Frailty is considered to be a complex concept based mainly on physical vulnerability, but also vulnerabilities in mental/psychological and social aspects. Frailty can be reversible with appropriate ...intervention; however, factors that are important in recovering from frailty have not been clarified. The aim of the present study was to identify factors that help an individual reverse frailty progression and characteristics of individuals that have recovered from frailty. Community-dwelling people aged ≥75 years who responded to the Kihon Checklist (KCL) were enrolled in the study. The KCL consists of 25 yes/no questions in 7 areas: daily-life related activities, motor functions, nutritional status, oral functions, homebound, cognitive functions, and depressed mood. The number of social activities, degree of trust in the community, degree of interaction with neighbors, and subjective age were also evaluated. Frailty was assessed based on the number of checked items: 0-3 for robust, 4-7 for pre-frailty, and ≥8 for frailty. A total of 5050 participants were included for statistical analysis. At the time of the baseline survey in 2016, 18.7% (n = 942) of respondents had frailty, and the follow-up survey showed that the recovery rate from frailty within 2 years (median 24 months) was 31.8% (n = 300). Multiple logistic regression analysis showed that exercise-based social participation (odds ratio OR 2.0, 95% confidence interval CI 1.2-3.4; P<0.01) and self-rated health (OR 1.2, CI 1.0-1.5; P = 0.02) were related to reversing frailty progression. Principal component analysis indicated that the main factors constituting the first principal component (contribution rate, 18.3%) included items related to social capital, such as interaction with neighbors, trust in the community, and number of social participation activities. Our results demonstrate that exercise-based social participation and high self-rated health have associations with reversing frailty progression. Individuals that recovered from frailty are characterized by high individual-level social capital components (i.e., trust in community, interaction with neighbors, and social participation).
Objective
To assess the sustained effects of a buddy-style intervention aiming to improve physical activity.
Design
A parallel-group, open-label, randomized controlled trial.
Setting
Three adult ...day-care centers.
Participants
Sixty-five community-dwelling older adults with disabilities.
Intervention
All participants received a 12-week home-based exercise program. An intervention group (n = 33) received a 5–10 min buddy-style intervention once a week at an adult day-care center for older adults.
Main measures
The primary outcome was the average daily time spent performing “walking outside home” and “muscle strength exercises” at 24 weeks follow-up post-intervention.
Results
Of the 65 participants, one participant in each group dropped out before the program began, 4 and 5 in the intervention and control groups by the 12-week assessment, and 4 and 3 by the 24-week assessment, respectively. Analysis of covariance of the 47 participants who were able to be assessed after 24 weeks revealed that outdoor walking time (min/day) was significantly longer in the intervention group (n = 24) than in the control group (n = 23) at 24 weeks (intervention group, 73.5 66.1; control group, 42.7 45.5; P = 0.030, f = 0.38). There was no significant difference in the duration of muscle strength exercises (min/day) between the two groups at 24 weeks (intervention group, 8.2 9.7; control group, 6.5 9.3; P = 0.593, f = 0.08).
Conclusions
The buddy-style intervention increased the duration of outdoor walking, with a sustained effect up to 12 weeks after the end of the intervention.
Objective
To assess the preliminary effects of a buddy-style intervention to improve exercise adherence.
Design
A parallel-group, open-label, pilot randomized controlled trial.
Setting
Adult day-care ...centers.
Participants
Sixty-five disabled older adults.
Interventions
All participants underwent a 12-week home exercise program, and the intervention group received a 5–10 min buddy-style intervention between older adults in the intervention group once weekly at an adult day-care center.
Main measures
Based on the exercise log calendar, the number of days of exercise was assessed for each of the three phases: 1–4 weeks, 5–8 weeks, and 9–12 weeks. Short physical performance battery was measured at baseline and after 12 weeks.
Results
Of the 590 screened older adults, 65 were recruited and 33 were assigned to the intervention group. One participant in each group withdrew before the program began, and four and five patients in the intervention and control groups, respectively, dropped out by the 12-week assessment. Analysis of covariance of the 28 and 26 patients in the intervention and control groups, respectively, for whom exercise log calendars could be retrieved, showed that the intervention group (24.4/28 days) exercised significantly more days than the control group (20.6/28 days) at 9–12 weeks (P = 0.009). In the between-group effect of the intention-to-treat analysis of short physical performance battery, walking and standing test (P = 0.790, P = 0.829) were not significantly different, and balance test (P = 0.049) was significantly better in the control group.
Conclusions
There was a preliminary effect of the buddy-style intervention to improve exercise adherence.
ObjectivesIn Japan, frailty is a major risk factor for requiring long-term care, especially among older adults aged 75 years or older (ie, late-stage older adults). Both physical and social factors ...(eg, social activities, social support and community trust) are protective factors against frailty. However, few longitudinal studies have examined reversible change or stage improvement in frailty. This study investigated social activity participation and trust in the community that may affect the transition of late-stage older adults’ frailty status.DesignA mail-based survey was used to analyse the improvement or deterioration of frailty status (categorised as frailty, pre-frailty and robust) over a 4-year period. Binomial and multinomial logistic regression analyses were conducted; the transition in frailty classification was the dependent variable, while a change in social activity participation and the degree of trust in the community were the independent variables.SettingIkoma City, Nara Prefecture, Japan.Participants4249 community-dwelling older adults, aged ≥75 years, not requiring long-term care who completed a follow-up questionnaire from April to May 2016.ResultsAdjusting for confounding factors, no significant social factors were detected regarding improvement in frailty. However, an increase in exercise-based social participation was an improvement factor in the pre-frailty group (OR 2.43 (95% CI 1.08 to 5.45)). Conversely, a decrease in community-based social activity was a risk factor in the deterioration from pre-frailty to frailty (OR 0.46 (95% CI 0.22 to 0.93)). In the robust group, increased community-based social activity (OR 1.38 (95% CI 1.00 to 1.90)) was a protective factor against frailty, whereas decreased community trust was a risk factor (OR 1.87 (95% CI 1.38 to 2.52)).ConclusionsNo social factors had a significant influence on the improvement of frailty in late-stage older adults. However, the promotion of exercise-based social participation was found to be important for improvement in the pre-frailty state.Trial registration numberUMIN000025621.
The present prospective study investigated the regional differences and trajectories of new-onset disabilities among older adults in the districts within a city in Japan. We analyzed data from 5050 ...Japanese residents aged ≥75 years old (men/women: 2512/2538) who completed the Kihon Checklist (a self-reported questionnaire on frailty) and a questionnaire on medical history and social capital in Ikoma city in 2015. The incidence of disability was determined using the new certification of long-term care insurance and was followed-up on 4 years after the primary outcome. A Cox proportional hazards regression model was used to determine the factors related to the risk of incident disability. During the 4-year follow-up period, 567 participants (11.2%) were newly certified to have a disability. The disability incidence rate ranged from 8.1% to 14.6%, depending on the district. After adjustment for the covariates of: older, women, stroke, prefrail, frail, participation in multiple social activities (hazard ratio HR = 0.72, 95% confidence interval CI = 0.56–0.91), and one of the districts (HR = 1.67, 95% CI = 1.06–2.61) were significantly associated with disability incidence. The findings of this longitudinal study suggest that there could be a regional difference in disability incidence among older adults in Japan. Thus, community-based approaches should be designed to prevent disability in older adults.
This study investigated neighborhood walkability using Walk Score® and social participation in districts within a city among older Japanese adults.
This study was a cross-sectional study using ...baseline data of older adults from the Keeping Active across Generations Uniting the Youth and the Aged study. In total, 2750 participants (1361 men and 1389 women, mean age 72.8 ± 6.4 years) were included in the analysis. The questionnaire included socioeconomic status, self-rated health, medical history, depressive symptoms, instrumental activities of daily living and social participation. We used the Walk Score® as neighborhood walkability and a walk score <50 was categorized as a "car-dependent" area and a score ≥50 as a "walkable" area. A Poisson regression analysis stratified by sex was performed to investigate the association of neighborhood walkability with social participation. Prevalence ratios were calculated and their 95% confidence intervals.
We found that dwelling in car-dependent areas (prevalence ratio 0.78, 95% confidence interval 0.64-0.94) had a significant negative effect on women's social participation, unlike men.
Our study showed that neighborhood walkability and social participation were associated with older Japanese women after adjusting for the covariates. These findings might provide helpful information for public health interventions targeted to promote social participation among older adults. Geriatr Gerontol Int 2022; 22: 350-359.
This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with ...others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01-1.61, and 1.26; 1.06-1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (
< 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.
To investigate the relationships between toe elevation ability in the standing position and dynamic balance and fall risk among community-dwelling older adults.
Cross-sectional survey.
General ...community.
Community-dwelling older adults (N = 287).
Toe elevation angles in the standing position.
Intra-rater and inter-rater reliability of measurements of the toe elevation angle was high (internal coefficient of correlation ICC (1,2) = 0.94 for the former and ICC (2,1) = 0.90 for the latter). Significant correlations were found between the toe elevation angle and age (r = -0.20, P < .01), 5-m walking time (r = -0.31, P < .01), Functional Reach Test (r = 0.36, P < .01), Timed Up and Go Test (r = -0.36, P < .01), and Chair Stand Test (r = 0.26, P < .01). Subjects who experienced a fall in the previous 6 months had a significantly lower toe elevation angle compared with subjects who did not experience a fall (t = 2.19, P < .05). Multiple regression analysis revealed that results of the Functional Reach Test (β = .22, P < .001) and Timed Up and Go Test (β = -0.74, P < .001) were significantly associated with the toe elevation angle.
Toe elevation angle was an index of dynamic balance ability and appears to be a simple screening test for fall risk in community-dwelling older adults.
The purpose of this study was to investigate abnormalities of the first three steps of gait initiation in patients with Parkinson's disease (PD) with freezing of gait (FOG). Ten PD patients with FOG ...and 10 age-matched healthy controls performed self-generated gait initiation. The center of pressure (COP), heel contact positions, and spatiotemporal parameters were estimated from the vertical pressures on the surface of the force platform. The initial swing side of gait initiation was consistent among the trials in healthy controls but not among the trials in PD patients. The COP and the heel contact position deviated to the initial swing side during the first step, and the COP passed medial to each heel contact position during the first two steps in PD patients. Medial deviation of the COP from the first heel contact position had significant correlation with FOG questionnaire item 5. These findings indicate that weight shifting between the legs is abnormal and that medial deviation of the COP from the first heel contact position sensitively reflects the severity of FOG during the first three steps of gait initiation in PD patients with FOG.
Background: Atherothrombosis due to arteriosclerosis is a risk factor for recurrence of stroke. Although exercise therapy is essential to prevent progression of arteriosclerosis and to improve ...endothelial function, little is known about the effect of rehabilitation in chronic stroke survivors. Objective: The purpose of this study was to investigate the effect of intensive rehabilitation on physical and arterial function among community-dwelling stroke survivors. Methods: Forty-four community-dwelling stroke survivors participated in the study. The experimental group (n = 22) received primarily intensive strengthening exercise and the control group (n = 22) received standard physical therapy consisting mainly of stretching and gait training. Both groups underwent the rehabilitation program for 12 weeks. Physical function was evaluated using 10-m gait velocity, the 30-s chair stand test, Timed Up and Go test, and grip strength. Arterial function of the affected and unaffected sides was evaluated using the cardio-ankle vascular index (CAVI) as an index of arterial stiffness and the ankle-brachial pressure index (ABI) as an index of arterial occlusion. Results: After the 12-week rehabilitation period, improvement in physical function did not differ between the 2 groups; whereas with regard to arterial function, a significant improvement in the CAVI for the affected side was observed in the experimental group (P < .001). Also, the ABI for the unaffected side in the experimental group was significantly improved after intervention (P < .001). No significant differences were found for the unaffected-side CAVI and affected-side ABI between the 2 groups. Conclusions: These findings suggested that intensive rehabilitation for stroke patients during the chronic stage preserved physical function and improved arterial function.
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