Intensity of community-based programs by long-term care insurers and the likelihood of frailty: Multilevel analysis of older Japanese adults

Research on the income and expenditure forecast of long-term care insurance fund in Shihezi City based on community care

Objective

This study forecasts the income and expenditures of the long-term care insurance fund, provides a basis for formulating the raising standard of the long-term care insurance fund, and explores the measures to improve the pilot work of long-term care insurance.

Methods

By using the exponential smoothing and ARIMA models to forecast the income and expenditure of the old-age care insurance fund in 2022, the problems existing in the operation of the long-term care insurance fund are discussed.

Results

In 2022, the income of the old-age insurance fund was 28.8934 million yuan, and the fund compensation expenditure was 28.4070 million yuan, with a slight balance of the fund. The highest relative errors of income and expenditure forecast models are -2.03% and - 2.76%, respectively. According to the results of fund expenditure, the annual financing standard should be 132.93 yuan/person, and the individual financing standard should be 66.47 yuan/person.

Conclusion

Through the integration of personal payment, welfare, sports lottery public welfare income, social donations, and other ways, we can gradually establish a multi-channel risk-sharing financing. We will appropriately raise the standard for individual financing and the annual contribution standard for individuals from 50 yuan to 66.47 yuan. This will promote sustainable development of long-term insurance system.

Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model

Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

Factors related to subjective well-being among community-dwelling older adults living alone: A stratified analysis by sex and marital status from the JAGES

BACKGROUND

Previous cross-sectional studies suggest that negative health outcomes such as mortality, social isolation, loneliness, and depression among older adults living alone vary by sex and marital status, with men often worse off than women and unmarried people worse off than married people. However, limited evidence exists from longitudinal studies regarding whether positive health outcomes such as subjective well-being (SWB) also vary by sex and marital status. The focus by sex and marital status on the positive health outcomes and diverse profiles of older adults living alone is important for public health in the near future. Therefore, the purpose of this study was to identify changes in SWB over time and its associated factors by sex and marital status among older adults living alone in the community using a longitudinal study in a representative population.

METHODS

This was a longitudinal study using data from the Japan Gerontological Evaluation Study. This study is the first to reveal differences in SWB and related factors over 3 years among older adults living alone in the community (n = 8,579) who were stratified by sex and marital status (married men, non-married men, married women, and non-married women).

RESULTS

Women moved to higher levels of SWB than did men, and married individuals moved to higher levels of SWB than did unmarried individuals. Independent functioning factors and interpersonal factors were significantly associated with SWB for married men and married women, but for unmarried women, the association by interpersonal factors was more pronounced, and for unmarried men, only limited emotional support and health promotion activities were significant among the interpersonal factors.

CONCLUSIONS

This study revealed that among older adults living alone, changes in SWB over time and the independent functioning factors and interpersonal factors associated with this change varied by sex and marital status among older people living alone. These findings are useful for policy-making and guiding intervention activities to promote SWB in a society in which the environment for older adults living alone is changing dramatically.

Social participation and incident disability and mortality among frail older adults: A JAGES longitudinal study

BACKGROUND

Frailty is the highest risk factor for incident disability and mortality. Social participation is a modifiable factor for reducing adverse outcomes among independent older adults. However, the association between social participation and incident disability and mortality among frail older adults remains unclear. Therefore, we examined the association between various social activities and incident disability and mortality.

METHODS

This nationwide prospective cohort study (The Japan Gerontological Evaluation Study) recruited older adults with frailty, aged 65 years and older (N = 9090) who were followed up for 6 years (2010-2016). We examined incident disability and all-cause mortality at the end of the follow-up period. Frailty was assessed using the Kihon Checklist. The independent variable was social participation in 2010, grouped into the following seven categories: hobby groups, sports groups or clubs, volunteer groups, senior citizens' clubs, industries, neighborhood communities, and paid work.

RESULTS

The incidence of disability among participants was 19.5% (1770) and that of mortality was 19.2% (1753). Belonging to sports groups or clubs (Hazard Ratios [HR] = 0.74; 95% Confidence Interval [CI] = 0.57, 0.98) or hobby groups (HR = 0.77; 95% CI = 0.60, 0.98) was significantly associated with a lower risk of incident disability. Meanwhile, hobby groups (HR = 0.68; 95% CI = 0.56, 0.83), sports groups or clubs (HR = 0.71; 95% CI = 0.57, 0.88), volunteer groups (HR = 0.69; 95% CI = 0.54, 0.88), and senior citizens' club (HR = 0.75; 95% CI = 0.61, 0.90) were associated with lower risk of incident mortality.

CONCLUSIONS

Social participation was associated with a lower risk of incident disability and mortality, not only in healthy older adults but also in frail older adults who are at higher risk of incident disability and mortality. This suggests that frail older adults should be encouraged to participate in all the seven types of social participation examined in this study, as this may lower the risk of subsequent disability and mortality.

Association between community-level health literacy and frailty in community-dwelling older adults

AIMS

We aimed to investigate whether high community-level health literacy, beyond individual-level health literacy, is associated with a low prevalence of frailty among community-dwelling older adults.

METHODS

A large cross-sectional questionnaire survey was conducted among citizens in Maizuru City, Kyoto, Japan, aged 65 years or older who were not certified as "support" or "care" level according to Japan's public long-term care insurance system, who could perform basic activities of daily living, and who did not have dementia or Parkinson's disease. Frailty status was assessed using the Kihon Checklist, with a score ≥ 8 indicating frailty. Health literacy was assessed using the Communicative and Critical Health Literacy Scale. The mean health literacy score of 20 school districts was used as the community-level health literacy index. We investigated demographic data and other potential confounding factors, including education, living arrangement, body mass index, comorbidity, smoking status, depressive symptoms, social networks, and community-level covariates.

RESULTS

The primary analysis included 6230 individuals (mean age = 74.3 years [SD = 6.1]). In each school district, the prevalence of frailty was 21.2-34.2% (mean: 26.2%), and community-level health literacy index was 3.1-3.5 (mean: 3.4). Multilevel logistic regression model including school district as random effect showed that the community-level health literacy was significantly associated with frailty (odds ratio [95% confidence interval] = 0.28 [0.08 to 0.96]) after adjusting for the covariates.

CONCLUSIONS

Not only high individual-level health literacy but also high community-level health literacy is associated with a low prevalence of frailty in community-dwelling older adults.

Relationship between Oral Function and Support/Care-Need Certification in Japanese Older People Aged ≥ 75 Years: A Three-Year Cohort Study

The aim was to examine the relationships between oral functions and support/care-need certification in older people aged ≥ 75 years using the National Health Insurance (NHI) database system and data from Kani City, Gifu, Japan. In total, 732 older Japanese people aged ≥ 75 years who did not have support/care-need certification and underwent dental check-ups in Kani City in 2017 were followed up until 2020. Chewing state, tongue and lip function, and swallowing function were assessed by a self-administered questionnaire, an oral diadochokinesis test, and a repetitive saliva-swallowing test, respectively. The presence or absence of systemic diseases and of support/care-need certification was based on data collected by the NHI database. At follow up, 121 (17%) participants had support/care-need certification. The participants with support/care-need certification included more women (p < 0.001) and older people (p < 0.001); and had more hypertension (p = 0.003), musculoskeletal disorders (p < 0.001), pneumonia (p = 0.044), poor chewing state (p < 0.001), and poor swallowing function (p = 0.003) than those without support/care-need certification. Furthermore, the presence of support/care-need certification at follow up was associated with sex (woman: odds ratio [OR], 2.120; 95% confidence interval [CI], 1.354 to 3.317), age (OR, 1.203; CI, 1.139 to 1.270), chewing state (poor: OR, 2.534; CI, 1.409 to 4.557), and swallowing function (poor: OR, 2.372; CI, 1.248 to 4.510) at baseline. However, tongue and lip function were not associated with support/care-need certification. The results indicate that older Japanese people aged ≥ 75 years with a poor chewing state and poor swallowing function at baseline had a higher risk for support/care-need certification after three years.

Built environments and frailty in older adults: A three-year longitudinal JAGES study

BACKGROUND

This study investigated the relationship between built environments and the onset of frailty after 3 years.

METHODS

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals.

RESULTS

After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99).

CONCLUSIONS

At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

Factors associated with community commitment among older adults: a stratified analysis of community group leaders and members

Background

Community commitment through group activities in the community is associated with improved health outcomes in older adults and has a ripple effect on community development. However, factors associated with community commitment through group activities in the community have not been examined. The purpose of this study was to examine individual factors and group-related factors in association with community commitment among older adult leaders and members of community groups in Japan.

Methods

We mailed self-administered questionnaires to all older adults participating in a community group (N = 1,898) in a ward of Yokohama city, the largest designated city in Japan. Variables included demographic characteristics, community commitment (Community Commitment Scale), individual factors, and group-related factors. We used logistic regression analysis to assess the association among study variables.

Results

A total of 1,154 people completed the questionnaire. The valid response rate was 48.8%. Respondents’ mean age was 78.3 years (standard deviation [SD] = 6.1, range 65–100 years), 79.6% were women, 55.9% were married, and 10.0% were employed. Factors associated with community commitment among group leaders were scores for self-efficacy in the health promotion scale (SF-15; mean ± SD: 48.5 ± 7.1), 5-item World Health Organization Well-Being Index (mean ± SD: 17.9 ± 4.3), and Lubben Social Network Scale, Japanese version (mean ± SD: 19.5 ± 6.9), as well as a perception of deriving pleasure from group participation (mean ± SD: 91.2 ± 9.4). Factors associated with community commitment among group members were economic status (Sufficient; n [%]: 749 [85.9]), frequency of going out (mean ± SD: 5.1 ± 1.8), years of group participation (mean ± SD: 6.2 ± 5.0), and perceptions of their role in the group (Yes; n [%]: 254 [30.4]) as well as the above factors for leaders. A supplementary qualitative analysis of participants’ free-text responses extracted seven categories: community support, resource mobilization, partnership action, asset management, participatory decision-making, linkages and networking, and community dissemination, related to perception of a role in the group.

Conclusion

Our results emphasize the importance of considering the different associations of community commitment through group activities in the community between group leaders and members, including the role of older adults in community groups, and suggest different approaches for group leaders and members.

Differences in spatial patterns of long-term care depending on severity in Hokkaido, Japan

The increasing demand for long-term care (LTC) among the ageing population is a serious problem worldwide, which has greatly increased also in Japan since the introduction of the LTC insurance system there. Since there is a difference between insurers with respect to the proportion of people needing LTC, this study aimed at clarifying the spatial patterns of LTC. Insurer (n=156) LTC data for the period 2012-2019 were obtained from Ministry of Health, Labour, and Welfare and those needing LTC were classified into three classes: total, mild and severe with ageand sex-adjusted proportions needing LTC. Global and local Moran’s I statistics were calculated for each 2-year period to clarify the trends of global and local spatial clusters. From 2012 to 2019, the mean proportion of mild class cases increased (10.6% to 11.6%), whereas that of severe class cases decreased slightly (5.9% to 5.7%). The spatial pattern of the proportion of each class revealed positive spatial autocorrelation. Based on analysis by local Moran’s I, differences in spatial patterns were emphasised between the mild and severe classes. In Hokkaido, High-High clusters of mild cases were identified in the central and southern parts and severe ones in the northern and southern parts. Spatial patterns differed depending on the LTC class. Some insurers had distinctly higher or lower certification rates than those of their neighbourhoods.

Management of frailty under COVID-19 pandemic in Japan

Frailty prevention is a cornerstone for the extension of healthy life expectancy. It is a multi-dimensional construct that includes physical, mental, and social aspects. Frailty is reversible and can be attenuated by intervention; therefore, its early detection is important in primary and community care. The mainstream of disability prevention in Japan, which comprises the Japanese and local governments as well as healthcare workers, was a high-risk approach until 2014. Given the revision on Japan's long-term care insurance law, current ageing health policies have shifted to more population centric approach. Implements group activities called "Kayoi-no-ba" has been valued in Japan as disability prevention initiative. The Kihon Checklist - a 25-item questionnaire - has been broadly used by health experts and researchers to assess frailty in Japan. However, a new 15-item questionnaire has been newly developed to identify frailty and other health-related problems in older people of 75 years and above. This will enable providing the necessary support to frail individuals at any healthcare facility in local communities. The increase in frailty prevalence in older people has been concern during the COVID-19 pandemic. Home-based physical exercise programs are expected to be effective for frailty prevention. Utilization of information and communication technologies, social network services, and video calls has attracted attention for being effective tools to facilitate communication for older people during the pandemic. Further, life course approaches are needed to clarify the midlife risk of frailty development in later life.

Associations of neighborhood built and social environments with frailty among mid-to-older aged Australian adults

AIM

Neighborhood environmental attributes are associated with physical activity and health status. We examined cross-sectional associations of built and social environmental attributes with frailty among community-dwelling mid-to-older aged adults in Australia.

METHODS

Data from 3419 adults aged 50-74 years living in 200 neighborhoods in Brisbane, Australia, were used. Frailty status was assessed by a frailty index comprising 32 items. The built environment attributes examined were residential density, street connectivity, land use mix, park area and bus stop density. Self-reported levels of safety and social cohesion were used as social environmental factors. Associations were examined using multilevel logistic regression.

RESULTS

The prevalence of frailty was 12%. One standard deviation increment in street connectivity in a 1-km network buffer around participants' homes and in a neighbourhood was associated with 23% and 13% higher odds of being frail, respectively. One standard deviation increment in land use mix at the neighborhood level was associated with 12% lower odds of being frail. Higher levels of safety and social cohesion were consistently associated with a lower odds of being frail.

CONCLUSIONS

Consistent with previous studies, we found that social environmental attributes were relevant to residents' frailty status, whereas the relationships between built environmental attributes and frailty were not clear (frailty was associated with lower street connectivity but with higher land used mix). Community-level initiatives to enhance safety and social cohesion might be effective to reduce frailty. Further research is required to explain the equivocal findings obtained for built environmental attributes and frailty. Geriatr Gerontol Int 2021; ••: ••-••.

Association between community-level social capital and frailty onset among older adults: a multilevel longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

Background

Little is known about the prospective association between community-level social capital and individual-level frailty onset. Therefore, this study aimed to examine the impact of community-level social capital on frailty onset among older adults using 3-year longitudinal data.

Methods

This prospective cohort study recruited non-institutionalised older adults from the Japan Gerontological Evaluation Study, established in 2013 and robust older adults were followed up for 3 years. We assessed three aspects of community-level social capital (civic participation, social cohesion and reciprocity), and employed a multilevel logistic regression analysis; frailty was evaluated using the Kihon Checklist questionnaire, which has been widely used as a screening tool for frailty in Japan.

Results

In total, 21 940 older adults (from 384 communities) who were robust at baseline (2013) completed the follow-up survey (2016). Participants’ mean age (SD) was 71.8 (4.9) years, and 51.2% were female. In the follow-up period, frailty onset occurred in 622 participants (2.8%). Regarding community-level social capital variables, civic participation was inversely associated with frailty onset (OR=0.94, 95% CI 0.90 to 0.97, p=0.001), after adjusting for individual-level and community-level covariates. The potential intermediate factors of individual social relationships and health behaviours did not largely change the results. This association was found regardless of individual socioeconomic status.

Conclusions

Living in a community with rich civic participation, such as engagement in social activities, was associated with lower frailty onset among older adults. Community development that fosters social participation is essential for frailty prevention.

'Care literacy' in super aging Japan

Accentuated by the ongoing coronavirus disease (COVID-19) pandemic, the change in Japan to community-based health and care services for older adults indicates an urgent need to enhance and spread citizens' understanding of care. This is a broader notion of care that incorporates conditions within the community to support the inclusion of older adults, involving not only those older adults receiving care and their direct providers of care, but also others in the community who are involved in the daily lives of these older adults. To underpin such a broader notion of care across citizens, this paper proposes 'care literacy' as a novel analytical concept, defined as the knowledge and capabilities that enable people in need of care to live their daily lives in the community and facilitate potential health and care solutions. Reflecting the interconnection of health and care and rooted in the local context, care literacy underpins aging by enabling this involvement of the broader community, and is disseminated through media and grassroot activities.

Regional Differences in Disability Incidence among Japanese Adults Aged 75 Years and Older: A 4-Year Prospective Cohort Study

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.

Social capital and pneumococcal vaccination (PPSV23) in community-dwelling older Japanese: a JAGES multilevel cross-sectional study

OBJECTIVE

Inequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses.

DESIGN

Cross-sectional study.

SETTING

We used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures.

PARTICIPANTS

The target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled.

PRIMARY OUTCOME MEASURE

The primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities.

RESULTS

After adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one.

CONCLUSIONS

Older adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.

Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers

PURPOSE

To determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA).

METHODS

We used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors.

RESULTS

We found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09-2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20-2.71. Active social participation: PR, 0.61; 95% CI 0.42-0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67-1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22-1.33. Active social participation: PR, 0.46; 95% CI 0.44-0.48). All other predictors were significantly associated with frailty in the community dwellers.

CONCLUSION

Maintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.

Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study)

Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.

Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study)

Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.

Depression, physical function, and disease activity associated with frailty in patients with rheumatoid arthritis

OBJECTIVES

To investigate the clinical and psychosocial backgrounds of frailty in rheumatoid arthritis (RA) patients.

METHODS

Patients with RA between 40 and 79 years of age who visited university hospitals in an urban area were recruited. Well-validated self-reported questionnaires were used to evaluate patient physical function (Health Assessment Questionnaire, HAQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), and frailty (Kihon Checklist). A 28-point Disease Activity Score (DAS-28) was calculated to evaluate RA disease activity.

RESULTS

A total of 375 RA patients, 323 of whom were women, were enrolled (average age: 65.2 ± 9.7 years; average disease duration: 16.6 ± 11.9 years). The prevalence rates of frailty, working-age (40-64 years), young-old (65-74 years), and old-old (≥75 years) patients were 18.5, 28.8, and 36.6%, respectively. Higher age and longer disease duration were associated with frailty. Multivariable logistic regression analysis revealed that HAQ, DAS-28, and BDI-II scores were independently associated with frailty in RA patients.

CONCLUSION

Frailty is common, even among working-age RA patients. Physical function, disease activity, and depressive symptoms were independently associated with frailty. A multidisciplinary intervention approach, along with adequate pharmacological therapy, may promote successful aging in patients with RA.

Two-Step Floating Catchment Area Model-Based Evaluation of Community Care Facilities' Spatial Accessibility in Xi'an, China

Due to the rapid increase in the number of elderly people in Chinese cities, the development and planning of aged care facilities, and particularly community care facilities, which will gradually become the mainstream choice for the elderly in China, is becoming an important topic for urban sustainability. Previous studies have shown that the number and scale of aged care facilities in many cities are far from meeting the needs of the elderly and the overall occupation rate is low. Some of these cities are still expanding and some are undergoing urban renovation. In this process, the scientific planning of community care facilities to promote efficient use of facility resources has become an urgent problem that needs to be solved. In this study, the two-step floating catchment area (2SFCA) method and a potential model based on the Geographic Information System (GIS) were used to carry out a scientific evaluation of the spatial accessibility of community care facilities in the Beilin district of Xi'an. The aims were to explore the best quantitative research methods for assessing the distribution of Xi'an community care facilities' spatial accessibility, provide ideas for similar studies in the future, and further the understanding of spatial allocation of urban community care facilities resources.

Community asset participation and social medicine increases qualities of life

Rationale

Social prescribing to community assets, like social groups, is a current policy goal. As aging adults lead longer, healthier lives, the effects of participating in community assets raises questions about whether subjective quality of life (QoL) improves during participation and on what dimensions.

Objective

The study's goal was to examine the effectiveness of community assets at improving QoL among older people living in the community.

Method

Examining longitudinal survey data which tracked health and wellbeing in older adults living in Salford, UK over 12 months, we first used regressions on community assets to compare the World Health Organization's QoL Assessment (WHOQOL-BREF) domains at baseline for those who already participated in community assets (54%) and with non-participants (46%). Second, we used propensity score matching to compare QoL in an ‘uptake’ group (no initial participation but who participated at 12 months), to those who never participated, and to a ‘cessation’ group who participated initially, but ceased within one year, to those who always participated.

Results

Group comparisons confirmed that participants reported significantly higher QoL on all domains – environmental, psychological, physical, and social QoL – and on 16 predicted facets. After affirming group matching reliability, the strongest results were for the uptake group, with significant improvements in all domains, and in 18 facets. All QoL domains decreased in the cessation group, but overall, the effect was weaker. As predicted from the context, QoL relating to ‘opportunities for recreation and leisure’ showed the greatest effect. Furthermore, QoL increased with uptake, and decreased with cessation.

Conclusion

Policies to improve QoL in later life should be designed not just to promote community assets, but also maintain participation once initiated.

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Social prescribing to community assets such as social groups is now a policy goal.

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Little is known about their effect on participants' quality of life (QoL).

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Community asset participants reported higher QoL on all four domains.

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Participation uptake strongly led to increased QoL.

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Cessation was detrimental to QoL.