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.

Social participation in the neighborhood community prevents onset of disability in community-dwelling older adults whose life space with activities is limited: A 2-year prospective cohort study.

AIMS: For older adults with limited life space and activity, social participation in the neighborhood community is essential to ensure social interaction and activity levels. This study examined the association between social participation in the neighborhood community and the onset of disability in older adults with different life spaces and activities. METHODS: The participants were 9513 older adults from a cohort study conducted at the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes (NCGG-SGS). Social participation in the neighborhood community was assessed by participating in the community meetings. Life space with activities was evaluated using the Activity Mobility Index (AMI) developed in the NCGG-SGS, with higher scores indicating better mobility and movement. The participants were divided into four groups based on the quartiles of their AMI scores (Q1-Q4). Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for disability incidence by social participation in each quartile. RESULTS: Over the 2-year follow-up period, disability occurred in 4.3% of the participants (n = 409). In the Q1 group, participants who participated in the neighborhood community had a significantly lower risk of developing a disability than those who did not (HR, 0.47; 95% CI, 0.28-0.76). There were no significant differences in onset of disability between the presence and absence of social participation for groups Q2, Q3, and Q4. CONCLUSIONS: Social participation in the neighborhood community was associated with the onset of disability in the lowest life space group. Social participation within a limited life space with activities may prevent disability onset. Geriatr Gerontol Int 2024; 24: 609-618.

Estimating the Effect of Engagement in Community-Based Going-Out Program on Incidence Disability in Older Adults.

OBJECTIVES: Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults. DESIGN: Longitudinal, observational study. SETTING AND PARTICIPANTS: Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score-matching scheme. METHODS: After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio. RESULTS: Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67). CONCLUSIONS AND IMPLICATIONS: This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities.

Association of objectively measured physical activity with incidence disability in older adults with/without social isolation.

PURPOSE: This study aimed to investigate association between objectively measured physical activities with incidence disability in older adults with and without social isolation. METHODS: This 5-year longitudinal observational study used a population-based study from a sub-cohort of the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome. In Japan, Incident disability is defined as a new case of public insurance certification for long-term care. As participants, we enrolled 5,257 community-dwelling older adults aged ≥ 70 years. The Participants on whom incomplete baseline physical activity assessments were performed; who required long-term care; had a history of dementia, Parkinson's disease, stroke, or depression; who lacked independence in basic ADL; who had Mini-Mental State Examination scores; or who had missing measurements; were excluded. Thus, 2,071 participants were included. RESULTS: Of the participants, 1,183 non-socially isolated participants had 151 (4.3%) cases of disability, while socially isolated participants had 150 (13%) cases. Cox proportional-hazards regression analysis presented the adjusted hazard ratio (HR) and 95% confidence interval (95%CI) of daily steps and low-intensity and moderate-to-vigorous physical activities-0.62(0.43-0.89), 0.84(0.60-1.18), 0.62(0.43-0.89) in participants with social isolation, and 0.58(0.40-0.85), 0.86(0.60-1.24), 0.70(0.49-1.01) in those with social isolation. CONCLUSIONS: Daily steps were significantly associated with a decreased risk of incidence disability, regardless of social isolation. These results suggest the greater importance of daily physical activity than its specific intensity in socially isolated older adults.

Association between dietary diversity and cognitive impairment in community-dwelling older adults.

AIM: The present study aimed to examine whether dietary diversity is associated with cognitive impairment, including mild cognitive impairment (MCI), in community-dwelling older Japanese adults. METHODS: This cross-sectional study was carried out in a general community setting. MCI and global cognitive impairment (GCI) were assessed using the Mini-Mental State Examination and National Center for Geriatrics and Gerontology-Functional Assessment Tool, which are multicomponent neurocognitive tests that include memory attention, executive function and processing speed. Dietary diversity was assessed using the diet variety score. The diet variety score assessed the 1-week consumption frequency of 10 food groups, and either 0 or 1 point was allocated to each category based on the following responses: (i) "eat almost every day" (1 point); and (ii) "not eaten almost daily" (0 points). Older adults with a diet variety score of ≥3 points were defined as having high dietary diversity. RESULTS: Data included 8987 older adults (mean age 73.9 ± 5.5 years; men 44.3%). The overall prevalences of MCI and GCI were 17.1% (n = 1538) and 8.4% (n = 753), respectively. The proportion of patients with a high dietary diversity was 69.9% (n = 6286). Multinomial logistic regression analysis revealed high dietary diversity was associated with MCI (OR 0.83, 95% CI 0.73-0.94) and GCI (OR 0.77, 95% CI 0.65-0.92) after adjusting for covariates. CONCLUSIONS: This study had a large sample size of older Japanese adults, and showed that high dietary diversity was associated with a lower proportion of MCI and GCI among older adults. Geriatr Gerontol Int 2024; 24: 75-81.

Cross-sectional associations between sedentary time with cognitive engagement and brain volume among community-dwelling vulnerable older adults.

AIMS: Vulnerable older adults tend to decrease physical activity (PA) and increase sedentary time (ST). Previous research on the associations between ST and brain volume have yielded inconsistent findings, without considering the impact of cognitive engagement (CE) on cognitive function. We aimed to examine the association between ST with CE and brain volume. METHODS: A structural magnetic resonance imaging survey was conducted among community-dwelling vulnerable older adults. Brain volumetric measurements were obtained using 3T magnetic resonance imaging and pre-processed using FreeSurfer. ST with low or high CE was assessed using a 12-item questionnaire. PA was assessed by the frequency of light and moderate levels of physical exercise according to the Japanese version of the Cardiovascular Health Study criteria. Participants were categorized into a low PA group and a moderate-to-high PA group. RESULTS: Among 91 participants (83.1 ± 5.2 years old, 61.5% female), 26 were low PA. The overall sample and moderate-to-high PA group did not show significant positive associations with brain volume for ST with high CE. In the low PA group, isotemporal substitution models showed that replacing ST with low CE by ST with high CE was significantly associated with increased brain volume in some areas, including the rostral and caudal anterior cingulate (ß = 0.486-0.618, all P < 0.05, adjusted R2 = 0.344-0.663). CONCLUSIONS: Our findings suggest that replacing ST with low CE by ST with high CE is positively associated with brain volume in vulnerable older adults with low PA. Geriatr Gerontol Int 2024; 24: 82-89.

Urinary incontinence and life-space activity/mobility additively increase the risk of incident disability among older adults.

OBJECTIVES: To examine the associations of a combination of urinary incontinence (UI) and life-space activity/mobility with the risk of incident disability among community-dwelling older adults. STUDY DESIGN: The participants were 12,808 older adults for the cross-sectional study and 12,516 older adults who completed the follow-up assessment. MAIN OUTCOME MEASURES: UI was assessed using a questionnaire. Life-space activity/mobility was evaluated using total, physical, and social scores on the Active Mobility Index (AMI). Participants were classified into four groups (high AMI total score + no UI; high AMI total score + UI; low AMI total score + no UI; low AMI total score + UI). Incident disability was extracted from the Japanese Long-Term Care System. RESULTS: During the 24-month follow-up, 562 participants (4.5 %) developed disability. Those with a low AMI score + no UI (hazard ratio, 1.35; 95 % confidence interval, 1.07-1.71) and those with a low AMI score + UI (hazard ratio, 2.00; 95 % confidence interval, 1.56-2.56) had a higher risk of incident disability than those with a high AMI score + no UI in the follow-up analysis. CONCLUSIONS: A combination of UI and low AMI score was associated with an increased risk of incident disability, whereas having UI but a high AMI score was not associated with an increased risk of incident disability. Our findings may help identify older adults at high risk of developing disabilities.

Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study.

BACKGROUND: Sarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia. METHOD: Participants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: "eat almost every day" (1 point), or "not eaten almost daily" (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months). RESULTS: The cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47-0.92; p = 0.015), after adjusting for covariates. CONCLUSIONS: This longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

Effect of driving training on car crashes and driving skills in older people: A systematic review and meta-analysis.

The primary aim of this systematic review was to examine the efficacy of driving interventions with regard to a reduction in motor vehicle crashes and improvements in driving skills among older people. The secondary aim was to identify the optimal type (on-road or off-road) and dosage (period, sessions, and duration) of driving interventions for improving driving skills in older people. We searched MEDLINE, EMBASE, PsycINFO, and Scopus of Systematic Reviews for papers published from their inception to December 1, 2020, as well as the reference lists of the included papers. The selected studies were randomized controlled trials examining the effects of driving interventions among community-dwelling older drivers aged 65 years and over. A meta-analysis of two studies (n = 960) showed that driving interventions significantly reduced the number of motor vehicle crashes per person-years. Ten studies (n = 575) were included in the meta-analysis showing that the interventions significantly improved the driving skill scores. Driving skill scores significantly improved after on-road training, and in interventions of at least 3 h, 3 sessions, and 3 weeks. Driving interventions significantly improve driving skills and reduce motor vehicle crashes among older drivers aged 65 years and over. On-road training is more efficacious than off-road training and driving interventions of at least 3 h taking place in 3 sessions over a period of 3 weeks may be required to improve driving skills in older drivers. Geriatr Gerontol Int 2023; 23: 771-778.

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.

Overlapping status of frailty and fear of falling: an elevated risk of incident disability in community-dwelling older adults.

BACKGROUND: Although overlapping frailty and fear of falling (FoF) are likely to increase with population aging, the combined effect of frailty and FoF on incident disability is not yet well understood. AIMS: The purpose of this study is to examine whether frailty combined with FoF increased the risk of incident disability in older adults. Our secondary purpose was to clarify the synergistic effect of frailty and FoF on incident disability. METHODS: This is a prospective study. Participants were 9372 older adults (mean age 73.5 years). Frailty status was assessed using the Japanese Cardiovascular Health Study index, and FoF was measured using two closed questions. Incident disability was prospectively monitored by their long-term care insurance records. RESULTS: During the follow-up period (mean duration 23.4 months), 487 (5.2%) participants developed disability. The proportion of incident disability linearly increased according to FoF level regardless of baseline frailty status. Frail participants with FoF had a higher risk of incident disability than those with frailty only or neither (adjusted hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.95-3.54). Frailty in combination with excessive FoF further increased the risk of incident disability (adjusted HR 4.30, 95% CI 2.56-7.23) although no synergistic effect was observed (relative excessive risk due to interaction 1.69, 95% CI - 0.55, 3.93). CONCLUSION: The overlapping status of frailty and FoF, especially excessive FoF, increases the risk of incident disability in older adults.

Self-Monitoring of Physical, Cognitive, and Social Activities and 2-Year Disability Onset in Community-Dwelling Older Adults.

OBJECTIVES: Self-monitoring of physical, cognitive, and social activities may be a means of helping older adults to adopt or maintain an active lifestyle, but its effect on disability onset is unknown. This study aimed to examine the association between self-monitoring of the activities and disability onset in older adults. DESIGN: Longitudinal, observational study. SETTING AND PARTICIPANTS: General community setting. Participants were 1399 older adults aged ≥75 years (mean age: 79.3 ± 3.6 years; 48.1% female). METHODS: Participants conducted self-monitoring of physical, cognitive, and social activities using a specialized booklet and a pedometer. Level of engagement in self-monitoring was assessed based on the percentage of days in a year for which activities were recorded: no-engagement group (0% of days recorded; n = 438), midlevel-engagement group (0.1-89.9% of days recorded; n = 416), and high-engagement group (≥90% of days recorded; n = 545). Disability onset was determined by whether the participants were awarded a long-term care insurance certification over the 2 years after the explanation of the booklet and pedometer. RESULTS: Cox proportional hazard regression models showed that the high-engagement group, when compared to the no-engagement group, had a significantly reduced hazard ratio (HR) for disability onset, after adjustment for covariates (HR 0.54, 95% CI 0.34-0.86, P = .010). After propensity score adjustment through inverse probability of treatment weighting (IPTW) and propensity score matching (PSM), the high-engagement group's HR remained significantly lower (IPTW: HR 0.54, 95% CI 0.34-0.86, P = .010; PSM: HR 0.58, 95% CI 0.35-0.96, P = .032). CONCLUSIONS AND IMPLICATIONS: Self-monitoring of physical, cognitive, and social activities reduces the risk of 2-year disability onset in community-dwelling older adults. Further studies in other settings are needed to examine whether self-monitoring of activities can be a population approach for the primary prevention of disability in other settings.

Association between dietary diversity and sarcopenia in community-dwelling older adults.

OBJECTIVES: The aim of this study was to examine whether dietary diversity is associated with sarcopenia in community-dwelling older Japanese adults. METHODS: We used a cross-sectional large cohort data set from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Data from 9080 older adults (mean age 74 ± 5.6 y; 44.4% were men) were included in this cross-sectional study. Sarcopenia was assessed using muscle mass, muscle strength, and physical performance represented by gait speed. We assessed 1-wk consumption frequency of food types, including meat, fish/shellfish, eggs, milk, soybean products, green and yellow vegetables, potatoes, fruits, seaweeds, fats, and oil. Consumption frequency was allotted to each category for the following responses: eat almost every day, eat 3 or 4 /wkd, eat 1 or 2 d/wk, and hardly ever eat. Poor dietary diversity was defined as those who responded hardly ever eat for any of the 10 foods. RESULTS: This study revealed that 2647 participants (29.2%) had poor dietary diversity. Poor dietary diversity was associated with confirmed sarcopenia (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08-1.96) and severe sarcopenia (OR, 1.58; 95% CI, 1.08-2.39). Furthermore, poor dietary diversity of low-protein foods was significantly associated with sarcopenia (OR, 1.57; 95% CI, 1.13-2.20) as well as poor dietary diversity of high-protein foods (OR, 1.47; 95% CI, 1.12-1.92). CONCLUSIONS: This cross-sectional study revealed that poor dietary diversity was associated with sarcopenia among older adults. Ingestion of low-protein foods and high-protein foods is infrequently associated with sarcopenia and ingestion of high-protein foods.

Associations between Active Mobility Index and objectively measured physical activity among older adults.

BACKGROUND: Active mobility index (AMI) is a questionnaire to assess going-out behavior with physical and social activity. The association between AMI scores and objectively measured physical activity (PA) in older adults is unknown. METHODS: Community-dwelling older adults aged ≥ 70 years participated in an examination and wore a triaxial accelerometer for seven or more days. The accelerometer measured the time of moderate-to-vigorous intensity PA (MVPA) and light intensity PA (LPA), and step counts. The AMI assessed life space (distance from the respondent's home: < 1, 1-10, or > 10 km) and related activities during the previous month. The AMI total, physical, and social scores were calculated. RESULTS: The analyzed data were 2499 participants (mean age: 75.5 ± 4.0 years; 54.4% female). Comparing PA among quartile groups of each AMI score, higher AMI total and physical score groups were associated with higher MVPA, LPA, and step counts (all P < 0.01). The Q4 group of AMI social scores showed significantly higher LPA and step counts than the Q1 and Q2 groups (P < 0.01). The logistic regression model showed higher score groups of AMI total and physical scores associated with increased adjusted odds ratio (aOR) of meeting recommended PA, ≥ 150 min/week of MVPA. CONCLUSIONS: Older adults with higher AMI total and physical scores, engaged in more PA. Future studies can use the present findings when estimating PA in older adults from AMI scores and examining the association between AMI scores and health outcomes.

The association of white matter hyperintensities with motoric cognitive risk syndrome.

Background: The motoric cognitive risk syndrome (MCR) was characterized by slow gait and subjective cognitive complaints. MCR was associated with brain structural changes. However, the association between white matter hyperintensities (WMH) and MCR was unclear and the aim of this study was to examine this association. Material and methods: The study participants were 1227 older adults (mean age: 72.0 ± 6.0 yrs, women: 52.6%). We collected magnetic resonance imaging (MRI) data to assess WMH. To assess MCR, data on gait speed and subjective cognitive complaints were collected. Demographical and medical data was collected as covariates. Results: Among participants, the proportion of MCR was 5.0% (n = 61) and severe WMH was 16.8% (n = 206). From logistic regression analysis, severe WMH associated with MCR even when adjusted for covariates (odds ratio 2.18 [95% confidential interval 1.15-4.16], p = 0.017). This association was observed in subgroups stratified by the participants' characteristics: higher age, not having fall history, not obesity, not being physical inactivity and not having depressive symptom. Conclusions: Our findings revealed that vascular pathophysiological changes in the brain were associated with MCR. The association was pronounced by several factors. Further evaluation was required to clarify pathophysiology of MCR.

Relationship between Diabetes Status and Sarcopenia in Community-Dwelling Older Adults.

OBJECTIVES: Diabetes mellitus (DM) is associated with risk of sarcopenia. However, whether glycated hemoglobin (HbA1c) levels are associated with sarcopenia has not reached a consensus. The purpose of this study was to examine the association between diabetes status based on HbA1c levels and sarcopenia indices in community-dwelling older adults stratified by body mass index (BMI) status. DESIGN: An observational cross-sectional study. SETTING AND PARTICIPANTS: General community setting. The participants were 18,940 community-dwelling older adults (mean age 73.7 ± 5.7 years, 45.0% men). METHODS: According to their medical history for diabetes mellitus and blood HbA1c levels the participants were classified into the control group (no DM history and HbA1c ≤5.6%), pre-DM group (no DM history and HbA1c 5.7%-6.4%), or DM group (DM history or HbA1c ≥6.5%). For assessments of sarcopenia, muscle mass and muscle strength were measured based on the clinical definition. RESULTS: A multiple logistic regression analysis showed that the DM group did not have a clear association with sarcopenia [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.82-1.38] or low muscle mass (OR 1.15, 95% CI 0.94-1.39), and was associated with low muscle strength (OR 1.21, 95% CI 1.08-1.36) in the adjusted model including BMI. There was a positive correlation between BMI and skeletal muscle index (r = 0.57, P < .001). Stratified by BMI, the DM group was associated with low muscle mass among the underweight participants (OR 1.87, 95% CI 1.03-3.39), and low muscle strength among the overweight participants (OR 1.22, 95% CI 1.04-1.43). CONCLUSIONS AND IMPLICATIONS: Diabetes status was associated with low muscle mass and low muscle strength, and the association depended on BMI. Our findings could be helpful for identifying older adults with a high risk of sarcopenia, although further study is needed.

Association between Active Mobility Index and sarcopenia among Japanese community-dwelling older adults.

BACKGROUND: A physically active lifestyle, including physical and social activities, is needed to maintain muscle mass, strength, and physical performance. A large life space characterizes an active lifestyle, but the association between life space with physical and social activities and sarcopenia is unclear. This study aimed to examine the association between life space with physical and social activities, assessed using the Active Mobility Index (AMI), and sarcopenia in community-dwelling Japanese older adults. METHODS: This study used a large, cross-sectional cohort dataset from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS). Between 2013 and 2018, community-dwelling Japanese adults aged ≥60 years participated in the NCGG-SGS. Sarcopenia was identified by measuring muscle mass and strength based on the clinical definition. The secondary outcomes were sarcopenia indices, including lower muscle mass, lower muscle strength, and lower gait speed. AMI assessed life space with physical and social activities in each life space (distance from the respondent's home: <1, 1-10, or >10 km) during the past month by noting the frequency, primary purpose, type of transportation, interaction with others, and physical activity. The associations between quartile groups of AMI total, physical, and social scores and sarcopenia were examined using a logistic regression model. RESULTS: From all participants, 21 644 participants (age 73.5 ± 5.8 years, 54.7% female) were included in the analysis. The prevalence of sarcopenia was 4.1% (n = 894). For the AMI total score, referred to Q1 group, Q3 and Q4 groups were significantly associated with a reduced odds ratio (OR) of sarcopenia after adjusting for all covariates [adjusted OR (aOR) (95% confidence interval), Q3: 0.71 (0.57-0.89), Q4: 0.69 (0.55-0.87)]. Q3 and Q4 of the AMI physical score groups were also significantly associated with reduced OR of sarcopenia [Q3: 0.71 (0.57-0.89), Q4: 0.67 (0.54-0.84)]. For the AMI social score, only the Q4 group showed reduced OR for sarcopenia [0.79 (0.62-1.01)]. Q3 and Q4 of the AMI total score and physical score were associated with reduced OR of all sarcopenia indices (aOR 0.55-0.82, all P < 0.05), whereas Q4 of AMI social score was associated with all indices (aOR 0.85-0.81, all P < 0.05). CONCLUSIONS: The extent of life space with physical activity was associated with sarcopenia in community-dwelling older adults. A longitudinal study is needed to examine whether life space with physical and social activities affect the development of sarcopenia.

Associations Between Active Mobility Index and Disability.

OBJECTIVES: To develop a questionnaire-based Active Mobility Index (AMI) to assess going-out behavior with physical and social activity among older adults, and to assess the criterion-related and predictive validity of the AMI. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)]. METHODS: AMI assessed life-space and activities in each life-space (distance from the respondent's home: <1 km, 1-10 km, or >10 km) according to physical or social activity during the past 1 month by noting frequency, purpose, type of transportation, interaction with others, and physical activity. Baseline characteristics and outcomes were compared by AMI score quartiles (highest: Q4). To examine the criterion-related validity of AMI, depressive symptoms, frailty, and cognitive function were assessed. During follow-up, incident disability was monitored by Long Term Care Insurance certification. RESULTS: Lower scores (Q1-Q3 groups) were associated with more depressive symptoms, frailty, and cognitive impairment compared with the Q4 group (all P < .001). Multiple logistic regression analyses revealed significantly higher odds ratios in the Q1 group in all health adverse outcomes compared with the Q4 group [depressive symptoms, odds ratio (OR) 3.94, 95% confidence interval (CI) 2.95-5.28; frailty, OR 3.20, 95% CI 2.31-4.44; cognitive impairment, OR 1.28, 95% CI 1.04-1.57]. Cox proportional hazards modeling indicated that the Q1 group had a higher risk of incident disability compared with the group (hazard ratio 1.53, 95% CI 1.24-1.88). CONCLUSIONS AND IMPLICATIONS: AMI to assess life-space with physical and social activity among older people was associated with depressive symptoms, frailty, and cognitive impairment. Lower AMI scores were associated with higher incident disability risk. Further studies are needed to elucidate whether AMI is causally associated with incident adverse health outcomes.

Development of a Questionnaire to Evaluate Older Adults' Total Sedentary Time and Sedentary Time With Cognitive Activity.

This study aimed to develop a questionnaire for evaluating total sedentary time (ST) and ST with cognitive activity, and to examine the association between ST and cognitive function among Japanese older adults. The questionnaire to evaluate ST comprised 12 items regarding behavior in specific settings, including 8 items on ST with cognitive activity, in a usual week. Older adults aged ≥75 years who participated in a health check-up assessing cognitive function completed the developed questionnaire and subsequently wore an accelerometer and recorded a diary of ST with cognitive activity for a week as validity measures. Cognitive function was assessed with neuropsychological tests covering 4 domains: memory, attention, executive function, and processing speed. Fifty-two participants were included in the validity analysis. Spearman's correlation coefficient indicated fair-to-good agreement between the questionnaire-measured and the diary-measured time for ST with cognitive activity (r = 0.59, p < 0.001), but this was not the case for total ST. Bland-Altman plots showed that the questionnaire-measured total ST contained proportional bias (r = 0.51, p < 0.001). Multiple regression analysis (n = 49) showed longer questionnaire-measured ST with cognitive activity was significantly associated with better neuropsychological test scores (attention: ß = -0.38, p = 0.025; executive function: ß = -0.46, p = 0.003; and processing speed: ß = 0.31, p = 0.041), while total ST was not associated with better cognitive performance. The developed questionnaire showed acceptable validity to measure ST with cognitive activity, which was found to be protectively associated with cognitive function.

The Association of Sleep Habits and Advancing Age in Japanese Older Adults: Results from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes.

BACKGROUND: The association of sleep habits with "advancing age among older adults" is not fully understood. OBJECTIVES: The purpose of the present study was to examine the association of sleep habits with advancing age among community-dwelling older adults in Japan. METHODS: A total of 18,005 older people (mean age: 73.2 ± 6.0 years; 8,070 men and 9,935 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analyzed. Participants were asked in face-to-face interviews about the times they usually go to bed, fall asleep, wake-up, and get up. The amount of time spent in bed and self-reported sleep duration were then calculated from the differences between these times. As other parameters, the subjects were also asked about sleep latency, time spent in bed after waking up, number of nocturnal awakenings, and duration of napping in a typical day. RESULTS: The results of the Jonckheere-Terpstra test showed that all sleep parameters shifted to an earlier time (going to bed, falling asleep, waking up, and getting out of bed), longer duration (sleep duration, time spent in bed, sleep latency, time spent in bed after waking up, and napping), or more nocturnal awakenings with advancing age (all p < 0.01). Among the men, the time of waking up was not significantly associated with age, while among the women, the time of getting up was not significantly associated with age. CONCLUSION: These results from a large cohort show the age-related trends of sleep habits in community-dwelling older adults in Japan. Our results revealed that a longer duration and earlier timing of sleep are associated with advancing age.