Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis.

This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.

Risk factors predicting subtypes of physical frailty incidence stratified by musculoskeletal diseases in community-dwelling older adults: The SONIC study.

AIM: This study aims to identify the key risk factors that lead to subtypes of physical frailty assessed by walking speed and grip strength among community-dwelling Japanese individuals, stratified by the presence of musculoskeletal diseases (MSDs) and age group. METHODS: We included 302 participants aged 70 or 80 years who did not exhibit subtypes of physical frailty at baseline through the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Our study was a longitudinal study. The outcome was the incidence of subtypes of physical frailty after 3 years. Subtypes of physical frailty were defined as a weak grip strength or slow walking speed, or both, based on the Japanese version of the Cardiovascular Health Study Index. The risk factors for subtypes of physical frailty incidence were examined by age group and MSD, using multivariate logistic regressions. RESULTS: Of the 302 participants, 110 (36.4%) had MSD. Those with MSD were significantly more likely to have subtypes of physical frailty after 3 years compared with those without MSD. Among all participants, older age was a risk factor of subtypes of physical frailty (P < 0.05). Without MSD, older age and dissatisfied financial status were risk factors (P < 0.05). With MSD, older age was a risk factor (P < 0.05). By age group, in individuals aged 70 years old, a dissatisfied financial status was a risk factor for those without MSD (P < 0.05), and a higher BMI was one for those with MSD (P < 0.05). CONCLUSIONS: Older age was a risk factor for subtypes of physical frailty, but other risk factors differed according to the presence of MSD and age. Geriatr Gerontol Int 2024; ••: ••-••.

Usefulness of the serum creatinine/cystatin C ratio as a blood biomarker for sarcopenia components among age groups in community-dwelling older people: The SONIC study.

AIM: The serum creatinine/cystatin C ratio (CCR) or sarcopenia index is considered a useful marker of muscle mass. However, its usefulness in late-stage older adults remains unclear. We aimed to determine the usefulness of CCR as an indicator of sarcopenia in community-dwelling Japanese adults aged >75 years. METHODS: Our study recruited participants aged 70, 80, and 90 ± 1 years during the baseline years, and included a 3-year follow-up in the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians study. From 2015 to 2018, 955 participants were eligible: 367 in their 70s, 304 in their 80s, and 284 in their 90s. The diagnostic components of sarcopenia, including "low muscle mass, plus low muscle strength, and/or low physical performance," were evaluated using the bioelectrical impedance analysis-measured skeletal muscle mass index (SMI), handgrip strength, and short physical performance battery (SPPB) score, respectively, in accordance with the Asia Working Group for Sarcopenia 2019 criteria. Separate analyses were performed between each component and CCR, adjusting for sex, body mass index, and other blood biomarkers in each group. RESULTS: The relationship between CCR and sarcopenia components was significant for handgrip strength (ß = 0.21, 0.13, 0.19, and P < 0.0001, =0.0088, <0.0001, for the 70s, 80s, and 90s age groups, respectively); however, it was limited for SMI (ß = 0.14; P = 0.0022, only for the 90s) and not significant for the SPPB score. CONCLUSION: CCR is a limited indicator of sarcopenia in late-stage older adults. Although its association with muscle strength was significant, its relationship with muscle mass and physical performance was less pronounced. Geriatr Gerontol Int 2024; 24: 529-536.

Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes-Evidence from a large national database in Japan.

BACKGROUND: The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40-74 years with treated and untreated type 2 diabetes. METHODS AND RESULTS: This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40-74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40-59 and 60-74 years) and baseline eGFR levels (60-85, 30-59, and <30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR >30 subgroups (60-85 or 30-59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60-74 age group and non-refreshing sleep in the 40-59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60-74 age group regardless of baseline eGFR levels. In the baseline eGFR <30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. CONCLUSIONS: We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

A characteristic N-glycopeptide signature associated with diabetic cognitive impairment identified in a longitudinal cohort study.

BACKGROUND: Identifying a biomarker for the decline in cognitive function in patients with diabetes is important. Therefore, we aimed to identify the N-glycopeptides on plasma proteins associated with diabetic cognitive impairment in participants in a longitudinal study using N-glycoproteomics. METHODS: We used samples from the 3-year SONIC (Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians) longitudinal cohort study of older Japanese people in the general population. First, we placed the participants with diabetes into two groups: those that did or did not have cognitive decline over a 6-year period. Next, their plasma protein profiles were compared between baseline and the 6-year time point using two-dimensional fluorescence difference gel electrophoresis. Finally, an N-glycoproteomic study of the focused proteins was performed using an enrichment technique and liquid chromatography-tandem mass spectrometry. RESULTS: Approximately 500 N-glycopeptides, derived from 18 proteins, were identified in each sample, from among which we identified the N-glycopeptides that were associated with diabetic cognitive impairment using multivariate analysis. We found that N-glycopeptides with sialylated tri- or tetra-antennary glycans on alpha-2-macroglobulin, clusterin, serum paraoxonase/arylesterase 1, and haptoglobin were less abundant, whereas 3-sialylated tri-antennary N-glycopeptides on serotransferrin were more abundant. CONCLUSION: N-glycopeptides with sialylated multi-antennary glycans comprise a characteristic signature associated with diabetic cognitive impairment. GENERAL SIGNIFICANCE: The characterized N-glycopeptides represent potential biomarker candidates for diabetic cognitive impairment.

Self-Monitoring Home Blood Pressure in Community-Dwelling Older People: Age Differences in White-Coat and Masked Phenomena and Related Factors-The SONIC Study.

Some studies reported that home blood pressure (HBP) monitoring was conducted by community-dwelling older people themselves, but there have been few studies on HBP including very old populations aged over 90 years old. Thus, the aim of the present study was to clarify the current situation of white-coat and masked phenomena defined by on-site and home BP measurements in community-dwelling old and oldest-old populations. The study subjects were 380 participants from the SONIC study, a cohort study of a community-dwelling old population, who measured their HBP in a series of 3-5 days by themselves and brought their HBP records to the venue on the survey day. Study participants' characteristics were as follows: female, 185 (48.7%); male, 195 (51.3%); 70s, 95 (25.0%); 80s, 245 (64.5%); and 90s, 40 (10.5%). A total of 344 (90.5%) participants had hypertension. A total of 291 (76.6%) hypertensive participants taking antihypertensive medication were analyzed in the present study. Regarding the types of hypertension defined by home and on-site BP, they showed white-coat phenomenon, 183 (48.2%); masked phenomenon, 115 (30.3%); sustained hypertension, 130 (34.2%); and normotension, 82 (21.6%). On comparison of age groups, there was a tendency for the white-coat phenomenon to be common in young-old people in their 70s and the masked phenomenon to be common in very old people in their 90s. Therefore, since the detection of white-coat and masked phenomena is closely associated with appropriate BP management, it is very important for community-dwelling older populations to self-monitor HBP.

Alcohol drinking patterns have a positive association with cognitive function among older people: a cross-sectional study.

BACKGROUND: The relationship between moderate alcohol drinking or other alcohol drinking patterns such as frequency, beverage type, and situation of drinking and cognitive function is not sufficiently clear in older people. The purpose of this study was to investigate the association between alcohol drinking patterns and cognitive function in community-dwelling Japanese people aged 75 and over. METHODS: This study was a cross-sectional design based on a prospective cohort study called the SONIC study. Subjects were older people aged 75-77 or 85-87 who voluntarily participated in 2016-2017. Drinking information was collected for daily drinking frequency, daily drinking intake, beverage type, and non-daily drinking opportunity. Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Other potential confounding factors evaluated were age, sex, medical factors, and psychosocial factors. An analysis of covariance was performed to evaluate the MoCA-J score relative to drinking frequency or alcohol intake. Multiple regression analysis was performed to investigate the association between beverage type or non-daily drinking opportunity and the MoCA-J score. RESULTS: The final number of participants analyzed was 1,226. The MoCA-J score for participants who reported drinking alcohol 1-6 days/week was significantly higher than that for those who reported drinking none or every day. No significant difference in the MoCA-J score was observed relative to daily alcohol intake. In terms of beverage type, wine was associated positively with the MoCA-J score. Non-daily drinking opportunity was also associated positively with the MoCA-J score. CONCLUSIONS: Moderate-frequency drinking, wine consumption, and non-daily drinking opportunities were associated with higher cognitive function in community-dwelling Japanese aged 75 and over. Further longitudinal studies are needed to clarify the causal relationships.

Association between protein intake and changes in renal function among Japanese community-dwelling older people: The SONIC study.

AIM: The aim of this study was to clarify the association between dietary protein intake and decline in the estimated glomerular filtration rate (eGFR) among Japanese older adults. METHODS: We used the data of the Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC) study, an ongoing narrow-age range cohort study: 69-71 years, 79-81 years and 89-91 years. The outcome variable, change in eGFR, was estimated from serum creatinine measured at the baseline and 3-year follow up, and the exposure variable, protein intake, was calculated using the brief-type self-administered diet history questionnaire at the baseline. Associations between eGFR change and protein intake were determined by multiple linear regression analysis. RESULTS: The mean eGFR change per year was -1.89 mL/min/1.73 m2 . The mean protein intake was 1.50 g/kg/day. The results of this study showed that there was no significant association between protein or animal protein intake and change in eGFR per year in the entire population of participants, including the very elderly, but there was a significant positive association in those whose renal function fell into chronic kidney disease stage G3 or G4. CONCLUSIONS: Protein intake among community-dwelling older adults was not associated with lower eGFR, and for older chronic kidney disease patients, protein and animal protein intakes were more beneficial in maintaining eGFR. The results provide evidence that protein intake should not be restricted for older patients with chronic kidney disease, including the very elderly. Geriatr Gerontol Int 2022; 22: 286-291.

The Association Between Longevity-Associated FOXO3 Allele and Heart Disease in Septuagenarians and Octogenarians: The SONIC Study.

The G allele of FOXO3 gene (single-nucleotide polymorphism; rs2802292) is strongly associated with human longevity. However, knowledge of the effect of FOXO3 in older populations, men or women, with heart disease is limited. This cross-sectional study in Japan included 1836 older adults in the 70- and 80-year-old groups. DNA samples isolated from buffy coat samples of peripheral blood were used to genotype FOXO3 (rs2802292). Self-reports were used to obtain heart disease data according to physician diagnosis. Multiple logistic regression was used to test the association by adjusting for the traditional risk factor of heart disease. The prevalence of heart disease in women FOXO3 G-allele carriers was higher than noncarriers (16.7% vs 11.6%, p = .022). The prevalence of coronary heart disease was lower for FOXO3 G carriers in the 70-year-old group for both sexes (men: 9.3% vs 4.3%, p = .042 and women: 10% vs 9%, p = .079, respectively). The G allele was negatively associated with heart disease after adjusting for diabetes, hypertension, dyslipidemia, and smoking in men (odds ratio [OR] = 0.70, 95% confidence intervals [CIs], 0.49-0.99, p = .046), although the association was weaker after full adjustment. In contrast, women carriers of the FOXO3 G allele showed a positive association with heart disease after total adjustment (OR = 1.49, 95% CI, 1.00-2.21, p = .049). In conclusion, the longevity-associated G allele of FOXO3 was observed to have contrasting associations with heart disease prevalence according to sex in older Japanese. To further confirm this association, a longitudinal study and a large sample size will be required.

[Effect of Iki-Iki Hyakusai Taiso on the prevention of progression of frailty in Nose Town, Osaka Prefecture].

AIM: We examined the effect of "IkiIki Hyakusai Taiso" as way to prevent the physical decline in community-dwelling elderly in Nose Town, Osaka Prefecture. METHODS: Participants were community-dwelling elderly who participated in the Preventive Care program "IkiIki Hyakusai Taiso" from October 2015 to June 2019 in Nose Town, Osaka Prefecture, Japan. They performed exercises once a week. An assessment of the physical function, basic health checklist, and questionnaire about daily life were collected. Frailty was determined based on responses to the basic health checklist. RESULTS: A total of 1,028 community-dwelling elderly people participated in this project. There were 766 (74.5%) women. The mean age of the participants was 72.6±8.0 years old, and 506 participants (49.2%) were part of the young-old generation. The physical function measurement values, including the 5-meter walking speed, time up and go test (TUG), 5 times sit to stand, and grip strength all significantly improved. Ninety percent of the participants participated in this program every time it was held. Regarding the self-rated health questionnaire, the rate of "feeling good due to participating in the program" increased from 29.1% to 45.4% after participating in this program for 6 months. The prevalence of partial social activities was mostly an increasing trend among the participants of this program. CONCLUSION: Our findings showed that "IkiIki Hyakusai Taiso" improves and maintains the physical function and self-rated health among community-dwelling elderly individuals. Therefore, "IkiIki Hyakusai Taiso" seems to be a very useful preventive care program in the community.

Real-Time Action Recognition System for Elderly People Using Stereo Depth Camera.

Smart technologies are necessary for ambient assisted living (AAL) to help family members, caregivers, and health-care professionals in providing care for elderly people independently. Among these technologies, the current work is proposed as a computer vision-based solution that can monitor the elderly by recognizing actions using a stereo depth camera. In this work, we introduce a system that fuses together feature extraction methods from previous works in a novel combination of action recognition. Using depth frame sequences provided by the depth camera, the system localizes people by extracting different regions of interest (ROI) from UV-disparity maps. As for feature vectors, the spatial-temporal features of two action representation maps (depth motion appearance (DMA) and depth motion history (DMH) with a histogram of oriented gradients (HOG) descriptor) are used in combination with the distance-based features, and fused together with the automatic rounding method for action recognition of continuous long frame sequences. The experimental results are tested using random frame sequences from a dataset that was collected at an elder care center, demonstrating that the proposed system can detect various actions in real-time with reasonable recognition rates, regardless of the length of the image sequences.

A Randomized Trial of Home Blood-Pressure Reduction by Alcohol Guidance During Outpatient Visits: OSAKE Study.

BACKGROUND: To evaluate the effectiveness of the nurse-led alcohol guidance to control home blood pressure (HBP) in the morning among male patients with hypertension during outpatient visits. METHODS: We enrolled 53 male patients with an HBP of ≥135/85 mm Hg with excessive drinking (alcohol ≥210 g/week or ≥60 g/day habitually) among outpatients in a randomized trial. Patients were assigned to a nurse-led alcohol guidance intervention or to the control. The primary outcomes were the mean HBP of 5 consecutive days at 6 months and alcohol consumption. RESULTS: Twenty-eight and 25 patients were randomized to intervention and control groups, respectively (mean age; 62.7 years old and 64.5, respectively). At baseline, the groups were well balanced across most characteristics. At 6 months, the mean HBP was 131/82 mm Hg in the intervention group vs. 145/87 mm Hg in the control group (SBP <0.001, DBP = 0.09). An HBP level of less than 135/85 mm Hg was achieved among 55.6% of the participants in the intervention group vs. 16.7% in the control group (P = 0.004). The alcohol consumption at 6 months was 256 ± 206 g/w vs. 413 ± 260 g/w, respectively (P = 0.020). CONCLUSIONS: We confirmed the effectiveness of the nurse-led alcohol guidance to control the HBP in male patients with hypertension during outpatient visits. PUBLIC TRIALS REGISTRY NUMBER: UMIN000017454 (UMIN Clinical Trials Registry).

Association between physical function and onset of coronary heart disease in a cohort of community-dwelling older populations: The SONIC study.

BACKGROUND: Physical function is a strong predictor of the adverse outcomes of cardiovascular disease in older populations. However, studies of healthy older people on the prevention of coronary heart disease (CHD) are very limited. OBJECTIVES: We prospectively examined the association of walking speed and handgrip strength with CHD in the community-dwelling older populations. METHODS: The study cohort in Japan included 1272 older people free from heart disease at the baseline. Physical function was identified based on walking speed and handgrip strength assessment at the survey site. Any new case of CHD was identified based on a self-reported doctor's diagnosis. Cox-proportion hazard models were adjusted for covariate factors to examine the CHD risk. RESULTS: During the 7-year follow-up, 45 new cases of CHD (25 men and 20 women) were documented. Slow walking speed was strongly associated with CHD risk after adjusting for all confounding factors in the total participants and women (hazard ratio (HR)= 2.53, 95%confidence interval (CI), 1.20-5.33, p=0.015, and HR= 4.78, 95% CI,1.07-21.35, p=0.040, respectively), but not in men. Weak grip strength was associated with CHD after age-adjustment (HR= 2.45, 95%CI, 1.03-5.81, p=0.043) only in men. However, after additional multivariate adjustment, the associations were getting weaker.

Association between uric acid and atherosclerosis in community-dwelling older people: The SONIC study.

AIM: The association between serum uric acid (UA) and atherosclerosis in old people is controversial. Therefore, in this study, we clarified this association by assessing serum UA and common carotid atherosclerosis examined by carotid ultrasound in community-dwelling older people in their 70s, 80s and 90s in the SONIC study. METHODS: A cross-sectional study was conducted involving 538 men and 577 women recruited from the community. The analysis was performed using serum UA as the explanatory variable and the maximum carotid intima-media thickness (max-CIMT) and mean-IMT as the dependent variables. The analysis was performed by multiple regression using traditional risk factors for atherosclerosis as adjustment variables. RESULTS: Analysis of the association between serum UA and IMT revealed a significant correlation only in women >70 years old. Max-CIMT (ß = 0.081, 95% CI = 0.026, 0.136; P = 0.004) and mean-IMT (ß = 0.015, 95% CI = 0.003, 0.029; P = 0.016) were significant. In the analysis of each age group, a significant correlation was only found in women in their 70s for mean-IMT (ß = 0.031, 95% CI = 0.008, 0.053; P = 0.008). CONCLUSION: In community-dwelling women aged about 70 years old, elevated serum UA may be an independent risk factor for IMT thickening as a surrogate marker for atherosclerosis. Geriatr Gerontol Int 2021; 21: 94-101.

Association between heart diseases, social factors and physical frailty in community-dwelling older populations: The septuagenarians, octogenarians, nonagenarians investigation with centenarians study.

AIM: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72-0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82-0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. CONCLUSIONS: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int 2020; 20: 974-979.

The association of blood pressure with physical frailty and cognitive function in community-dwelling septuagenarians, octogenarians, and nonagenarians: the SONIC study.

We investigated the association of systolic blood pressure (SBP) level with physical frailty and cognitive function in community-dwelling older Japanese. Using the 'Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians' survey as the baseline, we performed a cross-sectional analysis of people aged 70 ± 1 (n = 1000), 80 ± 1 (n = 978), and 90 ± 1 (n = 272) years. Medical histories and medications were collected via interviews conducted by medical professionals. Blood pressure (BP), grip strength, gait speed, and cognitive function were examined on site. Trend analysis and multiple regression analysis were used to determine the association of the SBP level with physical frailty and cognitive function. The principal finding was that the association of SBP with physical frailty and cognitive function varied depending on characteristics such as age, physical and cognitive function, and antihypertensive medication use. A lower SBP level was associated with a higher prevalence of physical frailty only among 80-year-olds who were on antihypertensive medication. A significant association was found between higher SBP and lower cognitive function among 70-year-olds, while among 90-year-olds, the opposite was found. No association was found among participants who were 80 years old or among participants of all ages without antihypertensive medication. Our finding that an inverted association between SBP and geriatric syndrome exists suggests that the treatment of older patients must be individualized to prevent geriatric syndrome.

Association of anemia and SRH in older people: the SONIC study.

AIM: The incidence of anemia increases with aging, and it is considered to affect mortality through complex pathophysiological outcomes. Although it has been suggested that self-rated health may also contribute to the prognosis of anemia in older people, the relationship between anemia and self-rated health is not well understood. This study thus examined the actual status of anemia in older community-dwelling Japanese people and clarified the relationship between anemia and self-rated health. METHODS: We conducted medical interviews, physical measurements and blood testing in 2083 people aged 69-91 years who participated in the long-term observational Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Subjects were divided into two groups according to whether they had anemia. Logistic regression analyses were used to assess the relationship between anemia and self-rated health after adjusting for possible confounding factors. RESULTS: The prevalence of anemia was 22.3% in all participants, 7.2% in men and 11.6% in women aged 69-71 years, 27.4% in men and 26.3% in women aged 79-81 years, and 55.8% in men and 44.9% in women aged 89-91 years. Multivariate analysis revealed a correlation between the presence of anemia and poor self-rated health in all (odds ratio 0.67, 95% confidence interval 0.48-0.93) and aged 69-71 years (odds ratio 0.47, 95% confidence interval 0.25-0.86). CONCLUSIONS: Anemia was associated with self-rated health in older Japanese people, suggesting that careful management of anemia may contribute to health and longevity. Geriatr Gerontol Int 2020; ••: ••-••.

The importance of stroke as a risk factor of cognitive decline in community dwelling older and oldest peoples: the SONIC study.

BACKGROUND: Cognitive impairment is a major health concern among older and oldest people. Moreover, stroke is a relevant contributor for cognitive decline and development of dementia. The study of cognitive decline focused on stroke as the important risk factor by recruiting older and oldest is still lagging behind. Therefore, the aim of this study was to investigate the importance of stroke as a risk factor of cognitive decline during 3 years in community dwelling older and oldest people. METHODS: This study was longitudinal study with a 3-year follow-up in Japan. The participants were 1333 community dwelling older and oldest people (70 years old = 675, 80 years old = 589, and 90 years old = 69). Data collected included basic data (age, sex, and history of stroke), vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and current smoking), and social factors (educational level, frequency of going outdoors, long-term care (LTC) service used, and residential area). The Japanese version of the Montreal Cognitive Assessment (MoCA-J) was decline of ≥2 points was defined as cognitive decline. Multiple logistic regression analysis was used to investigate the association between stroke and other risk factors with cognitive decline during a 3-year follow-up. RESULTS: The fit of the hypothesized model by multiple logistic regression showed that a history of stroke, advanced age, and greater MoCA-J score at the baseline were important risk factors, while the presence of dyslipidemia and a higher educational level were protective factors that were significantly correlated with cognitive decline during the 3-year follow-up. CONCLUSIONS: The cognitive decline after the 3-year follow-up was influenced by the history of stroke and advanced age, while greater MoCA-J score at the baseline was positively associated with subsequent 3 years cognitive decline. The protective factors were the presence of dyslipidemia and a higher educational level. Therefore, these factors are considered important and should be taken into consideration when searching for creative solutions to prevent cognitive decline after stroke in community dwelling older and oldest people.

Day-to-day blood pressure variability is associated with lower cognitive performance among the Japanese community-dwelling oldest-old population: the SONIC study.

Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85-87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = -0.36, p = 0.034) and diastolic BP (b = -0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.

Association between long-term care and chronic and lifestyle-related disease modified by social profiles in community-dwelling people aged 80 and 90; SONIC study.

BACKGROUND: Chronic and lifestyle-related diseases and social status were reported to be associated with long-term care (LTC). The social factors should be treated as social sub-groups of which characteristics show social profiles. However, few previous studies considered that. The present study aimed to investigate the associations between LTC and chronic and lifestyle-related diseases, and whether the associations were modified by the social sub-groups in the community-dwelling elderly. METHOD: A cross-sectional study was conducted among 1004 community-dwelling participants aged 80 and 90. LTC was used as the outcome. Chronic and lifestyle-related diseases (i.e., stroke, heart disease, joint pain, osteoporosis, lung disease, cancer, hypertension, dyslipidemia, and diabetes) were used as the predictors. Education, household income, residential area, and support environment were analyzed by latent class analysis (LCA) to derive social profiles. We obtained odds ratios (ORs) of LTC from those diseases and tested interactions between those diseases and the social profiles by logistic regression analyses. RESULT: The participants were categorized into two sub-groups of social factors (n = 675 and 329) by LCA. Logistic regression analyses showed ORs (95% CI) of LTC were 4.69 (2.49, 8.71) from stroke, 2.22 (1.46, 3.38) from joint pain, 1.99 (1.22, 3.25) from osteoporosis, and 2.05 (1.22, 3.40) from cancer adjusting for the social sub-groups. There were no significant interactions between the social subgroups and those diseases in relation to LTC except for osteoporosis. CONCLUSION: The associations between LTC and chronic and lifestyle-related diseases were significant with adjusting for the social sub-groups, and not modified by that except osteoporosis.