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Objectives This study aimed to investigate the association between falls and social frailty and its components among older Japanese adults. Methods This is a cross-sectional study. Participants were categorized into 3 groups based on the number of falls in the past year: no fall (none), a single fall (occasional), and more than one fall (recurrent). The participants who met 2 or more of the following criteria were defined as socially frail: living alone, going out less frequently compared with the previous year, rarely visiting friends, feeling unhelpful to friends or family, and not talking with someone daily. Results A total of 4,495 older Japanese adults living in a community analyzed in this study (51.0% women). Of the participants in this study, 3,851 (85.7%) were categorized as none, 443 (9.9%) as occasional, and 201 (4.5%) as recurrent. The proportion of participants considered socially frail was 11.5% in this study. Recurrent falls were associated with social frailty, even after adjusting for covariates (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.01–2.19). The experience of recurrent falls was associated with the following components: "feeling unhelpful to friends and family" (OR: 1.62; 95% CI: 1.14–2.31) and "going outside less frequently compared with last year" (OR: 1.57; 95% CI: 1.06–2.31). Discussion Among older Japanese adults, recurrent falls were associated with social frailty and with 2 of its components in particular: social roles and social participation. Future longitudinal studies should be conducted to gain insight into any causal relationships between these variables. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to examine whether dietary diversity is associated with cognitive impairment, including mild cognitive impairment (MCI), in community‐dwelling older Japanese adults. Methods: This cross‐sectional study was carried out in a general community setting. MCI and global cognitive impairment (GCI) were assessed using the Mini‐Mental State Examination and National Center for Geriatrics and Gerontology‐Functional Assessment Tool, which are multicomponent neurocognitive tests that include memory attention, executive function and processing speed. Dietary diversity was assessed using the diet variety score. The diet variety score assessed the 1‐week consumption frequency of 10 food groups, and either 0 or 1 point was allocated to each category based on the following responses: (i) "eat almost every day" (1 point); and (ii) "not eaten almost daily" (0 points). Older adults with a diet variety score of ≥3 points were defined as having high dietary diversity. Results: Data included 8987 older adults (mean age 73.9 ± 5.5 years; men 44.3%). The overall prevalences of MCI and GCI were 17.1% (n = 1538) and 8.4% (n = 753), respectively. The proportion of patients with a high dietary diversity was 69.9% (n = 6286). Multinomial logistic regression analysis revealed high dietary diversity was associated with MCI (OR 0.83, 95% CI 0.73–0.94) and GCI (OR 0.77, 95% CI 0.65–0.92) after adjusting for covariates. Conclusions: This study had a large sample size of older Japanese adults, and showed that high dietary diversity was associated with a lower proportion of MCI and GCI among older adults. Geriatr Gerontol Int 2024; 24: 75–81. [ABSTRACT FROM AUTHOR]

Previous SARS-CoV-2 infection and vaccination, coupled with the rapid evolution of SARS-CoV-2 variants, have modified COVID-19 clinical manifestations. We aimed to characterise the clinical symptoms of COVID-19 individuals in omicron BA.2 and BA.5 Japanese pandemic periods to identify omicron and subvariant associations between symptoms, immune status, and clinical outcomes. In this registry-based observational study, individuals registered in Sapporo's web-based COVID-19 information system entered 12 pre-selected symptoms, days since symptom onset, vaccination history, SARS-CoV-2 infection history, and background. Eligibility criteria included symptomatic individuals who tested positive for SARS-CoV-2 (PCR or antigen test), and individuals who were not tested for SARS-CoV-2 but developed new symptoms after a household member tested positive for SARS-CoV-2. Symptom prevalence, variables associated with symptoms, and symptoms associated with progression to severe disease were analysed. Data were collected and analysed between April 25 and Sept 25, 2022. For 157 861 omicron-infected symptomatic individuals, cough was the most common symptom (99 032 [62·7%] patients), followed by sore throat (95 838 [60·7%] patients), nasal discharge (69 968 [44·3%] patients), and fever (61 218 [38·8%] patients). Omicron BA.5 infection was associated with a higher prevalence of systemic symptoms than BA.2 in vaccinated and unvaccinated individuals (adjusted odds ratio [OR] for fever: 2·18 [95% CI 2·12–2·25]). Omicron breakthrough-infected individuals with three or more vaccinations or previous infection were less likely to exhibit systemic symptoms (fever 0·50 [0·49–0·51]), but more likely to exhibit upper respiratory symptoms (sore throat 1·33 [1·29–1·36]; nasal discharge 1·84 [1·80–1·89]). Infected older individuals (≥65 years) had lower odds for all symptoms. However, when symptoms were manifest, systemic symptoms were associated with increased odds for severe disease (dyspnoea 3·01 [1·84–4·91]; fever 2·93 [1·89–4·52]), whereas upper respiratory symptoms were associated with decreased odds (sore throat 0·38 [0·24–0·63]; nasal discharge 0·48 [0·28–0·81]). Host immunological status, omicron subvariant, and age were associated with a spectrum of COVID-19 symptoms and outcomes. BA.5 produced a higher systemic symptom prevalence than BA.2. Vaccination and previous infection reduced systemic symptom prevalence and improved outcomes but increased upper respiratory tract symptom prevalence. Systemic, but not upper respiratory, symptoms in older people heralded severe disease. Our findings could serve as a practical guide to use COVID-19 symptoms to appropriately modify health-care strategies and predict clinical outcomes for older patients with omicron infections. Japan Agency for Medical Research and Development. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the risk factors for household transmission of the omicron variant of SARS‐CoV‐2. Background: The household infection rate has been reported to be higher for the omicron variant than for non‐omicron variants of SARS‐CoV‐2. Determination of the risk factors for household transmission of the omicron variant is therefore important. Design: A Retrospective Cohort Study was conducted. Methods: When family members of health care workers (HCWs) were found to be infected with SARS‐CoV‐2, the HCWs had to receive two nucleic acid amplification tests for SARS‐CoV‐2: immediately after and 5 to 10 days after the onset of COVID‐19 in the family members. Risk factors of household transmission were analysed by comparing cases (HCWs infected with SARS‐CoV‐2) and controls (HCWs not infected with SARS‐CoV‐2) using multivariable analysis. Results: Unvaccinated status (OR: 3.97), age of index cases (≤6 years) (OR: 1.94) and staying at home with index cases (OR: 10.18) were risk factors for household transmission. Conclusion: If there is a strong desire to avoid household infection, family members infected with SARS‐CoV‐2 should live separately during the period of viral shedding. Summary statement: What is already known about this topic? During the COVID‐19 pandemic, nurses have been exposed to SARS‐CoV‐2 not only from COVID‐19 patients but also from family members infected with SARS‐CoV‐2 but prevention of SARS‐CoV‐2 infection to nurses is important to maintain health services function.The household infection rate was reported to be higher for the omicron variant (42.7%) than for non‐omicron variants (36.4% for Alpha, 29.7% for Delta and 22.5% for Beta). Determination of the risk factors for household transmission of the omicron variant is therefore important. What this paper adds? Unvaccinated HCWs had higher transmission rates (OR: 3.97, 95% CI: 1.22–12.88) than those of HCWs who received more than two doses of BNT162b2 or mRNA‐1273 mRNA COVID‐19 vaccines.Index cases aged 6 years or younger had higher transmission rates (OR: 1.94, 95% CI: 1.13–3.35) than those of index cases aged 7 years or older.The odds of transmitting to HCWs was higher (OR: 10.18, 95% CI: 2.98–34.72) for HCWs who stayed at home with the index cases than for HCWs who spent time in a different building from the index cases. The implications of this paper: If there is a strong desire to avoid household infection, family members infected with SARS‐CoV‐2 should live separately during the period of viral shedding. [ABSTRACT FROM AUTHOR]

Clinical features of COVID-19 are diverse, and a useful tool for predicting clinical outcomes based on clinical characteristics of COVID-19 is needed. This study examined the laboratory values and trends that influence mortality in hospitalised COVID-19 patients. Data on hospitalised patients enrolled in a registry study in Japan (COVID-19 Registry Japan) were obtained. Patients with records on basic information, outcomes, and laboratory data on the day of admission (day 1) and day 8 were included. In-hospital mortality was set as the outcome, and associated factors were identified by multivariate analysis using the stepwise method. A total of 8860 hospitalised patients were included. The group with lactate dehydrogenase (LDH) levels >222 IU/L on day 8 had a higher mortality rate compared to the group with LDH levels ≤222 IU/L. Similar results were observed in subgroups formed by age, body mass index (BMI), underlying disease, and mutation type, except for those aged <50 years. When age, sex, BMI, underlying disease, and laboratory values on days 1 and 8 were tested for factors strongly associated with in-hospital mortality, LDH on day 8 was most strongly associated with mortality. LDH level on day 8 was the strongest predictor of in-hospital mortality in hospitalised COVID-19 patients, indicating its potential usefulness in post-treatment decision-making in severe COVID-19 cases. [ABSTRACT FROM AUTHOR]

Background: The association of sleep habits with "advancing age among older adults" is not fully understood. Objectives: The purpose of the present study was to examine the association of sleep habits with advancing age among community-dwelling older adults in Japan. Methods: A total of 18,005 older people (mean age: 73.2 ± 6.0 years; 8,070 men and 9,935 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analyzed. Participants were asked in face-to-face interviews about the times they usually go to bed, fall asleep, wake-up, and get up. The amount of time spent in bed and self-reported sleep duration were then calculated from the differences between these times. As other parameters, the subjects were also asked about sleep latency, time spent in bed after waking up, number of nocturnal awakenings, and duration of napping in a typical day. Results: The results of the Jonckheere-Terpstra test showed that all sleep parameters shifted to an earlier time (going to bed, falling asleep, waking up, and getting out of bed), longer duration (sleep duration, time spent in bed, sleep latency, time spent in bed after waking up, and napping), or more nocturnal awakenings with advancing age (all p < 0.01). Among the men, the time of waking up was not significantly associated with age, while among the women, the time of getting up was not significantly associated with age. Conclusion: These results from a large cohort show the age-related trends of sleep habits in community-dwelling older adults in Japan. Our results revealed that a longer duration and earlier timing of sleep are associated with advancing age. [ABSTRACT FROM AUTHOR]

Aim: Physical frailty is a critical health problem that can increase the risk of adverse health outcomes in older adults. Driving cessation has been associated with negative outcomes such as disability. However, the relationship between physical frailty and driving cessation remains unclear. Thus, this study aimed to examine whether driving cessation is associated with physical frailty transition in community‐dwelling older adults. Methods: This prospective cohort study was performed in a community setting in Japan. Participants were 2934 older Japanese adults, classified into two groups according to their driving status: a driving group (drivers at baseline who continued driving at a 4‐year follow‐up) and a driving cessation group (drivers at baseline who ceased driving by 4‐year follow‐up). We examined the association between physical frailty transition and driving cessation over a 4‐year period, using logistic regression analysis before and after imputation. Results: In total, 3.9% of community‐dwelling older adults had ceased driving by the 4‐year follow‐up. Rates for physical frailty transition in the driving and driving cessation groups were 4.6% and 17.1%, respectively (P < 0.001). In fully adjusted logistic regression analysis, when compared with driving, driving cessation independently affected physical frailty transition. The results were similar after multiple imputations. Conclusions: Our findings indicated driving cessation was an independent risk factor associated with physical frailty transition in older adults. As physical frailty in older adults can contribute to negative health outcomes, including increased disability and mortality, preventing frailty has important public health implications. Geriatr Gerontol Int 2021; 21: 1047–1052. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. Objective: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. Methods: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. Results: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54–9.66) or pre-frail (2.40, 1.58–3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were ¥6,434 ($63.1) for robust, ¥19,324 ($189.5) for pre-frail, and ¥147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. Discussion/Conclusion: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs. [ABSTRACT FROM AUTHOR]

Background: Identifying factors that contribute to the development of sarcopenia in older adults is a public health priority. Although several studies have examined the association between sleep duration and sarcopenia, additional evidence is needed to reveal the causality of this association, especially from a longitudinal study. The purpose of the present study was to examine whether sleep duration was associated with the progression to sarcopenia and its subcomponents among community‐dwelling older adults in Japan. Methods: A total of 3918 older community‐dwelling people (mean age: 73.2 ± 6.0 years, 51.8% female) included in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analysed. Sleep duration was assessed using a self‐reported questionnaire. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of progression of sarcopenia at Wave 2 (4 years later), according to the three categories of sleep duration [short: ≤6.0 h, medium: 6.1–8.9 h (control), & long: ≥9.0 h)] at Wave 1. Results: The numbers in each group in the second wave among the total sample were as follows: short 403 (10.3%), medium 2877 (73.4%), and long 638 (16.3%). Significant associations with the progression of sarcopenia were found in the long sleep duration group compared with the medium one, even after adjustment for other covariates (OR 1.66, 95% CI: 1.02–2.69, P = 0.040). Long sleep duration was significantly associated with slow gait (OR: 1.55, 95% CI: 1.17–2.06, P = 0.002) and low grip strength (OR: 1.34, 95% CI: 1.00–1.78, P = 0.047) but was not associated with low muscle mass (OR: 1.33, 95% CI: 0.74–2.38, P = 0.343). Conclusions: This study revealed that long sleep duration was associated with an increased risk of progression to sarcopenia among older adults. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine the association between physical activity (PA) and/or cognitive activity (CA) and cognitive impairment in a sample of older adults from a community‐based cohort in Nagoya, Japan. Methods: A total of 2726 participants (mean age 75.5 ± 3.9 years; 51.8% women) met the study criteria. The time of moderate‐to‐vigorous intensity PA was measured using an accelerometer. CA was subjectively assessed by the frequency of engagement in six activities (reading, writing for pleasure, doing crossword puzzles, playing board games/cards, participating in organized group discussions and playing musical instruments). Participants were categorized into four groups by high or low PA combined with high or low CA. Cognitive impairment was defined by at least one of four neuropsychological tests with a result of at least 1.5 standard deviations below the reference threshold. Results: The prevalence of cognitive impairments differed significantly between the groups (P < 0.001), with 29.5% in the low PA and low CA group, to 14.8% in the high PA and high CA group. Compared with the low PA and low CA group, other groups had significantly lower odds ratio (OR) of cognitive impairment (low PA and high CA: OR 0.54, 95% CI 0.37–0.79; high PA and low CA: OR 0.64, 95% CI 0.45–0.92; high PA and high CA: OR 0.42, 95% CI 0.30–0.58). Conclusions: Both PA and CA showed a protective association with cognitive impairment, even when one or the other is lowly engaged. Therefore, older adults with difficulty engaging in sufficient PA might benefit from CA to prevent cognitive impairment. Geriatr Gerontol Int 2020; 20: 31–35. [ABSTRACT FROM AUTHOR]

Background Evaluating physical performance could facilitate dementia risk assessment. However, findings differ regarding which type of physical performance best predicts dementia. Objective The objective of this study was to examine the association between physical performance and incidence of dementia in Japanese community-dwelling older adults. Design This was a prospective study of community-dwelling older adults. Methods Of 14,313 invited individuals who were ≥ 65 years old, 5104 agreed to participate from 2011 to 2012, and 4086 (52% women; mean age = 72.0 years) met the criteria. Baseline assessments of the following physical performance indicators were obtained: grip strength, the Five-Times Sit-to-Stand Test, and the Timed "Up & Go" Test. The physical performance level in each test was categorized as C1 (highest), C2 (middle–high), C3 (middle–low), or C4 (lowest) on the basis of sex-stratified quartile values. Incident dementia status was obtained from medical records that were updated monthly. Results During follow-up (mean duration = 42.9 months), there were 243 incident cases of dementia (5.9%). Log-rank test results indicated that a lower physical performance level constituted a significant risk factor for dementia. After adjustment for covariates, Cox proportional hazards models (reference: highest physical performance level [C1]) demonstrated that the Five-Times Sit-to-Stand Test in the group with the lowest physical performance level (hazard ratio = 1.69; 95% CI = 1.10–2.59) was significantly associated with a risk of dementia. Likewise, the Timed "Up & Go" Test in the group with the lowest physical performance level (hazard ratio = 1.54; 95% CI = 1.01–2.35) was significantly associated with a risk of dementia. However, grip strength was not significantly associated with a risk of dementia. Limitations This study was limited by the use of medical record data. Conclusions A lower mobility-related physical performance level was associated with dementia risk. Dementia risk assessment should include an adequate evaluation of physical function. [ABSTRACT FROM AUTHOR]

We investigated the association between social frailty and Alzheimer's disease (AD) incidence among community-dwelling older adults in Japan. A 53-month follow-up cohort study was conducted in Obu City, Japan. Participants comprised 3,720 community-dwelling older adults (mean age, 71.7 years; 48.4% men). The operational definition of social frailty comprised five items: going out infrequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not always talking with someone each day. During follow-up, the cumulative AD incidence risk between socially robust, pre-frail, and frail groups was 4.1%, 5.5%, and 10.7%, respectively. In both crude (HR 2.72, 95% CI 1.90-3.89, p < 0.001) and adjusted Cox proportional hazards models (HR 1.53, 95% CI 1.03-2.28, p = 0.035), social frailty was associated with a significantly higher AD incidence risk. The present study revealed that social frailty is strongly associated with AD incidence among Japanese older adults. Further research should elucidate whether social frailty prevention is effective for decreasing AD risk. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have obtained inconsistent results regarding the association between sedentary behavior and cognitive impairment. The present study aimed to examine the association between cognitive activity in a sitting position (CAS) and cognitive impairment among older adults. Methods: Community‐dwelling older adults, from Obu or Nagoya in Japan, participated in a survey in 2013. A total of 5300 participants (mean age 75.0 ± 5.1 years; women 52.9%) met the criteria for the present study. We assessed the frequency and variety of CAS composed of six activities, including reading books or newspapers, writing a diary or letters, solving crossword puzzles, playing board games, using a computer and maintaining housekeeping records. The frequency of engagement in CAS was one or more time(s)/week. The variety of CAS was assessed by the number of engagements in CAS. Cognitive impairment was defined by two or more tests at least 1.5 standard deviations below the reference threshold in four neuropsychological tests. Logistic regression analysis was carried out to examine the associations between the frequency and variety of CAS and cognitive impairment, adjusted for covariates. Results: The proportion of participants engaging in each CAS varied from 12.3% (playing board games) to 93.6% (reading books or newspaper). After adjustment, five CAS were significantly associated with cognitive impairment (OR 0.33–0.65, all P < 0.001). The variety of CAS was significantly associated with the reduced OR of cognitive impairment (OR 0.61, 95% confidence interval 0.55–0.68). Conclusions: Almost every CAS and a greater variety of CAS are associated with cognitive impairment among older people. Geriatr Gerontol Int 2019; 19: 98–102. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to identify risk factors for physical frailty and to understand the transitional status of frailty. Methods: The participants were 4676 older adults in the National Center for Geriatrics and Gerontology ‐ Study of Geriatric Syndromes. Physical frailty status was classified as robust, pre‐frail and frail at baseline and 4‐year follow up (mean follow up 47.9 ± 1.8 months). Data for demographic variables, medical conditions, fall, depressive symptoms and cognitive function were also collected. Multiple imputation was used to reduce selection bias and loss of information. Results: Progression occurred from a robust to frail status in 52 participants (2.6%) and from pre‐frailty to frailty in 281 participants (12.0%). Mortality increased with frailty status at baseline: robust 46 (2.3%), pre‐frail 112 (4.8%) and frail 54 (15.6%). In logistic regression analysis, age (OR 1.10, 95% CI 1.06–1.13), sex (men; OR 0.67, 95% CI 0.46–0.95), body mass index (OR 1.06, 95% CI 1.01–1.12]), fall (OR 1.92, 95% CI 1.31–2.81), Geriatric Depression Scale (OR 1.15, 95% CI 1.08–1.22), Mini‐Mental State Examination (OR 0.87, 95% CI 0.82–0.93) and education (OR 0.91, 95% CI 0.85–0.98), were related with new incident frailty. Among participants in the pre‐frail class at baseline, exhaustion (OR 3.24, 95% CI 1.97–5.34), physical inactivity (OR 3.09, 95% CI 1.94–4.93), lower muscle strength (OR 3.77, 95% CI 2.35–6.03) and lower mobility (OR 2.54, 95% CI 1.57–4.10) were related to progression to frailty (all P < 0.05). Conclusions: The results of the present prospective study provide key information on the transitional status of frailty and the risk factors for progression to frailty. A further study is required to determine the pathophysiological changes that underlie the transition to frailty. Geriatr Gerontol Int 2018; 18: 1562–1566. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between cognitive function and unsafe driving acts among community‐dwelling older adults with cognitive impairments. Methods: Participants (n = 160) were older residents of Obu, Japan, aged ≥65 years with cognitive impairments. They regularly drove and were assessed for the number of unsafe driving acts without adequate verification during an on‐road test. We also evaluated cognitive function (attention, executive function and processing speed). Other examined variables included demographics, driving characteristics and visual condition. Results: Participants were classified into two groups according to the number of unsafe driving acts as follows: high group (≥4 unsafe driving acts) and low group (≤3 unsafe driving acts). The high group participants were older in age (P < 0.001) and obtained a lower score on the symbol digit substitution task (P = 0.002) than the low group. The number of unsafe driving acts showed modest significant positive correlations with age (r = 0.396, P < 0.001). The symbol digit substitution task score was significantly associated with the number of unsafe driving acts (β = −0.196, P < 0.05) after adjusting for age group. Conclusions: Processing speed was associated with unsafe driving acts that became worse with increasing age. Future study will be required to longitudinally examine the influence of processing speed on traffic accidents for those with cognitive impairments. Geriatr Gerontol Int 2018; 18: 847–852 [ABSTRACT FROM AUTHOR]

Objective: This study examined the association between excessive daytime sleepiness (EDS) and gait characteristics (e.g., speed, variability) in community-dwelling older adults. Method: This cross-sectional study included 3,901 individuals aged ≥65 years. Participants answered questions about EDS, sleep duration, and other sleep-related symptoms. Gait speed, stride length, and the variability in stride length were assessed by using a stopwatch and a WalkWay device. Results: EDS was significantly associated with slower gait speed among younger subjects (<75 years, p = .021) and with both slower gait speed (p = .045) and greater variability in stride length among older subjects (≥75 years, p = .048) in a multivariate analysis adjusted for age, sex, body mass index, medication, number of comorbidities, and education. Discussion: EDS associates with gait ability, particularly in older old adults. Further prospective studies are needed to determine the causal association between gait ability and sleep disturbances, including EDS. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to describe the age-dependent changes in the parameters of physical performance and body composition in Japanese older adults who are independently dwelling in the community. We also examined whether the age-dependent changes differ among physical performance and body composition parameters. Methods Cross-sectional data from 10 092 community-dwelling older adults (mean age 73.6 years; 5296 women) were analyzed. The measures of physical performance included hand-grip strength, the five-times-sit-to-stand test, and walking speed. Body composition parameters (body weight, fat mass, and appendicular skeletal muscle mass) were measured with a bioelectrical impedance analyser. Correlations between age and the physical performance and body composition parameters were tested. The T-scores of physical performance and body composition measurements were calculated and presented according to 5-year age groups to examine the differences in age-dependent changes in physical performance and body composition parameters. Results All physical performance measures significantly decreased with aging. The cumulative mean T-scores according to age group showed different age-dependent changes between body mass index (BMI) and appendicular skeletal muscle mass index (ASMI) (cumulative mean T-score change of BMI and ASMI of −5.7 to −2.9 and −12.7 to −12.1, respectively). The slope declines in age-associated changes were greater in grip strength ( β = −0.77, 95% confidence interval = −0.82 to −0.76) for men and in walking speed ( β = −0.95, 95% confidence interval = −0.99 to −0.90) for women. Conclusions The patterns of age-dependent decreases in physical performance measures differed among parameters and between sexes. There is a possibility of a difference in the age-related slope patterns among parameters; decreases in grip strength in men and walking speed in women may be more prominent with advancing age. Furthermore, the decrease in ASMI with age is more striking than that of BMI. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to evaluate the relationship between kidney function with concomitant diabetes or hypertension and frailty in community-dwelling Japanese older adults. Methods The participants were 9606 residents (community-dwelling Japanese older adults) who completed baseline assessments. The estimated glomerular filtration rate (mL/min/1.73 m2) was determined according to the serum creatinine level, and participants were classified into four mutually exclusive categories: ≥60.0 (normal range), 45.0-59.9, 30.0-44.9 and <30.0 mL/min/1.73 m2. Frailty status was defined using five criteria as described by Fried: slow gait speed, muscle weakness, low physical activity, exhaustion and unintentional weight loss. Participants who met three, four or five criteria satisfied the definition of having frailty. Multivariate logistic regression was used to examine the relationships between estimated glomerular filtration rate and frailty. Results After multivariate adjustment, participants with lower kidney function (estimated glomerular filtration rate <30.0 mL/min/1.73 m2) were more frail (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.01−3.59). In addition, individuals with a history of diabetes (OR 2.76, 95% CI 1.21−8.24) or hypertension (OR 2.53, 95% CI 1.45−5.12) showed a significantly increased risk of frailty in the lower kidney function group, regardless of multivariate controls. Furthermore, the analyses showed an even greater increase in the risk of frailty in patients with a history of both diabetes and hypertension (OR 3.67, 95% CI 1.13−14.1) Conclusions A lower level of kidney function was associated with a higher risk of frailty in community-dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 1527-1533. [ABSTRACT FROM AUTHOR]

Objective Although sleep disturbances are associated with disability among older adults, no longitudinal study has examined the impact of sleep assessed based on both sleep quality and quantity on incident disability. This study examined whether sleep duration and excessive daytime sleepiness were associated with incidence of disability in community-dwelling older adults. Methods A total of 4756 older adults (53.3% women, mean age 71.9 years) met the entry criteria for this study. We measured monthly incident disability, defined as the onset of being certified for personal support or care as required by Japanese public long-term care insurance during the preceding 24 months. Sleep duration, excessive daytime sleepiness (EDS), and demographic factors were assessed at baseline. Cox's proportional hazard regression analysis estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incidence of disability according to the 3 categories of sleep duration (short: ≤6.0 hours, mid: 6.1 to 8.9 hours, long: ≥9.0 hours), and we used mid duration sleepers as the reference group. Results Long sleep duration (HR 1.43, 95% CI 1.04–1.97) and presence of EDS (HR 1.41, 95% CI 1.01–1.98) were associated with higher rates of incident disability. Furthermore, a combination of sleep duration and EDS was associated with a higher rate of incident disability than the mid and no EDS group (HR 2.25, 95% CI 1.36–3.70). Conclusion Long sleep duration and EDS affected the incident of disability; thus, older adults with both sleep patterns may require an intervention to alter their sleep habit. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms and memory problems are significant risk factors for dementia. Exercise can reduce depressive symptoms and improve cognitive function in older people. In addition, the benefits of horticultural activity on physical and mental well-being have been demonstrated in people with dementia. Although evidence of such non-pharmacological interventions is mounting, no studies have examined whether physical exercise and horticultural activity exert a positive impact on brain and mental health (e.g., depressive symptoms) in non-demented older adults at high risk of cognitive impairment and depression. Therefore, we propose a randomized controlled trial to assess the efficacy and efficiency of physical exercise and horticultural activity in improving brain and mental health in community-dwelling older adults with memory problems and depressive symptoms.Methods/design: The 20-week randomized controlled trial will include 90 community-dwelling adults aged 65 years or older with memory problems and depressive symptoms. Participants will be randomized to one of three experiments: exercise, horticultural activity, or educational control group, using a 1:1:1 allocation ratio. The combined exercise program and horticultural activity program will consist of 20 weekly 90-minute sessions. Participants in the exercise group will practice aerobic exercise, muscle strength training, postural balance retraining, and dual-task training. The horticultural activity program will include crop-related activities, such as field cultivation, growing, and harvesting. Participants in the educational control group will attend two 90-minute educational classes during the 6-month trial period. Depressive symptoms and memory performance will be measured by the Geriatric Depression Scale-15, and the Logical Memory subtests of the Wechsler Memory Scale-Revised will be used to measure depressive symptoms and memory performance as primary outcomes, at baseline (prior to randomization), immediately following intervention (6 months from baseline), and 6 months after intervention. Hippocampal volume will be measured at baseline and immediately after intervention, using magnetic resonance imaging. Secondary outcomes will comprise cognitive function, including language, attention/executive performance, and processing speed; brain-derived neurotrophic-factor serum levels; and health-related quality of life.Discussion: This intervention study will determine the clinical importance and efficacy of physical exercise and horticultural activity as non-pharmacological interventions in community-dwelling older adults at high risk of poor brain and mental health.Trial Registration: UMIN000018547 ; registered 7 August 2015. [ABSTRACT FROM AUTHOR]

The updated definition of sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP2) recommends both low muscle mass and quality to diagnose sarcopenia; concurrent poor physical performance is considered indicative of severe sarcopenia; however, the relationship between the revised definition and disability incidence among Japanese older adults is unclear. Therefore, we aimed to examine the associations between EWGSOP2-defined sarcopenia and disability incidence among community-dwelling older Japanese adults. Nationwide study. We included 4561 individuals aged ≥65 years and enrolled in the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes (NCGG-SGS). Skeletal muscle mass was assessed using a bioimpedance analysis device; handgrip strength and walking speed were measured as physical performance indicators. We used the Asian Working Group for Sarcopenia cutoffs to define low muscle mass and poor physical performance. We stratified all participants into nonsarcopenia, sarcopenia, and severe sarcopenia groups. Disability incidence was prospectively determined over 49 months using data extracted from the Japanese long-term care insurance system. The prevalence of sarcopenia and severe sarcopenia was 3.4% and 1.7%, respectively. Participants with any form of sarcopenia were at a higher risk of disability [hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.27-2.49]. Although participants with severe sarcopenia showed a higher risk of disability (HR 2.00, 95% CI 1.32-3.02), there was no significant disability risk in the sarcopenia group (HR 1.54, 95% CI 0.97-2.46). Grip strength (HR 0.96, 95% CI 0.94-0.98) and walking speed (HR 0.19, 95% CI 0.12-0.30) negatively correlated with disability incidence. Severe sarcopenia, involving low muscle mass and poor physical performance, might increase disability risk in older adults, as opposed to low muscle mass alone. Further studies are needed to determine whether sarcopenia without poor physical performance increases disability risk. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults. Design Prospective cohort study. Setting General communities in Japan. Participants Participants comprised 3538 older Japanese adults. Measurements We assessed our participants in terms of frailty status (physical frailty, cognitive impairment, and social frailty), depressive symptoms (geriatric depression scale ≥6), and other covariates, and excluded those who showed evidence of depression. Then, after a 4-year interval, we again assessed the participants for depressive symptoms. Physical frailty was defined by the Fried criteria, showing 1 or more of these were physical frailty. To screen for cognitive impairment, receiving a score below an age-education adjusted reference threshold in 1 or more tests was cognitive impairment. Finally, social frailty was defined using 5 questions, and those who answered positively to 1 or more of these were considered to have social frailty. Results After multiple imputations, the incidence rate of depressive symptoms after 4 years of follow-up was 7.2%. The incidence rates of depressive symptoms for each frailty status were as follows: 9.6% for physical frailty vs 4.6% without, 9.3% for cognitive impairment vs 6.5% without, and 12.0% for social frailty vs 5.1% without. Finally, through the application of multivariable logistic regression analysis, the incidence of depressive symptoms was found to have a significant association with social frailty (odds ratio 1.55; 95% confidence interval 1.10–2.20) but not with physical frailty or cognitive impairment. Conclusions This study revealed that social frailty, in comparison with physical frailty and cognitive impairment, is more strongly associated with incidences of depressive symptoms among elderly. [ABSTRACT FROM AUTHOR]

Objectives To elucidate whether a combination of slow gait speed and depressive symptoms result in higher risk of incident disability in older adults than either symptom individually. Design Prospective cohort study. Setting Obu City, Aichi Prefecture, Japan. Participants Participants were 4038 older adults (48.7% male, mean age = 71 years) who met the study inclusion criteria. Measurements Longitudinal data on incident disability were collected up to 33 months [median 31 months (interquartile range 29–32 months)] after baseline. We monitored monthly incident disability, defined as Japanese long-term care insurance certification for personal support or care. Baseline measurements included covariates for incident disability, gait speed, and the Geriatric Depression Scale for assessing depressive symptoms. The associations between slow gait, depressive symptoms, or their co-occurrence, and incident disability were examined. Results Control participants were the reference in an adjusted Cox proportional hazard regression model. Participants with co-occurring slow gait and depressive symptoms showed a greater risk of incident disability [hazard ratio (HR) 3.08, confidence interval (CI) 95% 2.00–4.75]. Greater risk was also found for participants with slow gait speed alone (HR 2.44, CI 95% 1.71–3.47) and depressive symptoms alone (HR 1.60, CI 95% 1.01–2.53). Conclusions Older adults with both risk factors may require early detection and physical and psychological intervention. [ABSTRACT FROM AUTHOR]

• Several prospective studies have associated computer use with cognitive function, but these studies had several limitations, such as specific sampling, or limiting assessment to only a few cognitive domains. • Our findings showed computer use can contribute to the protection of cognitive function compared to non-use. • Risk factors of cognitive decline or dementia, such as lower education, presence of depressive symptoms, or slow gait speed, may hinder the maintenance of cognitive function through computer use. This study aimed to examine the prospective association between computer use and cognitive decline among community-dwelling Japanese older adults, considering the characteristics of computer users. This four-year prospective cohort study was conducted in Obu, Japan. Participants who were cognitive intact at Wave 1 (2011-2012) were followed through the study period. Cognitive decline was defined as scoring below the standard threshold in at least one of four neuropsychological tests at Wave 2 (2015-2016). The association between computer use at Wave 1 and cognitive decline was examined using logistic regression for complete samples (n = 2010, 52.5% female, mean 71.0 ± 4.7 years) and imputed samples (n = 3435, 51.8% female, mean 71.5 ± 5.3 years). The computer use group had a reduced adjusted odds ratio (aOR) of cognitive decline, after adjustment for covariates, in both the complete and imputed samples (complete samples: aOR 0.71, 95% confidence interval [CI] 0.52-0.97, p = 0.030; imputed samples: aOR 0.67, 95% CI 0.51-0.88, p < 0.003). Stratified analysis of both samples showed that computer users with ≥ 10 years' education, a GDS score of < 6, or a walking speed of ≥ 1.0m/s, showed reduced aOR for cognitive decline (aOR 0.61 to 0.69, p < 0.05). Those with < 10 years of education years, GDS scores ≥ 6 of GDS, or walking speed < 1.0m/s did not show significant association. Computer use is longitudinally associated with protected cognitive function, based on computer user characteristics. [ABSTRACT FROM AUTHOR]

Objectives Motoric cognitive syndrome (MCR), a newly described predementia syndrome characterized by cognitive complaints and slow gait, is associated with increased risk of developing dementia. Due to the potential differences in health, behavioral, and lifestyle factors between races that can influence dementia risk, it is important to examine risk factors for MCR in different countries. This study aimed to report the prevalence as well as modifiable factors associated with MCR in Japanese community-dwelling older adults. Design A cross-sectional design. Setting General community. Participants A total of 9683 older adults (52% women, mean age: 73.6 years) participating in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. Measurements Participants were screened for presence of MCR at baseline. The association of selected modifiable risk factors (medical illness, depressive symptoms, and falls) and lifestyle variables (obesity, physical inactivity, smoking, and alcohol consumption) with MCR was examined using multivariate logistic regression analysis. Results At cross-section, 619 participants met criteria for MCR, with an overall prevalence 6.4% (95% CI 5.9–6.9). A higher prevalence of MCR was seen with advancing age ( P < .001), but there were no sex differences. Diabetes (adjusted odds ratio [OR] 1.47, P = .001), depressive symptoms (OR 3.57, P < .001), and falls (OR 1.45, P < .001) were associated with increased risk of MCR. Among the lifestyle factors, obesity (OR 1.26, P = .018) and physical inactivity (OR 1.57, P < .001) were associated with increased risk of MCR. Conclusion MCR is common in the elderly Japanese population. The potentially modifiable risk and lifestyle factors identified for MCR should be further studied to develop interventions. [ABSTRACT FROM AUTHOR]

Objective To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults. Design Prospective cohort study. Setting Japanese community. Participants A total of 4304 adults age ≥65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment. Measurements Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty. Results During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (≥2/5) (hazard ratio 1.66, 95% confidence interval 1.00–2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02–2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5). Conclusions Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people. [ABSTRACT FROM AUTHOR]

Background: The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures in participating medical institutions nationwide and is intended to be used for promotion of AMR measures in participating facilities and their communities. This multicenter study aimed to determine the usefulness of the J-SIPHE system for evaluating the correlation between antibiotic use and antibiotic resistance in Hokkaido, Japan., Methods: Data on antibiotic use and detection rate of major resistant Gram-negative bacteria at 19 hospitals in 2020 were collected from the J-SIPHE system, and data correlations were analyzed using JMP Pro., Results: The detection rate of carbapenem-resistant Pseudomonas aeruginosa was significantly positively correlated with carbapenem use (Spearman's ρ = 0.551; P = .015). There were significant positive correlations between the detection rate of fluoroquinolone-resistant Escherichia coli and the use of piperacillin/tazobactam, carbapenems, and quinolones [ρ = 0.518 (P = .023), ρ = 0.76 (P < .001), and ρ = 0.502 (P = .029), respectively]., Conclusions: This is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using this system may be beneficial for promoting AMR measures., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: A physically active lifestyle, including physical and social activities, is needed to maintain muscle mass, strength, and physical performance. A large life space characterizes an active lifestyle, but the association between life space with physical and social activities and sarcopenia is unclear. This study aimed to examine the association between life space with physical and social activities, assessed using the Active Mobility Index (AMI), and sarcopenia in community-dwelling Japanese older adults., Methods: This study used a large, cross-sectional cohort dataset from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS). Between 2013 and 2018, community-dwelling Japanese adults aged ≥60 years participated in the NCGG-SGS. Sarcopenia was identified by measuring muscle mass and strength based on the clinical definition. The secondary outcomes were sarcopenia indices, including lower muscle mass, lower muscle strength, and lower gait speed. AMI assessed life space with physical and social activities in each life space (distance from the respondent's home: <1, 1-10, or >10 km) during the past month by noting the frequency, primary purpose, type of transportation, interaction with others, and physical activity. The associations between quartile groups of AMI total, physical, and social scores and sarcopenia were examined using a logistic regression model., Results: From all participants, 21 644 participants (age 73.5 ± 5.8 years, 54.7% female) were included in the analysis. The prevalence of sarcopenia was 4.1% (n = 894). For the AMI total score, referred to Q1 group, Q3 and Q4 groups were significantly associated with a reduced odds ratio (OR) of sarcopenia after adjusting for all covariates [adjusted OR (aOR) (95% confidence interval), Q3: 0.71 (0.57-0.89), Q4: 0.69 (0.55-0.87)]. Q3 and Q4 of the AMI physical score groups were also significantly associated with reduced OR of sarcopenia [Q3: 0.71 (0.57-0.89), Q4: 0.67 (0.54-0.84)]. For the AMI social score, only the Q4 group showed reduced OR for sarcopenia [0.79 (0.62-1.01)]. Q3 and Q4 of the AMI total score and physical score were associated with reduced OR of all sarcopenia indices (aOR 0.55-0.82, all P < 0.05), whereas Q4 of AMI social score was associated with all indices (aOR 0.85-0.81, all P < 0.05)., Conclusions: The extent of life space with physical activity was associated with sarcopenia in community-dwelling older adults. A longitudinal study is needed to examine whether life space with physical and social activities affect the development of sarcopenia., (© 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Background: The third wave of the COVID-19 epidemic in the island of Hokkaido, the second largest island in Japan, began abruptly in October 2020., Methods: We conducted a phylodynamic analysis of the SARS-CoV-2 genome sequences obtained from tertiary medical centers in the Greater Tokyo Area and Sapporo, the largest city in the island of Hokkaido, and genome sequences published by GISAID, an international SARS-CoV-2 genome database. We also analyzed the statistics on the person-nights of travelers in the island of Hokkaido from the Greater Tokyo Area in 2019 versus 2020., Results: At least eight sub-lineages belonging to the B.1.1.214 lineage were introduced to the island of Hokkaido from the island of Honshu, the mainland of Japan from late July to November 2020, during the governmental travel promotion program. Five of the eight sub-lineages originated from the Greater Tokyo Area. Comparison of the monthly ratios of the person-nights of travelers in the island of Hokkaido from the Greater Tokyo Area in 2019 and 2020 revealed that the highest value occurred in October 2020., Conclusion: We contend that the Japanese governmental travel promotion program contributed to the introduction of the B.1.1.214 sub-lineages from the main island of Honshu to the island of Hokkaido, and drove the third wave in Hokkaido, even if we are unable to establish the causality., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: This study aimed to examine whether physical activity measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) can predict incident disability in Japanese older adults., Methods: Community-dwelling older adults participated in a prospective cohort survey. The time spent in moderate- to vigorous-intensity physical activity was assessed at the survey baseline using the IPAQ-SF. The participants were categorized into those who spent ≥150 minutes per week (physically active) or <150 minutes per week (physically inactive) in moderate- to vigorous-intensity physical activity. Incident disability was monitored through Long-Term Care Insurance certification during a follow-up lasting 5 years., Results: Among the 4387 analyzable participants (mean age = 75.8 y, 53.5% female), the IPAQ-SF grouped 1577 (35.9%) and 2810 (64.1%) participants as those who were physically active and inactive, respectively. A log-rank test showed a significantly higher incidence of disability among the inactive group of participants (P < .001). The Cox proportional hazards model showed that physically inactive participants had a higher risk of incident disability than the physically active ones did, even after adjusting for covariates (hazard ratio, 1.24; 95% CI, 1.07-1.45, P < .001)., Conclusions: Older adults identified as physically inactive using the IPAQ-SF had a greater risk of developing disabilities than those identified as physically active. The IPAQ-SF seems to be appropriate to estimate the incidence risk of disability.

We provide the details of the successful management of a patient with active Cushing's disease complicated with coronavirus disease 2019 (COVID-19) pneumonia. The patient was a 27-year-old Japanese female healthcare worker who was scheduled to undergo pituitary surgery for Cushing's disease. She had been in close contact with an undiagnosed patient infected with COVID-19 and then developed COVID-19 pneumonia. Despite a lack of known risk factors associated with severe COVID-19 infection, the patient's dyspnea worsened and her respiratory condition deteriorated, as indicated by the need for 7 L/min oxygen supply by mask to maintain her oxygen saturation at >90%. Medical treatment was initiated to control hypercortisolism by the 'block and replace' regimen using steroidogenesis inhibitors and hydrocortisone. The COVID-19 pneumonia improved with multi-modal treatment including antiviral therapy. One month later, after a negative severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) test result and with appropriate protection against virus transmission to medical staff in the operating room and daily medical care nurses, trans-sphenoidal surgery was performed by our highly experienced pituitary surgeon. One month after the surgery, the patient's basal ACTH and cortisol levels and urinary free cortisol were all under the detection limit. Surgical remission was expected. Since hypercortisolism due to active Cushing's disease may worsen a COVID-19 infection, multi-disciplinary management that includes appropriate and prompt treatment strategies is mandatory in such cases.

Background/objective: A driving skill program had positive effects on safe driving performance in older adults, even those with cognitive impairment. However, the long-term effects of the program remain unclear. The purpose of this study was to examine whether such effects were maintained at 1 year after the intervention in older adults with cognitive impairment who had low driving skills., Design: A secondary analysis of single-blind randomized controlled trial., Setting: Community setting in Japan., Participants: Community-living adults, aged 65 years or older (n = 159), with mild cognitive impairment (MCI)., Intervention: The intervention group completed 10 classroom sessions of 1 hour and 10 on-road sessions of 50 minutes, focusing on common problem areas of older drivers. The control group received one education class about safety driving., Measurements: On-road driving performance was assessed by certified driving school instructors in a driving school at preintervention and postintervention, and 1-year follow-up., Results: A total of 159 community-living older drivers participated in this study and were randomized to either an intervention group (n = 71) or a control group (n = 88). One year after the intervention, 104 of 159 community-living older drivers completed the follow-up assessment (intervention group, n = 58). Regarding the safe driving skill score, there was a significant group × time interaction (P < .01), indicating benefits of the intervention over time. Although the intervention group showed a significant decline in the safe driving skill score from postintervention (score = 38.9 ± 46.1) to 1-year follow-up (score = -0.3 ± 55.2), there was a significant difference between the groups at 1-year follow-up (control group score = -148.5 ± 46.4) (P < .05), and between preintervention (score = -132.0 ± 54.6) and 1-year follow-up in the intervention group (P < .05)., Conclusion: The driving skill program maintained safe driving performance that had been improved by the intervention in older adults with MCI., (© 2020 The American Geriatrics Society.)

Background: No clinical scoring system has yet been established to estimate the likelihood of coronavirus disease (COVID-19) and determine the suitability of diagnostic testing in suspected COVID-19 patients., Methods: This was a single-center, retrospective, observational study of patients with suspected COVID-19 and confirmed COVID-19. Patient background, clinical course, laboratory and computed tomography (CT) findings, and the presence of alternative diagnoses were evaluated. Clinical risk scores were developed based on clinical differences between patients with and without COVID-19., Results: Among 110 patients suspected of having COVID-19, 60.9% underwent polymerase chain reaction (PCR) testing based on the judgment of physicians. Two patients were found to have COVID-19. The clinical characteristics of 108 non-COVID-19 patients were compared with those of 23 confirmed COVID-19 patients. Patients with COVID-19 were more likely to have a history of high-risk exposures and an abnormal sense of taste and smell. The COVID-19 group had significantly higher rates of subnormal white blood cell counts, lower eosinophil counts, and lower procalcitonin levels than the non-COVID-19 group. When blood test results, CT findings, and the presence of alternative diagnoses were scored on an 11-point scale (i.e., "COVID-19 Clinical Risk Score"), the COVID-19 group scored significantly higher than the non-COVID-19 group, more than four points in the COVID-19 group. All non-COVID patients who did not undergo PCR had a score of 4 or less., Conclusions: The COVID-19 Clinical Risk Score may enable the risk classification of patients suspected of having COVID-19 and can help in decision-making in clinical practice, including appropriateness of diagnostic testing. Further studies and prospective validation with an increased sample size are required.

Streptococcus pneumoniae may colonize the nasopharynx, and as pneumococcal colonization causes invasive diseases and the subsequent transmission, reducing bacterial burden in the nasal cavity is critical. Hochu-ekki-to (TJ-41) is a traditional Japanese herbal medicine that exerts immunomodulatory effects in host cells. In this study, we investigated the potency of TJ-41 in modulating pneumococcal colonization clearance by activating host immunity. Mice, intranasally inoculated with pneumococci, were treated orally with TJ-41. During colonization, TJ-41 treatment significantly reduced pneumococcal burden and increased macrophage population in the nasopharynx. Furthermore, interleukin 17A production was significantly enhanced after TJ-41 treatment. In vitro experiment using nasal-derived cells revealed that pneumococcal antigen exposure upregulated the transcription of interleukin 17A in the TJ-41-treated group compared with that in the control group. Macrophages activated by killed bacteria were significantly increased in the presence of TJ-41 in an interleukin 17A-dependent manner. Moreover, TJ-41 enhanced phagocytosis, inhibited bacterial growth, and improved the antigen-presenting capacity of macrophages. Our results demonstrate that TJ-41 accelerates the clearance of pneumococcal nasopharyngeal colonization via macrophage activation. Subsequent production of interleukin 17A provides an additional benefit to effector cells., (Copyright © 2020 Nakakubo, Kimura, Mimura, Kajiwara, Ishii, Konno and Tateda.)

Background: Malnutrition plays an essential role in the mechanism of pathogenesis for sarcopenia. In late life, both food consumption and energy intakes decline. One of key factors for reduced energy intakes is anorexia of ageing. The aim of this study is to examine the association between anorexia of ageing and sarcopenia among community-dwelling elderly Japanese individuals., Methods: This uses population-based, cross-sectional cohort study of elderly Japanese individuals. Anorexia of ageing was assessed via a simplified nutritional appetite questionnaire. Handgrip strength and walking speed were tested, and skeletal muscle mass was assessed using a bio-impedance analysis device. Subjects with sarcopenia were defined as those who met the criteria of the Asian Working Group for Sarcopenia. The association between anorexia of ageing and sarcopenia was then analysed via multiple regression analysis., Results: In total, 9,496 elderly Japanese individuals were evaluated (mean age 74.1 ± 5.4 years; male, 47.0%). The prevalence of anorexia of ageing was 9.8% (n = 927) in the present study. The prevalence of sarcopenia in men was 1.1%, 1.8%, 6.1%, 10.1%, and 21.2% and was 1.6%, 3.3%, 3.6%, 4.8%, and 7.4% in women aged 65-69, 70-74, 75-79, 80-84, and 85 years and older, respectively. The prevalence of anorexia also showed an age-dependent increase in both sexes (P < 0.001, respectively). The prevalence of anorexia in men was 8.3%, 6.3%, 9.8%, 13.6%, and 12.9% and was 7.9%, 9.4%, 10.5%, 17.6%, and 17.1% in women aged 65-69, 70-74, 75-79, 80-84, and 85 years and older, respectively. In multivariable logistic regression model adjusted for the covariates except for albumin, anorexia of ageing was independently associated with sarcopenia (OR: 1.45, 95% CI: 1.07 to 1.95; P = 0.015). This significant association remained even after adjusting for all covariates including nutritional status (OR: 1.42, 95% CI: 1.06 to 1.92, P = 0.020)., Conclusions: Anorexia of ageing is associated with sarcopenia among Japanese elderly individuals. Further studies are needed to determine whether a causal association exists between anorexia and sarcopenia., (© 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Objective: Engaging in physical activity (PA) and/or cognitive activity (CA) retains function in older adults, but whether the combination of these activities is associated with disability onset is still unknown. This study aimed to examine the prospective association of PA and/or CA with disability onset in older adults., Methods: This was an ongoing prospective community-based cohort study. Data collection was conducted through a health check. An analyzable sample of 2668 participants (mean age = 75.5 years; 51.6% female) were categorized into 4 groups based on quartile 1 (low) and 2 to 4 (high) values of accelerometer-measured moderate-to-vigorous PA and CA scale scores based on the frequency of 6 activities including reading, writing for pleasure, doing crossword puzzles, and playing board games or cards. Disability onset was monitored through long-term care insurance certification for at least 2 years., Results: A log-rank test showed significantly lower incidence of disability in the high PA and low CA group and the high PA and high CA group compared with the low PA and low CA group. Cox-proportional hazards models (referring to the low PA and low CA group) showed that only the high PA and high CA group was significantly associated with a lowered hazard ratio for disability onset (0.51; 95% CI = 0.29-0.90) after adjusting for covariates., Conclusions: Engaging in both PA and CA is effective for reducing risk of disability onset, but engaging in either PA or CA is not effective., Impact: Physical therapists can be guided by this research to design intervention strategies for people at risk of disability., (© 2020 American Physical Therapy Association.)

Objectives: The current study aimed to elucidate the associations between cognitive leisure activities and cognitive function in an older population stratified by having or not having depressive symptoms., Design: A retrospective cross-sectional study based on a self-report questionnaire., Setting: Annual health check-ups in a rural community in Japan., Participants: A total of 11 010 community-dwelling older adults aged ≥65 years (mean age: 74.0±5.4 years) was examined. Participants with missing data for the main outcome (n=1630) were excluded., Outcome Measures: Cognitive impairment was defined as at least 1.5 SD below the reference threshold (age-adjusted and education-adjusted score) on two of more of the tests in the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Depressive symptoms were defined by a 15-item Geriatric Depression Scale score ≥6. We assessed the frequency of participation in cognitive leisure activities using the validated scale (score: 0-42). A score of ≥8 points was defined as frequent participation in cognitive leisure activities., Results: A total of 12.6% (n=1186) of the participants had depressive symptoms. There was a significant association between cognitive leisure activities and cognitive impairment in older adults (adjusted OR=0.77, 95% CI=0.65 to 0.94). In older adults with depressive symptoms, a higher frequency of cognitive leisure activities was negatively associated with cognitive impairment (adjusted OR=0.45, 95% CI=0.28 to 0.70). In contrast, there was no significant association in older adults without depressive symptoms (adjusted OR=0.85, 95% CI=0.70 to 1.02)., Conclusions: Engaging in cognitive leisure activities in late life is associated with better cognitive function in older adults with depressive symptoms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Age-related functional decline elevates the risk of car accidents. Whether specific cognitive impairments and physical frailty increase the risk of car accidents is still unclarified., Objective: This study examines the association between car accidents, frailty, and cognitive function, owing to an increase in car accidents related to older adults., Methods: Data were collected from 12,013 older adults (45.4% women, mean age: 71.7 years [min: 60, max: 96]) enrolled in the National Center for Geriatrics and Gerontology (NCGG) - Study of Geriatric Syndromes. A 2-year self-reported history of car accidents was assessed. The Japanese cardiovascular health study index was used as the criterion and included the following components of frailty: shrinking, weakness, exhaustion, low activity, and slowness. "Frailty" was assigned a value of 1 or more based on these components. Cognitive function was assessed using the NCGG Functional Assessment Tool, and cognitive impairment was assessed using a standardized value., Results: Of the participants, 1,117 (9.3%) had a car accident history. The proportions of the frailty components' applicability were observed in the car accidents group compared to the non-car accidents group: shrinking (p = 0.006), exhaustion (p = 0.031), low activity (p = 0.034), and slowness (p = 0.030), but not weakness (p = 0.452). The proportion of cognitive impairment in executive function was also higher in the car accidents group (p = 0.011). A logistic regression analysis showed that both frailty (OR 1.26, 95% CI 1.11-1.43; p < 0.001) and cognitive impairment (OR 1.26, 95% CI 1.11-1.43, p < 0.001) are associated with car accidents., Discussion: This study's findings contribute to enhancing the utility of risk assessments for older drivers. Further study is required to clarify the risk of car accidents., (© 2020 S. Karger AG, Basel.)

Aim: This cross-sectional study examined whether sleep duration and excessive daytime sleepiness (EDS) were associated with social frailty in community-dwelling older people., Methods: A total of 4427 community-dwelling older people (51.4% women, mean age 71.9 years) who met the entry criteria were included in this study. Social frailty was assessed by five questions, relating to going out less frequently than last year, not visiting friends sometimes, not feeling helpful to friends or family, living alone and not talking with someone every day. Participants with two or more components were defined as having social frailty. Sleep duration and EDS were assessed by self-reported questionnaire. Logistic regression analysis estimated odds ratios and 95% confidence intervals of social frailty according to EDS or the three categories of sleep duration (short ≤6.0 h, medium 6.1-8.9 h, long ≥9.0 h), and we used medium-duration sleepers as the reference group., Results: Among all participants, the prevalence of social frailty in each sleep duration group was as follows: long 18.3%, short 9.9% and medium 9.7% (P < 0.001). The prevalence of social frailty in participants with EDS was 17.1% (no EDS 10.2%, P < 0.001). Long sleep duration (odds ratio 1.46, 95% confidence interval 1.14-1.84) and presence of EDS (hazard ratio 1.32, 95% confidence interval 1.02-1.71) were associated with higher rates of social frailty after adjustments for several covariates., Conclusions: Long sleep duration and EDS were associated with social frailty; thus, older people with both sleep patterns would have a higher risk of progression of social frailty. Geriatr Gerontol Int 2019; 19: 885-889., (© 2019 Japan Geriatrics Society.)

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community-dwelling older adults with intact cognition at baseline, using 4-year longitudinal data. A total of 3,151 community-dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age- and education-specific mean. Cognitive decline was defined in one or more cognitive tests at follow-up. Self-reported sleep duration (short, ≤6.0 hr; medium, 6.1-8.9 hr; long, ≥9.0 hr) and EDS at first-wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second-wave examination. The incidence of cognitive decline differed significantly among the sleep-duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05-2.13) and EDS (1.43; 1.01-2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12-2.52; EDS, 1.55, 1.05-2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults., (© 2018 European Sleep Research Society.)

Objectives: The gait variables that are related to the risk of incident dementia have not yet been clarified. To examine whether quantitative gait variables can predict incident dementia in older adults., Design: A prospective study., Setting: A community setting., Participants: The study included 4011 participants (54% women; mean age 72.2 years)., Measures: Gait speed, stride length, and stride length variability were measured at baseline. Dementia was prospectively confirmed from monthly updated medical records., Results: The mean follow-up duration was 42.8 months, and there were 245 incident cases of dementia. A receiver operating characteristic curve showed the cut-off value for each gait variable against incident dementia during follow-up using the Youden index (gait speed: 1.12 m/s; stride length: 1.15 m; stride length variability: 3.67%). Based on these cut-off values, Cox proportional hazards regression models showed that after adjusting for covariates, dementia was significantly related to slow gait speed [hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.10-2.01, P = .011], short stride length (HR 1.77, 95% CI 1.29-2.41, P < .001), and high stride length variability (HR 1.58, 95% CI 1.20-2.08, P = .001). Similarly, in a subanalysis stratified by sex, all gait variables were significantly related to the rate of incident dementia during follow-up in both men and women (all P < .05)., Conclusions/implications: Reduced gait function was related to incident dementia, and this association was independent of sex. Quantitative and multifaceted gait variables are valuable for assessing dementia risk., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined the association between excessive daytime sleepiness (EDS) and gait characteristics (e.g., speed, variability) in community-dwelling older adults., Method: This cross-sectional study included 3,901 individuals aged ≥65 years. Participants answered questions about EDS, sleep duration, and other sleep-related symptoms. Gait speed, stride length, and the variability in stride length were assessed by using a stopwatch and a WalkWay device., Results: EDS was significantly associated with slower gait speed among younger subjects (<75 years, p = .021) and with both slower gait speed ( p = .045) and greater variability in stride length among older subjects (≥75 years, p = .048) in a multivariate analysis adjusted for age, sex, body mass index, medication, number of comorbidities, and education., Discussion: EDS associates with gait ability, particularly in older old adults. Further prospective studies are needed to determine the causal association between gait ability and sleep disturbances, including EDS.

Background: Attention and executive function may play an important role in ensuring safe driving as they involve paying attention to complex information and making an instantaneous judgment during driving. We hypothesized that poor performance in attention and executive function may increase the risk of near-miss incidents among older drivers., Objective: The aim of this study was to examine associations of current experience of near-miss traffic incidents with attention and executive function among older Japanese drivers., Methods: The study included 3,421 general older drivers (mean age: 71.7 ± 4.9 years; 56.3% men) with a valid driver's license who were currently driving at least once per week and who had participated in a community-based cohort study between February 2015 and August 2016. The participants were asked about their experiences of near-miss traffic incidents in 10 situations that had almost happened during driving in the previous year., Results: Of the 3,421 older drivers, 1,840 (53.8%) had experienced near-miss incidents during driving in the previous year at least once. Male sex (OR 1.46, 95% CI 1.27-1.69) and high driving frequency (OR 1.11, 95% CI 1.07-1.15) were significantly associated with the current experience of near-miss traffic incidents when the overall data were analyzed. In young-old drivers aged 65-74 years, poor performance in attention as assessed by the Trail Making Test-part A (OR 1.45, 95% CI 1.05-2.00) was significantly associated with near-miss traffic incidents., Conclusion: Male sex, high driving frequency, and poor performance in attention (in young-old drivers) were associated with near-miss traffic incidents. Improvement in attention may play a role in decreasing the risk of traffic accidents among older drivers., (© 2018 S. Karger AG, Basel.)

Objectives: In this paper and prospective study, we examine the number of healthy behaviors and the incidence of disability in community-dwelling older adults aged 65 years and older., Methods: Participants (N = 4483) were residents of Obu, Japan who were asked about regular exercise, smoking status, and sleep duration. Demographic variables, history of disease, physi- cal function, and cognitive function were measured as confounders. Information about disabil- ity was obtained from the Obu City Office., Results: At 24 months after baseline assessment, 165 participants (3.7%) were certified as having disability. Participants with 2 healthy behaviors had a 1.61-fold increased risk of disability (95% CI: 1.08 -2.42) compared with those with 3 healthy behaviors; those with one or no healthy behaviors had a 2.01-fold risk (95% CI: 1.26-3.19) even though adjusting for confounders., Conclusions: The number of healthy behaviors was associated with the incidence of disability, with the hazard ratios increasing progressively as the number of healthy behaviors decreased.