Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study

BACKGROUND@#How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises.@*METHODS@#We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51).@*RESULTS@#The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups.@*CONCLUSION@#Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

Changes in Kihon Checklist items and new Certification of long-term care needs among Japanese community-dwelling elders / Journal of Rural Medicine

Objective: Physical frailty has been considered a risk factor for certification of long-term care needs (hereafter referred to as Certification) under Japan’s long-term care insurance (LTCI). Therefore, assessment of frailty in elders should be studied from multiple perspectives. The Kihon Checklist (KCL) is widely used to identify need for support/care among Japanese older adults. This study aims to examine the relationship between changes in KCL items and Certification among Japan’s young-old and old-old.Material and Methods: The KCL responses of 7,092 participants were assessed in April 2012 and March 2016, along with gender, age, and living environment. Deaths, Certifications, and relocations were tracked until March 2018. Changes in KCL items were categorized as bad, worse, improved, or good.Results: Between March 2016 and March 2018, about 7.3% of respondents obtained Certifications. KCL item changes increased the risk of new Certification for bad and worse groups, while improved cognitive function among the old-old possibly reduced the risk of new Certification.Conclusion: Therefore, rather than administering the KCL once, identifying KCL changes among people at risk could help prevent or delay their need for long-term care.

IDENTIFICATION OF THE PHYSICAL FUNCTION OF FRAIL OLDER ADULTS AND EFFECTIVITY OF THE HEALTH CHECK-UP QUESTIONNAIRE (KIHON CHECK-LIST) / 体力科学

The purposes of this study were (i) to determine the characteristics of physical function for frail older adults, compared with those for the independent and the dependent, (ii) to examine validity of the “health check-up questionnaire” (Kihon Check-list: CL) for finding frail older adults. Five hundred thirty-nine older Japanese people (75.5 ± 7.0 years) were assigned to each one of the three categories: the independent, the frail and the dependent according to the classification criteria of long-term care insurance system. Physical function score (PFS) was estimated by principal components analysis. Logistic regression analysis was conducted to assess validity of the CL and to examine the screening tool for detecting frail older adults who have a higher risk for becoming the dependent. Significant differences were observed among the three groups in PFS (the independent, 0.580 ± 0.467; the frail, -0.309 ± 0.733; the dependent -1.347 ± 0.949). The Odds ratio (OR) of the dependent for older adults to whom the CL was applied was 2.4 (95% confidence interval (CI): 1.3 - 4.5), and the OR for those to whom both the CL and the hand-grip strength test were applied was 5.4 (2.6 - 11.5). These data suggest that the comprehensive status of physical function of frail older adults, which varied widely, was intermediate between the independent and the dependent. It is useful to add the hand-grip strength test to the CL as a screening tool to subdivide frail older adults.