[Changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years].

Objective　This study aims to identify changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years in order to help with prevention and recovery from being homebound.Methods　A survey on needs in the sphere of daily life was conducted in July 2011 among 6,696 independent older adults in 10 regions of Kameoka City (baseline survey). Of the 6,696 adults, 1,379 responded to the survey and participated in a physical checkup held between March and April 2012. These individuals were then invited to a similar checkup again in September 2013. Of these, 638 consenting individuals were administered a questionnaire survey (follow-up survey). In all, 522 subjects responded to both surveys (baseline and follow-up) regarding being homebound. The responses involved basic attributes, state of daily living, state of health, items of the Kihon Checklist, items concerning daily living activities in the baseline survey, and items concerning being homebound in the follow-up survey. The responses were analyzed, and an evaluation of homebound status was conducted based on whether or not one (or both) of the two items of the Kihon Checklist were applicable. The subjects were classified according to the following: 1) whether non-homebound individuals remained non-homebound (non-homebound group) or whether they became homebound (homebound transition group) and 2) whether individuals who became homebound recovered (recovery group) or remained the same (persisting group). After comparing the characteristics of each group, a logistic regression analysis was employed to analyze the factors related to changes in homebound status after two years.Results　Of the 375 non-homebound individuals in the baseline survey, 326 (86.9%) and 49 (13.1%) were classified into non-homebound and homebound transition groups, respectively. Of the 147 subjects who became homebound, 85 (57.8%) and 62 (42.2%) were classified into the recovery and persisting groups, respectively.　Among the factors related to change in homebound status after two years, a low score of social role (OR=0.675, CI=0.458-0.997) was an independent factor for being at risk of becoming homebound (P<0.05). Having no diseases under treatment (OR=14.340, CI=1.345-152.944) and a high intellectual activity score (OR=2.643, CI=1.378-5.069) were independent factors of recovery from being homebound (P<0.05).Conclusion　The results of the two year longitudinal study suggest the need for support for non-homebound older individuals devoid of social roles to prevent homebound status. Additionally, there is a need for support surrounding the reduction in obtaining a disease and maintaining intellectual activity in order to recover from being homebound.

Sociodemographic and physical predictors of non-participation in community based physical checkup among older neighbors: a case-control study from the Kyoto-Kameoka longitudinal study, Japan.

BACKGROUND: It is difficult to obtain detailed information on non-participants in physical and health examination checkups in community-based epidemiological studies. We investigated the characteristics of non-participants in a physical and health examination checkup for older adults in a nested study from the Japanese Kyoto-Kameoka Longitudinal Study. METHODS: We approached a total of 4831 people aged ≥65 years in 10 randomly selected intervention regions. Participants responded to a mail-based population survey on needs in the sphere of daily life to encourage participation in a free face-to-face physical checkup examination; 1463 participants (706 men, 757 women) participated in the physical checkup. A multiple logistic regression model was performed to investigate the adjusted odds ratios (aOR) of non-participation based on sociodemographic status apart from psychological and physiological frailty as assessed by the validated Kihon Checklist. RESULTS: There was a significant, inverse relationship between non-participation and frequently spending time alone among individuals who lived with someone or other family structure (aOR = 0.53, standard error [SE] 0.08 in men, aOR = 0.66, SE 0.09 in women). Very elderly (over 80 years old) women, poorer health consciousness and current smoking in both sexes and poor self-rated health in men, were significantly related to higher non-participation rates. In both sexes, individuals who did not participate in community activities were significantly more likely to be non-participants than individuals who did (aOR = 1.94, SE 0.23 in men, aOR = 3.29, SE 0.39 in women). Having low IADL and physical functioning scores were also associated with higher rates of non-participation. CONCLUSION: Health consciousness and lack of community activity participation were predictors of non-participation in a physical checkup examination among older adults. In addition, lower IADL and physical functioning/strength were also predictors of non-participation. On the contrary, older inhabitants living with someone tended to participate in the physical checkup examination for social interchange when they were frequently alone in the household. This study suggests the importance of considering aging especially for women and poor sociodemographic background and physical frailty for both sexes so that older people can access health programs without difficulty. TRIAL REGISTRATION: UMIN000008105 . Registered 26 April 2012. Retrospectively registered.

[Fall risk factors and sex differences among community-dwelling elderly individuals in Japan. A Kameoka study].

OBJECTIVES: Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city. METHODS: A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role. RESULTS: Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men. CONCLUSION: One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

[Physical fitness and depression symptoms in community-dwelling elderly women].

OBJECTIVES: The aim of this study was to examine the relationship between geriatric depression scale (GDS) score and elements of physical fitness in community-dwelling, healthy, elderly women in Japan. METHODS: This cross-sectional study involved a total of 886 healthy elderly women (aged 265 years) living in Kyoto prefecture. Women voluntarily participated in physical performance tests. One-leg standing time, leg power, knee extension strength, grip strength, endurance capacity, trunk flexion, usual and maximal gait speed, chair stand, chair stepping, and functional reach were examined as fitness tests. A 15-item GDS and a battery of health status questionnaires were used to assess mental and physical health status. RESULTS: Of the participants, 21.1% had a GDS score of > or = 5 and were categorized as the depression group (D group). Leg power, knee extension strength, endurance capacity, gait speed, and chair stepping ability were significantly lower in the D group than in the non-depression group (GDS score < 5; ND group). After adjustment for physical characteristics, eating habits, and physical activity levels as co-variances, leg power, knee extension strength, and endurance capacity remained significantly lower in the D group than in the ND group (P < 0.05). CONCLUSION: A considerable number of active, healthy, elderly women who voluntarily participated in this study reported depressive symptoms. Reduced leg power, knee extension strength, and endurance capacity were associated with depressive symptoms independently of physical activity levels. These results suggest that exercise intervention to increase leg strength and endurance capacity may improve depressive symptoms in elderly women.

Constructing an index of physical fitness age for Japanese elderly based on 7-year longitudinal data: sex differences in estimated physical fitness age.

A standardized method for assessing the physical fitness of elderly adults has not yet been established. In this study, we developed an index of physical fitness age (fitness age score, FAS) for older Japanese adults and investigated sex differences based on the estimated FAS. Healthy elderly adults (52 men, 70 women) who underwent physical fitness tests once yearly for 7 years between 2002 and 2008 were included in this study. The age of the participants at the beginning of this study ranged from 60.0 to 83.0 years. The physical fitness tests consisted of 13 items to measure balance, agility, flexibility, muscle strength, and endurance. Three criteria were used to evaluate fitness markers of aging: (1) significant cross-sectional correlation with age; (2) significant longitudinal change with age consistent with the cross-sectional correlation; and (3) significant stability of individual differences. We developed an equation to assess individual FAS values using the first principal component derived from principal component analysis. Five candidate fitness markers of aging (10-m walking time, functional reach, one leg stand with eyes open, vertical jump and grip strength) were selected from the 13 physical fitness tests. Individual FAS was predicted from these five fitness markers using a principal component model. Individual FAS showed high longitudinal stability for age-related changes. This investigation of the longitudinal changes of individual FAS revealed that women had relatively lower physical fitness compared with men, but their rate of physical fitness aging was slower than that of men.

Proximal electrode placement improves the estimation of body composition in obese and lean elderly during segmental bioelectrical impedance analysis.

Bioelectrical impedance analysis (BIA) is an affordable, non-invasive, easy-to-operate, and fast alternative method to assess body composition. However, BIA tends to overestimate the percent body fat (%BF) in lean elderly and underestimate %BF in obese elderly people. This study examined whether proximal electrode placement eliminates this problem. Forty-two elderly men and women (64-96 years) who had a wide range of BMI [22.4 +/- 3.3 kg/m(2) (mean +/- SD), range 16.8-33.9 kg/m(2)] and %BF (11.3-44.8%) participated in this study. Using (2)H and (18)O dilutions as the criterion for measuring total body water (TBW), we compared various BIA electrode placements; wrist-to-ankle, arm-to-arm, leg-to-leg, elbow-to-knee, five- and nine-segment models, and the combination of distal (wrists or ankles) and proximal (elbows or knees) electrodes. TBW was most strongly correlated with the square height divided by the impedance between the knees and elbows (H(2)/Z (proximal); r = 0.965, P < 0.001). In the wrist-to-ankle, arm-to-arm, leg-to-leg, and five-segment models, we observed systematic errors associated with %BF (P < 0.05). After including the impedance ratio of the proximal to distal segments (P/D) as an independent variable, none of the BIA methods examined showed any systematic bias against %BF. In addition, all methods were able to estimate TBW more accurately (e.g., in the wrist-to-ankle model, from R(2) = 0.90, SEE = 1.69 kg to R(2) = 0.94, SEE = 1.30 kg). The results suggest that BIA using distal electrodes alone tends to overestimate TBW in obese and underestimate TBW in lean subjects, while proximal electrodes improve the accuracy of body composition measurements.