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Objectives: The deterioration of oral function to a state of oral hypofunction (OHF) has been associated with malnutrition and frailty. This cross-sectional pilot study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function. Methods: A total of 155 healthy adults (median age: 55 years, range: 22–89 years) participated in this study after providing informed consent. The cohort was age and sex matched. Seven oral function measures based on the concept of OHF were assessed: oral hygiene (Hygiene), oral dryness, maximum occlusal force (MOF), lip-tongue motor function (LTMF), maximum tongue pressure (MTP), masticatory function, and swallowing function. Hand grip strength (HGS) was also measured. The participants were divided into the young (20–39 years), middle (40–64 years), and old (≥ 65 years) age groups for linear regression analysis of differences in oral and physical function. Differences in OHF prevalence were tested by the chi-square test. Results: The prevalence of OHF was significantly higher in the old group than in the young and middle groups. Such OHF measures as Hygiene, MTP, LTMF, and MOF were significantly worse in the old group as well. The measures of Hygiene and LTMF showed a moderate correlation with age in the multiple regression model (standardized partial regression coefficient, β = 0.24 and -0.19, respectively). HGS was significantly associated with MTP (β = 0.58, p < 0.001) and LTMF (β = 0.38, p = 0.002) in both male and female participants. Conclusions: Our findings suggest that OHF prevalence increases with age, especially after 65 years old. However, the pathological route may vary among OHF categories. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis (JIA) is a chronic arthritis of unknown cause that develops in patients younger than 16 years of age and persists for at least 6 weeks. It is an important cause of short- and long-term physical and mental impairments in children. The goal of treatment for JIA is remission. A T2T (treatment-to-target) has been proposed and practiced as a means of achieving remission. The method of evaluating the disease activity of JIA depends on the disease type. For systemic JIA, disease activity is determined by comprehensively considering joint findings, systemic inflammatory findings, changes in inflammatory and synovitis markers, imaging findings, and other factors. For articular JIA other than systemic JIA, the Juvenile Arthritis Disease Activity Score (JADAS-27) is used to evaluate disease activity. The CHAQ (Childhood Health Assessment Questionnaire) and the Japanese version of the modified Rankin Scale (mRS) are mainly used to assess the physical function and ADL. The CHAQ is a global standard assessment method with the advantage that it can be transitioned to the HAQ used in adults, making it useful for international comparisons. The mRS is used to classify the severity of JIA as a chronic disease, and is an indispensable evaluation method in the specific disease procedure in Japan. It is necessary to have pediatric-specific knowledge of growth and development and routine childhood immunizations and to consider transition support tailored to the patient's situation. Ultimately, the goal is to foster the patient's independence and to provide an uninterrupted follow-up in the adult care department. Continuous follow-up will be provided during the schooling (and later, employment) period, and the relationship with the patient will be tailored to their developmental stage. It is also important to understand and communicate the importance of contraception and the drugs that cannot be used during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate factors associated with impaired physical function [defined as Health Assessment Questionnaire Disability Index (HAQ-DI) >0.5] of old-old (aged 75–84 years) patients with rheumatoid arthritis. Methods: Data from 15,185 rheumatoid arthritis patients in the National Database of Rheumatic Disease in Japan were extracted from 2017 to 2018. We enrolled 3708 patients aged 55–84 years in Simplified Disease Activity Index (SDAI) ≤11 and Steinbrocker Stage I/II. Factors associated with HAQ-DI >0.5 were analysed by multivariable logistic regression. Results: About half of the old-old patients received methotrexate, which was lower than middle-aged (55–64 years) and young-old patients (65–74 years). The proportion of glucocorticoids in the old-old patients was highest among the three groups, and biological disease-modifying antirheumatic drugs were similarly used. The prevalence of HAQ-DI >0.5 was significantly higher in old-old patients with low disease activity than in those with remission. The same was true in the middle-aged and young-old patients. Multivariable analysis showed age, higher SDAI, glucocorticoid use, and methotrexate nonuse were significantly associated with HAQ-DI >0.5 in the old-old patients. Conclusions: Achieving SDAI remission was an ideal goal for old-old patients in terms of physical function. Glucocorticoids and a low proportion of methotrexate use may influence the physical function of old-old patients. [ABSTRACT FROM AUTHOR]

Aim: To determine the predictors of physical function (PF) decline among nursing home residents using items from the Long‐term care Information system For Evidence (LIFE), a system launched in 2021 to ensure the quality of long‐term care. Methods: The LIFE data of 1648 residents from 45 nursing homes in Japan were retrospectively collected in July 2021 (T0) and January 2022 (T1), including demographics, PF assessed by the Barthel index (BI), nutrition and oral health, and cognitive function. The Dementia Behavior Disturbance scale was used to assess the frequency of certain behaviors, such as "waking at midnight." The predictors of PF decline, defined as a decrease ≥5 in the BI score at T1 compared with that at T0, were determined using mixed‐effects logistic regression analyses. PF at T0 was classified into high (>60 BI) and low (≤60 BI) groups. Results: The participants' mean age was 87.2 ± 7.1 years, and 45.3% experienced PF decline. The significant predictors of PF decline were age ≥ 90 years, body mass index <18.5 kg/m2, dementia diagnosis, moderate and severe cognitive impairments, not vocalizing reciprocal exchanges at will, always "waking at midnight," and high PF at T0. Conclusions: The LIFE items predicted PF decline among nursing home residents, suggesting that LIFE data can be used to ensure the quality of long‐term care. Geriatr Gerontol Int 2024; 24: 123–132. [ABSTRACT FROM AUTHOR]

Background: The amyloid-β1-42 (Aβ42) level is a biomarker that is widely used to evaluate individual cognitive dysfunction early in neurodegenerative diseases, as well as differentiate between normal cognitive function, mild cognitive impairment, Alzheimer's disease, and vascular cognitive impairment. Objective: Our cross-sectional study evaluated the association between daily exercise and physical and cognitive function and Aβ42 levels among a subsample of 325 older adults from the Kasama Study. Methods: Participants (age: 74.5 [range 65–90] years) were classified into three exercise groups: the dual-task (DEG, n = 128), single-task (SEG, n = 122), and non-exercise (NEG, n = 75) groups. The main outcomes were the plasma Aβ42 levels and the scores of the five cognitive (5-COG) tests and five cognition-related physical function (5-PHYS) tests. Results: The Aβ42 levels and 5-COG and 5-PHYS scores were higher in the SEG and DEG than in the NEG. The Aβ42 levels were higher in the DEG than in the NEG (p = 0.008). Conclusions: Physical activities such as regular exercise may benefit older adults, improving their cognitive and physical function. [ABSTRACT FROM AUTHOR]

Objectives: Accumulating evidence from cross-sectional studies suggests that the serum creatinine-to-cystatin C ratio (CCR) may be a useful biomarker for sarcopenia. This study aimed to assess the cross-sectional and longitudinal associations of CCR with sarcopenia and its parameters in community-dwelling older adults. Design: Cross-sectional and longitudinal study. Setting and Participants: This 6-year prospective cohort study included the repeated measurement data from 1,253 Japanese residents (662 males and 591 females) aged ≥65 years who underwent medical checkups in Kusatsu and Hatoyama, Japan. A total of 4,421 observations were collected. Measurements: The CCR was grouped into quartiles by sex (Q1–Q4) using Q4 as the reference category. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Skeletal muscle mass index (SMI) measured using segmental multifrequency bioelectrical impedance analysis, handgrip strength (HGS), usual gait speed (UGS), and maximal gait speed (MGS) were measured repeatedly as sarcopenia parameters. The association of the CCR with changes in sarcopenia, SMI, HGS, UGS, and MGS during the 6-year period were analyzed using a generalized linear mixed-effects model. Results: The prevalence of sarcopenia at baseline was 13.1% (11.9% in males and 14.5% in females). In a cross-sectional analysis, the CCR quartile was inversely associated with sarcopenia and was positively associated with SMI, HGS, and MGS (P for trend < 0.001). In a longitudinal analysis during the 6 years, a significant increase in sarcopenia in Q2 (B = 1.1% point/year; P = 0.026 for group-by-time interaction) and significant declines in SMI (B = −0.01 kg/m2/year; P = 0.044 for group-by-time interaction) and MGS (B = −0.008 m/sec/year; P = 0.041 for group-by-time interaction) in Q1 were observed compared with Q4. However, the dose-response relationship was significant only for MGS (P = 0.033 for trend). No significant group-by-time interaction was observed for HGS. CCR was not significantly associated with UGS either cross-sectionally or longitudinally. Conclusions: CCR is a useful biomarker regarding the status of sarcopenia. It may be used for sarcopenia screening even in older adults whose physical function is difficult to assess. However, further longitudinal studies are needed to determine whether CCR can be a predictor of future sarcopenia. [ABSTRACT FROM AUTHOR]

Japan has one of the fastest growing aging populations in the world. By 2040, Japan's aged adult population is estimated to increase to a historically unprecedented level of 40 percent. As the population ages, the prevalence of frailty, a significant predictive factor for nursing care, is expected to rise. Eggs are recognized as functional foods that provide an array of essential nutrients and bioactive compounds that can positively impact human health, making them a cost-effective dietary choice. Given that eggs are a rich source of high-quality protein, they have the potential to prevent frailty. However, few studies have investigated the association between habitual egg consumption and frailty prevention. In the Shimane University Cohort Study, which mainly focuses on the Oki Islands, we examined this association in community-dwelling older adults. In this paper, we will review the main findings regarding the link between habitual egg consumption and frailty in our cohort study, as well as other recent publications. [ABSTRACT FROM AUTHOR]

Objective: To compare walking efficiency, and associated physical function, between children, with and without developmental coordination disorder trait. Design: Cross-sectional study. Setting: The study was conducted in a Medical and Rehabilitation Center for Developmental Disabilities in Okazaki, Japan. Subjects: The study included 286 children, 6–12 years of age, with and without developmental coordination disorder trait. Developmental coordination disorder trait was defined by a score below the −1 standard deviation on the Japanese version of the Developmental Coordination Disorder Questionnaire. Based on this criterion, 45 children (28 boys) were classified into the developmental coordination disorder trait group and the other 241 (115 boys) in the control group. Measures: The following physical function outcomes were measured: single leg stance test; step length variability; and walking efficiency, measured using the 2-min walk test. Logistic regression analysis was used to determine the association between developmental coordination disorder trait and lower walking efficiency and physical function. Results: Compared to the control group, the developmental coordination disorder group showed lower walking efficiency (P = 0.026), higher step length variability (P = 0.047), and shorter single leg stance test (P = 0.001). Developmental coordination disorder was independently associated with walking efficiency (odds ratio, 1.03; 95% confidence interval [CI], 1.001–1.061; P = 0.041) and single leg stance test (odds ratio, 0.99; 95% CI, 0.978–0.996; P = 0.006), but not to step length variability, age, and sex. Conclusions: Lower walking efficiency increases energy expenditure in children with developmental coordination disorder trait. Interventions to improve walking efficiency could improve the physical function and participation of these children. [ABSTRACT FROM AUTHOR]

The amount of aerobic exercise time (AET) is an important factor for improving physical function in patients with stroke. However, there is a lack of evidence regarding the factors for AET during physiotherapy, particularly in stroke patients. To investigate the correlation between AET during physiotherapy and characteristics of patients with subacute stroke. In this cross-sectional study, 61 hospitalized subacute stroke patients (age = 72 (11) years, (median (interquartile range)) were enrolled and their exercise intensity was measured by wearable sensors (Mio Alpha 2) worn during physiotherapy sessions. All patients were divided into two groups, non-ambulatory group (functional ambulation classification (FAC); 0–2) and ambulatory group (FAC; 3–5). The correlations between AET and patient characteristics were assessed in each group. There was no significant difference in AET between the ambulatory and non-ambulatory groups (9 (12) min vs 5 (10) min, p =.27, respectively). There was a significant correlation between AET and the functional independent measures (FIM) motor score in the ambulatory group (r = 0.52, p =.005), and between AET and the FIM cognitive score in the non-ambulatory group (r = 0.44, p =.008). Correlations between AET and patient characteristics were different according to ambulation capacity in patients with subacute stroke. [ABSTRACT FROM AUTHOR]

Assessment-oriented group action (AGA) could be used to empower community-dwelling older adults to maintain their health by groups. AGA can be implemented with the support of a health professional to provide feedback to older adults on physical and cognitive function. To evaluate the effects of AGA. For this feasibility study, we enrolled 23 and 20 participants in the intervention and control groups, respectively. Thοse in the intervention group received feedback of their assessments and devised exercise plans with professional support. The participants performed their exercises over 12 weeks; the follow-up examination was conducted at 40 weeks. The control group only received feedback. The change in health-related consciousness and behavior was evaluated. Muscle strength and mass were measured and the timed up and go test, and the Brief-balance evaluation system test (BESTest) were performed. There were no significant differences in consciousness or behavior between the groups. The score was higher in the intervention than in the control group at 40 weeks in Section-I of the Brief-BESTest, indicating that the muscle strength contributed to balance function. AGA did not show positive changes in consciousness or behaviors but demonstrated significant improvements and lasting effects in balance function. [ABSTRACT FROM AUTHOR]

Aim: Preventing functional disability benefits the quality of life of older adults and mitigates the economic burden of an aging society. However, the most effective physical performance tests and optimal cut points for identifying older adults at risk of functional disability remain unclear, and Japan lacks physical function-based assessment tools. We aimed to identify the physical performance tests related to functional disability and to develop a predictive test battery for it., Methods: We included 975 older adults (mean 72.8 ± 5.2 years, 55.4% women) in Kasama City, Japan. Functional disability was defined as certification of care level 2 or above based on the long-term care insurance system. Cox proportional hazards analysis examined the association between physical performance tests and incident functional disability., Results: During a mean follow-up of 8.6 years (maximum 14 years), 236 participants (24.2%) developed functional disability. After adjusting for covariates, higher performances in grip strength, single-leg balance with eyes open (SLB), timed up-and-go (TUG), five-repetition sit-to-stand (5-STS), and 5-m habitual walk were significantly associated with a lower risk of functional disability. In a stepwise model, SLB, TUG, and 5-STS were key predictors of functional disability. Receiver operating characteristic analysis determined optimal cut points of 32.6/32.7 s for SLB, 6.5/6.6 s for TUG, and 7.8/7.9 s for 5-STS. We developed a predictive battery combining these cut points (area under the curve = 0.78)., Conclusions: The developed battery of physical performance tests predicts future functional disability and is useful for screening older adults at high risk. Geriatr Gerontol Int 2024; 24: 1343-1349., (© 2024 Japan Geriatrics Society.)

Aims: In heart failure (HF), inflammation is linked to malnutrition and impaired physical function. In this study, we aimed to assess how novel nutritional-inflammatory markers and lymphocyte-to-C-reactive protein ratio (LCR) and score (LCS) are associated with the nutritional status, physical function, and prognosis of patients with HF., Methods and Results: This study was a secondary analysis of the FRAGILE-HF study, a prospective observational study conducted across 15 hospitals in Japan. We included 1212 patients (mean age, 80.2 ± 7.8 years; 513 women) hospitalized with HF, who were classified into three groups according to their LCS score: 0 (n = 498), 1 (n = 533), and 2 (n = 181). Baseline data on physical examination, echocardiography, blood test results (including lymphocyte counts and CRP levels), and oral medication usage were collected in a clinically compensated state before discharge. Nutritional status and physical function were evaluated using several indices and tests. The primary outcome of this study was all-cause death within 2 years. Univariate and multivariate linear regression analyses were performed to evaluate the associations among the nutritional status, physical function, and LCR/LCS. Patients with an LCS score of 2 were older and had a lower body mass index than those in the other two groups. Multivariate linear regression analysis revealed that lower LCR and higher LCS were independently associated with worse nutritional status, lower handgrip strength, shorter physical performance battery score, and shorter 6-min walk distance. At 2 years, all-cause death occurred in 254 patients: 86 (17.6%), 113 (21.5%), and 55 (30.9%) with LCS scores of 0, 1, and 2, respectively (P = 0.001). Cox proportional hazards analysis revealed that LCR and LCS were significantly associated with 2-year mortality even after adjusting for the conventional risk model (LCS score, 0 vs. 2: hazard ratio, 1.64; 95% confidence interval [CI]; 1.14-2.35; P = 0.007; log-transformed LCR: hazard ratio, 0.88; 95% CI, 0.81-0.95; P = 0.002). LCR yielded additional prognostic predictability compared with the conventional risk model (continuous net reclassification improvement, 0.153; 95% CI, 0.007-0.299; P = 0.041)., Conclusions: LCR and LCS emerge as potential predictors of nutritional status, physical function, and prognosis in older patients with HF., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Purpose: Decreased physical function with increasing life expectancy is a public health concern worldwide. Knee osteoarthritis (KOA) is considered one of the primary illnesses causing decreased physical function. Depression affects decreased physical function and is closely related to knee pain in KOA. However, the effect of these interacting factors on physical function is not clear., Patients and Methods: We conducted a cross-sectional analysis of the baseline data of 1106 subjects of the 2009 Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). We determined the association between their Timed Up and Go test (TUG) scores and radiographic KOA, knee pain, and depression in a multivariate analysis., Results: Severe knee pain was significantly associated with decreased physical function (the odds ratio [OR] was 2.13, 95% confidence interval [CI]: 1.32-4.89), as was depression (OR 2.64, 95% CI 1.61-4.33). Only Kellgren-Lawrence (KL) grade 4 was significantly associated with decreased physical function in the radiographic KOA severity (OR 6.58, 95% CI 1.75-24.68)., Conclusion: Severe knee pain and depression were significantly associated with decreased physical function, but not radiographic KOA severity except for KL grade 4. The limitations of using radiographic KOA severity alone as the indicator of assessment for physical function were suggested. When assessing decreased physical function, the clinical focus tends to be on radiographic KOA severity, but it is important to consider the patient's knee pain and psychological factors., Competing Interests: The author reports no conflicts of interest in this work. This paper has a shared database with another paper published in BMC at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07421-1. This paper has been uploaded to Research Square as a preprint: https://www.researchsquare.com/article/rs-4010731/v1., (© 2024 Sonobe et al.)

Background: As a result of the increase in older people covered by long-term care insurance (LTCI), prevention of sarcopenia and maintenance and improvement of health-related quality of life (HRQOL) have become important themes. This study aimed to clarify both the differences in HRQOL in older people with and without sarcopenia covered by LTCI and the correlation between HRQOL and physical function. Methods: Participants were 101 older people with LTCI at a daycare center in Japan. We investigated clinical factors using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Analysis was by unpaired t-test, Mann–Whitney U test, chi-square test, analysis of covariance, Pearson's correlation coefficient, and Spearman's rank correlation coefficient. Results: Compared to the no sarcopenia group (n = 40), the sarcopenia group (n = 24) had significantly lower body mass index, skeletal muscle mass index, gait speed, EQ-5D-3L, and adjusted EQ-5D-3L (p < 0.05). The EQ-5D-3L showed a significant correlation with handgrip strength in the sarcopenia group (p = 0.02) and significant correlations with gait speed and one-leg standing time (both, p = 0.01) in the no sarcopenia group. Conclusion: We clarified differences in HRQOL in older people with and without sarcopenia covered by LTCI. This information on the interrelationship between HRQOL and physical function may help maintain and improve HRQOL in these people. [ABSTRACT FROM AUTHOR]

Background: Social isolation and decline of physical function, such as muscle strength and physical performance, are known to be associated with deterioration of functional capacity. However, the relationship between social isolation and physical function has not been sufficiently clarified by a longitudinal observational study. Aims: The aim of this study was to examine whether social isolation is associated with a future decline in physical function in older people. Methods: The participants were 166 community-dwelling older people (aged ≥ 65 years). Social isolation and physical function were assessed using the 6-item Lubben Social Network Scale and handgrip strength, knee extensor strength, usual walking time, and the Timed Up and Go (TUG) test in both the baseline and follow-up surveys. To define the presence or absence of physical function decline over time, we used the minimal detectable change. The associations between social isolation and physical function were analyzed using logistic regression analysis adjusted for confounding factors. Further, to examine the possibility of drop-out bias, inverse probability weighting (IPW) was performed. Results: The results of the logistic regression analysis adjusted for confounding factors showed social isolation at baseline was significantly associated with future TUG decline (OR 2.88, 95% CI 1.15–7.22). Social isolation was not associated with a decline in other physical functions. Similar results were found in an analysis using IPW. Conclusions: Social isolation was an independent risk factor for future TUG decline in community-dwelling older people. Our results indicated that assessment of social isolation may be necessary to assess the risk of physical performance decline. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to elucidate the clinical characteristics, including frailty status, of patients with heart failure with preserved ejection fraction (HFpEF) in comparison with those in patients with heart failure with reduced ejection fraction (HFrEF) in a super-aged region of Japan. Methods and results Of the 1061 Japanese patients enrolled in the Kochi YOSACOI study, a multicentre registry, we divided 645 patients (median age of 81 years [interquartile range, 72–87 years]; women, 49.1%) into two groups, HFpEF patients (61.2%) and HFrEF patients (38.8%). Physical frailty was diagnosed on the basis of the Japanese version of Cardiovascular Health (J-CHS) Study criteria. Patients for whom left ventricular ejection fraction data were not available (n = 19), patients with heart failure with mildly reduced ejection fraction (n = 172), and patients who were not assessed by the J-CHS criteria (n = 225) were excluded. The median ages of the HFpEF and HFrEF patients were 84 and 76 years, respectively. The proportion of patients with HFpEF gradually increased with advance of age. The proportion of patients with three or more comorbidities was larger in HFpEF patients than in HFrEF patients (77.9% vs. 65.6%, P = 0.003). Handgrip strength was significantly lower in HFpEF patients than in HFrEF patients for both men (P < 0.001) and women (P = 0.041). Comfortable 5 m walking speed was significantly slower in HFpEF patients than in HFrEF patients (P < 0.001). The proportions of patients with physical frailty were 55.2% in HFpEF patients and 46.8% in HFrEF patients, and the proportion was significantly higher in HFpEF patients (P = 0.043). In multivariate analysis, physical frailty was associated with advanced age [odds ratio (OR), 1.030; 95% confidence interval (CI), 1.010–1.050; P = 0.023] and low albumin level (OR, 0.334; 95% CI, 0.192–0.582; P < 0.001) in HFpEF patients, and physical frailty was associated with women (OR, 2.150; 95% CI, 1.030–4.500; P = 0.042) and anaemia (OR, 2.840; 95% CI, 1.300–6.230; P = 0.003) in HFrEF patients. Conclusions In a super-aged population of HF patients in Japan, HFpEF patients are more likely to be frail/have a high frailty status compared with HFrEF patients. The results suggested that physical frailty is associated with extracardiac factors in both HFpEF patients and HFrEF patients. [ABSTRACT FROM AUTHOR]

Introduction: Dual-task (DT) exercise can act as a substitute, which can help improve both physical and cognitive functions. Thus, this study investigated the effects of a game-like cognitive DT exercise called "Synapsology" (SYNAP) among the oldest residents of a nursing home. Methods: Participants (aged 85-97 years) were assigned to the intervention group (n = 12) and the control group (n = 12). The intervention group underwent 60-minute sessions, twice a week for 24 weeks. Results: A comparison of the Mini-Mental State Examination scores and six physical function tests, before and after the intervention, shows that the SYNAP had a positive impact on the cognitive and physical functions among the intervention group. Discussion: These findings suggest that SYNAP may help maintain or improve cognitive and physical functions among older adults compared to no interventions. Therefore, SYNAP would act as a beneficial tool amidst a "superaging" society like Japan. [ABSTRACT FROM AUTHOR]

Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

BACKGROUND: Some patients with end-stage osteoarthritis of the knee remain unsatisfied after total knee arthroplasty (TKA). We postulated that to increase satisfaction, self-efficacy (SE) for physical activity should receive more attention in rehabilitative intervention, alongside the management of patient expectations, pain, and function. OBJECTIVE: We examined the relative impact of Physical Activity SE on Health-Related Quality of Life (HRQOL) alongside other factors such as pain and physical function which are well-addressed by current interventions. METHODS: One hundred and six first-TKA recipients (15 Male/91 Female, age 73.6 ± 7.2) were evaluated at 3 and 6 months post-operatively using the Medical Outcomes Study 36-Item Health Survey (SF-36v2) for HRQOL, knee extension strength measurement, Timed Up and Go test (TUG), One Leg Standing time test (OLS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain and function, and an instrument for measuring Physical Activity SE among the frail elderly in Japan. RESULTS: Significant improvement over pre-operative values was found at 3 and 6 months in TUG, OLS, WOMAC Pain and Function, and the 8 subscales of the SF-36v2. Factors found to significantly impact SF-36v2 subscale scores at 6 months post-operatively were found to be knee pain, knee function, and SE for physical activity. CONCLUSION: These results support our postulation that interventions to improve SE for physical activity could have comparable impact alongside interventions for knee pain and knee function, on the advancement of HRQOL among TKA recipients. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate whether physical function was associated with urinary incontinence (UI) onset in community‐dwelling older Japanese women. Methods: This was a 4‐year prospective cohort study. After excluding participants with UI and missing data in the baseline survey, we included 890 participants in the analyses. Physical function including grip strength, maximal walking speed, knee extension strength, single‐leg balance, and timed up and go (TUG) were measured. The primary outcome was the onset of all UI and different types of UI (urge, stress and mixed) based on the questionnaire survey. Binary logistic regression analysis was applied to calculate the adjusted odds ratios and 95% confidence intervals for the association between physical function and the risk of all UI and different types of UI incident. Results: Among the 890 participants, 221 (25%) developed UI during the 4‐year follow‐up. After adjusting for confounders, better knee extension strength, maximal walking speed and TUG were significantly associated with a lower risk of all UI and urge UI onset, and better single‐leg balance and TUG were significantly associated with a lower risk of mixed UI onset (P for trend <0.05). No significant association was found between physical function and the risk of stress UI onset. Conclusions: This study confirmed that better lower extremity physical function is associated with lower risk of urge and mixed UI onset, indicating that exercise programs focusing on maintaining and improving lower extremity physical function may be useful for reducing such events among older women. Geriatr Gerontol Int 2021; 21: 178–184. [ABSTRACT FROM AUTHOR]

During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population 65 years of age and above to ∼28%. This study aimed to examine the changes in major health-related measures, including a physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, this study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, body mass index, walking speed, grip strength, and instrumental activity of daily living, between 2007 (±2 years) and 2017 (±2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of this study indicate that the phenomenon of "rejuvenation" is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be reacknowledged. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chronic kidney disease (CKD) are susceptible to frailty because of a range of nutrition-related factors. While protein restriction is commonly advised to preserve kidney function in patients with CKD, insufficient protein intake could potentially exacerbate frailty risk. This study aimed to elucidate the relationship between frailty and protein intake in patients with CKD., Methods: This cross-sectional study enrolled patients with CKD stage 3-5. Frailty and prefrailty were assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. To estimate dietary protein intake, Maroni's formula based on 24-h urine collection was used. The potential association between frailty/pre-frailty and protein intake was investigated using a logistic regression analysis., Results: Ninety-seven individuals with CKD were included in the study, with a median age of 73.0 years (interquartile range: 67.0, 82.0). Among them, 34 were women (35.1%), and the estimated glomerular filtration rate (eGFR) was 36.3 mL/min/1.73 m 2 (interquartile range: 26.9, 44.1). Frailty and pre-frailty were identified in 13.4% and 55.7% of participants, respectively. Comparing the groups, protein intake in the frailty/pre-frailty group (0.83 g/kgBW/day [0.72, 0.93]) was lower than that in the robust group (0.89 g/kgBW/day [0.84, 1.19], p = 0.002). Upon logistic regression analysis, protein intake exhibited an independent association with frailty/pre-frailty (odds ratio: 0.72, 95% confidence interval: 0.59-0.89, p = 0.003)., Conclusion: Reduced protein intake in patients with CKD is associated with frailty and pre-frailty. It is advisable to ensure that patients with CKD who are at risk of frailty consume an adequate amount of protein., (© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

Context: Physical symptoms such as pain and cancer-related fatigue limit physical function and activities of daily living among patients with terminal cancer, which can lead to a decline in quality of life. Therefore, comprehensive functional impairments should be evaluated to determine the progression of the disease and the effectiveness of palliative treatment., Objective: To validate the psychometric properties of the Japanese version of the Edmonton Functional Assessment Tool 2 (EFAT2-J)., Methods: We developed a Japanese version of the EFAT-2 in accordance with international guidelines. To verify the reliability and validity of the EFAT2-J, patients were evaluated by a physiotherapist and a nurse separately, and correlations with existing evaluation scales for physical function, physical symptoms, and quality of life were analyzed, respectively. The significance level was set at 5%., Results: Twenty patients participated in the reliability measurement. The average EFAT2-J scores were 7.95 ± 4.12 for physical therapists and 7.20 ± 4.23 for nurses, and the intraclass correlation coefficient was 0.95. The weighted kappa coefficient (κ) for each item was 0.57-1.00. Fifty-five patients participated in the validity measurement. The EFAT2-J showed significant correlations with Eastern Cooperative Oncology Group Performance Status and the Karnofsky Performance Scale, Barthel Index, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care sub-item "physical function.", Conclusion: These results indicate that the EFAT2-J has robust psychometric properties and is useful for evaluating physical function in patients with terminal cancer, and thus may be an acceptable clinical instrument in research and practice., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

This study was performed to identify factors that discriminate muscle echo intensity (EI) among parameters of body composition, physical function and daily physical activity in elderly individuals. A total of 209 men and women (73.7 ± 2.8 y) were evaluated. EI was measured on ultrasonographic axial thigh muscle images. The participants were categorized into the low, mid and high EI groups. We measured the skeletal muscle mass index (SMI) and physical functions. The high EI group exhibited a significantly lower SMI, slower 5-m walking time and shorter 6-min walking distance than the low EI group and had a shorter moderate-intensity activity time than the mid EI group. As a result of the discriminant analysis, elderly individuals were categorized into EI groups by SMI, daily activity and physical function. The data indicate that morphologic and functional parameters and the daily activity level help to discriminate higher and lower muscle EI. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether physical activity mediates the association of gait speed with incident disability and mortality in older adults.Study Design: Prospective cohort data from 782 community-dwelling Japanese older adults were analyzed. The median follow-up periods for incident disability and mortality were 4.4 and 4.5 years, respectively.Main Outcome Measures: Physical activity was assessed with the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire, gait speed was calculated from 5-m walking time, and incident disability was defined as long-term care insurance certification during follow-up.Results: There were 247 cases of incident disability and 202 deaths during follow-up. After adjusting for potential confounders, faster gait speed was associated with decreased risk of incident disability (hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.82-0.93), but physical activity level was not associated with incident disability (HR = 0.98, 95% CI = 0.95-1.01). Gait speed was associated with mortality risk in the model without physical activity (HR = 0.93, 95% CI = 0.88-1.00). When gait speed and physical activity were both included in the model, gait speed was not associated with mortality (HR = 0.95, 95% CI = 0.89-1.02) but physical activity was associated with mortality (HR = 0.95, 95% CI = 0.92-0.99). Physical activity was a mediating factor in the association between gait speed and mortality (Sobel test p = .025).Conclusions: Gait speed is directly associated with incident disability and is indirectly related to mortality through physical activity in older adults. [ABSTRACT FROM AUTHOR]

Aim: Patients who experience heart failure are prone to malnutrition. The aim of this study was to determine the association between risk of malnutrition and physical function in patients undergoing cardiac rehabilitation following heart failure. Methods: A cross‐sectional study was performed in consecutive patients hospitalised for cardiac rehabilitation following heart failure. Risk of malnutrition was evaluated using the Mini Nutritional Assessment‐Short Form (MNA‐SF). Physical function was evaluated using the Barthel index (BI). Univariate and multivariate analyses were used to determine whether nutritional status was associated with BI in these patients. Results: The present study included 105 patients (mean age of 77.3 years, 56 men and 49 women) for analysis. The median (interquartile range) scores of the MNA‐SF and BI were 11 (9–13) and 75 (45–90), respectively. Patients with high risk of malnutrition (MNA‐SF score < 7) were significantly older, had a lower body mass index, exhibited lower muscle mass and strength, could walk shorter distances, and had lower BI scores (all P < 0.05). On multivariate analysis, the MNA‐SF score was independently associated with BI (β = 0.409, P < 0.001) after adjusting for age, sex, muscle mass and strength, brain natriuretic peptide levels, ejection fraction of the left ventricle, and reason for admission. Conclusions: Risk of malnutrition is associated with physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection of malnutrition and commencement of nutritional support may improve functional recovery in these patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the effects of active learning education on health literacy, cognitive and physical function, physical activity, and dietary habits in older adults. DESIGN: Randomized controlled trial. SETTING: Rural community in Japan. PARTICIPANTS: Individuals aged 65 and older (N=84) randomly assigned to a health education intervention group (n=42) or a control group (n=42). INTERVENTION: The intervention group attended a weekly 90‐minute active learning program on exercise, diet and nutrition, and cognitive activity for health promotion in older age for 24 weeks. Active learning included exploratory learning, group work, and self‐planning for behavioral change, which promoted a healthy lifestyle. MEASUREMENTS: Outcome measures were obtained at baseline before randomization and at 24 weeks. Comprehensive health literacy was assessed as the primary outcome using the Health Literacy Scale‐14 (HLS‐14) and the 16‐item European Health Literacy Survey Questionnaire (HLS‐EU‐Q16). Cognitive function was evaluated in 4 domains: processing speed, verbal fluency, working memory, and memory. Physical function and amounts of physical activity were also objectively measured. RESULTS: HLS‐14, the disease prevention domain of the HLS‐EU‐Q16, category verbal fluency test, Scenery Picture Memory Test, and Timed Up and Go test scores; gait speed; number of steps per day; physical activity levels; and dietary variety scores were significantly improved in the intervention group than the control group. CONCLUSION: This study suggests that health education through active learning is effective in enhancing comprehensive health literacy, verbal fluency, memory, gait speed, balance ability, physical activity, and dietary variety in older adults. [ABSTRACT FROM AUTHOR]

Summary: Clinicians' evaluations of older adults sometimes reveal inconsistencies between objective and subjective dental status. This study investigated which factors contribute both to good objective masticatory function (OMF) and the poor subjective masticatory function (SMF) that often becomes a clinical issue. Study participants included 635 elderly community‐dwelling Japanese adults who underwent a comprehensive geriatric health examination in 2012. SMF was assessed with a question from the Kihon Checklist on eating difficulties (poor or good). OMF was assessed by a colour‐changing gum (poor or good). Also investigated were age, sex, depressive symptoms, instrumental activities of daily living (I‐ADLs), number of people who joined the participant at dinner, grip strength, usual walking speed, number of remaining teeth, number of functional teeth and their occlusal force. The group with good OMF and good SMF, defined as group 1, and the group with good OMF but poor SMF, group 2, were compared. Logistic regression analyses confirmed that the number of remaining and functional teeth participants had was statistically unrelated to differences between OMF and SMF. Instead, differences were related to stronger depressive symptoms (OR = 1.67, CI = 1.14‐2.44), less ability to conduct I‐ADL activities (OR = 0.73, CI = 0.59‐0.91), slower usual walking speeds (OR = 0.18, CI = 0.06‐0.58) and less occlusal force (OR = 0.99, CI = 0.99‐1.00). Depressive symptoms, I‐ADLs, and physical function are shown to be significantly related to divergence between objective and subjective masticatory function in elderly Japanese. This suggests that dissociations between objective and subjective dental evaluations of elderly adults indicate need for assessment of their mental and physical function. [ABSTRACT FROM AUTHOR]

Background: Despite a steady increase in life expectancy, a few studies have investigated cross-sectional correlates and longitudinal predictors of cognitive function, a core domain of the successful aging, among socio-clinico-demographic factors in the oldest-old exclusively.Objectives: The aims of this study were to examine socio-clinico-demographic characteristics associated with global cognition and its changes in the oldest-old.Methods: We reanalyzed a dataset of cognitively preserved community-dwelling subjects aged 85 years and older in the Tokyo Oldest Old Survey on Total Health, a 6-year longitudinal observational study. This study consisted of (1) baseline cross-sectional analyses examining correlates of global cognition (n = 248) among socio-clinico-demographic factors and (2) longitudinal analyses examining baseline predictors for changes of global cognition in 3-year follow-up (n = 195). The Mini-Mental State Examination was used as a screening test to assess global cognition.Results: At baseline, higher weights were related to higher cognitive function in the oldest-old. The baseline predictors of global cognitive decline in 3-year follow-up were higher global cognition, shorter education period, and lower sociocultural activities and lower instrumental activity of daily living, in this order.Conclusions: The present study suggests that it is crucial to attain higher education during early life and avoid leanness or obesity, participate in sociocultural cognitive activities during late life, and maintain instrumental activity of daily living to preserve optimal cognitive function in the oldest-old, which will facilitate developing prevention strategies for cognitive decline and promoting successful aging in this increasing population. [ABSTRACT FROM AUTHOR]

Objectives: Open surgery is performed to treat abdominal aortic aneurysm (AAA), although the subsequent surgical stress leads to worse physical status. Preoperative self-efficacy has been reported to predict postoperative physical status after orthopedic surgery; however, it has not been sufficiently investigated in patients undergoing abdominal surgery. The purpose of the present study is to investigate the correlation between preoperative self-efficacy and postoperative six-minute walk distance (6MWD) in open AAA surgery. Methods: Seventy patients who underwent open AAA surgery were included. Functional exercise capacity was measured using preoperative and 1 week postoperative 6MWD. Self-efficacy was preoperatively measured using self-efficacy for physical activity (SEPA). The correlations of postoperative 6MWD with age, height, BMI, preoperative 6MWD, SEPA, Hospital Anxiety and Depression Scale (HADS) score, operative time, and blood loss were investigated using multivariate analysis. Results: Single regression analysis showed that postoperative 6MWD was significantly correlated with age (r=-0.553, p≤0.001), height (r=0.292, p=0.014), Charlson's comorbidity index (r=-0.268, p=0.025), preoperative 6MWD (r=0.572, p≤0.001), SEPA (r=0.586, p≤0.001), and HADS-depression (r=-0.296, p=0.013). Multiple regression analysis showed that age (p=0.002), preoperative 6MWD (p=0.013), and SEPA (p=0.043) score were significantly correlated with postoperative 6MWD. Conclusions: Self-efficacy was an independent predictor for postoperative 6MWD after elective open AAA surgery. This suggests the importance of assessing not only physical status but also psychological factors such as self-efficacy. [ABSTRACT FROM AUTHOR]

Aim: Statin‐associated muscle symptoms (SAMS) are the muscle‐related side‐effects of statins, but the association between statin use and physical function among community‐dwelling older adults is unclear. The objective of the present study was to examine the association between statin use and physical function among community‐dwelling older Japanese adults by considering the risk factors of statin‐associated muscle symptoms. Methods: The participants were 1022 community‐dwelling older adults aged 65–88 years, who participated in comprehensive health checkups from 2013 to 2015. Statin use in the participants (381 men and 559 women) was verified by using data from their medicine notebooks. The differences between statin use (users and non‐users) and physical functions (grip strength, knee extension torque, normal and maximum gait speed, Timed Up & Go test, one‐legged stance, quadriceps muscle thickness and echo intensity) were analyzed using the t‐test. Multiple regression analyses were also carried out to examine the association between statin use and physical function. Results: A total of 93 men (24.4%) and 154 women (27.5%) were statin users. Grip strength, normal gait speed and one‐legged stance declined significantly in statin users compared with the non‐users. In multiple regression analysis while controlling for the risk factors of statin‐associated muscle symptoms, including age, sex, body mass index and number of medicines, no independent association, between statin use and the reduction of physical functions, was observed. Conclusions: Statin use was not associated with the decline of physical function in community‐dwelling older Japanese adults. Geriatr Gerontol Int 2018; 18: 623–630. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare the level of physical function (PF) and habitual exercise between older Japanese and Korean adults. Methods: A comparative study was carried out on 1069 community‐dwelling older Japanese and Korean adults (mean age 73.9 ± 5.2 years). The participants were asked to complete a self‐reported questionnaire regarding habitual exercise and covariates. PF age, a composite measure of PF, was derived from the 12 items, using principal component analysis. PF age and habitual exercise were compared between the Japanese and Korean adults, using analysis of covariance ( ancova) and multivariable logistic regression analysis adjusted for all covariates using propensity scores. Results: ancova showed that PF age in older Japanese adults was significantly younger than in their Korean counterparts. Older Japanese adults exercised significantly less frequently than their Korean counterparts. Furthermore, older Japanese adults practiced significantly less walking, mountain climbing and bicycling, but more calisthenics, resistance training, ball games and dances than their Korean counterparts. Conclusions: We found that older Korean adults had lower PF (3.7 years older in PF age) than their Japanese counterparts. Although the overall frequency and amount of habitual exercise in older Korean adults were higher than those in their Japanese counterparts, particular types of exercise might have contributed to the higher PF levels among older Japanese adults. Thus, older Korean adults might need to engage more in habitual exercises that are specifically effective in maintaining PF. Geriatr Gerontol Int 2018; 18: 576–583. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Functional Independence and Difficulty Scale (FiDS), a newly developed basic activities of daily living (BADL) assessment tool, assesses both independence and subjective difficulty of BADL performance. This patient-reported outcome measure has been shown to have acceptable internal consistency, concurrent validity, and reliability. However, little is known about the relationship between FIDS and objective measures of physical function among older Japanese adults using long-term care insurance services. This study aimed to reveal the relationship between FIDS and physical functions and to examine the concurrent validity of FIDS against physical functions. Methods: Participants of this cross-sectional, correlational research study included community-dwelling Japanese adults aged 65 years or older and certified as long-term care insurance service users with musculoskeletal disease, internal disease, cerebrovascular diseases without observable motor paralysis, and others. Data on physical functions, including muscle strength (grip strength and isometric knee extension muscle strength [IKEMS]), flexibility (range of motion [ROM] of hip flexion and knee flexion), balance (Modified Functional Reach Test [M-FRT]) and gait performance (timed 2.4-m walk), and BADL performance assessed by FIDS, were obtained. Associations between FIDS scores and physical functions were determined by Spearman correlation coefficient and partial correlations after controlling for subject age and sex. Results: Data were collected on 53 participants (mean age = 81.9 years; 62.3% women). Spearman partial correlation coefficients controlled for sex and age between FIDS score and grip strength, IKEMS, ROM of hip flexion, ROM of knee flexion, M-FRT, and timed 2.4-m walk were 0.47 (P = .001), 0.44 (P = .001), 0.29 (P = .04), -0.05 (P = .73), 0.51 (P < .001), and -0.64 (P < .001), respectively. The strength of association was moderate for the M-FRT and 2.4-m walk and was low for grip strength and IKEMS. However, ROM of the knee showed no significant association and hip flexion had negligible association with FIDS. Conclusions: The FIDS, a patient-reported BADL assessment tool, mainly reflected balance and gait performance and had concurrent validity as an objective measure of balance and gait performance. [ABSTRACT FROM AUTHOR]

This study is to evaluate the impact of cooperation between acute care hospital and rehabilitation hospital on physical function, exercise tolerance, activities of daily living (ADL), health-related quality of life (HR-QOL), and psychological function in heart disease patients undergoing cardiac rehabilitation. Among patients undergoing concurrent medical treatment and cardiac rehabilitation starting early in acute care hospitalization, we selected 30 patients who required continued cardiac rehabilitation in rehabilitation hospitals as subjects. At the time of admission and discharge from the rehabilitation hospital, we measured and compared physical function [grip strength, knee extension strength, and the short physical performance battery (SPPB)], ADL ability using the Functional Independence Measure (FIM), exercise tolerance [six-minute walking distance (6MD)], and psychological functions such as the MOS 36-Item Short-Form Health Survey (SF-36). The average age of the subjects was 76.8 years and 60% were women. In 70% of cases, musculoskeletal causes were the reasons for continued cardiac rehabilitation in a rehabilitation hospital. In evaluations before and after hospitalization, significant improvements were observed in knee extension strength and the results of the SPPB ( p < 0.01), FIM, and 6MD ( p < 0.01). In SF-36, significant improvements were observed in physical function, role functioning, vitality, and emotional functioning ( p < 0.05, p < 0.01). With intensive cardiac rehabilitation in rehabilitation hospitals, physical function, ADL, exercise tolerance, and HR-QOL improved significantly. As the severity and prevalence of heart disease are expected to increase in association with multiple disabilities and aging, the importance of cooperation between acute care hospitals and rehabilitation hospitals will increase; therefore, cardiac rehabilitation should be the basis for such cooperation. [ABSTRACT FROM AUTHOR]

Objective: To determine the physical indicators associated with oral intake status and swallowing function in gastrostomy patients under long-term care. Design: Cross-sectional study. Setting: Thirty-one hospitals that perform gastrostomy insertion, replacement and management. Participants: A total of 117 respondents from 31 hospitals in Japan underwent gastrostomy tube replacement and management between September 2012 and January 2014. Each participant underwent a gastrostomy at least 6 months prior to the study, and received long-term care either at home, a care facility, or a hospital. Measurements: We conducted a questionnaire survey at Japanese hospitals and used the data obtained from 117 respondents for analysis. The survey was conducted using a questionnaire form that collected information about the following items: oral intake status, sex, age, disease history, number of days elapsed since gastrostomy, residence status, modified Rankin Scale score, consciousness, oral hygiene status, articulation and phonation, voluntary saliva swallow, Modified Water Swallow Test, and Food Test. Results: Results revealed significant differences in modified Rankin Scale scores, sputum production, articulation and phonation, and voluntary saliva swallowing between patients who were orally fed and those who were not. Moreover, sputum production and voluntary saliva swallowing were strongly associated with oral intake status. Finally, sputum production, articulation and phonation, and voluntary saliva swallowing were strongly associated with swallowing function test results. Conclusion: Results from this study suggested that sputum production, articulation and phonation, and voluntary saliva swallowing could be used as indicators for estimating oral intake status and swallowing function in gastrostomy patients under long-term care. [ABSTRACT FROM AUTHOR]

Aim To explore the relationships between the built environment and older adults' physical function. Methods The present cross-sectional study carried out in 2010-2012 used data drawn from 509 community-dwelling older adults aged 65-86 years living in Kasama City, a Japanese rural region. We evaluated physical function with the following performance tests: grip strength, sit-to-stand, timed up & go and walking speed. Using geographic information systems, we measured population density and the number of destinations related to daily life, community centers, medical facilities and recreational facilities within participants' neighborhoods. Results After adjusting for potential confounders, we found lower population density was related to poor performance of sit-to-stand and walking speed in both sexes, and grip strength in women (trend P < 0.05). A lower number of daily life-related destinations was related to poor performance of sit-to-stand and walking speed in men, and grip strength and sit-to-stand in women. Similarly, the number of community centers was related to walking speed in both sexes. The number of medical and recreational facilities was also related to some physical performance in both sexes. A lower land use mix score, calculated by principal component analysis, was related to lower performance of sit-to-stand and walking speed in men, and grip strength and sit-to-stand in women. Conclusion The present study suggests that, although there are some sex differences, low population density, land use mix, and fewer daily life-related destinations, community centers, medical facilities and recreational facilities are negative determinants of physical function. Geriatr Gerontol Int 2017; 17: 382-390. [ABSTRACT FROM AUTHOR]

Objectives A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function. Design Cross-sectional study. Setting Single university hospital. Participants A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD. Measurements SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group). Results The sarcopenia prevalence rate was 25.5% and increased with age ( P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates. Conclusion The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings. [ABSTRACT FROM AUTHOR]

• We examined the association between sleep duration and sarcopenia and its components such as low muscle mass (LMM), low muscle strength (LMS), and low physical performance (LPP). • Long sleep had a positive association with sarcopenia, and LMS and LPP indicated strong positive association with long sleep. • When the data were stratified by sex, functional aging (such as a decline in measured physical performance) was found to be associated with long sleep in both sexes. • In long sleepers, there were no associations between insomnia and sarcopenia and its components. • Long sleep and poor sleep quality did not appear to synergize to further increase the risk of sarcopenia, although prolonged sleep and insomnia affected muscles. This study aimed to examine the association between sleep duration and quality and sarcopenia, assessed by factors such as low muscle mass (LMM), low muscle strength (LMS), and low physical performance (LPP) among older community-dwellers in Japan. In this cross-sectional study, a total of 2,069 (men, 902; women, 1,167) participants aged 65 to 80 years were included. Sarcopenia and each low physical function were defined using the definitions of the Asian Working Groups of Sarcopenia 2019. Sleep duration was stratified into three categories: short sleep (<6 h), normal sleep (6-8 h), and long sleep (>8 h). Sleep quality was classified into two groups based on 8-item Athens Insomnia Scale score: insomnia (≥6), and non-insomnia (<6). We analyzed the association between sleep parameters and sarcopenia, including low physical functions, by logistic regression analysis. Compared to normal sleepers, long sleepers had a positive association with sarcopenia (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.25-3.58). In particular, long sleep was strongly associated with LMS (OR 1.77, 95%CI 1.07-2.94) and LPP (OR 1.90, 95%CI 1.25-2.88). On the other hand, poor sleep quality was not associated with sarcopenia in long sleepers, but in normal sleepers. Long sleep was associated with sarcopenia, including LMS and LPP. However, in long sleepers, insomnia was not associated with sarcopenia or any of its components. [ABSTRACT FROM AUTHOR]

Background: The number of hospitalized older patients with chronic heart failure, chronic kidney disease, and worsening renal function is rising in Japan. This study aimed to clarify the impact of the severity of worsening renal function during hospitalization on low physical function at discharge of these patients., Methods: We included 573 consecutive heart failure patients who underwent phase I cardiac rehabilitation. Worsening renal function severity was defined according to elevation during hospitalization of baseline serum creatinine on admission: non-worsening renal function, serum creatinine < 0.2 mg/dL; worsening renal function II/I, serum creatinine ≥ 0.2 to < 0.5 mg/dL; worsening renal function III, and serum creatinine ≥ 0.5 mL/dL. Physical function was measured with the Short Performance Physical Battery. We compared background factors, clinical parameters, pre-hospitalization walking levels, Functional Independence Measure score, and physical function in the three renal function groups. Multiple regression analysis was performed with the Short Performance Physical Battery at discharge as the dependent variable., Results: The final analysis included 196 patients (mean age 82.7 years, male 51.5%) categorized into three groups based on worsening renal function: worsening renal function grade III group (n = 55), worsening renal function grade II/I group (n = 36), and non-worsening renal function group (n = 105). There is no significant difference in walking levels before hospitalization between the three groups, but physical function at discharge was significantly lower in the worsening renal function III group. Moreover, worsening renal function III was an independent factor for low physical function at discharge., Conclusion: Worsening of renal function during hospitalization in older patients with heart failure and chronic kidney disease was strongly associated with low physical function at discharge, even after adjusting for other potentially confounding factors, such as pre-hospitalization walking levels, walking start day, and Geriatric Nutrition Risk Index at discharge. Notably, worsening renal function of mild or moderate severity (grade II/I) did not show a significant association with low physical function., (© 2023. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Objective: To examine the relationship between the living location and outcomes of physical activity level and physical and psychological functioning in older women. The specific aim was to understand the association between living in a sloped versus non-sloped environment and these outcomes. Design: Cross-sectional study. Setting and Participants: 108 older women aged 65 years or older who resided in Nagasaki prefecture participated. Measurements: Physical activity, lung function, muscle strength (hand grip and quadriceps force) and depressive symptoms were assessed objectively. Results: In logistic regression, activity counts per day (OR 0.779, 95%CI 0.715-0.841, p<0.01), activity times per day (OR 0.821, 95%CI 0.801-0.913, p<0.01), hand grip force (OR 0.666, 95%CI 0.558-0.796, p<0.001), and depressed (Center for Epidemiological Studies Depression Scale score ≥16) (OR 1.093, 95%CI 1.019-1.427, p<0.05) showed statistically significant inverse associations with living in a sloped ground. Conclusions: Since dwelling on sloped ground was associated with negative (lower physical activity levels, lower grip strength, and more depression) outcomes, a comprehensive geriatric assessment, related to all aspects of older women, is recommended. Planning of home exercise programs for the elderly should take such environmental factors into consideration. [ABSTRACT FROM AUTHOR]

Aim Quality of sleep ( QOS) has been shown to have an affect on mental and physical well-being, and quality of life. However, few studies have investigated how sleep affects mobility in older adults. The aim of the present study was to examine the relationship between QOS and mobility disorder ( MD) in community-dwelling older adults. Methods Data collected through self-administered questionnaires was analyzed for 4564 Japanese older adults. Sleep outcomes included two self-reported questions regarding QOS. Logistic regression analysis was used to analyze the association between sleep and MD both by the QOS questions independently and grouped together by the two QOS questions into three groups: often sleeps well and good awakening ( GG), does not often sleep well and bad awakening ( BB) and a group with one of each ( GB/ BG). Results After adjustment for age, sex and depression, both those who did not often sleep well and those with poor awakening were more likely to show MD ( OR 1.45, 95% CI 1.29-1.75), ( OR 1.77, 95% CI 1.50-2.08), respectively. When grouped by both questions, those in the BB group had the least favorable outcome with increased odds ratio for possessing a MD ( OR 1.95, 95% CI 1.61-2.37), compared with GB group ( OR 1.40, 95% CI 1.18-1.67). Conclusions Often sleeping well and good morning awakening were both associated with MD, suggesting that self reported QOS is associated with MD. Further research is required to investigate whether improving sleep quality could be a possible means of preventing and reversing MD in older adults. Geriatr Gerontol Int 2016; 16: 266-271. [ABSTRACT FROM AUTHOR]

Background and Purpose: Falling is an unexpected event for older adults, but few studies have investigated falls related to arousal levels and mobility immediately after waking up in the morning. Therefore, the purpose of this study was to clarify the possible relationship of arousal level and mobility with falls in the early morning hours. Methods: We investigated both arousal levels and mobility of 14 community-dwelling older adults after waking up, from 4:00 am until 2:00 p m . Mobility and arousal levels were evaluated through the following tests: Timed Up and Go, Functional Reach, postural sway, and critical frequency of fusion. Baseline of mobility and arousal levels were measured before sleep and after 5 hours of sleep. Immediately after waking up, each participant's mobility and arousal levels were remeasured and then also remeasured 2 hours later, 6 hours later, and 10 hours later, respectively. Stanford Sleepiness Scale was also chosen to measure the internal state of subjective sleepiness and it was measured 7 times at 2-hour intervals after the participants woke up from sleep. Results: Significant differences were found between before sleep and after awakening in the score of Timed Up and Go test and Stanford Sleepiness Scale. The speed of Timed Up and Go test after awaking was slower than that before sleep. The Stanford Sleepiness Scale showed high states of sleepiness. Conclusion: We found that the decrease in arousal level in the early morning may affect mobility. The awareness of the degree of arousal levels may increase fall prevention in older adults in the early morning hours. [ABSTRACT FROM AUTHOR]

Summary Objective This study examined differences in physical function according to body mass index (BMI) in elderly Japanese individuals. Methods Participants (1754 men and 1795 women aged ≥65 years) were divided into the following five BMI groups: low BMI (≤20.0), low-medium BMI (20.1–22.5), medium BMI (22.6–25.0), medium-high BMI (25.1–27.5) and high BMI (≥27.6). Physical function was measured according to BMI and sex, and associations between BMI and physical function were examined. Results Compared with the medium BMI group, handgrip strength (HGS), knee extension torque (KET), and knee flexion torque (KFT) were significantly lower in both sexes in the low BMI group, while KET and KFT were significantly higher among men in the high BMI group. One-leg standing time (OLST) with open eyes was significantly shorter among men in the high BMI group than in the medium BMI group. The high BMI group was significantly inferior to the medium BMI group in 10 m gait time (10MGT), OLST, and maximum one-step length to height ratio among women. All physical functions, except for 10MGT in men, were associated with BMI adjusted age and/or sex. Muscle strength showed a positive association with BMI in both sexes. There was a stronger association between BMI and physical performance in women compared to men. Conclusion We found that BMI influences a variety of factors related to muscle strength and physical performance. Our findings may help contribute to the prevention of mobility impairments in elderly Japanese individuals. [ABSTRACT FROM AUTHOR]

Aim The present study examined the association between objective measures of sleep quality and performance-based measures of physical function in community-dwelling oldest old Japanese. Methods This cross-sectional study included 207 community-dwelling adults aged 80 years or older (92 men, 115 women; age 83.5 ± 2.6 years [range 80-95 years]). Participants wore an accelerometer ( ActiGraph GT3X+) on their non-dominant wrist for 24 h per day over seven consecutive nights. Sleep parameters included total sleep time, sleep efficiency and wake after sleep onset during the night for a week. Performance-based physical function measures were handgrip strength, knee extension strength, and usual and maximum walking speeds. Multivariable linear regression was carried out to determine the associations between weekly sleep parameter averages and physical function measures. Results Approximately 24% of participants had a total sleep time of less than 6 h a night, and 13% had greater than 8 h a night. Overall, average daily physical activity was 1771.8 ± 520.6 (counts/min/day). In multiple linear regression, sleep efficiency and wake after sleep onset were significantly associated with maximum walking speed (β = 0.277; 95% confidence interval [ CI] 0.103 to 0.351 and β = −0.214; 95% CI −0.339 to −0.082, respectively) and usual walking speed (β = 0.200, 95% CI 0.035 to 0.305 and β = −0.174; 95% CI −0.341 to −0.064, respectively), after adjusting for potential confounding factors including daily physical activity. Both sleep qualities were also independently associated with knee extension strength. However, wake after sleep onset was not associated with handgrip strength. Conclusion Objectively measured sleep quality was associated with physical function in the oldest old. Further research is required to identify the temporality of associations between sleep and physical function. Geriatr Gerontol Int 2015; 15: 1040-1048. [ABSTRACT FROM AUTHOR]

BACKGROUND: Posture and physical function have been quantified in mature adults, but not in elderly females. OBJECTIVE: To quantify standing posture and measures of physical function in community-dwelling women over the age of 65 years, and to examine relationships between these variables. METHODS: Fifty-three women were recruited from day care service users (average age: 83.7 ±6.3 years old). Standing postural alignments were assessed using 2-dimensional analyses with a digital video camera. The time up and go test (TUG) and other physical function tests were conducted. RESULTS: Decreased lower cervical angle (increased forward head position) was significantly correlated with increased upper cervical angle (increased chin-up, r = −0.45), increased thoracic spine angle (increased kyphosis, r = −0.38), and decreased lumbar spine angle (thoracolumbar segments backward relative to the pelvis, r = 0.48). The decreased lumbar spine angle was significantly correlated with increased thoracic angle (increased kyphosis, r = −0.37), increased pelvic plane angle (increased anterior pelvic tilt, r = −0.49), and decreased knee flexion angle (r = 0.46). Increased TUG time (slower walking speed) was correlated to increased forward head position (r = 0.30) and thoracolumbar segments forward relative to the pelvis (r = 0.34). CONCLUSIONS: Posture and physical function measures were provided for community-dwelling females who were >65 years of age. They did not demonstrate any correlation between measured knee strength, back strength or single leg standing with measures of postural alignment, but TUG showed a moderate correlation with the lower cervical and lumbar spine posture measures. [ABSTRACT FROM AUTHOR]

Aim The present study clarifies the effects of participation in a preventative health classroom program (exercise program) for 1 year on the physical functions of pre-frail elderly individuals in comparison with healthy elderly individuals. Methods Participants in the study included 28 elderly pre-frail female participants and 28 elderly healthy female participants. Participants engaged in the exercise program for 1 year. There was no significant age or physical differences between both groups. Before and after the exercise program, the following physical function tests were carried out: grip strength, one-legged balance with eyes open, 5-m walking time and a timed up & go ( TUG). Results The pre-frail elderly group tested significantly lower in the one-legged balance with eyes open test and the TUG test compared with the healthy elderly group. The 5-m walking time test improved significantly in both groups, but the TUG improved only in the pre-frail elderly group. Conversely, the grip strength and one-legged balance with eyes open tests remained unchanged. Conclusion Improvements in the TUG and 5-m walking time tests were found in the pre-frail elderly group after the 1-year exercise program. Their results in the TUG test might be greater than those among the healthy elderly individuals. Geriatr Gerontol Int 2014; 14: 975-982. [ABSTRACT FROM AUTHOR]

Aim To identify the direct and indirect effects of nutritional status, physical function, and cognitive function on activities of daily living in Japanese older adults requiring long-term care. Methods In total, 179 participants aged ≥65 years who were eligible for long-term care insurance (mean age 85.5 ± 7.8 years) were recruited for this study. Nutritional status (Mini Nutritional Assessment, Short Form) and physical function (Short Physical Performance Battery) were examined. Activities of daily living, cognitive function and frailty were assessed using the Barthel Index, Mini-Mental State Examination and Clinical Frailty Scale, respectively. Path analysis was used to determine relationships between these factors and the activities of daily living. Results For Japanese older adults requiring long-term care, pathways were modeled for nutritional status, physical function and the activities of daily living. The total effect of nutritional status was 0.516 ( P < 0.001). The indirect effect of nutritional status through physical function on the activities of daily living was 0.458 ( P < 0.001). Finally, no significant direct effect of nutritional status on activities of daily living was observed (b = 0.058, P = 0.258). Conclusions The present study identified the complex pathway from nutritional status to the activities of daily living through physical function in aged Japanese people requiring long-term care. These findings suggest that maintaining good nutritional status and nutritional support might delay physical function decline, and prolong the activities of daily living. Geriatr Gerontol Int 2014; 14: 799-805. [ABSTRACT FROM AUTHOR]

Detecting signs of cognitive impairment as early as possible is one of the most urgent challenges in preventive care of dementia. It has still been unclear whether physical fitness measures can serve as markers of low cognitive function, a sign of cognitive impairment, in older people free from dementia. The aim of the present study was to examine an association between each of five physical fitness measures and global cognition in Japanese community-dwelling older adults without apparent cognitive problems. The baseline research of the Sasaguri Genkimon Study was conducted from May to August 2011 in Sasaguri town, Fukuoka, Japan. Of the 2,629 baseline subjects who were aged 65 years or older and not certified as individuals requiring nursing care by the town, 1,552 participants without apparent cognitive problems (Mini-Mental State Examination score ≥24) were involved in the present study (59.0% of the baseline subjects, median age: 72 years, men: 40.1%). Global cognitive function was measured by the Japanese version of the Montreal Cognitive Assessment. Handgrip strength, leg strength, sit-to-stand rate, gait speed, and one-leg stand time were examined as physical fitness measures. In multiple linear regression analyses, each of the five physical fitness measures was positively associated with the Montreal Cognitive Assessment score after adjusting for age and sex (p < 0.001). These associations were preserved after additional adjustment for years of formal education, body mass index, and other confounding factors (p < 0.001). The present study first demonstrated the associations between multiple aspects of physical fitness and global cognitive function in Japanese community-dwelling older people without apparent cognitive problems. These results suggest that each of the physical fitness measures has a potential as a single marker of low cognitive function in older populations free from dementia and thereby can be useful in community-based preventive care of dementia. [ABSTRACT FROM AUTHOR]

Aim To test the hypothesis that static balance is associated with site-specific loss of muscle mass in older adults. Methods A total of 57 active women aged 52-83 years had their muscle thickness ( MTH) measured by ultrasound at four sites on the anterior and posterior aspects of their upper- and lower-leg. MTH ratios were calculated to assess the site-specific muscle loss. One-leg standing balance with eyes open and maximum isometric knee extension/flexion strength were measured. Daytime physical activity was also measured. The participants were separated into three groups based on achieved timed one-leg balance test: less than 60 s ( n = 19, G1), 60-120 s ( n = 12, G2) and over 120 s ( n = 26, G3). Results Age was inversely correlated to the upper-leg ( A50 : P70) MTH ratios ( r = −0.389, P < 0.001), but not lower-leg ratio ( r = 0.047), thus site-specific muscle loss was observed in the upper-leg. Total muscle mass was similar among the groups. A50 : P70 MTH ratio and absolute and relative knee flexion strength were lower in G1 than in G3. Step counts and durations of moderate and vigorous exercise were lower in G1 and G2 than in G3. There were significant correlations between one-leg balance and A50 : P70 MTH ratio ( r = 0.271, P < 0.05) and physical activity level ( r = 0.357-0.481, P < 0.01). After adjusting for step count, one-leg balance was only correlated significantly with duration of vigorous exercise ( r = 0.319, P < 0.05). Conclusion Higher physical activity could have more impact on balance regulation, as the influence of site-specific muscle loss was weak in active women. Geriatr Gerontol Int 2014; 14: 381-387. [ABSTRACT FROM AUTHOR]

Aim This study aimed to compare relationships of leisure-time, household, and work-related physical activity ( PA) with physical performance by age and gender in older Japanese adults. Methods This cross-sectional study included 525 community-dwelling older adults (73.3 ± 5.2 years) recruited in 2009-2011 in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess PA variables. Physical performance was evaluated by 11 performance tests: grip strength, single-leg balance, functional reach, sit-and-reach, standing time from long sitting position, sit-to-stand, timed up and go, habitual walk, hand working, and simple and choice reaction times. Results After adjusting for potential confounders, leisure-time PA in young-old (≤74 years) men correlated significantly with eight performance tests (absolute value of Spearman's partial rank correlation coefficient: r = 0.18-0.39), whereas in old-old (≥75 years) men it correlated with three performance tests ( r = 0.20-0.23). Although leisure-time PA correlated with six performance tests ( r = 0.19-0.22) in young-old women, there were no significant correlations between leisure-time PA and performance tests in old-old women. Household PA of young-old men ( r = 0.20-0.23) and old-old women ( r = 0.26-0.34) correlated with four performance tests. In old-old men and young-old women, no significant correlation was found between household PA and performance tests. Work-related PA did not relate significantly to any performance tests in any groups. Conclusion This study showed that leisure-time PA is related to physical performance, especially in young-old men and women, and household PA is especially related in young-old men and old-old women. Our findings suggest that supporting strategies for maintaining physical functions would differ by gender and age. Geriatr Gerontol Int 2013; 13: 919-927. [ABSTRACT FROM AUTHOR]