Effectiveness of a home hazard modification program for reducing falls in urban community-dwelling older adults: A randomized controlled trial.

AIM: To evaluate the potential improvement of fall prevention awareness and home modification behaviors and to decrease indoor falls by applying a home hazard modification program (HHMP) in community-dwelling older adults followed up to 1 year in this randomized controlled trial. METHODS: The present authors randomly assigned 130 older adults living in the Tokyo metropolitan region to either the HHMP intervention group (n = 67) or the control group (n = 63). Both groups received four, 2 h fall prevention multifactorial programs including education regarding fall risk factors, food and nutrition, foot self-care, and exercise sessions. However, only the HHMP group received education and practice regarding home safety by using a model mock-up of a typical Japanese home. RESULTS: The mean age of the HHMP group was 75.7 years and the control group 75.8. The HHMP group showed a 10.9% reduction in overall falls, and falls indoors showed an 11.7% reduction at 52 weeks. Those aged 75 years and over showed a significant reduction in both overall falls and indoor falls at 12 weeks. Fall prevention awareness and home modifications were significantly improved in the HHMP group. CONCLUSION: HHMP has the potential to improve fall prevention awareness and home modification behaviors, and specifically decreased overall and indoor falls in 12 weeks in those aged 75 years and older in community-dwelling older adults.

Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan.

Falls are a major public health problem and the second leading cause of death due to unintentional accidental injury after road traffic accidents. Inactive, older individuals with several chronic illnesses fall more frequently than older individuals who are active and healthy. No population-based study has addressed the association of stroke, arthritis, hypnotic and other prescription medications with falls among the elderly simultaneously in a single population in Japan. We examined the prevalence of falls among community-dwelling elderly Japanese individuals, whom we randomly selected from a list of inhabitants aged ≥ 65 years compiled from the resident registration, and the associations between falls and each of stroke, arthritis, and hypnotic and other prescription medications. We interviewed 295 men and 307 women, and collected information about the number of falls during the latest one year, hemiplegia due to stroke, arthritis in the legs, and the number of hypnotic and other medications. We found that 46 men (16%) and 67 women (22%) had fallen at least once during the latest one year. Logistic regression analysis adjusted for age showed that hemiplegia due to stroke (p < 0.001), arthritis in the legs (p < 0.001), and taking at least four daily prescription medications (p < 0.05) were significantly associated with falls in men. Arthritis in the legs (p = 0.05) and taking at least four daily prescription medications (p < 0.05) were associated with falls in women. Treatment of fall-related diseases and medication management are important strategies for reducing falls among elderly persons.

[Muscle and bone health as a risk factor of fall among the elderly. Fear of falling and the post-fall syndrome].

Fear of falling and the post-fall syndrome (fear-related activity restriction) are serious psychological symptoms associated with falls. This paper reported the definition and prevalence of fear of falling. Prevalence has yielded highly varying estimates due to the various definitions and instruments used to measure fear. Correlates of fear of falling by a longitudinal study were also described. As most of the research on fear of falling has been cross-sectional, more longitudinal studies are needed. As to the post-fall syndrome, definition and prevalence among community-dwelling elderly was discussed. It is difficult to measure general prevalence due to the lack of solid criteria of this syndrome.

Social support as a moderator in a fall prevention program for older adults.

This study examined the moderating effects of social support in a fall prevention program for community-dwelling older adults. Twenty-six Japanese older adults age 65 and older participated in a 2-month exercise program and were measured in anthropometrical, physical, and psychological functioning at baseline, 2 months (intervention termination), and 5 months (3 months after intervention termination). Analyses indicated that the program did not improve participants' body mass index, balance, or walking speed. However, participants'falls self-efficacy significantly increased from baseline to intervention termination and was maintained at a higher level at the 5-month postintervention follow up. This efficacy-improving effect was prominent in the participants who had received less social support at baseline. The findings emphasized the importance of considering participants' social resources and targeted intervention outcomes when evaluating the effect of exercise.

Distortion product otoacoustic emissions and tympanometric measurements in an adult population-based study.

OBJECTIVE: Otoacoustic emissions (OAEs) are useful clinical tools that can be used as a test to reflect hearing, especially cochlear function. When OAEs are recorded, the sound energy is conducted inwards and outwards through the middle ear system, but the degree to which the middle ear condition affects the OAEs level remains obscure. The objectives of the present study were to estimate the effect of the condition of the middle ear expressed by multifrequency tympanometry on the distortion product otoacoustic emissions (DPOAEs) adjusting for age and the corresponding pure-tone thresholds. SUBJECTS AND METHODS: The evaluation was conducted using 1,043 subjects without a history of ear disease or occupational noise exposure out of a population-based sample of 2,259 adults aged 40-82 years. Multifrequency tympanometry, DPOAEs, and pure-tone audiometry were administered. The resonance frequency (RF), static admittance (SA) and tympanometric peak pressure (PP) were taken as variables representing middle ear function. Subjects were categorized into three groups of variables < or = 5th percentile, between 5th and 95th percentile, and > or = 95th percentile. The signal-to-noise ratio in DPOAE levels were compared among three groups adjusting for age and the pure-tone threshold level. RESULTS: Both abnormally high and low RF exerted a negative effect on DPOAEs. Smaller RF values were related to smaller DPOAEs for the frequency around 1000 Hz, and greater RF values were related to smaller DPOAEs for the frequency around 4000 Hz. The tendency was similar between genders. Abnormally high SA had a negative influence on DPOAEs, while abnormally low SA had no significant effect on either gender. Smaller PP values were significantly related to smaller DPOAEs. CONCLUSIONS: We interpreted the findings of the present study as verification of the effect of the condition of the middle ear on DPOAEs after adjustment for age and the pure-tone threshold level, although ears out of normal range in tympanometric variables might conceivably include not only middle ear dysfunction but also inner ear abnormality. Tympanometric assessment must always be taken into account when OAEs are analyzed for an estimation of the cochlea function.

[Production of a fall prevention exercise programme considering suggestions from community-dwelling elderly].

OBJECTIVES: A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people. METHODS: A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls. RESULTS: A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants. CONCLUSIONS: This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.

Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese.

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.

[Characteristics of elderly leaders volunteering to participate in a fall prevention programme].

OBJECTIVES: This study was conducted to assess characteristics of elderly leaders volunteering to participate in a fall prevention programme. METHODS: We surveyed 1,503 individuals (75 elderly leaders volunteering to participate in a fall prevention programme and 1,428 non-leader elderly) among the elderly population living in a rural community, Miyagi Prefecture. Subjects were aged 70-84 years. The questionnaire covered socio-demographic factors, as well as physical, psychology and social variables. To analyze the characteristics of the elderly leaders volunteering to participate in this programme, the relationships of socio-demographic, physical, psychology and social factors to whether the elderly were leaders in the programme were analyzed using logistic regression. RESULT: As a result of multiple logistic regression analysis, the characteristics of elderly leaders volunteering to participate in the fall prevention programme were as follows; 1) being male (OR = 0.25, 95%CI 0.14-0.44); 2) young age (OR=0.43, 95%CI 0.25-0.73); 3) having a high intellectual activity (OR = 2.72, 95%CI 1.65-4.48); 4) being well satisfied with their health (OR = 1.45, 95%CI 1.02-2.07), and 5) having a high IKIGAI (OR = 1.06, 95%CI 1.01-1.13). CONCLUSION: Only elderly individuals capable of high-level intellectual activities can fill the roles of elderly volunteer group leaders discussed in this study.

Association of a -1997G-->T polymorphism of the collagen Ialpha1 gene with bone mineral density in postmenopausal Japanese women.

Genetic variants that affect collagen Ialpha1 metabolism may be important in the development of osteoporosis or osteoporotic fractures. A -1997G-->T polymorphism in the promoter of the collagen Ialpha1 gene (COL1A1) was shown to be associated with bone mineral density (BMD) for the lumbar spine in postmenopausal Spanish women. The relation of this polymorphism to BMD in Japanese women or men has now been examined in a population-based study. The subjects (1,110 women, 1,126 men) were 40 to 79 years of age and were randomly recruited for a population-based prospective cohort study of aging and age-related diseases. BMD for the lumbar spine, right femoral neck, right trochanter, and right Ward's triangle was measured using dual-energy x-ray absorptiometry. Genotypes for the -1997G-->T polymorphism of COL1A1 were determined with a fluorescence-based allele-specific DNA primer assay system. When all women were analyzed together, BMD for the lumbar spine and trochanter was significantly lower in subjects with the COL1A1 *G/*G genotype than in those in the combined group of COL1A1 *G/*T and COL1A1 *T/*T genotypes. When postmenopausal women were analyzed separately, BMD for the femoral neck and trochanter was also significantly lower in those with the COL1A1 *G/*G genotype than in those with the COL1A1 *G/*T genotype or those in the combined group of COL1A1*G/*T and COL1A1 *T/*T genotypes. BMD was not associated with -1997G-->T genotype in premenopausal women or in men. Multivariate regression analysis revealed that -1997G-->T genotype affected BMD at various sites with a variance of 0.46-0.62% for all women and 0.61-1.01% for postmenopausal women. The -1997G-->T genotype was not related to the serum concentration of osteocalcin, the serum activity of bone-specific alkaline phosphatase, or the urinary excretion of deoxypyridinoline or cross-linked N-telopeptides of type I collagen in men or in premenopausal or postmenopausal women. These results suggest that COL1A1 is a susceptibility locus for reduced BMD in postmenopausal Japanese women.

[The effects of bereavement of friends on depression in adulthood: age and family support as moderators].

The purpose of this longitudinal study was to examine the moderating effects of age and social support from family members in the relationship between the bereavement of friends and depression. The participants were 1 402 Japanese community-dwelling men and women aged between 40 and 79 years, who had done the baseline and the two-year follow-up surveys of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). By using hierarchical multiple regression analysis, we detected a significant interaction between age, social support from family members, and the bereavement of friends. Younger participants who were receiving less support from family members after the loss of friends showed significantly higher depression scores.

Is there a relevant effect of noise and smoking on hearing? A population-based aging study.

The objectives of the present study were to evaluate both the respective and combined effects of occupational noise exposure and smoking on hearing, taking age into consideration. The evaluation was conducted using 1478 subjects without a history of ear disease out of a population-based sample of 2267 adults, aged 40 79 years. Pure-tone audiometry and a questionnaire were administered. A deleterious effect of noise exposure on hearing was significantly observed in both genders at many frequencies after adjustment for age, income, and education. The smoking habit alone significantly affected hearing deterioration at 4000 Hz in noise-unexposed males. The combined effect of noise and smoking was not interactive but additive. A dose-response effect of smoking on hearing loss was observed in middle-aged males without noise exposure. Smoking and noise exposure were associated with hearing loss respectively.. This result is noteworthy for the preservation of good hearing especially at the beginning of aging.

Relationship between astigmatism and aging in middle-aged and elderly Japanese.

PURPOSE: To study the effect of aging on astigmatism in adult Japanese. METHODS: Measurements of refractive errors and keratometry were performed on 2161 randomly selected subjects (aged 40-79 years). The relation between age and the net value in diopters (D) of astigmatism was evaluated with a trend test. The relation between age and the polar value was also examined by linear regression analysis. RESULTS: The mean (+/-SD) value of total and corneal astigmatism was -0.97 +/- 0.72 D and -0.86 +/- 0.63 D, respectively, and the net value of both increased with age (P trend < 0.001). The prevalence of either type of astigmatism also increased with age, according to the Cochran-Mantel-Haenzel test (P < 0.0001 for total and P < 0.01 for corneal astigmatism). The prevalence of against-the-rule astigmatism increased with age for either type of astigmatism (P < 0.0001 for total, P < 0.0001 for corneal). According to the analysis of polar values by age, the regression coefficient (+/-SE) for total and corneal astigmatism was -0.024 +/- 0.002 (P < 0.0001) and -0.028 +/- 0.002 (P < 0.0001), respectively. There was no statistical difference between these two regression coefficients. CONCLUSIONS: The prevalence of astigmatism increases and the axis turns to against-the-rule with age. The result of the linear regression analysis indicates that the age-related change in astigmatism is mainly associated with changes in the cornea.

Cholecystokinin A receptor gene promoter polymorphism and intelligence.

PURPOSE: To study the association between Cholecystokinin A receptor (CCKAR) genotypes and intelligence in community-living men and women. METHOD: Subjects were 2251 community-dwelling Japanese men and women aged 40 to 79 years. The CCKAR gene promoter polymorphisms A-81G and G-128T were determined. Intelligence was assessed by Japanese Wechsler Adult Intelligence Scales - Revised Short Forms (JWAIS-R SF). The difference in intelligence between wild type and mutation was tested. RESULTS: There were no subjects with AA/GT, AA/TT, or AG/TT genotypic combinations. Both A-81G and G-128T genotypes were related to intelligence quotient (IQ) estimated by JWAIS-R SF. The mean and SE of IQ levels of subjects with the wild-type allele and the mutation allele at nucleotide -128 were 103.4 +/- 0.3 and 101.6 +/- 0.6, respectively. There was a significant difference in IQ for G-128T (p=0.008). The difference in IQ for A-81G was also significant (p=0.011). The IQ level was 103.6 +/- 0.4 in the subjects with the wild-type allele and 102.0 +/- 0.5 in the subjects with the mutation. Differences in IQ levels by haplotypes for combinations of A-81G/G-128T were examined. IQ significantly decreased with an increasing number of mutation alleles (p=0.018). CONCLUSION: There were statistically significant differences in IQ for CCKAR gene promoter polymorphisms A-81G and G-128T in community-living Japanese.

Association of polymorphisms of the androgen receptor and klotho genes with bone mineral density in Japanese women.

Genetic variants of the androgen receptor and klotho protein may contribute to variation in bone mass as well as to predisposition to osteoporosis. The relationship of a CAG repeat polymorphism of the androgen receptor gene (AR) and of a -395G-->A polymorphism of the klotho gene (KL) to bone mineral density (BMD) in Japanese women was examined in a population-based study. The subjects (1,101 and 1,110 women for AR and KL polymorphisms, respectively) were aged 40-79 years and were randomly recruited to a population-based prospective cohort study of aging and age-related diseases. BMD for the total body, lumbar spine, right femoral neck, right trochanter, and right Ward's triangle was measured by dual-energy X-ray absorptiometry. Genotypes for the AR and KL polymorphisms were determined by polymerase chain reaction based assays. The number of CAG repeats of AR was inversely correlated with BMD for the lumbar spine in premenopausal women but not in postmenopausal women. The (CAG)(n/=23) alleles were designated S and L, respectively. Among premenopausal women, BMD for the total body was significantly lower in subjects with the LL genotype than in those with the SS genotype or those in the combined group of SS and SL genotypes. In contrast, BMD was not associated with AR genotype in postmenopausal women. Among all women, BMD for the lumbar spine was significantly lower in subjects with the GG genotype of the -395G-->A polymorphism of KL than in those with the AA genotype. BMD was not associated with -395G-->A genotype among premenopausal women. In postmenopausal women, BMD for the total body or lumbar spine tended to be lower in subjects with the GG genotype than in those with the AA genotype or those in the combined group of GA and AA genotypes. These results suggest that AR is a susceptibility gene for reduced BMD in premenopausal Japanese women, and that KL is a susceptibility gene for reduced BMD in all women.

Association of cholecystokinin 1 receptor and beta3-adrenergic receptor polymorphisms with midlife weight gain.

We investigated the relationship of polymorphisms in the cholecystokinin 1 receptor [CCK1R; G to T (n-128), A to G (n-81)] and the beta3-adrenergic receptor (beta3-AR; Trp64Arg) with midlife weight gain. The participants were 1012 Japanese men and women (40 to 59 years of age). Their weight at 18 years old was obtained from a questionnaire. Weight change was defined as the current weight minus the weight at 18 years old. Subjects were grouped into four categories by these genotypes: W/W=noncarriers, W/H=Arg64 carriers of the beta3-AR, H/W=T (n-128) or G (n-81) carriers of the CCK1R, H/H=T (n-128) or G (n-81) and Arg64 carriers. In men, the interaction between the CCK1R and beta3-AR polymorphisms was significant (two-way ANOVA, p < 0.05), but neither the CCK1R nor the beta3-AR was individually associated with weight gain. The H/H group showed a higher possibility of weight gain of 10 kg or more compared with the W/W group in men. The odds ratio for weight gain (> or =10 kg) of H/H was 2.54 (95% confidence interval: 1.50 to 4.30) compared with W/W. In women, neither main effect nor interaction was significant. These results suggest that the combination of CCK1R and the beta3-AR polymorphisms is a contributing factor for midlife weight gain in men.

Age differences in the effect of physical activity on depressive symptoms.

This study examined associations between physical activity and depressive symptoms in 1,151 community-dwelling adults in Japan. Physical activity was measured using a pedometer, whereas depressive symptoms were assessed with the Center for Epidemiological Studies-Depression Scale. A structural equation modeling with a cross-lagged panel design revealed that for the older adults (65-79 years of age), daily walking at baseline predicted fewer depressive symptoms at the 2-year follow-up, even after adjusting for confounders. In contrast, the association was not confirmed for the middle-aged adults (40-64 years of age). Findings suggest that age should be considered when estimating the effect of physical activity on psychological well-being.

Japanese orthopedists' interests in prevention of fractures in the elderly from falls.

The aim of the present study was to survey the interest of Japanese orthopedists in preventing fractures in the elderly, and investigate their awareness with regard to main prevention strategies such as medications and hip protectors. From the list of 20,899 members of the Japanese Orthopedic Association, we randomly selected a sample of 2035 people. Each orthopedist was sent an anonymous survey consisting of 12 questions during July to August 2001. At that time, risedronate, raloxifene, and parathyroid hormone had not been approved for clinical use in Japan, and even alendronate had just been approved. Of the survey forms sent, 1011 responses were received, for a response rate of 50%. Analysis of these responses showed a very high interest in osteoporosis, fractures in the elderly from falls, and the prevention of such fractures. This interest was associated with physician age, with those above the age of 50 years being 2.3 times more likely to have an interest in each of these than physicians below that age. The respondents considered the most promising measure for the prevention of fractures in the elderly from falls to be fall prevention, followed by exercise and osteoporosis medications. The medication considered to be effective as a monotherapy by the overwhelming number of respondents was bisphosphonates, followed by vitamin D3 and calcitonin. Combination agents cited were vitamin D3, bisphosphonates, and calcitonin, in that order. Forty-two percent of respondents had some knowledge of hip protectors, but confidence in them as a means to prevent fractures was still low. The practical information from our survey should serve as a starting point for comparison to periods when new bisphosphonates or hip protectors become commonly available to Japanese orthopedists. The overall results indicate that Japanese orthopedists are very positive toward fracture prevention.

Visual acuity in a community-dwelling Japanese population and factors associated with visual impairment.

PURPOSE: The aim of this study was to describe the distribution of visual acuity and investigate the predictors of visual impairment in a Japanese population. METHODS: Best-corrected visual acuity was measured in 2263 subjects aged 40-79 years randomly selected from a local community. Relations between visual impairment and possible risk factors were investigated. RESULTS: Among these subjects, 41 individuals (1.8%) were identified as visually impaired (best-corrected visual acuity in the better eye <0.5). Both sexes in the older age groups had a higher frequency of visual impairment (Mantel-Haenszel chi-square test: P<0.001). A multiple logistic regression indicated that an increase in age of 10 years [odds ratio (OR) 3.9; 95% confidence interval (CI) 2.3-6.7] and myopia (OR 2.9; 95%CI 1.4-6.0) were independent risk factors for visual impairment. Individuals with the highest level of education (college or higher) had a lower risk of visual impairment (OR 0.1; 95%CI 0-0.7) compared to individuals with the lowest level of education. CONCLUSIONS: As expected, visual impairment increased with advancing age, although the prevalence of visual impairment in our population was lower than in other surveys. Racial and regional differences and differences in study design may be responsible for discrepancies between surveys. It is noteworthy that myopia was a significant risk factor for visual impairment, although the reasons for this association are uncertain and need further investigation.

Association of a polymorphism of the matrix metalloproteinase-9 gene with bone mineral density in Japanese men.

Matrix metalloproteinase-9 (MMP-9) is implicated in bone remodeling. A - 1562C--> T polymorphism in the promoter of the MMP-9 gene (MMP9) has been shown to influence gene transcription. The possible relation of this polymorphism to bone mineral density (BMD) was examined in 1,114 Japanese men and 1,087 women. BMD for the total body, lumbar spine, femoral neck, trochanter, or Ward's triangle was significantly lower in the combined group of men with the CT or TT genotypes or in men with the CT genotype than in those with the CC genotype. No significant differences in BMD among MMP9 genotypes were observed in premenopausal or postmenopausal women. The -1562C-->T polymorphism of MMP9 was thus associated with BMD in Japanese men.

The impact of health problems on depression and activities in middle-aged and older adults: age and social interactions as moderators.

In this study, we compared the impact of health problems (HPs) on everyday activities and depressive symptoms between middle-aged and older adults. We also examined what type and source of social interactions moderate the noxious effects of HPs. Longitudinal analyses of data with 1,802 Japanese community-dwelling adults indicated that HPs were significantly related to (a) an increase in depressive symptoms among middle-aged adults and (b) a decline in everyday activities among older adults. The former was buffered by emotional family support, whereas the latter (b) was buffered by instrumental family support and, surprisingly, by negative interactions with family. In contrast, social interactions with other friends and acquaintances did not show any moderating effect.