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Background:Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan.Methods:A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0–100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later.Results:One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3–4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16–1.61).Conclusions:SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Aim The aim of the present study was to show the status of objective geriatric functions and subjective quality of life in Ladakh, India, compared with Japanese controls. Methods We analyzed data of 117 people aged 60 years or older in Domkhar, and age- and sex-specific Japanese controls. Variables measured included blood pressure, hemoglobin, timed up & go test, basic activities of daily living, Geriatric Depression Scale and the Visual Analog Scale for subjective quality of life. Results People in Domkhar were more likely to have difficulties in basic activities of daily living compared with Japanese controls. However, they were significantly more likely to maintain social roles. The Visual Analog Scale scores in subjective friendship, economic satisfaction and happiness were higher in Domkhar compared with Japanese controls. Living alone (OR 9.92, 95% CI 2.13–46.26), high Geriatric Depression Scale score (6 or more; OR 8.45, 95% CI 1.65–43.35) and timed up & go test (17 s or more; OR 21.00, 95% CI 1.69–260.87) were significantly associated with a low score of subjective happiness (less than 50). Residence in Domkhar (OR 0.17, 95% CI 0.04–0.77) was a significant factor for low prevalence of a low score of subjective happiness by multivariate logistic regression analysis. Conclusions Subjective quality of life among older adults in Domkhar was higher than Japanese controls despite a higher rate of difficulty in basic activities of daily living. We have to consider prevention, treatment, and care of not only diseases and disabilities, but also loneliness for the older adults. Geriatr Gerontol Int 2017; 17: 480–486.

Background:Previous studies have found that social cohesion and trust (SCT) were associated with psychological well-being and physical health. In this study, we investigated the associations between SCT and mental and physical health among community-dwelling elderly in a town in southern Taiwan.Methods:The study population consisted of 149 community-dwelling elderly aged 65 years and older (68 men, 81 women; mean age, 75.4 ± 6.1 years) residing in the town of Dashe in southern Taiwan. Activities of daily living (ADL), SCT, depression, subjective quality of life (QOL), current medical status, past medical history, and health behaviors were assessed in face-to-face interviews. Objective neurobehavioral functions were assessed using the timed up & go (TUG) test, functional reach test, and handgrip test.Results:Scores for ADL and Geriatric Depression Scale (GDS) were significantly correlated with SCT, and SCT was significantly correlated with all subjective QOL items. In addition, a strong correlation was observed between SCT and relationship with friends. Values for SCT (median ≥ 20) were significantly associated with both subjective sense of health (median ≥ 68) and subjective happiness (median ≥ 73) after adjusting for age, sex, and ADL.Conclusion:SCT is an important variable that influences self-rated health and happiness, independently of ADL, age, and sex. When assessing geriatric psychological function, SCT should be examined more carefully, given its association with subjective sense of health and happiness, depression, and physical function.

The objective of this study is to investigate the cross-cultural relationship between depressive state and subjective economic status, as well as subjective quality of life (QOL) and activities of daily living (ADL) among elderly people in communities in Japan, Taiwan, and Korea. We studied 595 subjects aged 65 years or older in three Asian communities (261 subjects in T town in Japan, 164 in D town in Taiwan, and 170 in H town in Korea). The Geriatric Depression Scale-15, a self-rating questionnaire assessing ADL, subjective QOL, social situations, and past and current medical status, was used. Depression of the elderly was associated with dependence in basic ADL, subjective QOL, and subjective sense of low economic status. After adjusting for the effects of age, sex, and basic ADL, subjective sense of low economic status was closely associated with depression in community-living elderly people in all three communities in Asia. In conclusion, absolute and objective economic status is an important contributing factor to depressive state or psychosocial deterioration, however, we should pay more attention to the roles of perception of low economic status in determining depressive state in community-dwelling elderly people.

Aim Religious social networks are well known for their capacity to improve individual health, yet the effects of friendship networks within the Buddhist context remain largely unknown. The present study aimed to compare health status and social support in community-dwelling older adults according to their level of Buddhist social network (BSN) involvement, and to examine the association between BSN involvement and functional health among older adults. Methods A cross-sectional survey was carried out among 427 Buddhist community-dwelling older adults aged ≥60 years in Nakhon Pathom, Thailand. Data were collected from home-based personal interviews using a structured questionnaire. Health status was defined according to the measures of basic and advanced activities of daily living (ADL), the 15-item Geriatric Depression Scale and subjective quality of life. Perceived social support was assessed across the four dimensions of tangible, belonging, emotional and information support. Multiple logistic regression was used for analysis. Results Older adults with BSN involvement reported better functional, mental and social health status, and perceived greater social support than those without BSN involvement. In addition, BSN involvement was positively associated with independence in basic and advanced ADL. After adjusting for age, sex, education, income, morbidity and depressive symptoms, BSN showed a strong association with advanced ADL and a weak association with basic ADL. Conclusion The results show that involvement in BSN could contribute positively to functional health, particularly with regard to advanced ADL. Addressing the need for involvement in these networks by older adults might help delay functional decline and save on healthcare costs. Geriatr Gerontol Int 2015; 15: 1210–1218.

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. Geriatr Gerontol Int 2015; 15: 864–871.

Background Missing data are inevitable in almost all medical studies. Imputation methods using the probabilistic model are common, but they cannot impute individual data and require special software. In contrast, the ipsative imputation method, which substitutes the missing items by the mean of the remaining items within the individual, is easy and does not need any special software, but it can provide individual scores. The aim of the present study was to evaluate the validity of the ipsative imputation method using data involving the 15-item Geriatric Depression Scale. Methods Participants were community-dwelling elderly individuals (n = 1178). A structural equation model was constructed. The model fit indexes were calculated to assess the validity of the imputation method when it is used for individuals who were missing 20% of data or less and 40% of data or less, depending on whether we assumed that their correlation coefficients were the same as the dataset with no missing items. Finally, we compared path coefficients of the dataset imputed by ipsative imputation with those by multiple imputation. Results When compared with the assumption that the datasets differed, all of the model fit indexes were better under the assumption that the dataset without missing data is the same as that that was missing 20% of data or less. However, by the same assumption, the model fit indexes were worse in the dataset that was missing 40% of data or less. The path coefficients of the dataset imputed by ipsative imputation and by multiple imputation were compatible with each other if the proportion of missing items was 20% or less. Conclusion Ipsative imputation appears to be a valid imputation method and can be used to impute data in studies using the 15-item Geriatric Depression Scale, if the percentage of its missing items is 20% or less.

Aim To investigate whether positive affect independently predicts a lower risk of functional decline among community-dwelling older Japanese. Methods A 2-year prospective study was carried out among 505 residents of Tosa Town aged 65 years and older without disability in carrying out basic activities of daily living (BADL) at baseline. Positive and negative affect was measured using the 15-item Geriatric Depression Scale, which includes items that reflect positive affect, as well as items that reflect negative affect. Information on functional ability, sociodemographic factors and medical conditions was obtained using a self-administered questionnaire. Results A total of 72 (14.3%) participants reported a decline in BADL at the 2-year follow up. The sum-score of the positive items was significantly associated with a lower risk of functional decline (OR 0.78, 95% CI 0.64–0.97), after controlling for potential confounding factors. Of the five positive items, three items (feeling satisfied with life OR 0.49, 95% CI 0.25–0.95; feeling happy most of the time OR 0.50, 95% CI 0.25–0.99; and feeling full of energy OR 0.46, 95% CI 0.22–0.95) were significantly associated with functional decline after adjusting for confounders. These associations were also independent of negative affect. In contrast, none of the negative items predicted functional decline after controlling for confounding factors. Conclusions Positive psychological well-being, specifically the feeling of satisfaction with life, happiness and energy, might have a favorable effect on the maintenance of functional ability, regardless of negative affect. Geriatr Gerontol Int 2013; 13: 1051–1058.

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

It has been already known that people who temporarily stay at high altitude may develop insomnia as a symptom of acute mountain sickness. However, much less is known about people living at high altitude. The aim of this study was to determine the effect of high altitude environment on sleep quality for the elderly who have been living at high altitude for their whole lives. A cross-sectional study was conducted in Domkhar valley at altitudes of 2800-4200m, Ladakh. Sleep quality was assessed using Insomnia Severity Index (ISI). Measurement items include body mass index, blood pressure, blood sugar, hemoglobin, timed Up and Go test, oxygen saturation during wakefulness, respiratory function test, Oxford Knee Score (OKS), and Geriatric Depression Scale (GDS), and so on. The participants were Ladakhi older adults aged 60 years or over (n=112) in Domkhar valley. The participation rate was 65.1% (male: female=47:65, mean age: 71.3 years and 67.9 years, respectively). The prevalence of the high score of ISI (8 or more) was 15.2% (17 out of 112). Altitude of residence was significantly correlated with ISI. Stepwise multiple regression analysis showed that OKS and altitude of residence were significantly related with ISI.

Objectives: To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. Design: Cross-sectional epidemiological study on Tibetan highlanders. Participants: We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). Main outcome measure: Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. Results: The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs

Aim: The aim of this study was to show which dimensions of functions differ among community-dwelling elderly participants in four different certification levels of the current long-term care insurance system (LTCI) in a rural, depopulated and aging town in Japan, with special consideration for strengths and weaknesses of the LTCI. Methods: The study population consisted of 1077 community-dwelling elderly participants aged 65 years and older, with LTCI certification comprising 542 uncertified elderly (Ippan-Koureisya), 437 specified elderly (Tokutei-Koreisha), 57 support-level elderly (Youshien-Koureisha) and 41 care-level elderly (Youkaigo-Ninteisha). Each participant was rated regarding their health status, with question topics including basic activities of daily living (ADL), the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), the 15-item Geriatric Depression Scale (GDS-15), 21-item Fall Risk Index (FRI-21), the quantitative subjective quality of life (QOL), current medical situation, past medical histories and social backgrounds. Results: The scores in basic ADL, each item of the TMIG-IC and five items of the quantitative subjective QOL were significantly lower, and the scores in GDS-15 and in FRI-21 were significantly higher according to certification level, in order of uncertified, specified, support-level and care-level elderly in a dose–response manner. Exercise and drinking habits were significantly less common in support- or care-level elderly than in specified or uncertified elderly. The prevalence of taking antihypertensive, antihyperlipidemia, antidepressant or sleeping medications was significantly higher in the support- or care-level elderly than in uncertified or specified elderly people. Support- or care-level elderly also had a significantly higher prevalence of past medical histories of stroke, bone fractures, osteoarthropathy, heart disease and cancer than uncertified or specified elderly people. Conclusion: Actual standardized quantitative and qualitative geriatric functions of the elderly among four categories in newly revised LTCI system were shown in a depopulated and aging town in Japan. Based on the actual situation of functions of the elderly, the strengths and weaknesses of the current LTCI system were reconsidered. Further research on the measures to prevent future dependency among the specified and support-level elderly is required. Geriatr Gerontol Int 2013; 13: 63–69.

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. Geriatr Gerontol Int 2012; ••: ••-••. Language: en

Epidemiologic data examining the relationship between oral health status and cognitive status are sparse, especially in Asian populations. This study aimed to assess whether periodontal disease and tooth loss were related to cognitive impairment among older Japanese. Study participants were 291 Japanese (101 men and 190 women, average age: 80.9 years), classified into three groups based on a clinical examination of oral health status: no periodontal disease, periodontal disease, and edentulous. Periodontal disease was defined using criteria recommended in the consensus report of the European Workshop in Periodontology with a modification. Cognitive impairment was defined using the results of the Mini-mental State Examination (MMSE) and Hasegawa Dementia Scale-Revised (HDS-R) scores. Multivariable logistic regression analyses assessed the relationship of the three-category oral health status variable (reference category = no periodontal disease) with low MMSE score (≤23) and low HDS-R score (≤20). Age, gender, years of education, body mass index, smoking status, drinking behavior, and history of cardiovascular disease were tested as potential confounders in the multivariable models. Periodontal disease and edentulous were significantly associated with greater odds of low cognitive performance after controlling for potential confounders. The multivariable adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for low MMSE score associated with periodontal disease and edentulous were 2.21 (1.01–4.84) and 2.28 (1.06–4.90), respectively. The multivariable adjusted ORs (95% CIs) for low HDS-R score associated with periodontal disease and edentulous were 4.85 (1.29–18.15) and 3.86 (1.05–14.20), respectively. Poor oral health status was significantly associated with cognitive impairment among community-dwelling older Japanese. Additional well-controlled longitudinal studies are needed to elucidate whether there may be a possible cause-and-effect relationship between oral health status and cognitive function.