Multiple somatic symptoms and frailty: cross-sectional study in Japanese community-dwelling elderly people

Active use of local exercise facilities can improve physical performance of community-dwelling older adults

[Purpose] In this study, we investigated the effects of local exercise facility use on physical function of Japanese community-dwelling older adults. [Participants and Methods] We analyzed data obtained from a cohort project initiated in 1991. The study included approximately 4,800 individuals from suburban areas of central Japan; we investigated 322 older individuals residing in Municipality A, who underwent physical fitness assessments in 2018 and 2019. We recorded participants' exercise facility use frequency and physical performance, based on handgrip strength, open-eye single-leg standing, timed up-and-go, and walking speed tests. [Results] Baseline values in the open-eye single-leg standing test were significantly higher in the no-use than in the low- and high-use groups. Follow-up assessments revealed that grip strength was significantly higher in the high-use than in the no- and low-use groups. [Conclusion] Active use of exercise facilities was positively correlated with maintenance and improvement in physical fitness among participants, which highlights the benefits of easily accessible exercise facilities in maintaining long-term physical function. Future studies should focus on functions that extend beyond physical fitness to develop effective support programs that address the evolving health needs of the aging population.

Prevalence of Undernutrition, Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis

The world’s population aged ≥65 is expected to rise from one in eleven in 2019 to one in six by 2050. People aged ≥65 are at a risk of undernutrition, frailty, and sarcopenia. The association between these conditions is investigated in a hospital setting. However, there is little understanding about the overlap and adverse health outcomes of these conditions in community-dwelling people. This systematic review aims to quantify the reported prevalence and incidence of undernutrition, frailty, and sarcopenia among older people aged ≥50 living in community dwellings. Searches were conducted using six databases (AMED, CENTRAL, EMBASE, Web of Science, MEDLINE, and CINAHL), and 37 studies were included. Meta-analyses produced weighted combined estimates of prevalence for each condition (Metaprop, Stata V16/MP). The combined undernutrition prevalence was 17% (95% CI 0.01, 0.46, studies n = 5; participants = 4214), frailty was 13% (95% CI 0.11, 0.17 studies n = 28; participants = 95,036), and sarcopenia was 14% (95% CI 0.09, 0.20, studies n = 9; participants = 7656). Four studies reported incidence rates, of which three included data on frailty. Nearly one in five of those aged ≥50 was considered either undernourished, frail, or sarcopenic, with a higher occurrence in women, which may reflect a longer life expectancy generally observed in females. Few studies measured incidence rates. Further work is required to understand population characteristics with these conditions and the overlap between them. PROSPERO registration No. CRD42019153806.

Oral health-related quality of life is associated with physical frailty: A cross-sectional study of Japanese community-dwelling older adults

Background

Physical frailty is related to adverse outcomes, and poor oral health has been linked to malnourishment. Subjective measures of oral health‐related quality of life (OHRQoL) have been used as indicators of the oral health problems of older adults, and they have been associated with malnourishment. This study aimed to assess OHRQoL's association with physical frailty.

Methods

Cross‐sectional study was conducted using data from the Nagasaki Islands Study that enrolled participants aged ≥60 years at Japanese national medical check‐ups from 2014 to 2019. Physical frailty phenotype criteria were determined using the modified Fried frailty phenotype model. OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Dentists conducted clinical dental examinations. Simple correlation and linear regression analyses were performed to investigate the associations of number of physical frailty phenotype criteria with GOHAI and other oral health indicators.

Results

Among 1341 participants with a mean age of 72 years, GOHAI score was significantly associated with number of physical frailty phenotype criteria (B = −0.01, 95% confidence interval: −0.02 to −0.01, p < 0.001). The association remained significant after adjustment for age, sex, body mass index, history of hypertension, history of diabetes mellitus, smoking status, Kessler‐6 score, and number of remaining teeth.

Conclusions

Oral health‐related quality of life was associated with physical frailty in Japanese community‐dwelling older adults.

Multiple Physical Symptoms of Community-Dwelling Older People in Western China: Prevalence and Its Association with Frailty

INTRODUCTION

Physical symptoms and frailty are common in older adults. A previous study has reported that multiple somatic symptoms are associated with frailty. In this study, we aimed to describe the picture of physical symptoms in older adults in western China and examine the relationship of multiple physical symptoms and frailty, as well as the sex difference of this relationship.

METHODS

Cross-sectional analyses were based on the West China Health and Aging Trend (WCHAT) study comprising 4,106 community-dwelling older adults (60-95 years). Frailty was assessed using the physical frailty phenotype (PFP). Participants' experience of 28 different physical symptoms in the past 4 weeks was assessed. Physical symptoms were divided into several categories according to organ systems. Multinomial logistic regression analyses were performed to examine the association between frailty and multiple physical symptoms.

RESULTS

Nearly half of the subjects reported experiencing at least 1 physical symptom during the past 4 weeks. Musculoskeletal symptoms were the most prevalent symptoms. More than 5 physical symptoms were more likely to be frailty, even when all covariates were controlled. A significant association between multiple musculoskeletal symptoms and frailty also was found after adjusted for all covariates and multiple symptoms of other organ systems. Similar results were obtained for multiple cardiopulmonary symptoms. Furthermore, there were sex differences in these relationships.

CONCLUSION

Multiple physical symptoms appear to have a detrimental impact on frailty in older adults. Compared with counting total symptoms, multiple symptoms of the same organ system may have a greater impact on frailty. Effective interventions and management of multiple physical symptoms are warranted to prevent frailty.

Association between high psychological distress and poor oral health-related quality of life (OHQoL) in Japanese community-dwelling people: the Nagasaki Islands Study

Background

We investigated the association between psychological distress and oral health status/oral health-related quality of life (OHQoL) in Japanese community-dwelling people.

Methods

We conducted a cross-sectional study using data from the Nagasaki Islands Study. A total of 1183 (455 men and 728 women) has been analyzed in this study. Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Oral health status was measured by dental examination. The OHQoL was measured using the General Oral Health Assessment Index (GOHAI). We defined the total score of ≥5 points on the K6 as high psychological distress (high-K6 group).

Results

The multiple linear regression analysis to identify the GOHAI showed that gender, K6, the total number of teeth, the number of dental caries, and visiting a dental clinic within the past 6 months significantly associated with the GOHAI. Among all of these variables, high-K6 (≥ 5) was a substantial contributing factor of the GOHAI (β = − 0.23, 95% Cl − 2.31 to −1.41, p < 0.0001).

Conclusions

It is likely that the individual with high psychological distress was strongly related to poor OHQoL even in the general population.

Sarcopenia is associated with insomnia in Japanese older adults: a cross-sectional study of data from the Nagasaki Islands study

Background

Sarcopenia is associated with increased mortality among older adults. Sleep-related problems have been studied as factors related to sarcopenia. This study was conducted to determine the relationship between sleep-related problems and sarcopenia among Japanese community-dwelling older adults using data from the Nagasaki Islands Study.

Methods

This cross-sectional study analyzed data collected from 2017 to 2018. A total of 1592 older adults (575 men, 36.1%) aged 65 years or older participated. Sarcopenia was evaluated using the skeletal muscle mass index and grasp powers based on the criteria of the Asian Working Group for Sarcopenia. Odds ratios for sarcopenia were calculated using logistic regression analysis. Furthermore, subgroup analysis was performed based on the following tertiles of age: 65–70 years, 71–78 years, and 79–98 years.

Results

The number of participants with sarcopenia was 238 (14.9%). The median age of participants in the sarcopenia group (80 years; interquartile range: 74–84) was significantly higher than in the non-sarcopenia group (73 years; interquartile range 69–79; P <  0.001). In the sarcopenia group, 70.9% of participants had difficulty initiating and/or maintaining sleep, sleep duration tended to be longer (P <  0.001), and 33.3% of participants’ sleep duration was over 9 h. In a logistic regression analysis for sarcopenia, advancing age was the most prominent factor, and the adjusted odds ratio (95% confidence interval) of facing difficulty initiating and/or maintaining sleep was 1.60 (1.14–2.25). Despite longer sleep duration being a significant factor in the univariable analysis, it was not significant in the multivariable analysis. In the logistic regression analysis for sarcopenia among older adults aged 79–98 years, the odds ratio (95% confidence interval) among women was significantly low at 0.53 (0.33–0.83).

Conclusions

Sarcopenia is associated with difficulty initiating and/or maintaining sleep among Japanese older adults. In sarcopenia control measures, sleep/wake disorders related to insomnia are required to be evaluated in detail to help inform nursing and medical policy.

Human T-cell lymphotropic virus type-1 infection associated with sarcopenia: community-based cross-sectional study in Goto, Japan

Sarcopenia is characterized by a progressive skeletal muscle disorder that involves the loss of muscle mass and low muscle strength, which contributes to increased adverse outcomes. Few studies have investigated the association between chronic infection and sarcopenia. This study aimed to examine the association between human T-cell lymphotropic virus type-1 (HTLV-1) and sarcopenia. We conducted a cross-sectional study and enrolled 2,811 participants aged ≥ 40 years from a prospective cohort study in Japanese community dwellers during 2017-2019. Sarcopenia was defined as low appendicular skeletal muscle mass and low handgrip strength. The association between HTLV-1 seropositivity and sarcopenia was assessed using multivariable logistic regression. Odds ratio (OR) and 95% confidence interval (CI) of sarcopenia were analysed using HTLV-1 seropositivity. We adjusted for age, sex, body mass index, physical activity, systolic blood pressure, glycated haemoglobin, low-density lipoprotein cholesterol, and smoking and drinking status. Of 2,811 participants, 484 (17.2%) HTLV-1 infected participants were detected. HTLV-1 infection was significantly associated with sarcopenia (adjusted OR 1.46, 95% CI 1.03-2.07, P = 0.034). HTLV-1 was associated with sarcopenia among community-dwelling adults. Active surveillance and early detection of asymptomatic HTLV-1 infection might be beneficial to reinforce countermeasures to inhibit the progress of HTLV infection-associated sarcopenia.

Advances in pain management for older patients with cancer

The population of older patients is growing with a rising prevalence of cancer diagnoses and cancer-related pain syndromes. Older patients are also vulnerable to misleading pain evaluations and under treatment with opioids. Barriers to the effective and safe management of analgesics include pain assessments and the complex management of the best analgesic choice and dose-titration while achieving the fewest side effects. In this review, we will provide an overview of the challenges present in assessment and treatment choices, along with practical tips for routine clinical practice.

Marital Status and Risk of Physical Frailty: A Systematic Review and Meta-analysis

OBJECTIVES

Evidence on associations between marital status and frailty is limited. The objectives of this study were to perform a systematic review for associations between marital status and physical frailty and to perform a meta-analysis to combine findings.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older people with mean age ≥60 years.

METHODS

Systematic literature search using 5 databases was conducted in February 2019 to identify longitudinal and cross-sectional studies examining associations between marital status and Fried's phenotype-based frailty status. Additional studies were searched for by reviewing the reference lists of relevant articles and conducting forward citation tracking of included articles. Odds ratio (OR) of marital status and frailty was pooled using a random-effects meta-analysis. Subgroup analysis and analyses stratified by gender and marital status (married, widowed, divorced or separated, and never married) were completed.

RESULTS

A total of 1565 studies were found, from which 3 studies with longitudinal data and 35 studies with cross-sectional data were included. Although longitudinal studies suggested that married men had lower frailty risks than unmarried men while married women had higher frailty risks than widowed women, meta-analysis was not possible because of different methodologies. Meta-analyses of cross-sectional data from 35 studies including 80,754 individuals showed that unmarried individuals were almost twice more likely to be frail than married individuals (pooled odds ratio = 1.88, 95% confidence interval = 1.70-2.07). A high degree of heterogeneity was observed (I² = 69%) and was partially explained by reasons for not being married and study location. Stratified analyses showed that pooled risks of frailty in the unmarried compared with the married were not statistically different between women and women (P for difference = .62).

CONCLUSIONS AND IMPLICATIONS

Three and 35 studies, respectively, were found providing longitudinal and cross-sectional data regarding associations between marital status and frailty among community-dwelling older people. A meta-analysis of cross-sectional data showed almost twice higher frailty risk in unmarried individuals compared with married individuals. Marital status should be recognized as an important factor, and more longitudinal studies controlling for potential confounding factors are needed.

Association between atherosclerosis and handgrip strength in non-hypertensive populations in India and Japan

Aim

Although several risk factors contribute to the development of sarcopenia, whether preclinical atherosclerosis contributes to the risk of sarcopenia is not established. The present cross‐sectional study aimed to investigate if there is an association between preclinical atherosclerosis and muscle strength among two ethnic populations.

Methods

Participants included individuals aged ≥40 years and enrolled in the third follow‐up examination of the Andhra Pradesh Children and Parents Study, India, and in the baseline assessments of the Nagasaki Islands Study, Japan. Preclinical atherosclerosis was evaluated by carotid intima‐media thickness, brachial‐ankle pulse wave velocity, cardio‐ankle vascular index. The association of carotid intima‐media thickness and pulse wave velocity/cardio‐ankle vascular index with handgrip strength (HGS) was analyzed separately in the sexes and for hypertensive status from the two cohorts using a multivariable linear regression model.

Results

Data on a total of 1501 participants in India and 3136 participants in Japan were analyzed. Carotid intima‐media thickness was negatively associated with HGS in non‐hypertensive Indian men (B coefficient = −5.38, P = 0.036). Arterial stiffness was also associated with HGS in non‐hypertensive Indian men (B = −0.97, P = 0.001), but not in hypertensive Indian men. Same as Indian men, we found the significant associations between arterial stiffness and HGS in non‐hypertensive women in both India and Japan (B = −0.44, P = 0.020, B = −0.63, P = 0.016, respectively), but not in hypertensive women.

Conclusions

The negative association between preclinical atherosclerosis and HGS was dominantly found in non‐hypertensive participants. Geriatr Gerontol Int 2018; 18: 1071–1078.

Screening Validity of Arterial Pressure-Volume Index and Arterial Velocity-Pulse Index for Preclinical Atherosclerosis in Japanese Community-Dwelling Adults: the Nagasaki Islands Study

AIM

The arterial pressure-volume index (API) and arterial velocity-pulse index (AVI) are novel measurement indices of arterial stiffness. This study was performed to examine the screening validity of the API and AVI for preclinical atherosclerosis in Japanese community-dwelling adults.

METHODS

We conducted a cross-sectional study of 2,809 participants aged ≥40 years who underwent Japanese national medical check-ups from 2014 to 2016. Preclinical atherosclerosis was defined as a mean carotid intima-media thickness (CIMT) of ≥1.0 mm. Multivariable linear regression analysis was performed to investigate the association of CIMT with API and AVI, adjusting for body mass index, sex, and the Framingham-D'Agostino score. We also examined receiver operating characteristic curves, sensitivity, and specificity to predict preclinical atherosclerosis defined by the CIMT. The cardio-ankle vascular index was also measured for comparison with the API and AVI.

RESULTS

Of 2,809 participants, 68 (2.4%) had preclinical atherosclerosis. In the multivariable linear regression analysis, the API and AVI maintained a positive association with the mean CIMT (B=2.6, P=0.009 and B=3.7, P=0.001, respectively). The cut-offs of the API and AVI that demonstrated better sensitivity and specificity for detection of subclinical atherosclerosis were 31 [area under the curve (AUC), 0.64] and 29 (AUC, 0.60).

CONCLUSIONS

The API and AVI were positively associated with preclinical carotid atherosclerosis independent of the participants' cardiovascular risk. The ability of these scores to predict carotid atherosclerosis could make them a useful screening tool for atherosclerosis.

Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study

We examined correlating clinical biomarkers for the physical aspect of frailty among community-dwelling older adults in Japan, using Japanese Gerontological Evaluation Study (JAGES). We used information from the JAGES participants (N = 3,128) who also participated in the community health screening in 2010. We grouped participants' response to the Study of Osteoporotic Fracture (SOF) Frailty Index into robust (=0), intermediate frail (=1), and frail (=2+) ones to indicate physical aspect of frailty. Independent of sex and age, results from multinomial logistic regression showed above normal albumin and below normal HDL and haemoglobin levels were positively associated with intermediate frail (RRR = 1.99, 95% CI = 1.22–3.23; RRR = 1.36, 95% CI = 1.33–1.39; RRR = 1.36, 95% CI = 1.23–1.51, resp.) and frail cases (RRR = 2.27, 95% CI = 1.91–2.70; RRR = 1.59, 95% CI = 1.51–1.68; RRR = 1.40, 95% CI = 1.28–1.52, resp.). Limited to women, above normal Hb1Ac level was similarly associated with intermediate frail and frail cases (RRR = 1.18, 95% CI = 1.02, 1.38; RRR = 2.56, 95% CI = 2.23–2.95, resp.). Use of relevant clinical biomarkers can help in assessment of older adults' physical aspect of frailty.

Social networks, leisure activities and maximum tongue pressure: cross-sectional associations in the Nagasaki Islands Study

OBJECTIVES

Social environment is often associated with health outcomes, but epidemiological evidence for its effect on oral frailty, a potential risk factor for aspiration, is sparse. This study aimed to assess the association between social environment and tongue pressure, as an important measure of oral function. The study focused on family structure, social networks both with and beyond neighbours, and participation in leisure activities.

DESIGN

A population-based cross-sectional study.

SETTING

Annual health check-ups in a rural community in Japan.

PARTICIPANTS

A total of 1982 participants, all over 40 years old. Anyone with missing data for the main outcome (n=14) was excluded.

OUTCOME MEASURES

Tongue pressure was measured three times, and the maximum tongue pressure was used for analysis. A multivariable adjusted regression model was used to calculate parameter estimates (B) for tongue pressure.

RESULTS

Having a social network involving neighbours (B=2.43, P=0.0001) and taking part in leisure activities (B=1.58, P=0.005) were independently associated with higher tongue pressure, but there was no link with social networks beyond neighbours (B=0.23, P=0.77). Sex-specific analyses showed that for men, having a partner was associated with higher tongue pressure, independent of the number of people in the household (B=2.26, P=0.01), but there was no association among women (B=-0.24, P=0.72; P-interaction=0.059).

CONCLUSIONS

Having a social network involving neighbours and taking part in leisure activities were independently associated with higher tongue pressure. Marital status may be an important factor in higher tongue pressure in men.