Diversity in productive activities enhances life satisfaction among Japanese community-dwelling older adults: A cross-sectional study.

Few studies have reported an association between diversity in productive activities and life satisfaction; hence, this cross-sectional study conducted in Japan aimed to clarify this association. We assessed the life satisfaction of 4,498 Japanese community-dwelling older adults engaged in productive activities (e.g., paid work, volunteering, taking care of children, and supporting others) using the Life Satisfaction Scale. We took the sum of the number of engaging productive activities as the diversity in productive activities score. A dose-response relationship was observed for each additional productive activity on life satisfaction. Participants who engaged in one, two, three, or four productive activities were more likely to have higher life satisfaction than those who did not engage; the odds ratios (95 % confidence intervals) were 1.19 (1.02-1.39), 1.19 (1.00-1.42), 1.71 (1.37-2.13), and 2.27 (1.58-3.27), respectively. Diversity in productive activities may enhance higher life satisfaction likelihood among Japanese community-dwelling older adults.

Association between Hearing Aid Use and Cognitive Function in Persons with Hearing Impairment Stratified by Cardiovascular Risk.

The purpose of this study was to conduct a cross-sectional analysis of the association between hearing aid use and cognitive decline in community-dwelling older adults with hearing impairment, stratified by cardiovascular risk level. This cross-sectional study covers 1857 hearing-impaired individuals selected among 10,674 community-dwelling older adults (≥65 years of age) in Japan. We investigate the association between hearing aid use and cognitive decline stratified by cardiovascular risk level, by assessing self-reported hearing impairment and hearing aid use, absolute cardiovascular risk, cognitive function, and potential confounding factors. The association between hearing impairment severity and increased cardiovascular risk, and the benefit of hearing aid use in preventing cognitive decline, were examined in a binomial logistic regression analysis, with the presence of cognitive decline as the objective variable. In the low cardiovascular risk group, hearing aid users had a lower odds ratio for decline in executive function than non-users (odds ratio = 0.61, 95% confidence interval: 0.39-0.98). However, there was no significant association between hearing aid use and cognitive decline in the high cardiovascular risk group (p > 0.05). Among older adults with hearing impairment, hearing aid use was associated with the maintenance of executive function in individuals of low cardiovascular risk.

Association between perceived value of adopting new behaviors and incident disability among Japanese community-dwelling older adults.

OBJECTIVES: This longitudinal observational cohort study aimed to clarify the relationship between perceived value (PV) to adopt new behaviors and incident disability in community-dwelling older adults. METHOD: Participants were 5073 community-dwelling older adults aged ≥65 years in Japan (Mage = 74.0 ± 5.6 years; female = 55.1%). The mean follow-up time was 34.5 months. Baseline data were collected during health checkups in a prospective cohort study. Measurements included engagement in physical activity (PA), cognitive activity (CA), and social activity (SA), PV, health and physical conditions, and demographic characteristics. PV was assessed by asking whether participants thought it was valuable to adopt new behaviors related to PA, CA, and SA. Participants were classified as having higher/lower PV, PA, CA, and SA. Cox proportional hazard models were used to analyze the association between PV and incident disability. PV was examined both as an independent variable and in combination as follows: higher PV and higher PA/CA/SA (high/high); lower PV and higher PA/CA/SA (low/high); higher PV and lower PA/CA/SA (high/low); and lower PV and lower PA/CA/SA (low/low). RESULTS: Higher PV was significantly associated with a lower hazard ratio (HR) for incident disability. The low/high, high/low, and low/low significantly increased the HR compared to high/high in the analyses of PV & PA and CA. The analysis of PV & SA showed that only low/low increased the HR compared to high/high. CONCLUSION: Having both higher PV and higher activity engagement may contribute to preventing disability development. Both support for activities and value education in older adults may be needed.

Impacts of Negative and Positive Life Events on Development of Social Frailty among Community-Dwelling Older Adults.

OBJECTIVES: This study aimed to examine the impact of negative and positive life events on the development of social frailty. DESIGN: Population-based longitudinal study. SETTING AND PARTICIPANTS: This study was set in the Japanese community cohort and included 2174 adults aged ≥65 years without social frailty at baseline. METHODS: We assessed the experiences of 6 negative and positive life events (increase in economic difficulties, illness or injury of spouse, death of family or friends, marriage of children or grandchildren, birth of grandchildren or great-grandchildren, and making new friends) in the 15 months after baseline. We followed the social frailty status of the participants and identified the development of social frailty 48 months after the baseline. Social frailty was operationally defined as having 2 or more of Makizako's 5 items (going out less frequently, rarely visiting friends, not feeling helpful to friends or family, living alone, and not talking to someone daily). RESULTS: Among 2174 participants without social frailty at baseline, 161 (7.4%) developed social frailty after 48 months. Multivariate logistic regression models on each life event and development of social frailty showed that illness or injury of spouse was significantly associated with a higher risk of subsequent social frailty [adjusted odds ratio (OR), 1.74; 95% CI, 1.10-2.74] and making new friends was significantly associated with lower risk of subsequent social frailty (adjusted OR, 0.38; 95% CI, 0.27-0.54). No significant ORs of social frailty were found for other life events. CONCLUSIONS AND IMPLICATIONS: Life events in later life have both positive and negative impacts on the development of social frailty, depending on the nature of the event. To prevent social frailty, it may be important to monitor negative life events and promote positive life events in later life.

Association between the perceived value of adopting new behaviors and depressive symptoms among older adults.

Early preventive measures against depression have become important with unprecedented global aging. Increase in one's perceived value (PV) may correspond to better mental health outcomes. This cross-sectional observation study aimed to clarify whether the PV of adopting new behaviors is associated with depressive symptoms. The participants were 5266 community-dwelling older adults aged ≥ 65 years. We developed a questionnaire to measure the PV of adopting new behaviors, specifically activities beneficial for preventing depressive symptoms (physical, cognitive, and social activities) in older adults. The questionnaire asked whether adopting the ten selected behaviors was valuable. The scores were added, and the total score ranged from - 20 to 20. The odds ratios (OR) of depressive symptoms were calculated using binomial logistic regression according to the PV score quartiles. Depressive symptoms were reported by 595 (11.3%) participants. After adjusting for potential confounders, higher quartiles of PV scores were significantly associated with lower prevalence of depressive symptoms: vs Q1; Q2 OR 0.76 (95% confidence interval: 0.59-0.97); Q3 0.67 (0.51-0.87); Q4 0.54 (0.40-0.73) (P for trend < .001). Having a higher PV of adopting new behaviors may prevent depressive symptoms among older adults. Healthcare professionals need to pay attention to poor value orientation among older adults.

Lifetime Physical Activity and Late-Life Mild Cognitive Impairment in Community-Dwelling Older Adults.

OBJECTIVES: Regular physical activity throughout life is generally recommended to prevent dementia; however, there is little evidence regarding the association between lifetime physical activity and mild cognitive impairment (MCI), which often precedes dementia. This study aimed to examine the association of lifetime physical activity and their transitions with late-life MCI. DESIGN: A population-based case-control study. SETTING AND PARTICIPANTS: A total of 2968 Japanese community-dwelling older adults aged ≥70 years without dementia. METHODS: We evaluated the participants' early-, mid-, and late-life physical activity habits and categorized their transitions across life stages. Cognitive functions in late life were assessed for memory, attention, executive function, and processing speed; functional impairment in one or more cognitive domains was defined as MCI. RESULTS: Regular physical activity in early life was not significantly associated with late-life MCI [odds ratio (OR), 0.80; 95% CI, 0.63-1.02], although those in mid-life (OR, 0.64; 95% CI, 0.51-0.81) and late-life (OR, 0.74; 95% CI, 0.59-0.91) were associated with lower odds of late-life MCI. Compared with nonexercisers, participants who acquired new habits of physical activity during mid- or late-life (OR, 0.71; 95% CI, 0.55-0.91) and those who maintained physical activity throughout their life span (OR, 0.61; 95% CI, 0.42-0.87) had lower odds of late-life MCI; those who stopped regular activity during mid- or late-life did not (OR, 0.79; 95% CI, 0.58-1.06). CONCLUSIONS AND IMPLICATIONS: While physical activity throughout the life span is associated with the lowest odds of MCI, starting regular physical activity, even later in life, confers a benefit and should be encouraged as a "lifelong approach" to MCI risk reduction.

Physical frailty and survival time after the onset of functional disability: Is there a sex difference?

BACKGROUND: Physical frailty accelerates the timing of both subsequent disability and death; however, evidence regarding the impact of frailty on the period from disability onset to death and sex differences of this impact is lacking. The aim of this study was to examine the relationship among physical frailty, disability, death, and sex differences. METHODS: This Japanese cohort study included 10,524 community-dwelling people aged ≥65 years. Physical frailty was operationalized by key phenotypes as per Fried's criteria (slowness, weakness, exhaustion, weight loss, and low activity) at baseline. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for disability onset and post-disability survival according to the frailty status. RESULTS: During a 5-year follow-up, the risk of disability onset for pre-frailty (HR: 1.74, 95% CI: 1.51-2.00) and frailty (HR: 3.27, 95% CI: 2.77-3.87) were significantly higher than that for robust people. Furthermore, among participants who developed disabilities within 5 years (n = 1481), the risk of post-disability death for pre-frailty was not different from that for robust (HR: 1.49, 95% CI: 0.99-2.24), but frailty showed a higher risk of post-disability death than did robust people. (HR: 1.75, 95% CI: 1.13-2.72). In the sex-stratified analysis, although the female group showed no association between frailty status and post-disability death (HR: 1.21, 95% CI: 0.63-2.33 in pre-frailty; HR: 1.24, 95% CI: 0.60-2.57 in frailty), the male group showed higher risk of post-disability death in both pre-frailty (HR: 1.74, 95% CI: 1.03-2.96) and frailty (HR: 2.32, 95% CI: 1.32-4.09). CONCLUSIONS: Physical frailty shortens the period from disability onset to death. Additionally, the impact of frailty on post-disability death is greater for males than for females. Our findings suggest that physical frailty is an important clinical indicator distinct from disability and that interventions to prevent and address frailty in men need further investigation.

Neurophysiological markers in community-dwelling older adults with mild cognitive impairment: an EEG study.

BACKGROUND: Neurodegeneration and structural changes in the brain due to amyloid deposition have been observed even in individuals with mild cognitive impairment (MCI). EEG measurement is considered an effective tool because it is noninvasive, has few restrictions on the measurement environment, and is simple and easy to use. In this study, we investigated the neurophysiological characteristics of community-dwelling older adults with MCI using EEG. METHODS: Demographic characteristics, cognitive function, physical function, resting-state MRI and electroencephalogram (rs-EEG), event-related potentials (ERPs) during Simon tasks, and task proportion of correct responses and reaction times (RTs) were obtained from 402 healthy controls (HC) and 47 MCI participants. We introduced exact low-resolution brain electromagnetic tomography-independent component analysis (eLORETA-ICA) to assess the rs-EEG network in community-dwelling older adults with MCI. RESULTS: A lower proportion of correct responses to the Simon task and slower RTs were observed in the MCI group (p < 0.01). Despite no difference in brain volume between the HC and MCI groups, significant decreases in dorsal attention network (DAN) activity (p < 0.05) and N2 amplitude of ERP (p < 0.001) were observed in the MCI group. Moreover, DAN activity demonstrated a correlation with education (Rs = 0.32, p = 0.027), global cognitive function (Rs = 0.32, p = 0.030), and processing speed (Rs = 0.37, p = 0.010) in the MCI group. The discrimination accuracy for MCI with the addition of the eLORETA-ICA network ranged from 0.7817 to 0.7929, and the area under the curve ranged from 0.8492 to 0.8495. CONCLUSIONS: The eLORETA-ICA approach of rs-EEG using noninvasive and relatively inexpensive EEG demonstrates specific changes in elders with MCI. It may provide a simple and valid assessment method with few restrictions on the measurement environment and may be useful for early detection of MCI in community-dwelling older adults.

Subjective Cognitive Decline and Frailty Trajectories and Influencing Factors in Japanese Community-Dwelling Older Adults: A Longitudinal Study.

We studied frailty and subjective cognitive decline (SCD) trajectories in older Japanese adults and evaluated the influence of various factors on these trajectories. We analyzed data from 1157 non-demented adults aged 70 and above from 2013 to 2019. Frailty was assessed using the self-administered Kihon Checklist (KCL), a Japanese frailty index. SCD was evaluated using the questionnaire of the Subjective Memory Complaints scale. Through group-based joint trajectory models, we discerned three frailty trajectories: non-progressive (n = 775), moderate progressive (n = 312), and rapid progressive (n = 70); and three SCD trajectories: non-progressive (n = 302), moderate progressive (n = 625), and rapid progressive (n = 230). Individuals in the rapid progressive SCD trajectory had a 32.2% probability of also being in the rapid progressive frailty trajectory. In contrast, those in the non-progressive SCD trajectory had zero probability of being in the rapid progressive frailty trajectory. Both the rapid progressive frailty and SCD groups combined had a higher incidence of depressive symptoms and slow gait speed. Our results have found that frailty and SCD share a similar trajectory in Japanese older adults. Additionally, rapid progressive frailty and SCD were associated with the highest risk of depressive symptoms and slow gait speed. Thus, interventions targeting both frailty and cognitive decline should prioritize mental health enhancement and gait speed improvement.

Differential effects of lifestyle activities on disability incidence based on neighborhood amenities.

BACKGROUND: This study examined the effect of neighborhood amenities on disability risk among community-dwelling older adults in Japan, based on lifestyle activities. METHOD: This was an observational prospective cohort study. Participants comprised 13,258 older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We calculated participants' Walk Score using their home addresses and divided them into three groups: "car-dependent," "somewhat walkable," and "very walkable." We then calculated the average value of lifestyle activities. We divided the neighborhood amenity groups into two groups, "fewer lifestyle activities" and "more lifestyle activities," for a total of six groups. After identifying interactions between neighborhood amenities and lifestyle activities, Cox proportional hazard models to calculate hazard ratios for incident disability risk, based on neighborhood amenities and lifestyle activities. RESULTS: An interaction occurred between neighborhood amenities and lifestyle activities (p < 0.05). Survival probabilities for incident disability based on lifestyle activities were estimated for each neighborhood amenity group: car-dependent, 1.62 (95% CI 1.07 to 2.46); somewhat walkable, 1.08 (95% CI 0.84 to 1.40); and very walkable, 1.05 (95% CI 0.87 to 1.27). Those with fewer lifestyle activities in the car-dependent group exhibited the highest risk of incident disability in the unadjusted and adjusted models. CONCLUSION: Given that the aging population is increasing steadily, considering older adults' neighborhood amenities and lifestyle activities in their day-to-day lives can help clinicians to deliver more older adult-centered care. Incorporating the lifestyle activities and neighborhood amenities of older adults into care planning will lead to the design and development of integrated clinical and community screening programs.

Motoric Cognitive Risk Syndrome and Traffic Incidents in Older Drivers in Japan.

Importance: To prevent motor vehicle collisions by older drivers, the increased risk of collisions should be considered early. Cognitive decline increases the risk of car collisions. Motoric cognitive risk syndrome (MCR), characterized by the presence of cognitive concerns and slow gait, can be assessed conveniently and is useful to assess the risk of dementia. Objective: To examine the association between MCR assessment findings and car collisions among older drivers in Japan. Design, Setting, and Participants: This cross-sectional study used data from a community-based cohort study, the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes, conducted in Japan from 2015 to 2018. Participants were community-dwelling older adults aged at least 65 years. Data were analyzed from February to March 2023. Exposure: MCR was defined as having subjective memory concerns (SMC) and slow gait. Participants were classified into 4 groups: no SMC or slow gait, only SMC, only slow gait, and MCR. Main Outcomes and Measures: Participants were asked about the experience of car collisions during the last 2 years and near-miss traffic incidents during the previous year through face-to-face interviews. Odds of experiencing a collision or near-miss traffic incident were assessed using logistic regression. Results: Among a total of 12 475 participants, the mean (SD) age was 72.6 (5.2) years, and 7093 (56.9%) were male. The group with only SMC and the group with MCR showed a higher proportion of both car collisions and near-miss traffic incidents than the other groups (adjusted standardized residuals > 1.96; P < .001). Logistic regression analysis showed the only SMC and MCR groups had increased odds of car collisions (only SMC group: odds ratio [OR], 1.48; 95% CI, 1.27-1.72; MCR group: OR, 1.73; 95% CI, 1.39-2.16) and near-miss traffic incidents (only SMC group: OR, 2.07; 95% CI, 1.91-2.25; MCR group: OR, 2.13; 95% CI, 1.85-2.45) after adjusting for confounding factors. After stratifying MCR assessments by objective cognitive impairment, significant associations were still observed. In the only slow gait group, objective cognitive impairment was associated with increased odds of car collisions (OR, 1.96; 95% CI, 1.17-3.28). Conclusions and Relevance: In this cross-sectional study of community-dwelling older drivers in Japan, SMC and MCR were associated with car collisions and near-miss traffic incidents independent from objective cognitive impairment. Future studies should examine the mechanism of these associations in more detail.

Difference in employment status and onset of disability among Japanese community-dwelling older adults: a prospective cohort study.

OBJECTIVE: This prospective cohort study investigates the relationship between the onset of disability and employment status. METHODS: We investigated 3,741 community-dwelling adults aged 70 or older, who participated in a population-based cohort study in Japan. Their onset of disability was monitored monthly using the long-term care insurance certification registration system, for five years from baseline. Based on an employment status questionnaire, we categorized participants into three groups: (1) employee, (2) self-employed, and (3) not working. Covariates included demographic information, medical history, number of medications, educational level, living alone, social group engagement, smoking status, walking speed, instrumental activities of daily living, global cognitive function, and depressive symptoms. Missing values were managed using multiple imputation. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident disability risk by employment status. RESULTS: The disability incidence rates were 15.3/1,000 (95% CIs: 10.7-22.0) person-years among employees, and 33.0/1000 (95% CIs: 24.4-44.6) and 39.6/1000 (95% CIs: 36.5-43.0) person-years among self-employed and non-working participants, respectively. The adjusted HRs for the onset of disability among non-working and self-employed participants were 1.69 (95% CIs: 1.16-2.46, p = 0.007) and 1.63 (95% CIs: 1.01-2.62, p = 0.044) compared with employees, respectively. Similar results were found among men. Among women, disability onset was not associated with employment status. CONCLUSIONS: Older adults' risk of disability onset differed according to their employment status. Older employees had a lower risk of disability onset than those not working or self-employed.

Association between COVID-19 emergency declarations and physical activity among community-dwelling older adults enrolled in a physical activity measurement program: Evidence from a retrospective observational study using the regression discontinuity design.

BACKGROUND: The current study examines the negative impact of the coronavirus disease 2019 (COVID-19) emergency declarations on physical activity among the community-dwelling older adults, the participants of a physical activity measurement program, in Japan. METHODS: This retrospective observational study included 1,773 community-dwelling older adults (aged 74.6 ± 6.3 years, 53.9% women) who had participated in the physical activity measurement project from February 2020 to July 2021. We measured physical activity using a tri-axial accelerometer during 547 consecutive days. Three emergency declarations, requesting people to avoid going outside, occurred during the observational period. We multiply-imputed missing values for daily physical activity, such as steps, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) for several patterns of datasets according to the maximum missing rates on a person level. We mainly report the results based on less than 50% of the maximum missing rate (n = 1,056). Other results are reported in the supplemental file. Changes in physical activity before and after the start of each emergency declaration were examined by the regression discontinuity design (RDD) within 14-, 28-, and 56-day bandwidths. RESULTS: For all the participants in the multiply-imputed data with the 14-day bandwidth, steps (coefficients [[Formula: see text]][Formula: see text] 964.3 steps), LPA ([Formula: see text] 5.5 min), and MVPA ([Formula: see text] 4.9 min) increased after the first emergency declaration. However, the effects were attenuated as the RDD bandwidths were widened. No consistent negative impact was observed after the second and third declarations. After the second declaration, steps ([Formula: see text]-609.7 steps), LPA ([Formula: see text]-4.6 min), and MVPA ([Formula: see text]-2.8 min) decreased with the 14-day bandwidth. On the other hand, steps ([Formula: see text] 143.8 steps) and MVPA ([Formula: see text] 1.3 min) increased with the 56-day bandwidth. For the third declaration, LPA consistently decreased with all the bandwidths ([Formula: see text]-2.1, -3.0, -0.8 min for the 14, 28, 56-day bandwidth), whereas steps ([Formula: see text]-529 steps) and MVPA ([Formula: see text]-2.6 min) decreased only with the 28-day bandwidth. CONCLUSIONS: For the community-dwelling older adults who regularly self-monitor their physical activity, the current study concludes that there is no evidence of consistently negative impacts of the emergency declarations by the COVID-19 pandemic.

Reciprocal relationship between physical and social frailty among community-dwelling older adults.

OBJECTIVE: Both physical and social frailty are risk factors for major adverse health-related outcomes and influence each other. However, the longitudinal causal relationship between physical and social frailty has not been clarified. This study aimed to determine the reciprocal relationship between physical and social frailty by age group. METHODS: This study analyzed longitudinal data from a cohort study of older adults aged 65 years or older living in Obu City, Aichi Prefecture, Japan. The study included 2568 participants who participated in both a baseline assessment in 2011 and a follow-up assessment four years later. Participants participated in assessments of physical and cognitive function. Physical frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria. Social frailty was assessed with five questions about daily social activities, social roles, and social relationships. A total frailty score was calculated for each frailty type and used in the cross-lagged panel analysis. The reciprocal relationship between physical and social frailty status was analyzed using a cross-lagged panel model in each of the young-old (n = 2006) and old-old (n = 562) groups. RESULTS: In the old-old group, baseline physical frailty status predicted social frailty status four years later, and social frailty status at baseline predicted physical frailty status four years later. In the young-old group, the effect of social frailty status at baseline on physical frailty at four years was significant; however, the cross-lag effect from baseline physical frailty status to social frailty status at four years was insignificant, indicating that social frailty preceded physical frailty. CONCLUSION: The reciprocal relationship between physical and social frailty differed by age group. The results of this study suggest the importance of considering age when planning strategies to prevent frailty. Although a causal relationship between both physical and social frailty was observed in old-old, social frailty preceded physical frailty in the young-old, suggesting that early prevention of social frailty is important for the prevention of physical frailty.

Association of Loneliness With the Incidence of Disability in Older Adults With Hearing Impairment in Japan.

Importance: Loneliness is suggested to negatively affect physical and mental health and influence the development of disability; however, a consensus on the relationship between loneliness and disability has not been reached. Age-related hearing impairment worsens the daily-life activities of older adults, and the association between loneliness and the incidence of disability may be influenced by hearing impairment. Objective: To examine the association between loneliness and the incidence of disability among older adults stratified by hearing impairment. Design, Setting, and Participants: This prospective observational cohort study included 5563 community-dwelling adults 65 years or older who participated in functional health examinations in Tokai City, Aichi Prefecture, Japan, between September 2017 and June 2018. Data analysis was conducted from August 2022 to February 2023. Main Outcomes and Measures: Cox proportional hazards regression models were used to examine the association between loneliness and the incidence of disability stratified by hearing impairment. Results: Among the 4739 participants who met the inclusion criteria (mean [SD] age, 73.8 [5.5] years; 2622 [55.3%] female), 3792 (80.0%) were without hearing impairment and 947 (20.0%) were with hearing impairment. Of those who reported experiencing loneliness, 1215 (32.0%) were without hearing impairment, and 441 (46.6%) were with hearing impairment. After 2 years, the number of individuals with disabilities was 172 (4.5%) without hearing impairment and 79 (8.3%) with hearing impairment. Cox proportional hazards regression analysis showed no statistically significant association between loneliness and the incidence of disability in a model adjusted for potential confounding factors among community-dwelling older adults without hearing impairment (hazard ratio, 1.10; 95% CI, 0.80-1.52). Among community-dwelling older adults with hearing impairment, a model adjusted for potential confounding factors showed a statistically significant association between loneliness and the incidence of disability (hazard ratio, 1.71; 95% CI, 1.04-2.81). Conclusions and Relevance: This cohort study found that the association between loneliness and the incidence of disability was moderated by the presence or absence of hearing impairment. Hearing impairment is the most common symptom of geriatric syndromes, showing that among the various risk factors, loneliness may require special attention in the prevention of disability in people with hearing impairment.

Sarcopenic Obesity and Risk of Disability in Community-Dwelling Japanese Older Adults: A 5-Year Longitudinal Study.

OBJECTIVES: Previous studies have indicated that sarcopenic obesity is a risk factor for disability onset. However, these studies had disparities in terms of criteria for sarcopenia, study design, or study population. No longitudinal study has investigated the effect of sarcopenic obesity on disability onset in an Asian population using the Asian Working Group for Sarcopenia 2019 criteria for sarcopenia definition. Herein, we aimed to investigate the longitudinal effect of sarcopenic obesity on disability onset in Japanese older adults and extend the generalizability of results to other populations. DESIGN: Longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 4197 Japanese older adults (mean age 74.6 ± 5.0 years, 54.2% women) formed our study population. MEASUREMENTS: Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 algorithm. Obesity was determined when body fat percentage was ≥25%, or when visceral fat content was ≥100 cm2 for either sex. Disability onset was defined as a new case of long-term care insurance system certification for 5 years from baseline. Missing values were managed with multi-imputation. Cox proportional hazard regression analysis was used with disability onset as dependent variable and group (nonsarcopenia/nonobesity as a reference, nonsarcopenia/obesity, sarcopenia/non-obesity, possible sarcopenia/obesity, possible sarcopenia/non-obesity, sarcopenic obesity) as explanatory variable, and was adjusted for potential confounding factors. RESULTS: When the nonsarcopenia/nonobesity group was used as the reference category, other groups such as possible-sarcopenia/nonobesity [hazard ratio (HR) 1.38, 95% confidential interval (95% CI) 1.29‒1.47, P < .028], possible-sarcopenia/obesity (HR 1.54, 95% CI 1.46‒1.62 P < .001), sarcopenia/nonobesity (HR 2.09, 95% CI 1.96‒2.23, P < .001), and sarcopenic obesity (HR 2.48, 95% CI 2.24‒2.75, P < .001) showed significantly increased HRs. CONCLUSIONS AND IMPLICATIONS: The risk of disability onset because of sarcopenic obesity was exceedingly higher compared with sarcopenia alone among community-dwelling older adults in Japan The health providers should consider assessing the co-existence of sarcopenia and obesity to screen for the risk of disability onset in the community-dwelling population.

Association of sarcopenia and systolic blood pressure with mortality: A 5-year longitudinal study.

PURPOSE: Whether the combination of sarcopenia and systolic blood pressure (SBP) changes the risk of all-cause mortality is unknown. Thus, this study aimed to examine the association between sarcopenia and SBP in community-dwelling older adults and determine whether this association changes the mortality risk. METHODS: Older adults aged ≥65 years participated in the baseline assessment. The participants were classified into six groups according to a combination of the presence or absence of sarcopenia (sarcopenia, non-sarcopenia) and SBP (low SBP, ≤119 mmHg; normal SBP, 120-139 mmHg; high SBP, ≥140 mmHg). The participants were followed for the occurrence of death for 5 years after baseline assessment. Muscle mass, grip strength, and walking speed as indicators of sarcopenia, SBP, and all-cause mortality data for 5 years from baseline assessment were evaluated. RESULTS: This study included 13,569 community-dwelling older adults. During the 5-year follow-up period, 830 participants (6.6%) died. In the Cox proportional hazards models, the risk of all-cause mortality was higher in other non-sarcopenia groups than in the non-sarcopenia/normal SBP group. In particular, those with sarcopenia had a higher mortality risk. CONCLUSIONS: Low or high SBP increased the mortality risk in community-dwelling older adults. In those with sarcopenia, low or high SBP was associated with an even higher mortality risk. Older adults with sarcopenia and low/high blood pressure should be monitored as a population at a higher mortality risk.

Information and Communication Technology Use for Alleviation of Disability Onset in Socially Isolated Older Adults: A Longitudinal Cohort Study.

INTRODUCTION: Delaying the onset of disability is important for maintaining independence and quality of life in community-dwelling older adults. Given that social isolation is a significant risk factor for disability, effective means associated with social isolation are needed to alleviate disability. Although information and communication technology (ICT) may be a reasonable measure considering the recent social contexts due to the coronavirus disease 2019 pandemic, further insights are required. This study aimed to investigate whether ICT use can alleviate the onset of disability in community-dwelling older adults with and without social isolation. METHODS: This longitudinal cohort study on 4,346 community-dwelling independent Japanese older adults (mean age, 73.5 ± 5.3 years) was conducted between 2017 and 2018. Participants were classified into four groups based on social isolation (the condition where two or more of the following measures were met: domestic isolation, less social contact, and social disengagement) and ICT users (those who had recently used a computer or a smartphone) and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional-hazards regression models were used to identify the effect of social isolation and ICT use on the risk of disability onset by adjusting for age, sex, education history, number of medications, eye disease, level of annual income, Mini-Mental State Examination, Geriatric Depression Scale 15, and gait speed. RESULTS: The group comprised nonsocial isolation and ICT users (44.7%), social isolation and ICT users (5.4%), nonsocial isolation and ICT nonusers (41.7%), and social isolation and ICT nonusers (8.2%). At the follow-up, 2.2%, 2.4%, 5.5%, and 12.4% of the participants in the above order developed disability (p < 0.01). Cox regression models revealed a significantly higher risk of disability onset in the social isolation and ICT nonusers group than in the social isolation and ICT users group (HR = 2.939; 95% confidence interval (CI) 1.029-8.397; p = 0.044). In the subgroup analysis stratified by social isolation, ICT use significantly reduced the risk of disability onset in the socially isolated group (HR = 0.320; 95% CI 0.109-0.943; p = 0.039), although the same association was not observed in the nonsocially isolated group (HR = 0.845; 95% CI 0.565-1.264; p = 0.411). CONCLUSION: ICT use can alleviate the onset of disability in socially isolated older adults in a community setting. Considering ICT-applied methods for alleviating disability is beneficial for older adults in social isolation.

Association between driving a car and retention of brain volume in Japanese older adults.

BACKGROUND: Driving cessation is a major negative life event that has been associated with a decline in health conditions including dementia. The increase in activity owing to the expansion of life space is a possible explanation for the positive relationship between driving and brain health. The present study examined the association between driving, life space, and structural brain volume in older individuals. METHODS: High-resolution magnetic resonance imaging was employed to examine the brain volume in 1063 older adults. Participants were classified as non-drivers, those who drove <7 days a week, and everyday drivers. They were further classified into a non-driving group, an active group (drove 10 km at least once a week), and a less-active group (drove 10 km less than once a week). RESULTS: The hippocampal volume was greater in drivers than in non-drivers. Occipital cortex volume was greater in low-frequency drivers than in non-drivers and high-frequency drivers. Active drivers exhibited larger temporal cortex volumes than less-active drivers, larger cingulate cortex volumes than non-drivers and less-active drivers, and larger hippocampal volumes than non-drivers. CONCLUSION: Driving was associated with hippocampal brain atrophy attenuation, with active drivers exhibiting decreased brain atrophy in the temporal and cingulate cortices.

Differences in Subjective and Objective Cognitive Decline Outcomes Are Associated with Modifiable Protective Factors: A 4-Year Longitudinal Study.

Subjective cognitive decline (SCD) in older adults has been identified as a risk factor for dementia. However, the literature is inconsistent, and the underlying mechanisms are not well understood. We aimed to determine whether older adults with SCD had more modifiable protective factors against the risk of dementia and a lower risk of developing objective cognitive decline (OCD). We included 4363 older adults (71.7 ± 5.3 [mean ± standard deviation] years of age; 2239 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. SCD, OCD, and protective factors against dementia, such as lifestyle and activity, were assessed using interviews and objective cognitive-assessment tools. Based on initial cognitive status, participants were categorized into normal cognition, SCD-only, OCD-only, and both SCD and OCD groups. After 4 years, participants were classified as having either no impairment or mild or global cognitive impairment (i.e., OCD). Binomial logistic regression analyses were performed with the cognitive statuses of the groups at follow-up and baseline as the dependent and independent variables, respectively. After adjusting for potential confounding factors, we found that the SCD-only group had more modifiable protective factors against the risk of dementia than the OCD-only group. Community-dwelling older adults with normal cognition or those part of the SCD-only group had a lower risk of developing OCD during the 4-year follow-up, which may have been due to having more modifiable protective factors against the risk of dementia. Additionally, these factors may contribute to the inconsistencies in the literature on SCD outcomes.