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Aim: To present practical predictors for the difficulty of carrying out basic activities of daily living (ADL) among the old-old during a 2-year period., Methods: Assessment was carried out using data obtained from the Tosa Longitudinal Aging Study, a community-based cohort survey on geriatric functions in the elderly. Predictor variables measured at baseline included age; sex; height; weight; blood pressure; oxygen saturation; neurobehavioral functions, such as Mini-Mental State Examination, Kohs Block Design test, Timed Up and Go test, button score, functional reach test, geriatric depression scale, cardio-ankle vascular index, ankle brachial pressure index; and blood chemical results, such as hemoglobin, fasting blood sugar, hemoglobin A1c, serum lipids, serum albumin and serum creatinine. The outcome variable was the presence of difficulties while carrying out basic ADL after 2 years., Results: Age of ≥85 years, Timed Up and Go test of ≥15 s, button score of >17 s and presence of knee pain were independent predictors of difficulty in carrying out basic ADL after 2 years. Elderly individuals who have had at least two positive findings out of these four variables were likely to have impaired basic ADL during a 2-year period with a positive predictive value of 52.0%, negative predictive value of 90.2%, sensitivity of 70.3% and specificity of 80.8%., Conclusions: Assessment of age, Timed Up and Go test, manual dexterity, and presence of knee pain is a useful and relevant way to identify patients who should be informed about their likelihood of developing difficulties in carrying out basic ADL., (© 2015 Japan Geriatrics Society.)

Aim: The 25-item Kihon Checklist (KCL) is the official self-administered questionnaire tool to screen frail older adults, consisting of seven categories: physical strength, nutritional status, oral function, houseboundness, cognitive function, depression risk and a score of more than 9 out of 1-20 items. The aim of the present study was to evaluate the relationships between each category of the KCL and newly certified cases under the Long-Term Care Insurance (LTCI) in Japan during 24 months., Method: The study population consisted of 883 community-dwelling adults aged 65 years or older uncertified by LTCI completing a questionnaire, which included the KCL and scales of basic/advanced activities of daily living (ADL), quality of life (QOL), and depressive symptoms. The participants were categorized into the risk or non-risk group depending on the official criteria of each KCL category. The outcome was the incidence of newly certified cases by LTCI during 24 months. The difference between the risk and non-risk group was analyzed by Cox regression hazard models., Results: Scores in basic/advanced ADL and QOL were higher, and the score in the geriatric depression scale was lower in the non-risk than the risk group in KCL criteria. In men, the incidence of newly certified cases was higher in the risk group of the physical strength category after adjusting for age and the other categories of the KCL., Conclusion: The physical strength category in men was the only significant predictor of the incidence of newly certified cases by LTCI. Further studies are required to improve the assessment item of cognitive function in KCL under LTCI., (© 2014 Japan Geriatrics Society.)

Aim: The 21-item Fall Risk Index (FRI-21) has been used to detect elderly persons at risk for falls. The aim of this longitudinal study was to evaluate the FRI-21 as a predictor of decline in basic activities of daily living (BADL) among Japanese community-dwelling elderly persons independent of fall risk., Methods: The study population consisted of 518 elderly participants aged 65 years and older who were BADL independent at baseline in Tosa, Japan. We examined risk factors for BADL decline from 2008 to 2009 by multiple logistic regression analysis on the FRI-21 and other functional status measures in all participants. We carried out the same analysis in selected participants who had no experience of falls to remove the effect of falls., Results: A total of 45 of 518 participants showed decline in BADL within 1 year. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05-1.20), FRI-21 ≥ 10 (OR 3.81, 95% CI 1.49-9.27), intellectual activity dependence (OR 3.25, 95% CI 1.42-7.44) and history of osteoarthropathy (OR 3.17, 95% CI 1.40-7.21) were significant independent risk factors for BADL decline within 1 year. FRI-21 ≥ 10 and intellectual activity dependence (≤ 3) remained significant predictors, even in selected non-fallers., Conclusion: FRI-21 ≥ 10 and intellectual activity dependence were significant predictive factors of BADL decline, regardless of fall experience, after adjustment for confounding variables. The FRI-21 is a brief, useful tool not only for predicting falls, but also future decline in functional ability in community-dwelling elderly persons., (© 2012 Japan Geriatrics Society.)

Background: Although there are several factors which may contribute to oxidative stress at high altitude, little is known about the association between oxidative stress and aging in the community-dwelling elderly in the Tibetan Plateau., Methods: Reactive oxygen species (ROS) and comprehensive geriatric functions were examined among 235 community-dwelling elderly subjects aged 60 years or more (146 Hans and 89 Tibetans). As a marker of ROS, the levels of reactive oxygen metabolites (ROM) were measured using the d-ROM test., Results: The rate of dependence of basic activities of daily living (basic ADL) among Tibetan elderly highlanders was significantly higher than that among Han elderly highlanders. The d-ROM level was higher among the Tibetan elderly than those among the Han elderly (Tibetan 465.6 +/- 97.9 Carr U, Han 415.3 +/- 72.0 Carr U, P = 0.003). The ROM level was higher among women than those among men. Stepwise multiple regression analysis showed that being Tibetan, female, and oxygen saturation were independent predictors of increasing d-ROM level (Tibetan beta, 0.241; female beta, 0.206; oxygen saturation beta, 0.218). The high levels of ROM (d-ROM >500 Carr U) were significantly associated with dependence of basic ADL after adjustment for age, sex and ethnicity (odds ratio = 2.51, P = 0.028)., Conclusion: The findings of this study imply the possibility that ROS is higher among Tibetan elderly highlanders than that of Han, which related to the geriatric items. Further studies are needed to show the impact of oxidative stress on the aging of highlanders.

Aim: The objective of this study is to disclose the association of polycythemia with lifestyle-related diseases (hypertension, obesity and glucose intolerance) among the three ethnicities in Qinghai, China., Methods: The subjects were 393 elderly people (247 Han, 97 Tibetan and 49 Mongolian) aged 60 years and more living in Qinghai (3000 m a.s.l.) in China. The associated factors with polycythemia were analyzed in the subjects. Excessive polycythemia was defined as hemoglobin concentration over 20 mg/dL., Results: Polycythemia was associated with men, hypoxemia, obesity and high diastolic blood pressure (DBP) in the elderly in Qinghai. Male sex was associated with polycythemia in all ethnicities. Obesity was associated with Han and Tibetan men. Glucose intolerance and activities of daily living were not directly associated with polycythemia after adjustment for sex. There were 7.9% with excessive polycythemia. Independently-associated factors for excessive polycythemia were male sex, body mass index of 25 or more, SpO(2) of less than 85%, DBP of 85 mmHg or more and Han ethnicity (vs Tibetan) by multiple logistic regression., Conclusion: There was a close association of polycythemia with diastolic hypertension and obesity in lifestyle-related diseases in high-altitude elderly people. Han people had a higher hemoglobin concentration after adjustment of lifestyle-related diseases compared with Tibetan people. The difference of hemoglobin concentration may be due to Tibetans undergoing a much longer period of adaptation than Han people. Further study is needed to disclose the association between the difference of hypoxic adaptation, lifestyle-related diseases and chronic mountain sickness for their prevention.

Aim: To reveal the comparison of comprehensive geriatric functions of elderly highlanders in Qinghai Plateau in China among three different ethnic groups., Methods: Activities of daily living (ADL), screening-based depression, quality of life (QOL) and checking-up of metabolic syndrome including community-based oral glucose tolerance test were assessed in 393 community-dwelling elderly subjects aged 60 years or more (247 Han elderly subjects, 49 Mongolian ones and 97 Tibetan ones)., Results: Tibetan elderly highlanders were more disabled in ADL, but had higher QOL than Han elderly ones in Qinghai Plateau. Blood pressure measurements, rate of hypertension and hemoglobin concentrations in Tibetan elderly highlanders were lower than Han ones. Rates of diabetes and impaired glucose tolerance in elderly highlanders were relatively lower than other Asian elderly lowlanders., Conclusion: Prevalence of metabolic syndrome in elderly highlanders in Qinghai was still not high, however, we should pay attention to its tendency related with socialglobalism in the near future. Further investigation on physiological adaptability to hypoxic environment and human ageing phenomena in a global context may open a new research frontier for ageing science.

Aim: To examine the association between food diversity and health status of Han and Tibetan elderly highlanders in Qinghai Plateau, China., Methods: The study population consisted of 240 community-dwelling elderly subjects aged 60 years or more (176 Han elderly subjects, 64 Tibetan ones). Food diversity was determined using an 11-item Food Diversity Score Kyoto (FDSK-11). Subjects were interviewed on health status including activities of daily living (ADL), screening-based depression and quality of life (QOL). Blood chemical investigation was carried out in association with food diversity., Results: ADL was significantly lower in both Han and Tibetan elderly with lower food diversity than those with higher diversity. In Han elderly with lower food diversity, QOL was significantly lower in the items of subjective sense of health, relationship with family and subjective happiness, but not significant in Tibetan elderly. A close association was found between lower food diversity and lower financial satisfaction in both Han and Tibetan subjects. No association was found between food diversity and age or body mass index. Higher food diversity was associated with lower blood glucose level in Han elderly subjects, but the opposite association was found in Tibetan ones., Conclusion: Food diversity was associated with ADL and QOL in highlanders in Qinghai, China. Food assessment is very important as a useful indicator to establish the actual condition of diet and its relation to health status of community-dwelling elderly as well as the change of economic background in the Qinghai highlands.

Aim The aim of this study was to assess chewing ability using color-changeable chewing gum and to show the association between chewing ability and geriatric functions, as well as dietary status in the community-dwelling elderly. Methods The study population consisted of 269 community-dwelling elderly aged ≥75 living in Tosa, Japan. Assessment of chewing ability was carried out by a dentist using color-changeable chewing gum. Activities of daily living ( ADL), depression and subjective quality of life ( QOL) were assessed by questionnaire. Cognitive status was assessed by; Mini- Mental State Examination ( MMSE), Hasegawa Dementia Scale- Revised ( HDS-R) and Frontal Assessment Battery ( FAB) during the check-up. Food diversity was assessed using the 11-item Food Diversity Score Kyoto ( FDSK-11). Results Number of teeth was significantly related to chewing ability ( P < 0.001). The participants with low chewing ability had significantly lower ADL scores in the items of self-maintenance ( P = 0.029) and intellectual activity ( P = 0.021). There was a significant association between low chewing ability and depression ( P < 0.001). Lower cognitive functions were significantly related to low chewing ability; MMSE ( P = 0.022), HDSR ( P = 0.017) and FAB ( P = 0.002). The participants with low chewing ability had lower food variety ( P < 0.001), and less frequent intake of beans, vegetables, seaweed and nuts, than the participants with high chewing ability. Conclusion Low chewing ability evaluated by color-changeable gum was associated with lower ADL, lower cognitive functioning, depression and food insufficiency in the community-dwelling elderly. More attention should be paid to assessing chewing ability of elderly persons in community settings. Geriatr Gerontol Int 2013; 13: 718-725. [ABSTRACT FROM AUTHOR]

Background: To elucidate the characteristics of daily living functions of the elderly requiring home visits. Methods: Fifty-two elderly individuals (17 men and 35 women; age range, 72–95 years; average age, 82.2 ± 5.4 years) who visited a clinic for the elderly underwent comprehensive geriatric assessment. Activities of daily living were assessed using the Barthel Index and Lawton Scale. Cognitive function was assessed using the clock-drawing test (modified Shulman method), Mini-Mental State Examination, and the revised version of Hasegawa's Dementia Scale. Depression was assessed using the 15-item Geriatric Depression Scale. Volition was assessed using the Vitality Index. The 52 participants were divided into two groups: 41 who continued clinic visits after assessment (clinic group: 15 men and 26 women; age range, 72–95 years; average age, 81.5 ± 5.4 years), and 11 who required home visits (visit group: two men and nine women; age range, 75–91 years; average age, 84.7 ± 4.5 years). Various daily living functions were compared between the two groups. Results: Barthel Index, Lawton Scale, Mini-Mental State Examination, and Vitality Index scores were significantly lower in the home group. Moreover, Vitality Index score was low at the start of home visits. Conclusions: It is difficult for the elderly with cognitive and physical disorders to make periodical visits to medical institutions and they eventually require home visits. For effective prevention of dependence on nursing care, fragile elderly persons themselves must understand and actively participate in interventions, emphasizing the underlying difficulties associated with such interventions. [ABSTRACT FROM AUTHOR]

In this article the authors discuss a five-year longitudinal study of the effect of early diagnosis and lifestyle modification on functional activities in community-dwelling elderly adults with glucose intolerance. The statistical association between glucose intolerance in older people with diabetes mellitus (DM) and instrumental activity of daily living (IADL) disability, compared to normal glucose tolerance (NGT) groups and impaired glucose tolerance (IGT) groups, is discussed.