Association between excess mortality in depressive status and frailty among older adults: A population-based Kyoto-Kameoka prospective cohort study.

OBJECTIVES: Frailty has been shown to be a mediator of the risk of excess death due to depression in older adults, although this relationship has not been sufficiently investigated. Our objective was to evaluate this relationship. METHODS: We used data from 7,913 Japanese people aged≥65 years who participated in the Kyoto-Kameoka prospective cohort study and who provided valid responses to the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization-Five Well-Being Index (WHO-5) in mail-in surveys. Depressive status was assessed using the GDS-15 and WHO-5. Frailty was evaluated using the Kihon Checklist. Data on mortality were collected from February 15, 2012, to November 30, 2016. We evaluated the relationship between depression and all-cause mortality risk using a Cox proportional-hazards model. RESULTS: The prevalence of depressive status assessed by GDS-15 and WHO-5 was 25.4% and 40.1%, respectively. In total, 665 deaths were recorded during a median follow-up period of 4.75 years (35,878 person-years). After adjusting for confounders, we found that depressive status assessed by the GDS-15 had a higher risk of mortality than those without it (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.38-1.91). This association was moderately weaker when adjusted for frailty (HR 1.46, 95% CI 1.23-1.73). Similar results were observed when depression was assessed with the WHO-5. CONCLUSION: Our findings suggest that the risk of excess death due to depressive status in older adults may be partially explained by frailty. This indicates a need to focus on improving frailty besides conventional depression treatments.

[Changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years].

Objective　This study aims to identify changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years in order to help with prevention and recovery from being homebound.Methods　A survey on needs in the sphere of daily life was conducted in July 2011 among 6,696 independent older adults in 10 regions of Kameoka City (baseline survey). Of the 6,696 adults, 1,379 responded to the survey and participated in a physical checkup held between March and April 2012. These individuals were then invited to a similar checkup again in September 2013. Of these, 638 consenting individuals were administered a questionnaire survey (follow-up survey). In all, 522 subjects responded to both surveys (baseline and follow-up) regarding being homebound. The responses involved basic attributes, state of daily living, state of health, items of the Kihon Checklist, items concerning daily living activities in the baseline survey, and items concerning being homebound in the follow-up survey. The responses were analyzed, and an evaluation of homebound status was conducted based on whether or not one (or both) of the two items of the Kihon Checklist were applicable. The subjects were classified according to the following: 1) whether non-homebound individuals remained non-homebound (non-homebound group) or whether they became homebound (homebound transition group) and 2) whether individuals who became homebound recovered (recovery group) or remained the same (persisting group). After comparing the characteristics of each group, a logistic regression analysis was employed to analyze the factors related to changes in homebound status after two years.Results　Of the 375 non-homebound individuals in the baseline survey, 326 (86.9%) and 49 (13.1%) were classified into non-homebound and homebound transition groups, respectively. Of the 147 subjects who became homebound, 85 (57.8%) and 62 (42.2%) were classified into the recovery and persisting groups, respectively.　Among the factors related to change in homebound status after two years, a low score of social role (OR=0.675, CI=0.458-0.997) was an independent factor for being at risk of becoming homebound (P<0.05). Having no diseases under treatment (OR=14.340, CI=1.345-152.944) and a high intellectual activity score (OR=2.643, CI=1.378-5.069) were independent factors of recovery from being homebound (P<0.05).Conclusion　The results of the two year longitudinal study suggest the need for support for non-homebound older individuals devoid of social roles to prevent homebound status. Additionally, there is a need for support surrounding the reduction in obtaining a disease and maintaining intellectual activity in order to recover from being homebound.

Comprehensive geriatric intervention in community-dwelling older adults: a cluster-randomized controlled trial.

BACKGROUND: In longevity societies, one of the most serious social issues is sarcopenia and/or frailty. Preventing them is important for maintaining independence and quality of life in the older population. This study investigated the effect of a self-monitoring comprehensive geriatric intervention programme (CGIP) on physical function and muscle size in community-dwelling older adults. We compared the effects of a CGIP using weekly class-styled (CS) sessions and a home-based (HB) programme. METHODS: The 526 participants were randomized into one of two groups (CS 251, HB 275) based on their residential districts. We conducted a 12 week CGIP, which consisted of low-load resistance exercise, physical activity increments, oral function improvements, and a nutritional guide. All participants were encouraged to attend two 90 min lectures that included instructions on the CGIP. They were provided with exercise materials (triaxial-accelerometers/pedometers, ankle weights, and elastic bands) and diary logs. The CS group attended 90 min weekly sessions and independently executed the programme on other days, whereas the HB group only received instructions on how to execute the programme. Physical functions, such as knee extension strength (KES), normal and maximum walking speed, the timed up-and-go test, and anterior thigh muscle thickness (MT), were measured and analysed using intention-to-treat analysis before and after the 12 week intervention. RESULTS: Of the 526 participants identified, 517 (CS 243 age 74.0 ± 5.4 women 57.2%, HB 274 age 74.0 ± 5.6 women 58.8%) were enrolled. Nine (CS 8, HB 1) were excluded from the analysis because they did not participate in the pre-intervention measurements. Both interventions significantly improved KES (CS 18.5%, HB 10.6%), normal walking speed (CS 3.7%, HB 2.8%), and MT (CS 3.2%, HB 3.5%). Greater improvement of KES was observed in the CS group (P = 0.003). Maximum walking speed (CS 4.7%, HB 1.8%; P = 0.001) and timed up-and-go (CS -4.7%, HB -0.2%; P < 0.001) significantly improved in the CS group only. CONCLUSIONS: The intervention was effective in preventing sarcopenia and/or frailty. Most physical functions and MT improved after both interventions. The HB intervention is cost-effective and may help prevent sarcopenia and/or frailty in the large older population.

Consumption of green tea but not coffee is associated with the oral health-related quality of life among an older Japanese population: Kyoto-Kameoka cross-sectional study.

BACKGROUND/OBJECTIVES: The consumption of both green tea and coffee is known to induce positive health effects; however, it remains unclear whether there is an association between the consumption of these beverages and oral health-related quality of life (OHRQoL). Thus, the present study investigated the relationship between the consumption of green tea and coffee and OHRQoL. SUBJECTS/METHODS: We analyzed cross-sectional baseline data in 2012. The subjects were 7514 Japanese participants (3563 men, 3951 women; ≥65 years of age). Each subject completed a validated self-administered questionnaire that included items on the frequency of the consumption of green tea and coffee. OHRQoL was evaluated using the self-reported General Oral Health Assessment Index (GOHAI), which assesses oral health problems in older adults. A GOHAI score <50 points was defined as a poor OHRQoL. RESULTS: Following adjustment for age, body mass index, total energy intake, alcohol, smoking, medication use, coffee, and fruit and vegetable consumption, increased consumption of green tea showed a strong positive association with the GOHAI score in both men and women (Ptrend < 0.001 in both). In contrast, after adjusting for all factors, no statistically significant association was observed between coffee consumption and the GOHAI score in men (Ptrend = 0.538) or women (Ptrend = 0.607). The respective multivariate-odds ratios (95% confidence intervals) for a poor OHRQoL associated with green tea consumption frequencies of none, <1 cup/day, 1-2 cups/day, and ≥3 cups/day were 1.00, 1.01 (0.80-1.27), 0.95 (0.74-1.21), and 0.78 (0.61-0.99) (Ptrend = 0.024) in men, and 1.00, 1.19 (0.90-1.57), 0.98 (0.74-1.29), and 0.86 (0.67-1.12) (Ptrend = 0.014) in women. CONCLUSIONS: Regardless of sex, green tea consumption was positively associated with the GOHAI score. Therefore, ≥3 cups/day of green tea may reduce the risk of a poor OHRQoL, especially in men.

Comprehensive geriatric intervention program with and without weekly class-style exercise: research protocol of a cluster randomized controlled trial in Kyoto-Kameoka Study.

OBJECTIVE: The number of long-term care (LTC) users and the associated expenditures in Japan are increasing dramatically. The national government recommends LTC prevention through activation of communities. However, there is no clear evidence of the effect of population-based comprehensive geriatric intervention program (CGIP) for restraints of LTC users and the associated expenditures in the future. The aims of the current paper are to describe the study protocol and progress of a cluster randomized controlled trial (RCT) with a CGIP in Kameoka City. METHODS: The cluster RCT involved random allocation of regions as intervention (n=4,859) and nonintervention (n=7,195). Participants were elderly persons aged ≥65 years without LTC certification who had responded to a mailing survey. The residents living in intervention regions were invited to a physical check-up, and 1,463 people participated (30.3%). These individuals were invited to the CGIP, and 526 accepted. The CGIP comprised instructions on: 1) low-load resistance training using bodyweight, ankle weights, and elastic bands; 2) increasing daily physical activity; 3) oral motor exercise and care; and 4) a well-balanced diet based on a program from Ministry of Health, Labour and Welfare. We allocated the intervention regions randomly into home-based self-care program alone (HB group, 5 regions, n=275) and home-based program+weekly class-style session (CS group, 5 regions, n=251). We evaluated the effects of the CGIP at 12 weeks and at 12 or 15 months on physical function, and are conducting follow-up data collection for an indefinite period regarding LTC certification, medical costs, and mortality. RESULTS AND DISCUSSION: The study was launched with good response rates in each phase. Participants of both groups significantly increased their step counts by ~1,000 per day from the baseline during the CGIP. This RCT will provide valuable information and evidence about effectiveness of a community-based CGIP.

Sociodemographic and physical predictors of non-participation in community based physical checkup among older neighbors: a case-control study from the Kyoto-Kameoka longitudinal study, Japan.

BACKGROUND: It is difficult to obtain detailed information on non-participants in physical and health examination checkups in community-based epidemiological studies. We investigated the characteristics of non-participants in a physical and health examination checkup for older adults in a nested study from the Japanese Kyoto-Kameoka Longitudinal Study. METHODS: We approached a total of 4831 people aged ≥65 years in 10 randomly selected intervention regions. Participants responded to a mail-based population survey on needs in the sphere of daily life to encourage participation in a free face-to-face physical checkup examination; 1463 participants (706 men, 757 women) participated in the physical checkup. A multiple logistic regression model was performed to investigate the adjusted odds ratios (aOR) of non-participation based on sociodemographic status apart from psychological and physiological frailty as assessed by the validated Kihon Checklist. RESULTS: There was a significant, inverse relationship between non-participation and frequently spending time alone among individuals who lived with someone or other family structure (aOR = 0.53, standard error [SE] 0.08 in men, aOR = 0.66, SE 0.09 in women). Very elderly (over 80 years old) women, poorer health consciousness and current smoking in both sexes and poor self-rated health in men, were significantly related to higher non-participation rates. In both sexes, individuals who did not participate in community activities were significantly more likely to be non-participants than individuals who did (aOR = 1.94, SE 0.23 in men, aOR = 3.29, SE 0.39 in women). Having low IADL and physical functioning scores were also associated with higher rates of non-participation. CONCLUSION: Health consciousness and lack of community activity participation were predictors of non-participation in a physical checkup examination among older adults. In addition, lower IADL and physical functioning/strength were also predictors of non-participation. On the contrary, older inhabitants living with someone tended to participate in the physical checkup examination for social interchange when they were frequently alone in the household. This study suggests the importance of considering aging especially for women and poor sociodemographic background and physical frailty for both sexes so that older people can access health programs without difficulty. TRIAL REGISTRATION: UMIN000008105 . Registered 26 April 2012. Retrospectively registered.

Frequency of Fruit and Vegetable Consumption and the Oral Health-Related Quality of Life among Japanese Elderly: A Cross-Sectional Study from the Kyoto-Kameoka Study.

OBJECTIVE: Many previous studies have reported that fruit and vegetable consumption is associated with a reduced risk of various disease, but whether or not their consumption is associated with the oral health-related quality of life (OHRQoL) is unclear. The objective of this study was to examine the association between the frequency of fruit and vegetable consumption and the OHRQoL in elderly subjects by sex. METHODS: We analyzed cross-sectional data from a population-based Kyoto-Kameoka Study in 2012 of 3112 men and 3439 women (age ≥ 65 years). The frequencies of fruit and vegetable consumption were assessed using a validated food frequency questionnaire. We evaluated the OHRQoL using the General Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems in old adults. RESULTS: After adjusting for age, body mass index, alcohol, smoking, education, socioeconomic status, history of disease, medication use, mobility disability, and total energy intake, a higher frequency of combined fruit and vegetable consumption showed a significant positive association with the GOHAI score in both men and women (p-trend < 0.001 in both sexes). These associations remained significant after adjustment for poor mastication and denture use (p-trend all < 0.05 in both sexes). We observed a significant positive association even when the frequencies of fruit or vegetable consumption were analyzed separately (all p-trend < 0.05 in both sexes). CONCLUSIONS: A higher frequency of fruit and/or vegetable consumption independently showed a strong positive association with the OHRQoL in both men and women. Further prospective studies are needed to confirm these findings.

Prevalence of Frailty Assessed by Fried and Kihon Checklist Indexes in a Prospective Cohort Study: Design and Demographics of the Kyoto-Kameoka Longitudinal Study.

OBJECTIVE: The Kyoto-Kameoka Study was launched in 2011-2012 to identify the associations among food intake, nutritional status, physical activity, oral function, quality of life or social capital, the use of long-term care insurance (LTCI) system, and healthy lifespan in community-dwelling older people as a part of the World Health Organization Safe Community program. DESIGN: A prospective cohort study, reporting baseline demographics (cross-sectional data). SETTING AND PARTICIPANTS: We conducted 2 mailed self-administered questionnaire surveys; one is a complete population survey with a comprehensive survey of needs in the sphere of daily life (NSDL) that included 2 different frailty indexes, the Kihon Checklist (KCL) and the Fried phenotype, socioeconomic status, general and psychological health, and social relationships; followed by the more detailed Health and Nutrition Survey. A slightly modified NSDL survey was conducted again in 2013. Survival time, LTCI certification, and medical and long-term care costs after the baseline survey will be followed. RESULTS: Of 18,231 NSDL questionnaires distributed, 13,294 people responded (response rate: 72.92%; mean age 73.7 ± 6.4 and 75.1 ± 7.2 years for men and women, respectively; 12,054 people without and 1240 with LTCI certification). In people without LTCI, the proportion of robust, prefrail, and frail were 30.3%, 59.8%, and 9.9% in men and 25.3%, 64.7%, and 10.0% in women, according to the Fried index. The proportion of frail people as defined by KCL ≥7 was 30.8% in men and 33.3% in women. CONCLUSIONS: The study is the first to document frailty prevalence using both Fried and KCL measures with a complete city population survey among older Japanese in the community as a part of World Health Organization Safe Community program. The study is expected to provide valuable evidence of the effects of lifestyle habits on long-term care prevention and healthy life span.

The Extracellular to Intracellular Water Ratio in Upper Legs is Negatively Associated With Skeletal Muscle Strength and Gait Speed in Older People.

Skeletal muscles contain a large volume of water that is classified into intracellular (ICW) and extracellular (ECW) water fractions. Nuclear magnetic resonance-based biomarkers suggest that increased water T2 heterogeneities, as well as elevated water T2 relaxation in the quadriceps occurs in the elderly when compared with young adults. However, nuclear magnetic resonance is difficult to apply to a large-scale study or a clinical setting for sarcopenia and frailty screening. Segmental bioelectrical impedance spectroscopy is a unique tool used to assess the segmental ratio of ECW/ICW in the limbs. We evaluated 405 community-living people aged between 65 and 90 years. ECW and ICW in the upper legs were assessed by segmental bioelectrical impedance spectroscopy. Isometric knee extension strength, gait speed, and skeletal muscle mass were measured. Thigh ECW/ICW was negatively correlated with knee extension strength and gait speed (r = -.617 and -.431, respectively, p < .001) and increased with age (p < .001). Thigh ECW/ICW was a significant predictor of knee extension strength and gait speed independent of age, sex, body mass index, and skeletal muscle mass. Relative expansion of ECW against ICW in the thigh muscles is a factor in decreased muscle quality and a biomarker of muscle aging.

[Fall risk factors and sex differences among community-dwelling elderly individuals in Japan. A Kameoka study].

OBJECTIVES: Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city. METHODS: A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role. RESULTS: Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men. CONCLUSION: One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

Echo intensity obtained from ultrasonography images reflecting muscle strength in elderly men.

BACKGROUND: It is well known that loss of muscle mass (quantitative change) is a major change that occurs with aging. Qualitative changes in skeletal muscle, such as increased intramuscular fat, also occur as one ages. Enhanced echo intensity (EI) on ultrasonography images of skeletal muscle is believed to reflect muscle quality. Recent studies evaluating the quality of skeletal muscle using computer-aided gray scale analysis showed that EI is associated with muscle strength independently of age or muscle size in middle-aged and elderly women. The aim of the present study was to investigate whether muscle quality based on EI is associated with muscle strength independently of muscle size for elderly men. METHODS: A total of 184 elderly men (65-91 years) living independently in Kyoto, Japan, participated in this study. The EI, muscle thickness (MT), and subcutaneous fat thickness (FT) of the anterior compartment of the right thigh were determined by assessing ultrasonography images. The maximum isometric torque of knee extension at a knee angle of 90° was measured. RESULTS: The EI showed a significant negative correlation with muscle strength (r = -0.333, P < 0.001). Multivariate regression analysis revealed that the MT and EI of the knee extensor muscle were independently associated with maximum isometric knee extension strength. Even when partial correlation analysis was performed with age, height, weight, and FT as control variables, EI was still significantly correlated with muscle strength. CONCLUSION: The results of this study indicate that aging-related changes in muscle quality contribute to diminishing muscle strength. Ultrasonography is a low-cost, easily accessible, and safe method suitable for the assessment of EI as an index of muscle quality.

[Physical fitness and depression symptoms in community-dwelling elderly women].

OBJECTIVES: The aim of this study was to examine the relationship between geriatric depression scale (GDS) score and elements of physical fitness in community-dwelling, healthy, elderly women in Japan. METHODS: This cross-sectional study involved a total of 886 healthy elderly women (aged 265 years) living in Kyoto prefecture. Women voluntarily participated in physical performance tests. One-leg standing time, leg power, knee extension strength, grip strength, endurance capacity, trunk flexion, usual and maximal gait speed, chair stand, chair stepping, and functional reach were examined as fitness tests. A 15-item GDS and a battery of health status questionnaires were used to assess mental and physical health status. RESULTS: Of the participants, 21.1% had a GDS score of > or = 5 and were categorized as the depression group (D group). Leg power, knee extension strength, endurance capacity, gait speed, and chair stepping ability were significantly lower in the D group than in the non-depression group (GDS score < 5; ND group). After adjustment for physical characteristics, eating habits, and physical activity levels as co-variances, leg power, knee extension strength, and endurance capacity remained significantly lower in the D group than in the ND group (P < 0.05). CONCLUSION: A considerable number of active, healthy, elderly women who voluntarily participated in this study reported depressive symptoms. Reduced leg power, knee extension strength, and endurance capacity were associated with depressive symptoms independently of physical activity levels. These results suggest that exercise intervention to increase leg strength and endurance capacity may improve depressive symptoms in elderly women.