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Approximately 10% of the Japanese elderly are dependent and have cognitive impairments according to the Long-Term Care Insurance system. This apparent dementia is assumed to be heterogeneous. We attempted to classify it based on the development of cognitive manifestations preceding dementia, and to identify risk factors specific to the respective types. From 2007 to 2016 in Kusatsu town, 365 subjects developed apparent dementia: a combination of dementia diagnosis or dementia-like signs reported by physicians and dependency certified by the insurance system. In total, 134 of the 365 subjects had been evaluated using the Mini-Mental State Examination (MMSE) during annual health check-ups for the preceding 5 years. The multivariate trajectory model was applied to the repeated measurements of MMSE sub-scores, yielding two major and three minor types of apparent dementia with proportions of 41% and 38%, and 7%, 7%, and 7%, respectively. Risk factors of the two major types were explored using Cox regression analysis that utilized a cohort of the 1053 participants in check-ups who were cognitively intact at the first visit from 2002 through 2010 and followed up until 2016. One of the major types was characterized by early decline in attention and memory; its risk factors were both high and low levels of serum cholesterol, moderately increased glycated hemoglobin and decreased diastolic blood pressure. The other major type was characterized by no cognitive decline as observed in preceding check-ups; its risk factors were smoking, decreased hemoglobin, and decreased albumin. The latter type warrants further research.

Background: It remains unknown whether the negative effect of eating alone in old ages is independent from living arrangement. Methods: 11,925 older adults who lived in Ota City, Tokyo responded to a mail survey (response, 77%). Physical and mental health were assessed by the “Kaigo-Yobo Checklist (CL15)” and WHO-5, respectively. Eating alone was defined by the answer “alone” to the question “do you usually have meals together?” According to eating status and living arrangement, they were classified into four groups; living with and eating with others (reference group; 3,905 men and 3,546 women), living with others but eating alone (221 men, 220 women), living alone but eating with others (235 men, 684 women), living alone and eating alone (550 men, 556 women). The multi-level logistic regression analysis was used to examine independent associations of eating alone with frailty (CL15, 4 or more) and mental ill-health (WHO-5, less than 13). Results: In men, the multivariate-adjusted odds ratios for frailty were 1.74(95%CI, 1.26–2.41) for those living with others but eating alone, 1.08(0.71–1.65) for those living alone but eating with others, 1.74(1.22–2.48) for those living alone and eating alone. In women, the respective values were 2.09(1.50–2.92), 0.89(0.67–1.18) and 1.10(0.83–1.45). Likewise, the multivariate-adjusted odds ratios for mental ill-health were 1.64(1.18–2.28), 1.38(0.93–2.06) and 1.51(1.07–2.14) in men, and 1.56(1.12–2.19), 0.87(0.67–1.14) and 1.35(1.03–1.76) in women. Conclusion: In both sexes, the negative effects of eating alone on frailty and mental ill-health were more prominent in older persons living with others than in those living alone.

Growth differentiation factor 15 (GDF15) is a member of the TGF-β superfamily, which has been implicated in aging and various age-related diseases. We and others have recently reported that the serum GDF15 level was increased in patients with mitochondrial diseases, suggesting its potential as a marker for mitochondrial dysfunction. The epidemiological relevance of GDF15 to adverse health outcomes of the elderly has not been well established. In the present study, we aimed to determine the relationship between GDF15 and all-cause mortality in a general population of Japanese elderly. 1,832 community-dwelling older adults aged 65 years or older participated in baseline surveys in the towns of Kusatsu and Hatoyama in Japan. The serum GDF15 concentration was determined by the AlphaLISA immunoassay. There occurred 134 deaths during a median follow-up of 4.7 years. We used the Cox proportional hazard model to assess the association of the serum GDF15 level with mortality, controlling for important confounders at baseline (sex, age, years of education, number of chronic diseases, diastolic blood pressure, red blood cell count, total cholesterol, eGFR, albumin, cognitive function, gait speed, higher-level competence, and inflammation markers). Participants in the highest quartile (GDF15 concentrations of >974 pg/mL) had a hazard ratio of 2.33 (95% confidence interval: 1.06–5.12) for all-cause mortality compared with those in the lowest quartile (GDF15 concentrations of < 562 pg/mL). These results suggest that serum GDF15 concentration independently predicts all-cause mortality in a general population of Japanese elderly.

This study examined the short- and long-term effects of a multifactorial intervention on frailty using a randomized, crossover trial with a follow-up survey within the Hatoyama Cohort Study. Seventy-seven pre-frail or frail older adults were randomly allocated to an immediate intervention group (IIG, n=38) or a delayed intervention group (DIG, n=39). The IIG participated in the twice-weekly multifactorial intervention class consisting of resistance exercise, nutritional, and psychosocial programs. The DIG was provided no intervention for the initial 3-month period, and both groups were crossed over for the latter 3-month period. Pre-frail and frailty were determined by the Check-List 15 (CL15) score, which was validated against Fried’s frailty criteria. Intervention effects on the CL15 score and frailty status were examined for the two 3-month periods (Analysis 1). A propensity score-matched analysis was performed to balance the baseline characteristics between the participants (IIG and DIG) and non-participants of the intervention within the same cohort, and follow-up was conducted 6 and 16 months after the intervention (Analysis 2). As compared with DIG, IIG exhibited significant reductions in the CL15 score (-0.36; 95% confidence interval: -0.74, -0.03) and prevalence of frailty (-23.5%; -40.4%, -6.7%), but not in pre-frailty at 3 months, which persisted at 6 months. The DIG exhibited almost similar intervention effects in the latter 3-month period. Analysis 2 showed that CL15 scores further reduced significantly in participants who received the multifactorial intervention, with a significant group-by-time interaction (P=0.036). In summary, this multifactorial intervention was effective in improving frailty status on a short- and long-term basis.

Although health inevitably declines with advancing age, the pattern of health changes varies from person to person. To analyze health changes in old age, the analysis of longitudinal data is essential. In this symposium, five speakers from Japan (Murayama H, Shinkai S, Taniguchi Y) and United States (Liang J and Botoseneanu A) will report findings on health trajectories by using longitudinal data from nationally representative cohorts of older adults (the National Survey of Japanese Elderly in Japan and the Health and Retirement Study in U.S.) as well as community-based studies (the Kusatsu Longitudinal Study on Aging and Health in Japan, KLSAH; Piedmont Dental Study in U.S., PDS). KLSAH is a longitudinal study, which entailed 2,000 community dwelling older adults assessed annually on functional health. PDS involved repeated observations of 810 dentate individuals aged 65 and over in North Carolina from 1988 to 1994. Using such data, each speaker will examine patterns of trajectories including cognitive function, oral health, and physical performance such as gait speed and muscle strength. They will also show the relative contribution of life-style related diseases such as cardiovascular disease and aging-related pathologies such as sarcopenia to different trajectory pattern of functional health. Finally, Shaw B (USA) will discuss how these findings contribute to a better understanding of health in later life and their implications for public health.

This study examined the association between the trajectories of body mass index (BMI) and all-cause mortality in old age. Data came from the National Survey of the Japanese Elderly, which included 4,869 adults aged 60 and over, with up to seven repeated observations between 1987 and 2006. Four distinct BMI trajectories were identified: “low-normal weight, decreasing” (baseline BMI=18.7; 23.8% of sample), “mid-normal weight, decreasing” (baseline BMI=21.9; 44.6% of sample), “high-normal weight, decreasing” (baseline BMI=24.8; 26.5% of sample), and “overweight, stable” (baseline BMI=28.7; 5.2% of sample). Survival analysis showed that, relative to those with mid-normal decreasing BMI, those with stable overweight trajectory had the lowest mortality, whereas those with low-normal, decreasing BMI had the highest mortality. In a sharp contrast with prior observations from Western populations, BMI changes primarily lie within the normal-weight range and virtually none are obese among older Japanese. The association between BMI trajectories and mortality varies according to the distribution of BMI within the population.

Arterial stiffness (brachial-ankle pulse wave velocity; baPWV) is good predictor of mortality in later life. This prospective study used repeated measures analysis to examine potential baPWV trajectory patterns, and determine whether baPWV trajectory patterns were associated with all-cause mortality. 1,744 adults (mean age, 71.0 years; women, 57.0%) aged 65 years or older underwent tests of baPWV during 2003–2015 (total observation number was 7,419). We ascertained all death by checking local registry; 294 (16.9%) deaths occurred during the follow-up period (median follow-up of 7.2 years). We identified four major trajectory patterns of baPWV: lowest, second, third, highest trajectory groups. The mean baPWV for low level group (28.8%) was 1386cm/sec at age 65. Likewise, those for the second (46.2%), third (21.2%), and highest trajectory groups (3.8%) were 1667cm/sec, 2026cm/sec, and 2611cm/sec at 65y, respectively. All four group tracked parallel declining trajectory after 65 year-old. Compared with those in the lowest trajectory group, participants in the second, third, and highest trajectory groups showed 1.20 (95% CI: 0.87–1.65), 0.95 (0.65–1.40), and 1.78 (1.02–3.12) times higher risks for all-cause mortality even after adjusting for important confounders. Regardless of initial level, baPWV tended to show similar age-related change in later life. Our findings indicate that individual in highest baPWV trajectory group was at increased risk for mortality, which highlights the importance of interventions that improve arterial stiffness, even among older adults with high baPWV.

We reported previously that low nutritional status was an independent risk for all-cause and cardiovascular mortality in a general population of older Japanese. This study further examined its association with active life expectancy. A total of 1,620 older persons participated in the annual health assessments in Kusatsu, Gunma prefecture, Japan from 2002 through 2012. They were followed until June 2013 for death, moving out from the town, and new certification under the public Long-Term Care Insurance (LTCI). Baseline nutritional status of participants was evaluated by BMI, serum albumin and total cholesterol, and blood hemoglobin. The outcome events included new certification under the LTCI and death without prior certification. Cox proportional analysis was used for multivariate adjustment. Out of 1,546 participants who had not been certified under the LTCI at baseline, 284 events (new certification 202, death without prior certification 82) occurred during the follow-up period. After adjustment for age, baseline year and history of medical condition (hypertension, diabetes mellitus, stroke, heart disease, or cancer), those in the lowest quartile of BMI, albumin, total cholesterol or hemoglobin compared with those in the respective highest quartile showed the hazard ratio of 1.94 (95%CI; 1.14–3.33), 3.41 (1.77–6.59), 1.80 (1.03–3.14), or 2.03 (1.14–3.61) for males, and 0.74 (0.48–1.16), 2.38 (1.29–4.39), 1.03 (0.66–1.60), or 1.63 (1.05–2.51) for females, respectively. In summary, the effect of nutrition on active life expectancy differed slightly depending on sex and biomarkers, but low nutritional status had significantly negative effect on active life expectancy in a general population of older Japanese.

Objectives. Although there is extensive research on the stress-buffering effects of social support on health, there is little understanding of this effect on health behaviors such as smoking, particularly during old age. This study aimed to estimate the effect of financial strain and the stress-buffering effect of social support, on the trajectory of smoking over an extended period of time among older Japanese. Method. Data came from a national sample of more than 4,800 adults, aged 60 and older in Japan, with up to 7 repeated observations between 1987 and 2006 (16,669 observations). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in smoking. Results. Higher financial strain at baseline was associated with greater amount of smoking, and a slower rate of decline, after adjusting for sociodemographic attributes. Greater instrumental support partially offset the deleterious effect of financial strain on the rate of decline in smoking. Discussion. Our findings add a dynamic dimension to understanding the relationship among financial strain, social support, and smoking in old age. This knowledge is significant when designing health policies and interventions regarding health behaviors in late life.