Associations Between Active Mobility Index and Disability

Social participation in the neighborhood community prevents onset of disability in community-dwelling older adults whose life space with activities is limited: A 2-year prospective cohort study

AIMS

For older adults with limited life space and activity, social participation in the neighborhood community is essential to ensure social interaction and activity levels. This study examined the association between social participation in the neighborhood community and the onset of disability in older adults with different life spaces and activities.

METHODS

The participants were 9513 older adults from a cohort study conducted at the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes (NCGG-SGS). Social participation in the neighborhood community was assessed by participating in the community meetings. Life space with activities was evaluated using the Activity Mobility Index (AMI) developed in the NCGG-SGS, with higher scores indicating better mobility and movement. The participants were divided into four groups based on the quartiles of their AMI scores (Q1-Q4). Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for disability incidence by social participation in each quartile.

RESULTS

Over the 2-year follow-up period, disability occurred in 4.3% of the participants (n = 409). In the Q1 group, participants who participated in the neighborhood community had a significantly lower risk of developing a disability than those who did not (HR, 0.47; 95% CI, 0.28-0.76). There were no significant differences in onset of disability between the presence and absence of social participation for groups Q2, Q3, and Q4.

CONCLUSIONS

Social participation in the neighborhood community was associated with the onset of disability in the lowest life space group. Social participation within a limited life space with activities may prevent disability onset. Geriatr Gerontol Int 2024; 24: 609-618.

Estimating the Effect of Engagement in Community-Based Going-Out Program on Incidence Disability in Older Adults

OBJECTIVES

Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults.

DESIGN

Longitudinal, observational study.

SETTING AND PARTICIPANTS

Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score-matching scheme.

METHODS

After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio.

RESULTS

Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67).

CONCLUSIONS AND IMPLICATIONS

This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities.

Cross-sectional associations between sedentary time with cognitive engagement and brain volume among community-dwelling vulnerable older adults

AIMS

Vulnerable older adults tend to decrease physical activity (PA) and increase sedentary time (ST). Previous research on the associations between ST and brain volume have yielded inconsistent findings, without considering the impact of cognitive engagement (CE) on cognitive function. We aimed to examine the association between ST with CE and brain volume.

METHODS

A structural magnetic resonance imaging survey was conducted among community-dwelling vulnerable older adults. Brain volumetric measurements were obtained using 3T magnetic resonance imaging and pre-processed using FreeSurfer. ST with low or high CE was assessed using a 12-item questionnaire. PA was assessed by the frequency of light and moderate levels of physical exercise according to the Japanese version of the Cardiovascular Health Study criteria. Participants were categorized into a low PA group and a moderate-to-high PA group.

RESULTS

Among 91 participants (83.1 ± 5.2 years old, 61.5% female), 26 were low PA. The overall sample and moderate-to-high PA group did not show significant positive associations with brain volume for ST with high CE. In the low PA group, isotemporal substitution models showed that replacing ST with low CE by ST with high CE was significantly associated with increased brain volume in some areas, including the rostral and caudal anterior cingulate (β = 0.486-0.618, all P < 0.05, adjusted R2  = 0.344-0.663).

CONCLUSIONS

Our findings suggest that replacing ST with low CE by ST with high CE is positively associated with brain volume in vulnerable older adults with low PA. Geriatr Gerontol Int 2024; 24: 82-89.

Urinary incontinence and life-space activity/mobility additively increase the risk of incident disability among older adults

OBJECTIVES

To examine the associations of a combination of urinary incontinence (UI) and life-space activity/mobility with the risk of incident disability among community-dwelling older adults.

STUDY DESIGN

The participants were 12,808 older adults for the cross-sectional study and 12,516 older adults who completed the follow-up assessment.

MAIN OUTCOME MEASURES

UI was assessed using a questionnaire. Life-space activity/mobility was evaluated using total, physical, and social scores on the Active Mobility Index (AMI). Participants were classified into four groups (high AMI total score + no UI; high AMI total score + UI; low AMI total score + no UI; low AMI total score + UI). Incident disability was extracted from the Japanese Long-Term Care System.

RESULTS

During the 24-month follow-up, 562 participants (4.5 %) developed disability. Those with a low AMI score + no UI (hazard ratio, 1.35; 95 % confidence interval, 1.07-1.71) and those with a low AMI score + UI (hazard ratio, 2.00; 95 % confidence interval, 1.56-2.56) had a higher risk of incident disability than those with a high AMI score + no UI in the follow-up analysis.

CONCLUSIONS

A combination of UI and low AMI score was associated with an increased risk of incident disability, whereas having UI but a high AMI score was not associated with an increased risk of incident disability. Our findings may help identify older adults at high risk of developing disabilities.

Associations between Active Mobility Index and objectively measured physical activity among older adults

BACKGROUND

Active mobility index (AMI) is a questionnaire to assess going-out behavior with physical and social activity. The association between AMI scores and objectively measured physical activity (PA) in older adults is unknown.

METHODS

Community-dwelling older adults aged ≥ 70 years participated in an examination and wore a triaxial accelerometer for seven or more days. The accelerometer measured the time of moderate-to-vigorous intensity PA (MVPA) and light intensity PA (LPA), and step counts. The AMI assessed life space (distance from the respondent's home: < 1, 1-10, or > 10 km) and related activities during the previous month. The AMI total, physical, and social scores were calculated.

RESULTS

The analyzed data were 2499 participants (mean age: 75.5 ± 4.0 years; 54.4% female). Comparing PA among quartile groups of each AMI score, higher AMI total and physical score groups were associated with higher MVPA, LPA, and step counts (all P < 0.01). The Q4 group of AMI social scores showed significantly higher LPA and step counts than the Q1 and Q2 groups (P < 0.01). The logistic regression model showed higher score groups of AMI total and physical scores associated with increased adjusted odds ratio (aOR) of meeting recommended PA, ≥ 150 min/week of MVPA.

CONCLUSIONS

Older adults with higher AMI total and physical scores, engaged in more PA. Future studies can use the present findings when estimating PA in older adults from AMI scores and examining the association between AMI scores and health outcomes.

Association between Active Mobility Index and sarcopenia among Japanese community-dwelling older adults

BACKGROUND

A physically active lifestyle, including physical and social activities, is needed to maintain muscle mass, strength, and physical performance. A large life space characterizes an active lifestyle, but the association between life space with physical and social activities and sarcopenia is unclear. This study aimed to examine the association between life space with physical and social activities, assessed using the Active Mobility Index (AMI), and sarcopenia in community-dwelling Japanese older adults.

METHODS

This study used a large, cross-sectional cohort dataset from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS). Between 2013 and 2018, community-dwelling Japanese adults aged ≥60 years participated in the NCGG-SGS. Sarcopenia was identified by measuring muscle mass and strength based on the clinical definition. The secondary outcomes were sarcopenia indices, including lower muscle mass, lower muscle strength, and lower gait speed. AMI assessed life space with physical and social activities in each life space (distance from the respondent's home: <1, 1-10, or >10 km) during the past month by noting the frequency, primary purpose, type of transportation, interaction with others, and physical activity. The associations between quartile groups of AMI total, physical, and social scores and sarcopenia were examined using a logistic regression model.

RESULTS

From all participants, 21 644 participants (age 73.5 ± 5.8 years, 54.7% female) were included in the analysis. The prevalence of sarcopenia was 4.1% (n = 894). For the AMI total score, referred to Q1 group, Q3 and Q4 groups were significantly associated with a reduced odds ratio (OR) of sarcopenia after adjusting for all covariates [adjusted OR (aOR) (95% confidence interval), Q3: 0.71 (0.57-0.89), Q4: 0.69 (0.55-0.87)]. Q3 and Q4 of the AMI physical score groups were also significantly associated with reduced OR of sarcopenia [Q3: 0.71 (0.57-0.89), Q4: 0.67 (0.54-0.84)]. For the AMI social score, only the Q4 group showed reduced OR for sarcopenia [0.79 (0.62-1.01)]. Q3 and Q4 of the AMI total score and physical score were associated with reduced OR of all sarcopenia indices (aOR 0.55-0.82, all P < 0.05), whereas Q4 of AMI social score was associated with all indices (aOR 0.85-0.81, all P < 0.05).

CONCLUSIONS

The extent of life space with physical activity was associated with sarcopenia in community-dwelling older adults. A longitudinal study is needed to examine whether life space with physical and social activities affect the development of sarcopenia.

Association between Frequency of Going Out and Psychological Condition among Community-Dwelling Older Adults after the COVID-19 Pandemic in Japan

Background: The psychological condition and frequency of going out (FGO) of community-dwelling older adults after the spread of COVID-19 will provide insights for supporting the daily lives of community-dwelling older adults. Going out is defined as moving from one’s own home to a place or region beyond one’s own home and is considered to reflect the daily and social life of community-dwelling older adults. This study investigates the relationship between the FGO and current psychological condition after the second wave of COVID-19 in community-dwelling older adults in Japan. Methods: This study adopted a self-administered questionnaire by mail. A total of 493 members of CO-OP Kagoshima were included in the analysis and divided into two groups according to the change in FGO. Multiple logistic regression analysis was conducted after a bivariate analysis to investigate the relationship between the FGO and psychological condition. Results: Significant differences were noted between the groups with decreased FGO and those with increased/unchanged FGO in general and pandemic-related psychological condition. Multiple logistic regression analysis showed a significant relationship between FGO and psychological condition, such as mental fatigue, not smiling as much as before, and anxiousness to go outside. Conclusion: Community-dwelling older adults may have experienced a decrease in the frequency of going out and a detrimental effect on their psychological condition after the COVID-19 pandemic. This finding may inform strategies to identify priorities for psychological approaches altered by COVID-19 to prevent confinement and stress in older adults.