Comparative Analysis of Frailty Risk and Associated Factors: Community-Based vs. Open Recruitment Groups.

BACKGROUND: Frailty leads to vulnerability to stress, impaired daily functioning, and an increased need for care. Frailty is considered reversible, and it is crucial to detect the risk of frailty early and investigate factors that may delay its progression. OBJECTIVES: To identify tests that can explain frailty risk and compare the situation of local residents with and without frailty support. METHODS: Participants were recruited in two ways: through public advertisements in Akita City (open recruitment group) and through invites from frailty supporters in their immediate communities (community-based group). We examined the differences in frailty risk and oral, motor, and social functions between the two groups and identified factors associated with frailty risk in both groups. RESULTS: The community-based group exhibited a lower risk of frailty than the open recruitment group despite having more older members on average. Additionally, the community-based group demonstrated better social functioning than the open-recruitment group. Furthermore, factors such as oral diadochokinesis (ODK), one-leg stand test (OLS), and grip strength (GS) showed significant association with frailty risk. CONCLUSION: The ODK, OLS, and GS were identified as factors explaining frailty risk, and Frailty Supporters may reduce the risk of frailty.

Impact of the COVID-19 pandemic on the primary lung cancer screening program in Akita Prefecture, a region with the fastest aging population in Japan.

AIM: Akita Prefecture has the largest proportion of older inhabitants and the highest cancer mortality rate in Japan. Lung cancer is one of the biggest killers, and early detection is critical. Chest X-ray examinations are the main screening method for lung cancer; however, the COVID-19 pandemic has affected the screening system. Here, we evaluate how COVID-19 has affected lung cancer screening in Akita Prefecture. METHODS: Using the Akita General Health Corporation database, the average annual number of chest X-ray screening tests, close examinations and lung cancer diagnoses (stratified by sex and age) was evaluated during 2016-2019, and compared with the 2020 values. Furthermore, data on lung cancer registrations from 2018 to 2020 were obtained from the Collaborative Akita Prefecture Hospital-Based Cancer Registration System and analyzed. RESULTS: The average annual number of screening tests, close examinations and lung cancer diagnoses declined (by >50%) between 2016 to 2019 and 2020, especially among older people (aged ≥65 years). Furthermore, by stage, the number of patients with early-stage lung cancer (stage 0-I) decreased, and the number with advanced-stage cancer (stage IV) increased. CONCLUSIONS: The COVID-19 pandemic reduced lung cancer screening participation, especially among the older adult population in Akita Prefecture, resulting in a decrease in lung cancer diagnoses through screening. This might have reduced the number of early-stage cancer registrations. It is necessary to improve health education among the public regarding the importance of chest X-ray screening. Geriatr Gerontol Int 2023; 23: 622-627.

Effect of a multicomponent programme based on reality orientation therapy on the physical performance and cognitive function of elderly community-dwellers: a quasi-experimental study.

BACKGROUND: Effects of a multicomponent exercise programme have an impact on the physical, cognitive, and psychological domains in elderly community-dwellers. However, some individuals aged 65 years or more have not shown positive effects after the intervention as reported in similar research. The objective of this quasi-experimental study was to clarify the effectiveness of a multicomponent programme based on reality orientation therapy (ROT) on the physical performance, cognitive ability, and psychological state in the elderly. METHOD: Participants were recruited from the general public in 20 areas of Akita Prefecture, Japan, and they took part in each exercise programme for 90 min a day, once every 2 weeks, for 3 months, according to the group classification using cluster randomization into 20 cohorts in Akita. Physical, cognitive, and geriatric depression assessments were performed at baseline and after the 3-month intervention in both the ROT-based intervention group and the control group. RESULT: The final samples for analysis consisted of 31 participants in the control group and 30 participants in the intervention group. The results of the statistical analysis comparing the two groups showed that the 5-repetition sit-to-stand test was performed significantly faster (P < 0.05) and that the results of the word list memory (WM) test and the Symbol Digit Substitution Task also had significantly improved (P < 0.05) after the intervention in both groups. The WM score did not show an interactive effect between the group and time factors, but it had a significant main effect on time in both groups (P < 0.05). CONCLUSION: The results of our quasi-experimental study indicated that the multicomponent programme based on the ROT would be as effective as the original multicomponent programme combined with aerobic exercise and cognitive tasks, as highlighted in the WM.

Initial symptoms of early-onset dementia in Japan: nationwide survey.

AIM: The aim of this study was to investigate initial symptoms of early-onset dementia (EOD) for each dementia subtype. METHOD: We conducted a nationwide, population-based EOD prevalence study in Japan. Data were collected through service providers for people with EOD. Initial symptoms were assessed in six domains: loss of memory, difficulty in word generation, irritability, loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed. RESULTS: Participants were 770 people with EOD. Characteristic initial symptoms were observed for each EOD subtype. Loss of memory was more common in early-onset Alzheimer's disease (75.7%, P < 0.001), difficulty in word generation was more common in early-onset vascular dementia (41.3%, P < 0.001), and loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed were more common in early-onset frontotemporal dementia (34.9%, P < 0.001; 49.4%, P < 0.001; 34.9%, P < 0.001, respectively). In addition, we observed gender differences whereby loss of memory was more common among women and irritability was more common among men. More than half of the participants were employed at symptom onset, and 57.2% of those who were employed at the onset had initial symptoms of increased mistakes in the workplace or domestically. CONCLUSION: This report reveals differences in the frequency of initial symptoms by EOD subtype. The results contribute to increasing public awareness of the initial symptoms of EOD, which will facilitate early diagnosis and social support.

[An examination of the performance efficiency among dementia community support coordinators in Akita Prefecture].

AIM: To consider what is necessary to ensure the efficient performance of dementia community support coordinators. METHODS: In Akita Prefecture, we conducted a simple questionnaire survey of dementia community support coordinators in 25 municipalities to clarify the current status of their activities and examine what needs to be done to develop their projects more efficiently. RESULTS: It became clear that residents were not aware of the existence of these coordinators, underscoring the need to publicize their existence and activities. The lack of tools to improve the public's understanding of social resources for sharing information on building a support system was also demonstrated. In terms of cooperation, it was found that, despite the establishment of cooperation with IPIST and the medical center for dementia, cooperation with dementia support coordinators was insufficient. Furthermore, we confirmed that support coordinators were not very involved in the creation and activities of dementia care paths. CONCLUSIONS: Based on the above findings, we propose five points to support further efficient development. 1. Disseminate information to inform local residents about dementia community support coordinators, 2. Collaborate with dementia support coordinators and the welfare commissioner, 3. Create social resource maps and facilitate their understanding and establish dementia care path activities, 4. Create a work environment where dementia community support coordinators do not have to work concurrently, and 5. Create learning opportunities to improve understanding of the overall dementia policy.

Associations of fall history and fear of falling with multidimensional cognitive function in independent community-dwelling older adults: findings from ORANGE study.

BACKGROUND: Falls and fear of falling (FoF) inhibit healthy longevity and have been suggested to be associated with cognitive function. However, the domains of cognitive function that are associated with them remain controversial. It is speculated that clarifying this will help in the assessment of health status and interventions in the community. AIM: To analyse the associations between fall history and FoF and multidimensional cognitive function in independent community-dwelling older adults. METHODS: The data from 9759 (73.3 ± 5.4 years, 59.9% women) older individuals enrolled in the cross-sectional ORANGE study were analysed. Simple questions were used to assess fall history in the past year and current FoF. Assessments of multidimensional cognitive function were performed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) to evaluate memory, attention, executive function, and processing speed. The independent associations of fall history and FoF with multidimensional cognitive function were assessed using multivariate linear regressions adjusted for potential confounding variables. RESULTS: A total of 18.3% and 35.4% of participants presented with fall history and FoF, respectively. Fall history (p = 0.008) and FoF (p = 0.002) were significantly associated with memory. FoF, but not fall history was associated with attention (p = 0.004), executive function (p < 0.01), and processing speed (p < 0.01). CONCLUSION: In independent community-dwelling older adults, fall history was associated only with the memory domain; in contrast, fear of falling was associated with multidimensional cognitive function. This study provides weak evidence suggesting the need to assess falls and FoF in all situations involving independent community-dwelling older adults.

[Challenge to promote a city that is friendly for the elderly: A joint research "The Ageing in Place in Cities" between Manchester Urban Ageing Research Group, the University of Manchester, UK and Advanced Research Center for Geriatric and Gerontology (ARGG), Akita University, Japan].

In Japan, the ageing population is increasing, and the issue of "the declining birthrate and increasing ageing population", "population declining", and "extending healthy life expectancy" have been taken up in various academic fields, but they are still unsolved in the term of effective methods. Currently, in each region of Japan unlike big cities such as Tokyo and Osaka, there is the shortage of medical doctors, hospitals, living supportive infrastructure of roads, communications, public transportation, banks, post offices, and supermarkets, etc. All the necessary infrastructure is collapsing, and the current situation is becoming apparent in population declining villages of Japan. Will our country become more concentrated in big cities in the future? In particular, it is the elderly living in the community who are directly affected by these factors. In this article, we would like to introduce the history and recent activities of "Age-friendly cities and communities (AFCC)" led by the World Health Organization (WHO), and also introduce the efforts of "The Ageing in Place in Cities" project by Manchester Urban Ageing Research Group, the University of Manchester, UK, Akita City Hall, and Advanced Research Center for Geriatric and Gerontology (ARGG), Akita University, Japan.

A Pilot Survey: Oral Function as One of the Risk Factors for Physical Frailty.

BACKGROUND: The aim of this study was to examine the association of the multiple facets of oral, motor, and social functions in community-dwelling older adults, to identify factors that might influence the risk of frailty. METHODS: Of the 82 participants included in the study, 39 (5 males and 34 females) were young-old adults, with an average age of 70.5 ± 2.8 years, and 43 (14 males and 29 females) were old-old adults, with an average age of 78.7 ± 2.9 years. We assessed the risk factors for frailty among oral, motor, and social functions. RESULTS: Statistical analysis showed a significant difference in the oral diadochokinesis between the groups (p = 0.006). According to the Spearman correlation analysis, a significant association was observed with age and oral diadochokinesis (rs = -0.262, p = 0.018), and social support (rs = -0.219, p = 0.049). Moreover, binomial logistic regression analysis revealed a significant association of frailty with the occlusal force (odds ratio, 0.031; 95% confidence interval (95% CI), 0.002-0.430; p = 0.010), General Oral Health Index (odds ratio, 0.930; 95% CI, 0.867-0.999, p = 0.046), and availability of social support (odds ratio, 0.803, 95% CI, 0.690-0.934, p = 0.004). CONCLUSIONS: To prevent frailty at an early stage, assessments of oral functions, and also that of the availability of social support, are important.

The Effect of Deep Micro Vibrotactile Stimulation on Cognitive Function of Mild Cognitive Impairment and Mild Dementia.

Background: The purpose of this study was to clarify the effect of Deep Micro Vibrotactile (DMV) stimulation on the cognitive functions in elderly people with mild cognitive impairment or mild dementia. Methods: A total of 35 participants with dementia from three nursing homes, who had completed treatment with DMV stimulation at 15−40 Hz (hereinafter, 15−40 Hz DMV stimulation) for a month were recruited for this study. The subjects had received continuous 15−40 Hz DMV stimulation for 24 h a day for 1 month. We assessed the effect of the treatment on the cognitive functions (by the word list memory (WM) test, trail making test-part A (TMT-A) and part B (TMT-B), and symbol digit substitution task (SDST)) and physical functions (grip strength (GS) and usual walking speed (UWS)), by comparing the results at the baseline and after the 1-month intervention (DMV stimulation). Results: The results revealed that the performances in the WM test (p < 0.05), TMT-B (p < 0.05), and SDST (p < 0.01) improved significantly after the intervention. Conclusion: Our findings suggest that 15−40 Hz DMV stimulation is might be effective for improving the cognitive functions in elderly people with dementia. Furthermore, our novel findings showed the different effectiveness of the treatment depending on the stage of cognitive impairments.

[Factors influencing changes in daily life due to the state of emergency among older adults living in Akita Prefecture].

The present study is assessed the effects of COVID-19 on the mental and physical function after the declaration of an emergency situation, which included the request that residents refrain from going out, in order to prevent the spread of COVID-19 infection. The investigation was conducted from 2019 to 2020. Our samples consisted of 506 older adults (332 people in 2019 and 174 people in 2020), whose physical, cognitive, depression, and independence in daily and social activities were measured annually. Furthermore, a questionnaire survey (COVID-19 questionnaire) on the impact of the spread of COVID-19 infection on respondents' daily lives (reduction in social interaction, going out, exercise, and sleep time) was conducted among participants in 2020. According to a statistical analysis, the UWS (Usual Walking Speed) was significantly faster in 2020 than it had been in 2019 (p<0.000). However, no significant differences were found in other items. A correlation analysis, revealed a significant association between the reduction in sleep time and GDS-15 (Geriatric Depression Scale) score (r=0.200, p=0.019) and between the COVID-19 questionnaire total score and body mass index (r=0.282, p=0.001).These results suggest that the decline in the physical and mental function might not have been evident in older adults in Akita Prefecture, where the number of infected people is small, although a more detailed long-term follow-up is needed. Even in such areas, there might be a significant relationship between depression and sleep or between changes in daily life due to self-imposed restraint and obesity as an effect of self-imposed restraint among older adults.

Person-centered dementia care during COVID-19: a qualitative case study of impact on and collaborations between caregivers.

BACKGROUND: Little is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care. METHODS: This is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis. RESULTS: The interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were "re-acknowledgement of care priorities" and "rebuilding of relationships." When caregivers' perceptions were aligned in the decision-making processes regarding care priorities, "reaffirmation of trust" and "strengthening of intimate relationships" emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to "anxiety during COVID-19 pandemic" and caused a "gap in perception" regarding infection control. CONCLUSIONS: The present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.

Dasatinib plus quercetin attenuates some frailty characteristics in SAMP10 mice.

Senolytics are a class of drugs that selectively remove senescent cells. Dasatinib and quercetin have been discovered, and their combination has shown various anti-ageing effects. The SAMP10 mouse strain is a model of brain ageing. Here, we investigated the effect of combination on frailty characteristics in SAMP10. By comparing SAMP10 with SAMR1 mice as normal ageing controls, we investigated some frailty characteristics. Frailty was assessed at 18-38 weeks of age with a clinical frailty index. Motor and cognitive function of these mice were evaluated using behavioral experiments. SAMP10 mice were divided into vehicle and combination, and these functions and histological changes in the brain hippocampus were investigated. Finally, the in vitro effects of combination on oxidative stress-induced senescent muscle and neuronal cells were investigated. As a result, we found that frailty index was higher in SAMP10 than SAMR1. Motor and cognitive function were worse in SAMP10 than SAMR1. Furthermore, combination therapy improved frailty, motor and cognitive function, and the senescent phenotype of the hippocampus compared with vehicle in SAMP10. In summary, SAMP10 showed more marked frailty characteristics than SAMR1, and dasatinib and quercetin attenuated them in SAMP10. From our results, senolytic therapy might contribute protective effects against frailty.

Impact of COVID-19 Pandemic Exacerbation of Depressive Symptoms for Social Frailty from the ORANGE Registry.

BACKGROUND: Recent longitudinal studies have reported proportion of frailty transition in older individuals during the COVID-19 pandemic. Our study aimed at clarifying the impact of social frailty in community-dwelling older adults during the COVID-19 pandemic and at identifying factors that can predict transition to social frailty. METHODS: We performed this study from 2019 (before declaration of the state of emergency over the rising number of COVID-19 cases) to 2020 (after declaration of the emergency). We applied Makizako's social frail index to our study subjects at the baseline and classified into robust, social prefrailty, and social frailty groups. Multiple logistic regression analysis was performed using robust, social prefrailty, or social frailty status as dependent variable. RESULTS: Analysis by the Kruskal-Wallis test revealed significant differences in the score on the GDS-15 among the robust, social prefrailty, and social frailty groups (p < 0.05). Furthermore, multiple regression analysis identified a significant association between the social frailty status and the score on GDS-15 (odds ratio, 1.57; 95% confidence interval (95% CI), 1.15-2.13; p = 0.001). CONCLUSION: The increase in the rate of transition of elderly individuals to the social frailty group could have been related to the implementation of the stay-at-home order as part of the countermeasures for COVID-19. Furthermore, the increased prevalence of depressive symptoms associated with the stay-at-home order could also have influenced the increase in the prevalence of social frailty during the COVID-19 pandemic.

Social frailty is independently associated with geriatric depression among older adults living in northern Japan: A cross-sectional study of ORANGE registry.

AIM: To clarify prevalence of social frailty among older adults living in a rural Japanese community, and factors associated with social frailty status. METHODS: In total, 322 adults aged ≥65 years living in a Japanese rural community took part in the study from 2018 to 2020. Social frailty was defined as deficiencies of: (i) living alone; (ii) talking with someone every day; (iii) feeling helpful to friends or family; (iv) going out less frequently compared with last year; and (v) visiting friends sometimes. Social frail status was categorized as robust (0), social prefrail (1), and social frail (≥2), according to the summated score of Makizako's criteria. Multiple logistic regression analysis was applied to clarify factors associated with social frailty status. RESULTS: Final samples were classified into 68 persons with social frailty, 98 persons with social prefrailty and 147 persons as robust. We observed the prevalence of social frailty (21.7%) and social prefrailty (31.3%) and the GDS-15 had significantly high scores in the social frail groups. Social frailty was significantly associated with the GDS-15 score (odds ratio, 1.33; 95% CI, 1.19-1.49) and TMT-A (odds ratio, 1.04; 95% CI, 1.01-1.08) and GDS-15 (odds ratio, 1.13; 95% CI, 1.03-1.26) were extracted as independent variables of social prefrail status, with adjustment for demographics, polypharmacy and lifestyle-related diseases. CONCLUSIONS: Our results suggest that social frailty tends to be increasing gradually in a Japanese rural area, and social prefrailty might be potentially associated with attentional function, as well as the GDS-15 score. Geriatr Gerontol Int 2022; 22: 145-151.

Association between Kihon check list score and geriatric depression among older adults from ORANGE registry.

OBJECTIVE: Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression. METHODS: This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8,760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6,755 persons in Chubu, 1,328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts. RESULTS: The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference. CONCLUSIONS: These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.

[An examination for efficient project promotion of the initial-phase intensive support team for dementia in Akita Prefecture].

The purpose of this study was to clarify the trends in the activity of the initial-phase intensive support teams in Akita Prefecture and to, clarify the factors contributing to the more efficient promotion of future projects. A survey was conducted by questionnaire among 46 initial-phase intensive support team member for dementia. The results indicated that it is mostly maintained cooperation medical center for dementia and community support promoter for dementia. However, the question was insufficient cooperation with family doctor including visit the home. These findings suggest that it is important to disseminate information and improve awareness among the community as well as foster relationships of trust by families.

Polypharmacy and Lack of Joy Are Related to Physical Frailty among Northern Japanese Community-Dwellers from the ORANGE Cohort Study.

INTRODUCTION: A prevalence of frailty is gradually increasing with the progress of aging in Japan, and critical challenges regarding early diagnosis and prevention of frailty were necessary in community. Although previous studies have well documented the characteristics of physical disability, there is limited information on frail state differences among older adults in Japanese rural areas. The aim of our cross-sectional observational study was to clarify the association of frail status in northern Japanese community-dwellers aged 65 or more. METHODS: 345 participants were recruited from 2018 to 2020, and after getting informed consent from each participant, assessments and outcomes were evaluated according to the ORANGE protocol. We applied the frailty index of Gerontology-the Study of Geriatric Syndromes (NCGG-SGS) to classify frailty status by collecting data of demographics and psychosocial status using the Kihon checklist (KCL) and cognitive domains used by the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). RESULTS: Our subjects included 313 older adults divided into 138 robust, 163 prefrail, and 12 frail. For statistical analysis, we found that the frail group had a lower educational duration, worsened KCL items, lower cognitive functions, and a tendency toward depression compared to the other groups. Moreover, physical frailty and cognitive decline were related, and polypharmacy and a lack of joy in daily life were explanatory variables of frail status. CONCLUSIONS: We suggest that KCL is important for frail discrimination, and in order to prevent physical frailty, our community should take care of not only exercise and nutrition but also cognitive functioning and depressive tendencies. In particular, polypharmacy and the presence of fun in your life are possible to be related to frailty.

Prevalence and subtype distribution of early-onset dementia in Japan.

AIM: People living with early-onset dementia (EOD) have specific social needs. Epidemiological studies are needed to obtain current information and provide appropriate service planning. This study aimed to clarify the current prevalence and subtype distribution of EOD, as well as the services frequently used by individuals with EOD. METHODS: A multisite, population-based, two-step study was conducted. Questionnaires were sent to 26 416 candidate facilities in 12 areas with a target population of 11 630 322 to inquire whether any individuals with EOD had sought services or stayed during the last 12 months (step 1). When "yes" responses were received, additional questionnaires were sent to the facilities both to complete and to distribute to the target individuals with EOD to obtain more detailed information, including the dementia subtype (step 2). RESULTS: In step 1, valid responses were obtained from 16 848 facilities (63.8%), and 4077 cases were identified. In step 2, detailed information was obtained for 1614 cases (39.6%) from the facilities and 530 cases (13.0%) from the individuals. The national EOD prevalence rate was estimated to be 50.9/100 000 population at risk (95% confidence interval: 43.9-57.9; age range, 18-64 years). The number of individuals with EOD was estimated to be 35 700 as of 2018. Alzheimer-type dementia (52.6%) was the most frequent subtype, followed by vascular dementia (17.1%), frontotemporal dementia (9.4%), dementia due to traumatic brain injury (4.2%), dementia with Lewy bodies/Parkinson's disease dementia (4.1%), and dementia due to alcohol-related disorders (2.8%). Individuals with EOD were most frequently identified at medical centers for dementia. CONCLUSION: The prevalence rate estimated in this study was comparable to those in previous studies in Japan. However, the subtype distribution differed, with Alzheimer-type dementia being the most prominent. Based on the case identification frequencies, medical centers for dementia are expected to continue to function as the primary special health service by providing quality diagnosis and post-diagnostic support for individuals with EOD.