TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J.

OBJECTIVE: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. DESIGN: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. SETTING: The ILSA-J studies were conducted on community-living older adults. PARTICIPANTS: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. MEASUREMENTS: The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss. RESULTS: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. CONCLUSIONS: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

Factors related to dissociation between objective and subjective masticatory function in Japanese community-dwelling elderly adults.

Clinicians' evaluations of older adults sometimes reveal inconsistencies between objective and subjective dental status. This study investigated which factors contribute both to good objective masticatory function (OMF) and the poor subjective masticatory function (SMF) that often becomes a clinical issue. Study participants included 635 elderly community-dwelling Japanese adults who underwent a comprehensive geriatric health examination in 2012. SMF was assessed with a question from the Kihon Checklist on eating difficulties (poor or good). OMF was assessed by a colour-changing gum (poor or good). Also investigated were age, sex, depressive symptoms, instrumental activities of daily living (I-ADLs), number of people who joined the participant at dinner, grip strength, usual walking speed, number of remaining teeth, number of functional teeth and their occlusal force. The group with good OMF and good SMF, defined as group 1, and the group with good OMF but poor SMF, group 2, were compared. Logistic regression analyses confirmed that the number of remaining and functional teeth participants had was statistically unrelated to differences between OMF and SMF. Instead, differences were related to stronger depressive symptoms (OR = 1.67, CI = 1.14-2.44), less ability to conduct I-ADL activities (OR = 0.73, CI = 0.59-0.91), slower usual walking speeds (OR = 0.18, CI = 0.06-0.58) and less occlusal force (OR = 0.99, CI = 0.99-1.00). Depressive symptoms, I-ADLs, and physical function are shown to be significantly related to divergence between objective and subjective masticatory function in elderly Japanese. This suggests that dissociations between objective and subjective dental evaluations of elderly adults indicate need for assessment of their mental and physical function.

Frailty Severity and Dietary Variety in Japanese Older Persons: A Cross-Sectional Study.

Providing older person individuals with an appropriate intervention at the time of frailty onset is important to prevent the progression of the condition and the need for long-term care. However, the proper timing of starting nutritional and dietary interventions for frail older person subjects has not been fully elucidated. Therefore, in this cross-sectional study, we aimed to clarify the association between frailty and dietary variety among older persons in Japan. We surveyed sex, age, body height, body weight, body mass index, serum albumin level, dietary variety, and nutritional intake indexes in 747 community-dwelling older person individuals who underwent a comprehensive health examination in October 2014. Frailty was determined using the Kihon Checklist (25 questions). Kihon Checklist is widely used to assess frailty in Japan, and their physical, cognitive and social function was evaluated. After excluding those who did not complete the Kihon Checklist and those who required long-term care, frailty status was analyzed in 665 older person individuals. The numbers and percentages of frail, pre-frail and robust older persons were found to be 77 (11.6%), 182 (27.4%) and 406 (61.0%) respectively. Significant differences among robust, pre-frail, and frail subjects were observed in terms of age, serum albumin level, alcohol consumption, smoking, and history of diabetes. Among the nutrition-related indexes, only the dietary variety showed a significant difference. The results of ordinal logistic regression analysis showed a significant association between frailty and sex, age, smoking status, diabetes, and dietary variety score. Dietary variety was significantly associated with the progression of frailty among older persons in the community.

Relationship between Sensory Perception and Frailty in a Community-Dwelling Elderly Population.

BACKGROUND: Aging anorexia, defined as loss of appetite and/or reduced food intake, has been postulated as a risk factor for frailty. Impairments of taste and smell perception in elderly people can lead to reduced enjoyment of food and contribute to the anorexia of aging. OBJECTIVE: To evaluate the relationship between frailty and taste and smell perception in elderly people living in urban areas. DESIGN: Data from the baseline evaluation of 768 residents aged ≥ 65 years who enrolled in a comprehensive geriatric health examination survey was analyzed. Fourteen out of 29-items of Appetite, Hunger, Sensory Perception questionnaire (AHSP), frailty, age, sex, BMI, chronic conditions and IADL were evaluated. AHSP was analyzed as the total score of 8 taste items (T) and 6 smell items (S). Frailty was diagnosed using a modified Fried's frailty criteria. RESULTS: The area under the receiver operator curves for detection of frailty demonstrated that T (0.715) had moderate accuracy, but S (0.657) had low accuracy. The cutoffs, sensitivity, specificity and Youden Index (YI) values for each perception were T: Cutoff 26.5 (YI: 0.350, sensitivity: 0.639, specificity: 0.711) and S: Cutoff 18.5 (YI: 0.246, sensitivity: 0.690, specificity: 0.556). Results from multiple logistic regression models, after adjusting for age, sex, IADL and chronic conditions showed that participants under the T cutoff were associated with exhaustion and those below the S cutoff were associated with slow walking speed. The adjusted logistic models for age, sex, IADL and chronic conditions showed significant association between T and frailty (OR 2.81, 95% CI 1.29-6.12), but not between S and frailty (OR 1.73, 95% CI 0.83-3.63). CONCLUSIONS: Taste and smell perception, particularly taste perception, were associated with a greater risk of frailty in community-dwelling elderly people. These results suggest that lower taste and smell perception may be an indicator of frailty in old age.

In vitro investigation of molecules involved in Lactobacillus gasseri SBT2055 adhesion to host intestinal tract components.

AIMS: The adhesion ability of Lactobacillus gasseri SBT2055 was investigated in vitro by searching for its adhesion molecules. METHODS AND RESULTS: Lactobacillus gasseri SBT2055 showed adherence to host components, including two commercially available mucins, Caco-2 epithelial-like cells and the extracellular matrix molecule fibronectin (Fn). Its adhesion rates to host components were generally higher than those of other Lactobacillus strains. We examined sortase-dependent proteins (SDPs) anchored by a sortase enzyme encoded by srtA1. The adhesion rates of an srtA1 disruptant were lower than those of Lact. gasseri SBT2055, and the relative adherences were as follows: two mucins, 43 and 40%; Caco-2, 66% and Fn, 28%. Seven additional gene disruptants were generated to determine the precise SDPs that contribute to adhesion to each component. CONCLUSIONS: The adhesion ability of Lact. gasseri SBT2055 was superior to those of other Lactobacillus strains. Additionally, four adhesion molecules were newly identified from candidate SDPs. SIGNIFICANCE AND IMPACT OF THE STUDY: Although the contribution of SDPs to adhesion has been reported using sortase gene disruptants, this is the first report to identify the precise SDPs that act as adhesion molecules. Our results will contribute to achieving better understanding of probiotic bacterial adherence.

Screening for Malnutrition in Community Dwelling Older Japanese: Preliminary Development and Evaluation of the Japanese Nutritional Risk Screening Tool (NRST).

BACKGROUND: Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations. OBJECTIVE: This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II. PARTICIPANTS: The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people. MEASUREMENTS: Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People. RESULTS: The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST). CONCLUSIONS: These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.

Analysis of Compression Force in the Hip Joint during Impulsive Exercises: A Preliminary Study for Developing Exercise Protocol for Osteoporosis.

Past intervention studies on bone remodeling for preventing osteoporosis in elderly women often lack sufficient description of the intensity of the exercise, though bone remodeling is dependent on applied force at specific sites. The effectiveness of exercise in increasing bone density cannot be defined without sufficient description of the intensity and targeted site of the exercise. We conducted kinetic and kinematic analyses of the lower extremities in order to categorize exercise in terms of compression force applied at the proximal end of the femur, to formulate guidelines for prescribing exercise to elderly women. Thirty healthy women aged 18-24 participated in the study. Joint compression force at the proximal end of the femur was measured with the aid of motion analysis devices under several conditions of impulsive loading. Joint compression force at the proximal end of the femur was estimated for twenty-two exercise regimes varying from low to high-impact exercises, including jumping off, stepping down, vertical jumping, and dropping down after heel raises. Some exercises appear to be inappropriate for exercise intervention, because the variability for these exercises is high. Most of the jumping exercises, with coefficients exceeding 0.36, were excluded from further analysis. Of the remaining exercises, four were categorized as statistically different loads, as determined by a posthoc test of one-way analysis of variance of joint compression force. These included jumping off a 10 cm platform, stepping down from a 20 cm platform with the knees in the extended position, stepping down from a 20 cm platform with the knees in a relaxed position, and heel dropping at 80 cycles per minute with the knees in a relaxed position. The joint compression forces during these exercises were 2.32 ± .81, 1.81 ± .59, 1.45 ± .59, and 1.00 ± .27 times as much as the subject's body weight, respectively.

Assessment of anteroposterior instability of the knee during gait.

A noninvasive kinematic recording technique involving geometric modeling of the knee joint was employed to determine anteroposterior displacements of the knee during walking. The model estimated how much the femoral condyles slid and rolled on the tibial plateau. Movement not due to sliding or rolling was attributed to horizontal translation of the tibia with respect to the femur. Thirty normal adults participated in this study. A three-dimensional analysis system with noninvasive skin markers was employed to collect kinematic data of the femur and tibia during walking. Within-session and between-session reliabilities were high in the tested subjects. Normal subjects had an average of 5.5 mm of maximum anterior displacement of the tibia during stance phase of walking. These results differed neither between left and right knees, nor between men and women. Dynamic instability of the knee during walking can be reasonably measured by the proposed method in normal subjects.

Kinematic and electromyographic analysis of elbow flexion during inertial exercise.

Inertial exercise protocols are currently used clinically to improve and restore normal muscle function even though research to substantiate their effectiveness cannot be cited in the literature. The purpose of this study was to compare simultaneous kinematic and electromyographic (EMG) data obtained from 12 subjects during elbow flexion on the Impulse Inertial Exercise System. Testing sessions consisted of inertial exercise performed using phasic and tonic techniques with loads of: a) 0 kg, b) 2.27 kg, c) 4.54 kg, d) 6.80 kg, e) 9.07 kg. Greater peak angular velocities, peak platform accelerations (change in velocity of platform during elbow flexion), mean and peak triceps brachii muscle EMG activity, and less range of motion were observed during phasic exercise. There was also a general trend for peak angular velocities and peak platform acceleration to increase as the load decreased. No significant difference in mean or peak EMG activity of the biceps brachii muscle was seen between techniques. Clinicians and athletic trainers using inertial exercise should consider both the exercise technique and load characteristics when designing protocols to meet the specific needs of patients.