Is unwilling volunteering protective for functional decline? The interactive effects of volunteer willingness and engagement on health in a 3-year longitudinal study of Japanese older adults.

AIM: The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study. METHODS: We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period. RESULTS: During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers. CONCLUSION: Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.

Low plasma tryptophan is associated with olfactory function in healthy elderly community dwellers in Japan.

BACKGROUND: Decreased circulating tryptophan (Trp) levels are frequently observed in elderly patients with neurodegenerative disease including Alzheimer's disease. Trp may serve as a potential biomarker for monitoring disease risk in elderly people. We aimed to investigate the association between low plasma Trp levels and olfactory function, which is known to predict age-related diseases including dementia in elderly people. METHODS: A total of 144 healthy elderly Japanese community (≥ 65 years old) dwellers from the Health, Aging and Nutritional Improvement study (HANI study) were the subjects of our analysis. Low Trp levels were classified using the lower limit values of the reference interval according to a previous report. Olfactory function was assessed using a card-type test called Open Essence, which includes 12 odour items that are familiar to Japanese people. The elderly subjects with low circulating Trp levels were compared to a control group with normal plasma Trp levels. RESULTS: We conducted the analyses using 144 people aged 65 years or older (mean age 73.7 ± 5.5 years; 36.1% men). The subjects showed normal serum albumin levels (4.4 ± 0.2 g/dL) and no daily living disabilities. Low plasma Trp levels (low Trp group) were found in 11.1% of the study population. The low Trp group showed a significantly lower correct-answer rate for the items india ink, perfume, curry and sweaty smelling socks than control group (P < 0.05). There was also a significant association between low Trp levels and low olfactory ability, after adjusting for age and sex. CONCLUSIONS: Lower plasma Trp levels were associated with a decrease in olfactory function in functionally competent older individuals. Because olfactory dysfunction predicts age-related diseases, low plasma Trp levels may represent a clinical sign of disease risk in elderly people.

Evaluation of the comprehensive health program "Sumida TAKE10!" for community-dwelling older adults, which aims to prevent or delay the need for long-term nursing care.

Objective The purpose of this study was to evaluate the comprehensive health program "Sumida TAKE10!", which aims to improve dietary habits and promote physical activity among community-dwelling older adults including the pre-frail elderly. This study has been ongoing since 2005 in Sumida Ward, Tokyo with the ultimate aim of preventing or delaying the need for long-term nursing care. We used the term "pre-frail elderly" for older adults who are at risk of requiring long-term care.Methods "Sumida TAKE10!" consists of a general lecture in a public hall followed by 5 educational sessions biweekly at 4-6 community centers. From 2008 to 2013, 402 participants aged ≥65 years were enrolled and included as subjects of the study. The main outcome measures were changes in 10 food intake frequencies, food frequency score (FFS), dietary variety score (DVS), frequency of exercise (obtained via questionnaire) and physical fitness (5-meter maximal walking time, 5-meter walking time, handgrip strength, one-leg standing time with eyes opened (time to upright posture for standing on one leg with eyes open), and the timed up & go test). The secondary outcome measures were changes in the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score, appetite, frequency of walking and sports, self-rated health, frequency of leaving the house, communication with neighbors, engagement in hobbies, participation in group activities and participation in volunteer activities (obtained via questionnaire).Results Compared to baseline, all outcomes showed significant improvement. "Sumida TAKE10!" can improve dietary habits and increase the physical activity of participants. Positive secondary effects were seen for life function, self-rated health, and social activities. Almost identical positive results were obtained from the pre-frail elderly group, while improvement was also seen in the dietary habits of the subjects who do not cook.Conclusion These results suggest that this program may be useful for population-based approach programs. In addition, comprehensive programs like TAKE10! may increase the health consciousness of community-dwelling older adults.

Engagement in paid work as a protective predictor of basic activities of daily living disability in Japanese urban and rural community-dwelling elderly residents: An 8-year prospective study.

AIM: To examine whether engaging in paid work is a predictor of maintaining good functional health among Japanese older adults in both urban and rural communities. METHODS: We used the 8-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging with 306 and 675 persons aged 65-84 years from Koganei City (urban) and Nangai Village (rural), respectively, who are independent in basic activities of daily living (BADL). In order to examine the declining patterns in BADL and evaluate the predictive value of working status for future BADL disability, we applied the log-rank test of cumulative proportion curves and the Cox proportional hazard model by sex, controlling for age, research fields, years of education, marital state, chronic medical conditions, pain, instrumental activities of daily living (IADL), smoking status, exercise habits, life satisfaction, usual walking speed and serum albumin for evaluating the predictive value of working status at baseline for future BADL disability. RESULTS: In both areas, participants who were not working were more likely to decline in BADL than those working (P < 0.05), except for women in urban Koganei. Male participants who did not engage in paid work had a higher adjusted hazard ratio of onset of BADL disability, compared with those working, but this was not seen for female participants. CONCLUSIONS: Working might be protective from a decline in BADL only for men, but not for women. Regarding the difference of sex roles in conventional Japanese society, working would be an effective solution especially for men to participate in social activities.

Longitudinal association between habitual physical activity and depressive symptoms in older people.

AIMS: Prevention of depressive symptoms is an essential issue with regard to the promotion of healthy lifestyles in older people. To date, few studies have examined the relation between fluctuations in physical activity and depression among older individuals. We thus conducted a longitudinal survey of older adults to examine the effect of long-term fluctuating physical activity on the incidence of depressive symptoms. METHODS: A 3-year prospective cohort study was performed in a community-based environment. A total of 680 individuals (291 men and 389 women) aged 65 years and over at the baseline assessment participated. The 15-item Geriatric Depression Scale was used to assess depressive symptoms, with scores of ≥6 indicative of depression. Participants were categorized into the following four groups based on change in physical activity status between 2002 and 2003: sedentary, cessation, initiation, and maintenance. RESULTS: The incidence of depressive symptoms was 16.9% (16.8% in men and 17.0% in women) at the 3-year follow up (in 2006). Multiple logistic regression analyses showed that physical activity maintenance (odds ratio, 0.50; 95% confidence interval, 0.30-0.83) only reduced the incidence of depressive symptoms at the 3-year follow up after adjusting for confounding variables. CONCLUSIONS: Continuous physical activity may be a valuable and simple way to prevent depressive symptoms in community-dwelling older people. Therefore, it is necessary to implement interventions that teach older adults how to integrate physical activity into their daily lives.

Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial.

BACKGROUND: The fastest growing age group globally is older adults, and preventing the need for long-term nursing care in this group is important for social and financial reasons. A population approach to diet and physical activity through the use of social services can play an important role in prevention. This study examined the effectiveness of a social health program for community-dwelling older adults aimed at introducing and promoting physical activity in the home at each individual's pace, helping participants maintain good dietary habits by keeping self-check sheets, and determining whether long-standing unhealthy or less-than-ideal physical and dietary habits can be changed. METHOD: This cluster randomized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65-90 years. The intervention group (3 community centers; n = 57) participated in the social health program "Sumida TAKE10!" which is an educational program incorporating the "TAKE10!® for Older Adults" program, once every 2 weeks for 3 months. The control group (3 community centers; n=35) was subsequently provided with the same program as a crossover intervention group. The main outcome measures were changes in food intake frequency, food frequency score (FFS), dietary variety score (DVS), and frequency of walking and exercise. The secondary outcome measures were changes in self-rated health, appetite, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score. RESULTS: Compared to baseline, post-intervention food intake frequency for 6 of 10 food groups (meat, fish/shellfish, eggs, potatoes, fruits, and seaweed), FFS, and DVS were significantly increased in the intervention group, and interaction effects of FFS and DVS were seen between the two groups. No significant differences were observed between baseline and post-intervention in the control group. Frequency of walking and exercise remained unchanged in both groups, and no significant difference in improvement rate was seen between the groups. Self-rated health was significantly increased in the intervention group. Appetite and TMIG Index of Competence score were unchanged in both groups. CONCLUSIONS: The social health program resulted in improved dietary habits, as measured by food intake frequency, FFS, and DVS, and may improve self-rated health among community-dwelling older adults. TRIAL REGISTRATION NUMBER: UMIN000007357.

Declines in physical performance by sex and age among nondisabled community-dwelling older Japanese during a 6-year period.

BACKGROUND: Few studies have examined whether declines over time in hand-grip strength (HGS) and fast walking speed (FWS) differ by sex and age among non-Western community-dwelling older adults. This study aimed to quantify changes in HGS and FWS over the 6-year period from 1994 to 2000 and examine whether these changes differed by sex and baseline age among older individuals in a Japanese community. METHODS: We conducted a community-based prospective cohort study. The participants were 513 nondisabled men and women aged 67 to 91 years at the 1994 survey. Independent variables regarding time since baseline, in addition to various time-dependent and time-independent covariates, were obtained in 1994, 1996, 1998, and 2000. The outcome variables were HGS and FWS assessed at each survey. All data on independent and dependent variables that were collected at each survey were simultaneously analyzed using a linear mixed-effects model. RESULTS: The linear mixed-effects model revealed significant declines in both HGS (-0.70 kg/year, P < 0.001) and FWS (-0.027 m/sec/year, P < 0.001) among nondisabled older participants who had analyzable data in any survey during the 6-year period. Sex was significantly associated with the rate of decline in HGS (P < 0.001), but not FWS (P = 0.211). CONCLUSIONS: In this analysis of nondisabled older Japanese, a mixed-effects model confirmed a significant effect of aging on declines in HGS and FWS and showed that men had a significantly steeper decline in HGS than did women during a 6-year period.

Association between C-reactive protein (CRP) level and physical performance in community-dwelling elderly in Japan.

Inflammatory cytokines may contribute to lower physical function in elderly. The purpose of this study was to clarify the relation between circulating level of C-reactive protein (CRP) and physical performance among the community-dwelling elderly in Japan. Participants were 803 (329 men and 474 women) aged 65 years and over. Four physical performances were assessed using hand-grip strength, length of time standing on one leg, and walking speed (usual and maximal). Low physical performance was defined as the lowest 25% of study sample in each sex. Multiple logistic regression analysis showed that CRP was negatively associated with physical performance in hand-grip strength (odds ratio=OR=1.86, 95% confidence interval=95% CI=1.32-3.05, OR=2.92, 95% CI=1.53-5.58, for the middle and highest, respectively), time of one leg standing (OR=1.96, 95% CI=1.28-3.00, OR=2.16, 95% CI=1.19-3.92, for the middle and highest, respectively) and maximal walking speed (OR=2.46, 95% CI=1.23-4.93, for the highest) when adjusted for the confounding factors. The results showed the negatively associated between CRP level and physical performance when adjusted for the confounding factors. CRP level may be a useful indicator for detecting the lower physical performance in elderly.

Depression status as a reliable predictor of functional decline among Japanese community-dwelling older adults: a 12-year population-based prospective cohort study.

OBJECTIVE: This study aimed to examine a longitudinal relationship between depression status and functional decline among Japanese community-dwelling older adults, using a 12-year population-based, prospective cohort study design. METHOD: A total of 710 men and women, aged 65 years and over, participated in the study. Katz's Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence were used to measure the functional capacities of basic activities of daily living (BADL) and higher-level competence, respectively. For the purpose of analysis, a decline in each subscale of functional capacity during the follow-up period were used as outcome variables; depression status assessed by the Japanese version of the 30-item Geriatric Depression Scale (GDS), with a cut-off of 11, was used as an independent variable; and age, gender, education level, history of chronic disease, hospitalization, smoking, physical activity, living alone, hearing problems, physical pain, dietary habits, and usual walking speed at baseline were used as covariates. RESULTS: Use of the multivariate Cox proportional hazards model adjusted for potential confounders showed that depression status was significantly and independently associated with BADL decline (risk ratio (RR) = 1.46, 95% confidence interval (CI): 1.13-1.89) and with higher-level competence decline (RR = 1.56, 95% CI: 1.18-2.04). CONCLUSION: Our study found an independent relationship between depression status and longitudinal change in functional capacity among community-dwelling older individuals, suggesting that depression status is a reliable predictor of functional decline (both of BADL decline and higher-level competence decline) in older adults.

[Economic evaluation of disability prevention programs for community-dwelling elderly secular trend analyses of medical and care expenses comparing participants and non-participants in the programs].

OBJECTIVE: This study was conducted to evaluate disability prevention programs for community-dwelling elderly in terms of the cost/benefit balance. METHODS: Out of all residents aged 65 years and over who lived in Yoita Town, Niigata Prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline survey conducted in November, 2000 (response rate, 92.2%). Based on the results, Yoita town then launched several kinds of disability prevention programs for community-dwelling elderly, e.g., preventive programs for falls, dementia and homeboundness. The subjects for the present study included only those aged 70 years and over who responded to the baseline survey and were alive as of March 2004. During 2001 to 2003, 146 persons had participated at lease once in one of disability prevention programs (denoted as the participant group), whereas 846 persons had not participated in any of the programs (denoted as the non-participant group). We compared medical and care expenses (sum of national and employment health insurance benefits, and long-term care insurance) between the two groups during 2000-2003, and determined whether participating in program affected subsequent medical and care expenses independent of key confounders [sex, age, and baseline medical and care expenses or health indicator (TMIG-Index of Competence or Generic Mobility Index)], using general linear models. RESULTS: The mean medical expenses per capita and per month slightly decreased over the period of the study in the participant group (51,606 yen for 2000 to 47,539 yen for 2003), while those in non-participant group steadily increased (41,888 yen, to 51,558 yen, respectively). During the same period, the mean care cost per capita and per month increased in both groups, but the increase was much more moderate in the participating group (507 yen to 5,186 yen vs. 8,127 yen to 27,072 yen for non-participant group). Summed cost reduction through the program participation accounted for 49 million yen during the three years (2001-2003). After adjustment for sex, age and baseline medical and care expenses or health indicator, it was estimated as 12 million yen per year. Given that the expenses for the disability prevention programs summed 2.3 million yen per year, the net benefit of disability prevention programs was estimated to be approx. 10 million yen per year. CONCLUSION: Disability preventive programs for the community-dwelling elderly are economically efficient in terms of the cost/benefit balance. Future research is needed to examine how such programs lead to cost reduction.

[Physical activity level and physical, mental and social factors in community-dwelling elderly people].

PURPOSE: This study was conducted to examine the relationship between physical activity level (PAL) and physical, mental and social factors in community-dwelling elderly people. METHODS: The subjects comprised 428 residents aged 70 or over living in Kusatsu-machi, Gunma, who took part in an interview and tests of physical fitness as part of the "NIKKORI-KENKOSODANJIGYO". Data for 330 out of the 428 residents were adopted for this study. The PAL was evaluated with a questionnaire developed by Naito et al. (2003). Subjects were interviewed on physical, mental and social functioning including the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence and cognitive function (Mini Mental State Examination: MMSE). Physical fitness tests included assessment of handgrip strength, usual and maximal walking speed, and one-leg standing balance with eyes open. RESULTS: Correlations between PAL and the TMIG Index of Competence, physical (e.g. physical fitness), mental (e.g. depression) and social (e.g. roles at home) factors, and smoking status were significant by ANCOVA adjusted for age and sex. Analysis using a general linear model indicated that smoking status, usual walking speed, depression, roles at home, frequency of going outdoors and visual impairment all together explained 13.5% of the PAL variance. CONCLUSION: The findings indicate that PAL in the community-dwelling elderly aged 70 years or over is associated with physical, mental and social factors.

[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].

OBJECTIVE: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community. METHODS: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification. RESULTS: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females. CONCLUSIONS: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

[Predictors for the onset of different types of homeboundness among community-living older adults: two-year prospective study].

BACKGROUND: Little is known about predictors for the onset of different types of homeboundness among community-living older adults. PURPOSE: This 2-year prospective study examined predictors for the onset of "type 1" and "type2" homeboundness (see definitions below) among community-living older adults. METHODS: Study subjects comprised all residents aged 65 years and over living in Yoita town, Niigata, Japan, who answered the baseline (2000) and follow-up (2002) surveys. Persons were defined as being homebound if he/she went outdoors once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e., level 3 or over). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., level 1 or 2). A stepwise, multiple logistic regression model was used to identify the most parsimonious combination of risk factors for each type of homeboundness. RESULTS: Out of 1,322 persons who were level 1,2 non-homebound at the baseline, 77.6% remained as level 1,2 non-homebound (n = 1,026), but 1.7% were "type 1" homebound (n = 22), and 4.8% were "type 2" homebound (n = 66) at follow-up. The final model for prediction of "type 1" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 2.10; 95%CI: 1.36-3.24), not having a job (OR: 4.42; 95%CI: 1.21-16.2), unable to walk 1 km (OR: 4.24; 95%CI: 1.37-13.1), and a low cognitive function identified as MMSE <24 (OR: 5.22; 95%CI: 1.98-13.8). The final model for prediction of "type 2" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 1.65; 95%CI: 1.32-2.06), a depressive mode indicated by a GDS short version score >5 (OR: 2.18; 95%CI: 1.23-3.88), a low cognitive function (OR: 2.72; 95% CI: 1.47-5.05), not having close friends (OR: 2.30; 95%CI: 1.08-4.87), and not having a walking or calisthetics habit (OR: 2.21; 95%CI: 1.26-3.86). CONCLUSIONS: Reduced physical and mental functioning contribute to the subsequent occurrence of "type 1" homeboundness. Additionally, psychosocial factors are independent predictors of "type 2" homeboundness. These results suggest that different public health strategies might be required for prevention of the different types of homeboundness in Japanese older adults.

[Prognosis of different types of homeboundness among community-living older adults: two-year prospective study].

PURPOSE: This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders. METHODS: Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n = 1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline. RESULTS: At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%) . As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE < 20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05[0.54-7.75] in the fully adjusted model). CONCLUSIONS: Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

Arterial pulse wave velocity as a marker of poor cognitive function in an elderly community-dwelling population.

BACKGROUND: Knowledge about potentially modifiable risk factors for cognitive decline is limited at this time. The aim of this study was to determine the cross-sectional relationship between a low level of cognitive function and brachial-ankle pulse wave velocity (baPWV) in a community-dwelling elderly population. METHODS: The study population included 352 community-dwelling Japanese persons ages 70 years and older who participated in a comprehensive health examination in April 2003. None had any history of cardiovascular disease. In addition to conventional medical examinations such as blood pressure and routine blood analyses, cognitive function was tested using the Mini-Mental State Examination (MMSE), and baPWV was determined using a recently developed noninvasive and automatic arterial waveform analyzer (AT-Form). This measure, with well-established validity and reproducibility, reflects both central and peripheral arterial flow. A multivariate logistic regression model tested the possible association between poor cognitive function (an MMSE score < 24) and baPWV. RESULTS: Poor cognitive function was independently associated with the middle tertile of baPWV (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 1.15 to 80.93), age (1-year increment; OR = 1.12, 95% CI = 1.04 to 1.22), and the highest tertile of pulse pressure (OR = 4.70, 95% CI = 1.08 to 20.48) even after multivariate adjustment of data for the effects of age, educational level, and hemodynamic and metabolic antecedents of atherosclerosis. CONCLUSIONS: A high baPWV may be a potent risk factor for poor cognitive function in an elderly community-dwelling population, and this effect is independent of another marker of arterial stiffness: pulse pressure.

Glycated hemoglobin levels and intellectual activity in an aged population.

OBJECTIVES: To examine the association between glycated hemoglobin (GHb) and aspects of daily activities in an elderly population. DESIGN: Cross-sectional population-based survey. SETTING: Nangai village, an agricultural community with a population of about 5,000 located in Akita prefecture in the north of Japan. PARTICIPANTS: Nine hundred thirty-five people aged 65 and older. MEASUREMENTS: GHb percentages, self-reported measures of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), intellectual activity (IA), and social role (SR). RESULTS: An exploratory analysis indicated that nondiabetic subjects in the lowest tertile of GHb tend to have lower IA than those in the middle tertile, if they were aged 70 and older. No consistent association appeared between GHb and ADLs, IADLs, or SR. Linear and logistic regression analyses, controlling for other risk factors, indicated significantly lower IA scores in the low and high GHb tertiles (P<.001 and P=.04, respectively) than in the middle in nondiabetic subjects aged 70 and older and without stroke history or IADL impairments. The value of GHb related to the maximal IA score was 5.0% to 5.2% as the middle tertile; or 5.2%, assuming a logistic regression model including a squared term with GHb as a continuous variable. A similar relationship was observed in the whole nondiabetic sample aged 70 and older but not in the younger counterpart. CONCLUSION: There is an inverted U-shaped relationship between GHb and intellectual activity in older people without diabetes mellitus. One possible interpretation is that suboptimal blood glucose could contribute to intellectual inactivity in older people.

Relationships between brachial-ankle pulse wave velocity and conventional atherosclerotic risk factors in community-dwelling people.

BACKGROUND: A simple instrument has been developed to measure brachial-ankle pulse wave velocity (baPWV). The aim of the present study was to use this instrument to study the relationship between baPWV and conventional atherosclerotic risk factors. METHODS: Community-dwelling Japanese (632) living in a rural area (234 men and 398 women) participated in a municipal medical health survey that included baPWV measurement and a traditional clinical examination, conducted in June, 2002. RESULTS: Men had a significantly higher baPWV than women. No interaction between gender and age on baPWV was identified. Multiple linear regression analysis indicated that age, hemodynamic factors (diastolic blood pressure, pulse pressure, and heart rate), hemoglobinA1c, current drinking and smoking status, and mild retinal changes had significant independent influences on higher baPWV. CONCLUSIONS: In this rural population, age, gender, and hemodynamic factors were independently associated with baPWV, along with traditional atherosclerotic risk factors, although no significant associations between baPWV and histories of atherosclerotic diseases or subclinical atherosclerosis except for mild retinal changes were demonstrated.