[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

[Intervention effects of inclusive support in an "exercise and a nutritional community-based prevention program" for pre-frail elderly individuals].

OBJECTIVES: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care). METHODS: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention. RESULTS: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study. CONCLUSION: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

[Examination of effects of alfacalcidol vitamin D supplement and renal function on improvement in the physical fitness of pre-frail elderly persons attending a nursing care prevention class].

AIM: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people. METHODS: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m(2)) was calculated using a new formula. Alfacalcidol 1 µg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed. RESULTS: The prevalence of eGFR <60.0 ml/min/1.73 m(2) was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)(2)D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests. CONCLUSIONS: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

[Factors affecting burden of caregivers for the elderly of Han Chinese and the Korean minority living in a community in northeast China].

UNLABELLED: Objective In the People's Republic of China (China), caregivers carry a large burden because of the rapid aging of the population, the one-child policy and the uncertainty of the social security system. The situation is further complicated by the fact of 56 ethnic groups in the country. Few studies on caregiver burden in different ethnic groups have been reported, although different customs, cultures and methods of caring for the elderly do certainly exist. The aim of the present study was to compare the caregiver burden for the elderly among Han Chinese and the Korean Minority living in a community and to examine the factors affecting this burden. METHODS: An investigation was conducted using a questionnaire for 76 pairs of elderly people and their caregivers in Yanji City, China (Korean Minority pairs 52, Han pairs 24). The questionnaires for the elderly included their characteristics, economic conditions, ADL, behavioral disturbances associated with dementia, etc. For the caregivers, their characteristics, the state of their health, daily length of care time, social support, intent to continue home care, and Zarit Caregiver Burden Interview (ZBI) score were investigated. RESULTS: The rate (70.8%) of caregivers with a "high caregiver burden," i.e., those with a median ZBI total score of 33 or more, and the personal strain scores of the Han Chinese were significantly higher than in the Korean Minority. As for who was a suitable caregiver, a high percentage of Han caregivers answered the "children" of the elderly, while Korean Minority caregivers answered the "spouses". When the caregiver was a child of the elderly receiving care, the Hans' ZBI score was higher than that for the Korean Minority. Factors most affecting caregiver burden in the Korean Minority were behavioral disturbances associated with dementia of the elderly, ADL, and degree of life independence of the elderly, along with disorders, sex and health state of the caregivers, relations, length of daily care time, number of vice-caregivers, and social support. Factors affecting caregiver burden in the Han group were the presence of private rooms for the elderly, their life satisfaction and family economic conditions. About 80% of caregivers of both groups had the intention to continue home care, and about 50% of the elderly of both groups answered that entering an institution was not acceptable. CONCLUSION: Factors affecting caregiver burden differ between these two ethnic groups, although in both cases about 80% of caregivers intend to continue home care. Therefore, it is necessary to support the elderly and caregivers in ways that suit their ethnic characteristics.

[A functional fitness test battery for pre-frail older adults (so-called "specified elderly individuals")].

BACKGROUND: In Japan, an exercise program for pre-frail older adults (so-called "specified elderly individuals") (SEIs) has been prescribed under the newly developed long-term care insurance system. Three functional fitness measures (grip strength, one-leg balance with eyes open, and 5-m habitual walk) are used in the system; however, it has yet to be determined if applying these measures to SEIs is appropriate. PURPOSE: The purpose of this study was to develop a new test battery assessing functional fitness for SEIs, and to determine cross-validity and responsiveness of these measures. METHODS: One hundred and twenty seven SEIs (76.6 +/- 5.9 yr) and 315 healthy older adults (HOAs) (72.2 +/- 5.8 yr) completed twelve functional fitness tests related to activities of daily living (ADL) and mobility. The SEI was defined by the Japanese Ministry of Health, Labour and Welfare in 2005. The test battery items were selected by logistic regression analysis. A functional fitness score (FFS) equation was developed by principal component analysis. The cross-validity of the FFS equation was then tested using a different set of 28 SEIs (77.5 +/- 6.5 yr) and 143 HOAs (71.5 +/- 4.7 yr). Responsiveness of the FFS was also assessed in 62 SEIs (76.7 +/- 5.9 yr) after a 3-month exercise program. RESULTS: The following 4 test items were selected for assessment of functional fitness in SEIs: tandem stance, 5-repetition sit-to-stand, alternate step, and timed up and go. Applying principal component analysis to the 4 selected functional fitness items, the first principal component was interpreted as total functional fitness. The following equation was developed to estimate FFS based on the first principal component coefficient of each variable: FFS = 0.031X1-0.106X2-0.192X3-0.096X4 + 1.672, X1 = tandem stance(s), X2 = 5-repetition sit-to-stand (s), X3 = alternate step(s), X4 = timed up and go(s). The cut-off value to distinguish SEIs from HOAs using receiver operating characteristic ROC) curve was 0.065 (sensitivity 82.2%, specificity 81.9%). The cross-validity and responsiveness of the FFS equation was considered acceptable. CONCLUSION This newly developed test battery should be a useful tool for comprehensively evaluating functional fitness in SEIs.