Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES.

Few studies have focused on a relationship between the built environment and musculoskeletal pain. This study aimed to investigate an association between neighborhood walkability and knee and low back pain in older people. Data were derived from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based study of independently living people ≥65 years old. A cross-sectional multilevel analysis was performed, of 22,892 participants in 792 neighborhoods. Neighborhood walkability was assessed by residents' perceptions and population density. Dependent variables were knee and low back pain restricting daily activities within the past year. The prevalence of knee pain was 26.2% and of low back pain 29.3%. After adjusting for sociodemographic covariates, the prevalence ratio (PR) of knee and low back pain was significantly lower in neighborhoods with better access to parks and sidewalks, good access to fresh food stores, and higher population densities. After additionally adjusting for population density, easier walking in neighborhoods without slopes or stairs was significantly inversely correlated with knee pain (PR 0.91, 95% confidence interval 0.85-0.99). Neighborhoods with walkability enhanced by good access to parks and sidewalks and fresh food stores, easy walking without slopes or stairs, and high population densities, had lower prevalences of knee and low back pain among older people. Further studies should examine environmental determinants of pain.

[The Comprehensive Geriatric Assessment predicts healthy life expectancy better than health checkups in older people: JAGES cohort study].

AIM: In Japan, the Kihon checklist, which a useful part of the Comprehensive Geriatric Assessment (CGA), is performed using questionnaire. On the other hand, specific health checkup screens are available for some basic diseases, such as diabetes and dyslipidemia, which can cause stroke, the largest cause of long-term care need. However, to date, no report has compared CGA and health checkups in older people for their ability to predict healthy life expectancy; therefore, this study was undertaken to do that. METHODS: Data from the Japan Gerontological Evaluation Study (JAGES) 2010, a self-administered mail survey of independent people aged 65 years or older, were used. A total of 9,756 participants in six cities responded to the questionnaire, underwent a health check, and were followed up for 3 years.Cox proportional hazards models were used to estimate hazard ratios (HR) for the eventual need for long-term care level 2 or more or death, adjusting for sex, age, drinking or smoking habits, educational years, and equivalent income. Explanatory variables in the Kihon checklist included seven risks, namely, general frailty, functional disability, malnutrition, oral dysfunction, seclusion, cognitive impairment, and depression, and in specific health checkups, 15 required items including metabolic syndrome. RESULTS: The incident rate of long-term care level 2 or more or death was 19.4/1,000 person-years. All risks in the Kihon checklist, excluding oral dysfunction, were significant (range of HRs: 1.44-3.63). Six items in the specific health checkups (urine protein, low BMI, AST, HDL, FPG, and HbA1c) were significant (range of HRs: 1.37-2.07). Metabolic syndrome was not significant (HR: 1.05). CONCLUSIONS: Therefore, CGA performed using questionnaire predicts healthy life expectancy better than a health checkup based on a blood test.