1
|
Yang C, Gao Y, An R, Lan Y, Yang Y, Wan Q. Oral frailty: A concept analysis. J Adv Nurs 2024; 80:3134-3145. [PMID: 38214108 DOI: 10.1111/jan.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/20/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024]
Abstract
AIM To clarify the concept of oral frailty to provide a clear and standardized conceptual basis for further research in older people. DESIGN Rodgers and Knafl's evolutionary concept analysis approach. METHODS The narrative analysis detailedly extracted and synthesized the attributes of oral frailty, as well as its antecedents, consequences and related terms under the guidance of Rodgers' evolutionary method. DATA SOURCES Multiple databases including Pubmed, CINAHL and Cochrane were searched using selected search terms 'oral frail*', 'oral health' and 'aged' respectively. Articles written between 2013 and 2023 were included, and grey literature was excluded. RESULTS A total of 32 articles were included for further analysis and synthesis. The attributes of oral frailty were hypofunction, predisposing in nature, non-specific and multidimensional. Antecedents of prefrailty were classified into four categories, namely, sociodemographic characteristics, comorbidity, physical function and psychosocial factors. Consequences of oral frailty include three themes: increased risk of adverse outcomes, poor nutritional status and possibility of social withdrawal. Related terms that had shared attributes with oral frailty were oral health, functional dentition, oral hypofunction and deterioration of oral function. CONCLUSIONS Oral frailty is an age-related phenomenon reflected in decreased oral function. The findings of this concept analysis are conducive to understanding and clarifying the oral frailty, which can help clinicians or other healthcare providers to consider how to distinguish oral frailty in older adults and further promote the development of this field. IMPACT Oral frailty is increasingly recognized as an age-related phenomenon reflected in decreased oral function. As it is newly proposed, no consensus has been reached regarding the theoretical and operational concept of it. Through clarifying the concept, this paper will guide future healthcare research on oral frailty regarding the influencing factors, mechanisms and interventions, thus raising the awareness with regard to oral health among older adults. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: In the context of older adults, oral frailty is a concept that requires further research to guide future theoretical development, and the influencing factors, mechanisms and interventions need to be further studied. Raise awareness with regard to oral health among older people and more attention will be paid to the early identification and intervention of oral frailty, so as to further improve the quality of life of older adults.
Collapse
Affiliation(s)
- Chengfengyi Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Yajing Gao
- School of Nursing, Peking University, Beijing, China
| | - Ran An
- School of Nursing, Peking University, Beijing, China
| | - Yue Lan
- School of Nursing, Peking University, Beijing, China
| | - Yue Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
2
|
Ortuño D, Martínez C, Caneo C, Paredes F, Soto M, González MI, Vargas JP, Koller G. Tooth loss and depression in Chilean participants of the National Health Survey 2016-2017: Oral and social functions mediation analysis. J Affect Disord 2024; 358:19-27. [PMID: 38703903 DOI: 10.1016/j.jad.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Previous studies have indicated the association between poor oral health and depression in adults. This study evaluated oral and social functions contribution to the association between tooth loss and depressive symptoms in Chilean individuals. METHODS We used data from the Chilean National Health Survey. The number of remaining teeth (≤19 versus ≥20 teeth) and anterior tooth losses were the exposure variables. Outcome was depression, measured through a self-report question and with the Composite International Diagnostic Interview - Short Form (CIDI SF). Mediating variables were determined by five questions, including problems regarding "speaking", "pain and suffering", "eating", "daily activities", and "social relationships". We performed logistic regression models adjusted by multiple confounders variables. Finally, we calculated indirect, direct effect, total effect, and the proportion mediated (PM). RESULTS We included 5383 participants. The self-reported depression and suspected depression prevalence were 22,1 % and 14,0 % respectively. The total effect of fewer remaining teeth (≤19) on self-reported depression was 1.21 (95 % CI 1.02-1.44), and 1.09 (95 % CI 0.90-1.33) for suspected depression. All five variables of oral and social functions significantly mediated the association between tooth loss and depression. Feeling uncomfortable when speaking or eating discomfort were the most significant mediators. LIMITATIONS The mediation analysis should be interpreted with caution due to the cross-sectional design. CONCLUSIONS Deterioration of oral and social functions was a significant mediator in the association between tooth loss and depression, in particular feeling uncomfortable when speaking or eating. This mechanism should be considered in interventions to improve mental health.
Collapse
Affiliation(s)
- Duniel Ortuño
- Pontificia Universidad Católica de Chile, Programa Doctorado en Epidemiología, Chile; Facultad de Odontología, Universidad de los Andes, Chile..
| | - Constanza Martínez
- Pontificia Universidad Católica de Chile, Programa Doctorado en Epidemiología, Chile; Facultad de Odontología, Universidad de los Andes, Chile
| | - Constanza Caneo
- Pontificia Universidad Católica de Chile, Programa Doctorado en Epidemiología, Chile
| | - Fabio Paredes
- Faculty of Mathematics, Pontificia Universidad Católica de Chile, Chile
| | - Mario Soto
- Escuela de Tecnología Médica, Facultad de Salud y Odontología, Universidad Diego Portales
| | | | - Juan Pablo Vargas
- Escuela de Odontología, Pontificia Universidad Católica de Chile, Chile
| | - Garrit Koller
- Department of Endodontics, Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom; London Centre for Nanotechnology, London, United Kingdom
| |
Collapse
|
3
|
Shimizu A, Ikeda T, Miyaguni Y, Takeda S, Tamada Y, Aida J. Association between the incidence of functional disability and frequency of eating together among older adults living alone: a 6-year follow-up study from the Japan Gerontological Evaluation Study. Age Ageing 2024; 53:afae153. [PMID: 39041734 DOI: 10.1093/ageing/afae153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE This study aimed to determine whether the frequency of eating together is associated with the incidence of functional disability in older adults who live alone. METHODS This 6-year observational prospective cohort study utilised self-reported questionnaires. Data were drawn from the participants of the Japan Gerontological Evaluation Study project between 2016 and 2022. The participants were independent older adults aged ≥65 years living alone in Japan. The primary outcome was the incidence of functional disability during the follow-up period, with the self-reported frequency of eating together serving as the explanatory variable. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models after adjusting for confounders associated with incident functional disability. RESULTS Among the 7167 participants, the mean age at baseline was 75.3 ± 6.5 years and 69.2% were female. About, 12.8% of participants (n = 917) developed functional disabilities during the observation period. The incidence rates were 11.7% for 'every day', 11.3% for 'several times a week', 11.5% for 'several times a month', 12.7% for 'several times a year' and 19.0% for 'seldom'. The frequency of eating together 'seldom' was significantly associated with an increased incidence of functional disability (HR: 1.55, 95% CI: 1.10-2.18). CONCLUSION Among older adults living alone, infrequent eating together ('seldom') was identified as a risk factor for developing functional disability.
Collapse
Affiliation(s)
- Akio Shimizu
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu-City, Mie 514-8507, Japan
| | - Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata-City, Yamagata 997-8555, Japan
| | - Yasuhiro Miyaguni
- Department of Social Welfare, Nihon Fukushi University, Mihama-Cho, Aichi 470-3295, Japan
| | - Sho Takeda
- Health and Counseling Center, Osaka University, Toyonaka-City, Osaka 560-0043, Japan
| | - Yudai Tamada
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai-City, Miyagi 980-8575, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya-City, Aichi 466-8550, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo 113-8510, Japan
| |
Collapse
|
4
|
Li T, Shen Y, Leng Y, Zeng Y, Li L, Yang Z, Wang S, Jiang Y. The prevalence of oral frailty among older adults: a systematic review and meta‑analysis. Eur Geriatr Med 2024; 15:645-655. [PMID: 38528284 DOI: 10.1007/s41999-023-00930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/29/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND In recent years, oral frailty was proposed as a new concept regarding dental and oral health in older adults. Poor oral health is linked to preserving general health and has become a geriatric public health problem that deeply affects healthy aging. While in present, evidence on the prevalence associated with oral frailty in older adults remains unclear. OBJECTIVE To systematically evaluate the prevalence of oral frailty among older adults, stratified by relevant factors such as gender, source, study design, region, and the evaluation scales for oral frailty and provide an evidence-based foundation for healthcare professionals and policymakers to formulate relevant measures. METHODS Ten electronic databases were systematically searched from inception to September 2023, including PubMed, Web of Science, Embase, PsycINFO, The Cochrane Library, CINAHL, China National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Database (Sinomed), Weipu Database, and Wanfang database. Based on the Stata 15.0 software package, a random effect model was used to calculate the pooled prevalence of oral frailty among older adults. In addition, sensitivity analysis, subgroup analysis, and meta-regression were conducted based on different study characteristics to detect heterogeneity sources. Funnel plots, Begg's and Egger's tests were used to evaluate the publication bias. RESULTS Eighteen studies with a total of 12,932 older adults were included for meta-analysis. The pooled prevalence of oral frailty and oral pre-frailty was 24% (95% CI: 20-28%) and 57% (95% CI: 52-61%) respectively. Based on different assessment tools of oral frailty, the pooled prevalence of oral frailty was higher when using the OFI-8 scale (44.1%; 95% CI: 35.4-52.8%) than the OFI-6 scale (18.3%; 95% CI: 15.8-20.8%) or OF checklist (22.1%; 95% CI: 17.4-26.7%). The prevalence of oral frailty was higher among older adults in females (23.8%; 95% CI: 18.4-29.2%), hospital settings (31%, 95% CI: 16.6-45.5%), cross-sectional design (26.7%, 95% CI: 19.2-34.2%), and China (45.9%, 95% CI: 34.4-57.3%). CONCLUSIONS Our study showed that oral frailty was common among older adults and various characteristics may affect its prevalence. Thus, healthcare professionals and policymakers should take oral frailty seriously in clinical practice and program planning and develop more preventive measures for oral frailty among older adults.
Collapse
Affiliation(s)
- Tao Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Yinli Shen
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yingjie Leng
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - You Zeng
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Long Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Zijiang Yang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Siyu Wang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Yunlan Jiang
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| |
Collapse
|
5
|
Iwasaki M, Shirobe M, Motokawa K, Tanaka T, Ikebe K, Ueda T, Minakuchi S, Akishita M, Arai H, Iijima K, Sasai H, Obuchi S, Hirano H. Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: Results from the Oral Frailty 5-Item Checklist. Geriatr Gerontol Int 2024; 24:371-377. [PMID: 38390632 DOI: 10.1111/ggi.14846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty. METHODS We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score ≤3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score ≥3). RESULTS A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94). CONCLUSIONS Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. Geriatr Gerontol Int 2024; 24: 371-377.
Collapse
Affiliation(s)
- Masanori Iwasaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Ikebe
- Department of Removable Prosthodontics and Gerodontology, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Takayuki Ueda
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Sasai
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| |
Collapse
|
6
|
Yoo MY, Song HJ, Park KH, Seo YG, An HJ, Paek YJ, Noh HM. Relationship between Eating Alone and Handgrip Strength in Korean Older Adults. Nutrients 2024; 16:654. [PMID: 38474782 DOI: 10.3390/nu16050654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Sarcopenia is defined as an age-related decline in muscle mass, muscle strength, and physical performance. Eating alone has been linked to various health issues in older adults. This study investigated the relationship between eating alone and handgrip strength (HGS) in older adults using data from 7278 individuals (≥65 years) who participated in the 2014-2019 Korea National Health and Nutrition Examination Survey. HGS was measured using a digital grip strength dynamometer, relative HGS was calculated by dividing HGS by body mass index, and dynapenia was defined as an HGS < 28 kg for men and <18 kg for women. Multivariable logistic regression analysis showed that women who ate two meals alone were more likely to exhibit dynapenia than those who never ate alone (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.03-1.77). If the groups that never ate alone or ate one meal alone were combined as the reference group, the probability of dynapenia was higher in the combined groups that ate two or three meals alone (OR, 1.25; 95% CI, 1.04-1.50). No association was observed between eating alone and dynapenia in men. This suggests that eating alone is a modifiable related factor of dynapenia in older women.
Collapse
Affiliation(s)
- Min Young Yoo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Hye-Ji An
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea
| |
Collapse
|
7
|
Iwasaki M, Shirobe M, Motokawa K, Hayakawa M, Miura K, Kalantar L, Edahiro A, Kawai H, Fujiwara Y, Ihara K, Watanabe Y, Obuchi S, Hirano H. Validation of self-reported articulatory oral motor skill against objectively measured repetitive articulatory rate in community-dwelling older Japanese adults: The Otassha Study. Geriatr Gerontol Int 2023; 23:729-735. [PMID: 37673795 DOI: 10.1111/ggi.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
AIM To assess the validity of self-reported articulatory oral motor skill against objectively measured repetitive articulatory rate (oral diadochokinesis [oral-DDK]) as a gold standard index for articulatory oral motor skill in community-dwelling older Japanese adults. METHODS This cross-sectional study included 607 Japanese adults (mean age = 73.9 years). A single-item self-report questionnaire for articulatory oral motor skill was developed. Study participants completed a 1-month-interval test-retest protocol to assess reliability of the questionnaire, and the protocol was tested by the kappa statistic. Oral-DDK with /ta/ (i.e., the number of repetitions of the monosyllable /ta/ per second) was measured during the on-site examination. Low oral-DDK performance was defined as <5.2 times/s in men and <5.4 times/s in women. Oral-DDK performance, oral functions other than articulatory oral motor skill, and physical frailty were compared in the groups with and without self-reported low articulatory oral motor skill as determined by the response to the questionnaire. RESULTS Self-reported low articulatory oral motor skill was identified in 18.5% of the study population. The self-report questionnaire had good test-retest reliability, with a kappa statistic of 0.71. Self-reported low articulatory oral motor skill was significantly associated with a lower value of oral-DDK with /ta/ and a higher proportion of low oral-DDK performance, difficulties in chewing and swallowing, dry mouth, and physical frailty. Self-report had high specificity (83.1%) but low sensitivity (42.1%) for detecting low oral-DDK performance. CONCLUSIONS A single-item self-report questionnaire for articulatory oral motor skill had acceptable test-retest reliability and was associated with objectively measured articulatory oral motor skill. Geriatr Gerontol Int 2023; 23: 729-735.
Collapse
Affiliation(s)
- Masanori Iwasaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Misato Hayakawa
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazuhito Miura
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Lena Kalantar
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hisashi Kawai
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yutaka Watanabe
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| |
Collapse
|
8
|
Maehara T, Nishimura R, Yoshitake A, Tsukamoto M, Kadomatsu Y, Kubo Y, Okada R, Nagayoshi M, Tamura T, Hishida A, Takeuchi K, Wakai K, Naito M. Association of daily physical activity and leisure-time exercise with dysphagia risk in community-dwelling older adults: a cross-sectional study. Sci Rep 2023; 13:10893. [PMID: 37407654 DOI: 10.1038/s41598-023-37605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
This study aimed to clarify the association of daily physical activity and leisure-time exercise with the risk of dysphagia in community-dwelling Japanese older adults using a questionnaire-based survey. We analyzed 3070 participants (1657 men, 1413 women; age 66 ± 4 years [mean ± SD]) of the Shizuoka and Daiko studies within the Japanese Multi-Institutional Collaborative Cohort study. We used the Dysphagia Risk Assessment for the Community-dwelling Elderly questionnaire to assess dysphagia risk and the International Physical Activity Questionnaire to assess daily physical activity and leisure-time exercise. Logistic regression analyses were used to evaluate the independent association of the amount of physical activity and leisure-time exercise with dysphagia risk. The proportion of participants with dysphagia risk was 27.5% (n = 844) and the risk was significantly higher in women (29.8%, n = 421) than in men (25.5%, n = 423; P = 0.008). Daily physical activity was not associated with dysphagia risk. A greater amount of leisure-time exercise was associated with lower dysphagia risk (P for trend = 0.003) and individuals in the highest leisure-time exercise quartile had a significantly lower odds ratio (0.68, 95% CI 0.52-0.89) than those in the lowest quartile, even after adjusting for the covariates.
Collapse
Affiliation(s)
- Tomoko Maehara
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
- Department of Public Oral Health, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Rumi Nishimura
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Akari Yoshitake
- Division of Dentistry and Oral Surgery, Japan, Community Health Care Organization, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, 745-0822, Japan
| | - Mineko Tsukamoto
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuka Kadomatsu
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan.
| |
Collapse
|
9
|
Severe Periodontitis Increases the Risk of Oral Frailty: A Six-Year Follow-Up Study from Kashiwa Cohort Study. Geriatrics (Basel) 2023; 8:geriatrics8010025. [PMID: 36826367 PMCID: PMC9956982 DOI: 10.3390/geriatrics8010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Oral frailty, overlapping a decline in multi-faceted oral functions and often seen in older adults, increases risks of adverse health outcomes, thereby necessitating earlier measures. Tooth loss, a major element of oral frailty, is mainly caused by periodontal disease and is an irreversible event. Therefore, this study aimed to clarify whether advanced periodontal disease increases the risks of "new-onset" oral frailty through a longitudinal analysis based on the 2012 baseline survey of the Kashiwa cohort and the follow-up assessments conducted in 2013, 2014, 2016, and 2018. The participants were disability-free, non-orally frail older adults living in Kashiwa City. Of the 1234 participants (72.2 ± 5.1 years old; 50.8% men) analyzed in this study, oral frailty occurred in 23.1% within the six-year period. The group with Community Periodontal Index (CPI) ≥ 3 at baseline had no significant difference in the risk of oral frailty compared with CPI ≤ 2; however, CPI4 at baseline was related to the increased risk of oral frailty compared with CPI ≤ 3 (an adjusted hazard ratio (95% confidence interval): 1.42 (1.12-1.81). Conclusively, severe periodontitis (CPI4) might be associated with new-onset oral frailty, suggesting that prevention of periodontal disease could contribute to oral frailty prevention.
Collapse
|
10
|
Zhou S, Ding X, Leung JTY. Healthy Aging at Family Mealtimes: Associations of Clean Cooking, Protein Intake, and Dining Together with Mental Health of Chinese Older Adults amid COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1672. [PMID: 36767039 PMCID: PMC9914416 DOI: 10.3390/ijerph20031672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
The present study aims to examine whether multiple dietary factors affect the mental health of older adults amid the COVID-19 pandemic. It proposes an integrative dietary framework that highlights environmental, nutritional, and social aspects of diet for healthy aging. Based on a sample of 7858 Chinese older adults, the associations between diet and depressive symptoms, along with the rural-urban divide, were examined using zero-inflated negative binomial regression. Overall, protein intake (incidence-rate ratio [IRR] = 0.89, p < 0.001), frequency of family dining together (IRR = 0.98, p < 0.001), and using tap water for cooking (IRR = 0.92, p < 0.01) were associated with lower incidence rates of depressive symptoms among older adults. Among rural older adults, frequency of family dining together (IRR = 0.97, p < 0.001) and tap water use (IRR = 0.89, p < 0.001) were associated with fewer depressive symptoms. However, urban residents who had a higher frequency of family dining together (IRR = 0.98, p < 0.05) and protein intake (IRR = 0.81, p < 0.001) exhibited fewer depressive symptoms. The findings revealed multifaceted dietary pathways towards healthy aging, which call for policies and interventions that improve diet quality for community-dwelling older adults.
Collapse
|
11
|
Miyano T, Kaneko R, Kimura T, Maruoka M, Kishimura A, Kato K, Furuta M, Yamashita Y. Dietary Problems Are Associated with Frailty Status in Older People with Fewer Teeth in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316260. [PMID: 36498332 PMCID: PMC9738370 DOI: 10.3390/ijerph192316260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate the association between dietary problems and frailty according to tooth loss in older Japanese people. This cross-sectional study included 160 older people (mean age 82.6 years) from Japan. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria, which consists of (i) weight loss > 5% in the past year, (ii) inability to perform five chair stands, and (iii) self-perceived reduced energy level. Frailty was defined as the presence of ≥2 items of SOF criteria. Multivariate logistic regression analyses were performed with frailty as the dependent variable and dietary problems as the independent variable, stratified according to having <20 teeth. Low appetite and no enjoyment of eating were associated with frailty after adjusting for covariates in participants with <20 teeth. Dietary problems, including low appetite, eating alone, and negative attitudes toward enjoyment of eating were associated with a self-perceived reduced energy level in participants with <20 teeth. However, this association was not observed in participants with ≥20 teeth. In older people with fewer teeth, dietary problems have been suggested to be associated with frailty. Therefore, it may be necessary to pay attention to dietary problems, especially in older people with tooth loss.
Collapse
Affiliation(s)
- Takashi Miyano
- Graduate School of Systems Life Sciences, Kyushu University, Fukuoka 819-0395, Japan
- Nissan Chemical Corporation, Tokyo 103-6119, Japan
| | - Ryosuke Kaneko
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
| | - Toshihide Kimura
- Manno-Cho Kokumin Kenko Hoken Soda Dental Clinic, Takamatsu 766-0201, Japan
| | - Misa Maruoka
- Manno-Cho Kokumin Kenko Hoken Soda Dental Clinic, Takamatsu 766-0201, Japan
| | - Akihiro Kishimura
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
- Center for Future Chemistry, Kyushu University, Fukuoka 819-0395, Japan
- Center for Molecular Systems, Kyushu University, Fukuoka 819-0395, Japan
| | - Koichiro Kato
- Department of Applied Chemistry, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan
- Center for Molecular Systems, Kyushu University, Fukuoka 819-0395, Japan
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| |
Collapse
|
12
|
Iwasaki M, Hirano H. Decline in Oral Function and Its Management. Int Dent J 2022; 72:S12-S20. [PMID: 36031320 PMCID: PMC9437811 DOI: 10.1016/j.identj.2022.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/15/2023] Open
Abstract
With the renewed focus on eating abilities in the ageing population, new concepts referred to as oral frailty and oral hypofunction have been introduced in Japan. We aimed to provide an overview of (i) the evaluation and management of oral function in ageing populations according to oral frailty and oral hypofunction and (ii) recent scientific evidence of the associations of poor oral function with physical function and nutritional status. Both oral frailty and oral hypofunction are multidimensional concepts that describe poor oral function. In epidemiologic and/or clinical settings, they are defined as the accumulation of factors leading to poor oral status. Oral hypofunction is a core component of oral frailty. To date, there are no systematic strategies for addressing oral frailty or oral hypofunction. Nevertheless, recent randomised controlled trials revealed that several components of oral function can be improved through appropriate training. On the other hand, multiple observational studies published in recent years have demonstrated that oral frailty and oral hypofunction are associated with physical function (gait performance, frailty, and sarcopenia) and nutritional status (low protein intake, poor dietary diversity, and malnutrition) in community-dwelling older adults. Moreover, studies have reported a significant association between insufficient participation in social networks and poor oral function. However, most of the studies conducted to date have utilised a cross-sectional design, which does not permit assessment of the temporal association between comprehensive oral function and general health. Maintaining good oral function may be key to longevity. However, evidence is limited thus far, and comprehensive oral function has not been studied in detail; thus, additional high-quality studies are needed.
Collapse
|
13
|
|
14
|
Tanaka T, Son BK, Lyu W, Iijima K. Impact of social engagement on the development of sarcopenia among community-dwelling older adults: A Kashiwa cohort study. Geriatr Gerontol Int 2022; 22:384-391. [PMID: 35322539 DOI: 10.1111/ggi.14372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 12/25/2022]
Abstract
AIM How older adults develop sarcopenia in the community setting is unclear. Focusing on social engagement, we aimed to validate our hypothesized model of sarcopenia development with various contributing factors, such as physical activity, oral function, psychological status and nutritional status. We also clarified direct and indirect effects of social engagement, physical activity, nutritional status, oral function and psychological status on new-onset sarcopenia. METHODS We analyzed 1483 participants' (72.6 ± 5.4 years) longitudinal data from the Kashiwa study. Sarcopenia was assessed in all the surveys in the Kashiwa study. Measures regarding social engagement, physical activity, oral function, psychological status and nutritional status were assessed at baseline. Structural equation modeling was used to analyze the efficiency of the hypothesized model, and calculate direct and indirect effects of factors affecting new-onset sarcopenia. RESULTS Over the follow-up period (median 6 years [interquartile range 4-6 years]), 12% of individuals developed new-onset sarcopenia. Our structural hypothesis model starting from social engagement to new-onset sarcopenia was suitable (root mean square error of approximation = 0.031, goodness-of-fit index = 0.967, adjusted goodness-of-fit index = 0.954, comparative fix index = 0.911, parsimonious comparative fit index = 0.755; all paths were significant), showing direct effects of social engagement on psychological status, physical activity and oral function, and indirect effects on nutritional status through oral function and psychological status. CONCLUSIONS The present results showed that social engagement could potentially decrease new-onset sarcopenia risks by influencing multidimensional factors, such as physical activity, oral function, and psychological and nutritional status. To prevent sarcopenia, it might be essential to promote social engagement through populational approaches. Geriatr Gerontol Int 2022; 22: 384-391.
Collapse
Affiliation(s)
- Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Bo-Kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Weida Lyu
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
15
|
Regular Oral Health Management Improved Oral Function of Outpatients with Oral Hypofunction in Dental Hospital: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042154. [PMID: 35206345 PMCID: PMC8871729 DOI: 10.3390/ijerph19042154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
This longitudinal study aimed to clarify the impact of regular oral health management for oral hypofunction on the oral function of older dental outpatients. The 68 participants enrolled in this study were older dental outpatients (mean age 78.5 ± 8.1 years). According to the number of declined oral examinations after the first exam, participants were assigned to the oral hypofunction group (Hypo group, ≥3), receiving regular oral health management with a leaflet at the dental clinic, or the pre-oral hypofunction group (Pre-hypo group, ≤2), which served as a control. At the second oral examination, after approximately 6 months to 1 year, the Hypo group showed significant improvement in the tongue-lip motor function (Oral diadochokinesis, ODK) /pa/, /ta/, and masticatory function, while the Pre-hypo group showed significant worsening in oral hygiene and oral wetness. Temporal changes in ODK /pa/, /ta/, and the number of declined examination items were significantly different between the groups. Multiple analysis revealed that the number of improved oral examination items were associated with presence of regular oral health management after adjusting for age, sex, number of visits, measuring period, and dental treatment. Regular comprehensive oral health management for oral hypofunction improves and maintains oral function among older dental outpatients.
Collapse
|
16
|
Janakiram C, Ayoob A, Neelamana S. Impact of oral frailty on general frailty in geriatric population: A scoping review. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Kinugawa A, Kusama T, Yamamoto T, Kiuchi S, Nakazawa N, Kondo K, Osaka K, Aida J. Association of poor dental status with eating alone: A cross-sectional Japan gerontological evaluation study among independent older adults. Appetite 2022; 168:105732. [PMID: 34619246 DOI: 10.1016/j.appet.2021.105732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 11/02/2022]
Abstract
Eating alone is reported to deteriorate health; however, the relationship between eating alone and poor dental health remains unclear. This cross-sectional study aimed to investigate the association between poor dental health and eating alone. Data of participants (n = 156,287) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dental status, including prosthesis use, and eating status. Differences in these associations according to living status were also examined. The mean age of participants was 73.7 (SD = 6.0) years. The percentages of participants eating alone with 20 or more teeth, 10-19 teeth with dental prostheses, 0-9 teeth with dental prostheses, 10-19 teeth without dental prostheses, and 0-9 teeth without dental prostheses were 13.8%, 16.0%, 18.6%, 18.9%, and 27.0%, respectively. After adjusting for covariates, participants with 0-9 teeth without any dental prosthesis showed a significantly higher odds ratio for eating alone (OR = 1.81, 95% CI = 1.58-2.07) than those with 20 or more teeth. Among participants with poorer dental status, the probability of eating alone was higher in those living alone than in those living with others. Among older adults, poor dental status was significantly associated with eating alone, and this association was stronger among those living alone. Maintaining better dental status by using a dental prosthesis might reduce the risk of eating alone, especially for those living alone.
Collapse
Affiliation(s)
- Anna Kinugawa
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan; Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Takafumi Yamamoto
- Department of Health Promotion, National Institute of Public Health, 2-choume-3-6 Minami, Wako, Saitama, 351-0104, Japan.
| | - Sakura Kiuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Noriko Nakazawa
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba, 263-8522, Japan; National Center for Geriatrics and Gerontology, 7-430, Moriokacho, Obu, Aichi, 474-8511, Japan.
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Jun Aida
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan; Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1Choume-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| |
Collapse
|
18
|
Moon JH, Huh JS, Won CW, Kim HJ. Living and eating alone on depressive symptoms by physical frailty status: A cross-sectional study based on the Korean Frailty and Aging Cohort Study. Arch Gerontol Geriatr 2021; 98:104570. [PMID: 34773874 DOI: 10.1016/j.archger.2021.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND General health conditions in older adults, including their mental health, differ greatly based on their physical health conditions rather than age. Thus, we evaluated how lifestyle factors, which included eating and living, affected depressive symptoms in older adults based on their physical frailty status. METHODS We included older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS). Based on their eating and living patterns, we classified them into four groups: "lived and ate with others," "lived alone yet ate with others," "lived with others yet ate alone," and "lived and ate alone." Depressive symptoms and physical frailty were measured using the Korean version of the Geriatric Depression Scale and modified version of the Cardiovascular Health Study (CHS) Frailty Index, respectively. RESULTS A total of 2,702 participants, 11.4% lived with others yet ate alone, and 19.7% lived and ate alone. For robust older adults, after adjusting for variables, the "ate alone" group was significantly related with depressive symptoms, and the "lived and ate alone" group showed a higher risk of depressive symptoms. In the prefrail to frail participants, the "lived and ate alone" group was at a higher risk of depressive symptoms. CONCLUSION Eating and living alone are key risk factors for depressive symptoms in community-dwelling older adults regardless of their physical frailty status. Therefore, social interventions are needed for both physically frail and healthy older adults to support their eating patterns and increase opportunities for social interaction.
Collapse
Affiliation(s)
- Ji Hyun Moon
- Department of Family Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea; Department of Family Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jung Sik Huh
- Department of Urology, Jeju National University College of Medicine, Jeju, Republic of Korea; Department of Urology, Jeju National University Hospital, Jeju, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
| | - Hyeon Ju Kim
- Department of Family Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea; Department of Family Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
| |
Collapse
|
19
|
Associations between Oral Hypofunction Tests, Age, and Sex. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910256. [PMID: 34639564 PMCID: PMC8508206 DOI: 10.3390/ijerph181910256] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
Oral function declines in older individuals due to disease and age-related changes, making them vulnerable to oral and physical frailty. Therefore, it is important to manage the decline in oral function in older outpatients. Oral hypofunction is diagnosed by seven tests related to oral function, oral hygiene, oral moisture, occlusal force, oral diadochokinesis, tongue pressure, masticatory function, and swallowing function. However, sex or age were not factored into the current reference values of these tests. We included subjects attending the dental hospital clinic for maintenance, and recorded and analyzed oral hypofunction and the factors associated with its diagnosis. Of the 134 outpatients (53 males and 81 females, mean age 75.2 ± 11.2 years), 63% were diagnosed with oral hypofunction. Oral hypofunction prevalence increased significantly with age, and significant variations were observed in all tests. Furthermore, oral hygiene and swallowing function were not associated with oral hypofunction diagnosis. All examined factors decreased with increasing age, even after adjusting sex, except for oral hygiene and moisture. Occlusal force and masticatory function were higher in men after adjusting age. This study suggested that older outpatients were likely to be diagnosed with oral hypofunction, and that the test reference value and their selection for oral hypofunction should be reconsidered.
Collapse
|
20
|
Kuwahara K, Kuroda A, Murayama H, Fukuda Y. High prevalence of eating alone among community-dwelling adults living alone: A cross-sectional study in Japan. Geriatr Gerontol Int 2021; 21:1060-1061. [PMID: 34545681 DOI: 10.1111/ggi.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Keisuke Kuwahara
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Ai Kuroda
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hiroshi Murayama
- Teikyo University Graduate School of Public Health, Tokyo, Japan.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshiharu Fukuda
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| |
Collapse
|
21
|
Ohi T, Murakami T, Komiyama T, Miyoshi Y, Endo K, Hiratsuka T, Satoh M, Asayama K, Inoue R, Kikuya M, Metoki H, Hozawa A, Imai Y, Watanabe M, Ohkubo T, Hattori Y. Oral health-related quality of life is associated with the prevalence and development of depressive symptoms in older Japanese individuals: The Ohasama Study. Gerodontology 2021; 39:204-212. [PMID: 34009675 DOI: 10.1111/ger.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This prospective study investigated the cross-sectional association between impaired oral health-related quality of life (OHRQoL) and the prevalence of depressive symptoms, and the longitudinal association between impaired OHRQoL and development of depressive symptoms among older adults. BACKGROUND Previous studies have shown a relationship between poor oral health and depression among older adults; however, findings are inconsistent. MATERIALS AND METHODS Participants were 669 community-dwelling older Japanese individuals aged≥55 years (mean: 67.8 ± 7.2 years). Data of 296 participants were used for longitudinal analyses. OHRQoL was evaluated using the Oral Impacts on Daily Performances scale. Impaired OHRQoL was defined as the presence of at least one impact on the scale. Depressive symptoms were assessed using the Japanese version of the Zung self-rating depression scale with a cut-off score of 40. RESULTS The cross-sectional logistic regression model demonstrated that impaired OHRQoL was significantly associated with depressive symptoms (odds ratio [OR], 5.17; 95% confidence interval [CI], 2.99-8.95) independent of age, sex, body mass index, hypertension, cerebrovascular/cardiovascular disease, smoking, drinking alcohol, education, cognitive function, objective oral health (dentition status) and oral health behaviour (dental visit within 1 year). Similarly, impaired OHRQoL predicted the development of depressive symptoms within 4 years in a fully adjusted longitudinal model (OR, 6.00; 95% CI, 1.38-26.09). CONCLUSION Impaired OHRQoL was identified as a potential comorbidity of depressive symptoms and a predictor for depressive disorder later in life. OHRQoL may be a useful clinical outcome for elder patients with regard to their mental and oral health.
Collapse
Affiliation(s)
- Takashi Ohi
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Takahisa Murakami
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takamasa Komiyama
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoshitada Miyoshi
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kosei Endo
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takako Hiratsuka
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Ryusuke Inoue
- Department of Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Makoto Watanabe
- Research Institute of Living and Environmental Sciences, Miyagi Gakuin Women's University, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yoshinori Hattori
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| |
Collapse
|
22
|
Kusama T, Kiuchi S, Umehara N, Kondo K, Osaka K, Aida J. The deterioration of oral function and orofacial appearance mediated the relationship between tooth loss and depression among community-dwelling older adults: A JAGES cohort study using causal mediation analysis. J Affect Disord 2021; 286:174-179. [PMID: 33730661 DOI: 10.1016/j.jad.2021.02.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is a major health problem among older adults, for which previous studies have suggested tooth loss as a risk factor. This study examined the mediating effect of oral function and orofacial appearance in the relationship between tooth loss and depression. METHODS This three-year follow-up longitudinal study was based on a self-reported questionnaire targeting community-dwelling older adults aged ≥65 years. We used the incidence of depressive symptoms during follow-up as the outcome, the number of remaining teeth (≥20/≤19) as the exposure, and the deterioration of oral function and orofacial appearance (speaking, smiling, and eating) as mediators. We fitted the logistic regression model including confounders and calculated the natural indirect effect (NIE), natural direct effect, and the proportion mediated (PM) by the deterioration of oral functions by applying the causal mediation analysis framework. RESULTS The mean age of the 8,875 participants was 72.7 years (1SD=5.5) and 48.0% were male. Depressive symptoms developed during follow-up in 11.5% of the participants (n=1,024). The incidence for those with ≤19 and ≥20 remaining teeth was 13.1% and 9.2%, respectively. Total effect of fewer remaining teeth (≤19) on depressive symptoms was OR=1.30 (95%CI=1.12-1.51). Difficulty in speaking (NIE OR=1.03, 95%CI=1.00-1.06, PM=12.4%), problems in smiling (NIE OR=1.04, 95%CI=1.01-1.07, PM=16.9%), and difficulty in chewing (NIE OR=1.05, 95%CI=1.02-1.09, PM=21.9%) significantly mediated the relationship. LIMITATION Selection bias due to dropout. CONCLUSION Deterioration of oral function and orofacial appearance were mediating factors of the mechanism for the relationship between tooth loss and the incidence of depressive symptoms.
Collapse
Affiliation(s)
- Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan
| | - Sakura Kiuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan
| | - Noriko Umehara
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chuo Ward, Chiba-shi, Chiba, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Division for Regional Community Development, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Miyagi, Japan.
| |
Collapse
|
23
|
Relationship between Decreased Mineral Intake Due to Oral Frailty and Bone Mineral Density: Findings from Shika Study. Nutrients 2021; 13:nu13041193. [PMID: 33916336 PMCID: PMC8066385 DOI: 10.3390/nu13041193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
The relationship between oral frailty (OF) and bone mineral density is unclear. This cross-sectional study analyzed the relationship between mineral intake and bone mineral density in middle-aged and older people with pre-oral and OF. The participants, which included 240 people aged 40 years and older, completed the three oral questions on the Kihon Checklist (KCL), which is a self-reported comprehensive health checklist, the brief-type self-administered diet history questionnaire (BDHQ), and the osteo-sono assessment index (OSI). A two-way analysis of covariance on oral function and OSI indicated that the intake of potassium, magnesium, phosphorus, squid/octopus/shrimp/shellfish, carrots/pumpkins, and mushroom was significantly lower in the OF and low-OSI groups than in the non-OF and high-OSI groups. A multiple logistic regression analysis for OF showed that potassium, magnesium, phosphorous and carrots/pumpkins were significantly associated with OF in the low-OSI group but not in the high-OSI group. These results demonstrated that the decrease in mineral intake due to OF was associated with decreased bone mineral density, suggesting that the maintenance of oral function prevents a decrease in bone mineral density.
Collapse
|
24
|
Low Dietary Variety and Diabetes Mellitus Are Associated with Frailty among Community-Dwelling Older Japanese Adults: A Cross-Sectional Study. Nutrients 2021; 13:nu13020641. [PMID: 33669388 PMCID: PMC7920314 DOI: 10.3390/nu13020641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 12/25/2022] Open
Abstract
The association between dietary diversity and frailty remains unknown in older people. We evaluated whether a limited dietary variety is associated with frailty in older adults with diabetes mellitus (DM). This cross-sectional investigation included 1357 adults (median age: 77 years, women: 61.3%). DM was determined by self-reporting, the Dietary Variety Score (DVS) was used to evaluate dietary variety, and the revised Japanese version of the Cardiovascular Health Study criteria evaluated frailty. Participants were divided into 4 groups: no DM/high DVS (non-DMHV), no DM/low DVS (non-DMLV), DM/high DVS (DMHV), and DM/low DVS (DMLV). The prevalence of frailty in each group was 3.6%, 6.7%, 6.7%, and 12.2%. After adjusting for covariates, logistic regression analysis revealed the highest odds ratio (OR) of frailty in the DMLV (non-DMLV, OR = 2.18 (95% confidence interval (CI): 1.25–3.83); DMHV, OR = 1.87 (95% CI: 0.63–5.52); DML, OR = 5.03 (95% CI: 2.05–12.35)). Another logistic regression analysis revealed that a low DVS and DM were independently associated with frailty. Both a low dietary variety and DM were independently related to frailty in older people and the combination increased the prevalence of frailty. These findings suggest that high dietary variety could be important for the prevention of frailty in people with DM.
Collapse
|
25
|
Tanaka T, Hirano H, Ohara Y, Nishimoto M, Iijima K. Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults. Arch Gerontol Geriatr 2021; 94:104340. [PMID: 33529863 DOI: 10.1016/j.archger.2021.104340] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Oral frailty is associated with the loss of oral function and increased care needs. We have previously developed an Oral Frailty Index (OFI-8) to identify older adults at risk of oral frailty. Herein, we aimed to examine whether OFI-8 scores are indicative of oral frailty or functional disability risk in community-dwelling older adults. METHODS A total of 2,011 individuals (51% women; mean age, 73.0 ± 5.5 years) participated in the 2012 baseline survey (last follow-up wave 2018). Oral frailty was assessed at each time point, based on tooth status, oral function, and other subjective measures. Functional disability was defined as long-term care certification granted during 2012-2019. The OFI-8 items were assessed at baseline. RESULTS The prevalence and incidence rates of oral frailty at baseline and 6 years were 16% and 24%, respectively. The area under the receiver operating characteristic curve of OFI-8 was 0.88 with 95% confidence interval of 0.86-0.90 for oral frailty. The OFI-8 score of ≥4 points maximized the sum of sensitivity and specificity values. The corresponding positive rate, sensitivity, specificity, positive, and negative predictive values were 30%, 80%, 80%, 43%, and 95%, respectively, for baseline oral frailty. A 1-point increase in the OFI-8 score corresponded to a 1.3-fold increase in the risk of new-onset oral frailty and 1.1-fold increase in the risk of disability. CONCLUSIONS OFI-8 may help identify individuals at risk of oral frailty and functional disability. It may also increase the awareness of oral care and facilitate its uptake.
Collapse
Affiliation(s)
- Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | | | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Misa Nishimoto
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan; Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
26
|
Hakeem FF, Bernabé E, Sabbah W. Self-rated oral health and frailty index among older Americans. Gerodontology 2020; 38:185-190. [PMID: 33231321 DOI: 10.1111/ger.12513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the association between self-rated oral health and frailty index among older American adults aged 60 years and over. MATERIALS AND METHODS Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates. RESULTS A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates. CONCLUSION Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.
Collapse
Affiliation(s)
- Faisal F Hakeem
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Preventive Dental Sciences, College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| |
Collapse
|
27
|
Takahashi K, Murayama H, Tanaka T, Takase M, Suthutvoravut U, Iijima K. A qualitative study on the reasons for solitary eating habits of older adults living with family. PLoS One 2020; 15:e0234379. [PMID: 32511277 PMCID: PMC7279577 DOI: 10.1371/journal.pone.0234379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Eating alone while living with family members is a risk factor for mental health decline in old age. However, little is known as to why older adults choose to eat alone, even with family present. This study therefore aimed to explore reasons for older adults eating alone despite living with family members, using a qualitative approach. Fifteen people aged 65 years and older (11 men and 4 women) who were eating alone while living with family members were included in the study. These individuals were selected from the participants of the Kashiwa cohort study conducted in 2016. Individual interviews were conducted using an open-ended format. All interviews were recorded and transcribed. The data were further thematically analyzed using a qualitative software package, NVivo 11. We extracted six themes as reasons for eating alone and hypothesized interactions among these themes. The extracted themes were: “age-related changes,” “solo-friendly environment,” “family structure changes,” “time lag for eating,” “bad relationships with family members” and “routinization.” To assess interactions, the themes were categorized as “background factors,” “triggers,” and “stabilizers.” The aforementioned themes could lead to the development and sustained behavior of eating alone among older adults living with family members. As most themes describe conditions that are likely to remain static, it may not be realistic to encourage such individuals to begin eating with family members. The promotion of meals with neighbors or friends could be effective in alleviating the negative consequences of eating alone.
Collapse
Affiliation(s)
- Kyo Takahashi
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Japan
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | | | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Mai Takase
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | | | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|