J scores, the dependent variable was each variation. This study used an analysis of covariance in which the fixed factors were types of living alone, sex, annual income, and having children who lived separately in the 2013 survey, and the covariance comprised the base-line scores for the dependent variables, age, and chronic diseases in the 2013 survey.Results With regards to the variation in TMIG-IC total scores, main effects of the types of living alone were observed. The adjusted variation of covariance decreased most in the separation group (-0.95). For the variation in WHO-5-J scores, main effects of the types of living alone were indicated. In the divorce group, the adjusted variation of covariance was significantly higher than for the unmarried group (2.33 vs. -0.55).Conclusion The results revealed that the types of marital status: separated, divorced, bereaved, and unmarried, affect changes in the higher-level functional capacity and mental health status of elderly adults living alone, 2 years later. Thus, although previously regarded as a single category, types of marital status should be considered in the analysis of elderly adults who live alone.

Hearing-impaired elderly people have smaller social networks: A population-based aging study

Background and objectivesHearing impairment (HI) is a major global health concern. In addition, social networks are important for healthy aging. This study aimed to examine the association between HI and social relationships. Research design and methodsThis study was conducted by the National Institute for Longevity Sciences as part of its Longitudinal Study of Aging with 1176 Japanese participants aged 60 years or older (mean age 71.0 ± 7.4). The convoy model was used to evaluate participants’ network size. A pure-tone average hearing level (HL) of 0.5, 1, 2, and 4 kHz in the better ear >25 dB HL was defined as HI. Multivariate analysis was performed to assess the relationship between HI and the network size, adjusting for age, gender, years of education, presence of depressive symptoms, and higher-level functional capacity score. ResultsThe mean network sizes across the three circles of the convoy model differed significantly by HI status (18.7 ± 0.4 in the no-HI group vs 17.0 ± 0.5 in the HI group, p = 0.003). In particular, the number of non-kin in the outer circle was significantly less in the HI group (4.1 ± 0.2 vs 3.3 ± 0.3, p = 0.004). Discussion and implicationsThe social network size was significantly smaller in the HI group. The outer circle of people to whom the individual feels less close and the number of non-kin were related to the presence of HI. Therefore, HI may be associated with elderly people’s social relationships.

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.

Effects of the dietary program "SHIKKARITABE CheckSheet 12" to improve dietary variety on higher-level functional capacity among community-dwelling older individuals

Effects of the dietary program "SHIKKARITABE CheckSheet 12" to improve dietary variety on higher-level functional capacity among community-dwelling older individuals

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Tendency of Depression in High-Level Functional Capacity Comparison -From “Okigaru Health Check-up Program’ in Nishinoomote City, Kagoshima Prefecture-

Tendency of Depression in High-Level Functional Capacity Comparison -From “Okigaru Health Check-up Program’ in Nishinoomote City, Kagoshima Prefecture-

Cross-sectional association between medical expenses and intellectual activity in community-dwelling older adults

BackgroundLittle is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese.MethodsSelf-administered questionnaires were mailed to all residents born between 1945 and 1949 and covered by A City’s medical insurance system (n = 19,354). Independent variables including health behaviors, oral health, social capital, neighborhood environment, and physical and mental functioning were included in the questionnaires. Medical fee receipts were used to evaluate ME for fiscal 2014, and respondents were classified into no, low, medium, and high ME groups. Higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is comprised of three subscales: instrumental activities of daily living, IA, and social role. Poisson regression models were used to examine the association of ME with IA, with the low ME group as reference.ResultsQuestionnaires were returned by 12,747 individuals (response rate 65.9%). The no ME group had the lowest response rate, the worst lifestyle behaviors, and the lowest social capital, but no problems with neighborhood environment. Higher-level functional capacity, especially IA, was reduced in both the high ME and no ME groups. After adjustments for age, gender, health insurance, accessibility to public facilities in their residential area, family size, body mass index, and physical and mental functioning, the prevalence ratio (PR) for impaired IA lost its significance in the high ME group (PR 0.97, 95% confidence interval 0.90–1.05), but remained significant in the no ME group (1.19, 1.08–1.31). After additional adjustments for health behaviors (i.e., health checks, smoking, fitness, and dietary variety), the PR of the no ME group was attenuated towards the null (1.08, 0.98–1.20).ConclusionsCommunity-dwelling elderly who did not seek medical treatment were indifferent to health surveys and health-promoting behaviors, and undesirable health behaviors were a possible determinant of their impaired IA. Further longitudinal research is needed to confirm the causal associations.

Higher pain level and lower functional capacity are associated with the number of altered kinematics in women with patellofemoral pain

This study investigated whether women with patellofemoral pain (PFP) present kinematic alterations in proximal, local, and distal factors simultaneously, and determined the association between the number of kinematic alterations, pain level, and functional status. A three-dimensional motion analysis system was used to analyze the peak hip adduction, peak knee flexion, and peak rearfoot eversion, addressing the proximal, local, and distal factors, respectively, in fifty women. Functional status and pain level were assessed using the anterior knee pain scale (AKPS) and a visual analogic scale. Receiver operating characteristic curves were calculated to identify participants with and without kinematic alterations and the number of them was obtained for each participant. Associations between the number of kinematic alterations, pain level, and AKPS score were determined by the Pearson correlation. Results showed that 52% of women with PFP presented at least two kinematic alterations of which 24% were local/proximal, 16% local/distal, and 12% proximal/distal. Three kinematic alterations were found in 48% of the women with PFP. A strong positive correlation was found between the number of kinematic alterations and pain (r=0.78; p<0.001). A strong negative correlation was found between the number of altered kinematics and functional status (r=−0.79; p<0.001). Findings revealed that women with PFP presented at least two kinematic alterations and a higher number of kinematic alterations was associated with higher pain levels and lower functional status. Clinicians should carefully assess movement pattern of women with PFP as it could indicate a more severe condition, which is associated with a poor prognosis.