Relationship between the Kihon Checklist and all-cause hospitalization among community-dwelling older adults

Relationships between Loneliness and Occupational Dysfunction in Community-Dwelling Older Adults: A Cross-Sectional Study

The study explored cross-sectional associations between loneliness and occupational dysfunction in community-dwelling older adults. Seventy-four older adults (12 men and 62 women; mean age 73.9 ± 8.3 years) completed a questionnaire survey that included the Japanese version of the UCLA Loneliness Scale Version 3 and the Classification and Assessment of Occupational Dysfunction (CAOD). Bayesian statistical modeling was used for a more stable estimation given the small sample. For model selection, we assumed a univariate analysis model of the CAOD (Model 1); a multivariate analysis model, including confounding factors in Model 1 (Model 2); and a multivariate analysis model, including random effects in Model 2 (Model 3). The best model was selected by comparing the widely applicable information criterion (WAIC) and the widely applicable Bayesian information criterion (WBIC) for each model. Bayesian statistics with the dependent variable as "loneliness" showed that the best model used "occupational dysfunction" as the independent variable and included confounding factors and random effects (WAIC = 474.5 and WBIC = 213.1). The best model identified an association between occupational dysfunction and loneliness (odds ratio [OR] = 2.363; 95% Bayesian confidence interval [CI] = 1.105-5.259). This study highlights the role of occupational dysfunction in addition to the risks and related factors reported to date when dealing with loneliness. Therapists could help older adults cope with loneliness by supporting their social participation and improving their occupational dysfunction.

Impact of exercising alone and exercising with others on the risk of cognitive impairment among older Japanese adults

PURPOSE

This longitudinal study investigates the influence of the stratified frequency of exercising alone and exercising with others on the prevention of cognitive impairment among older Japanese adults.

METHODS

This four-year follow-up study targeted 4,358 individuals (mean age: 76.9 ± 5.6 years, female: 51.8%) who participated in an inventory mail survey in one region of Japan. The exercise forms surveyed involved the frequency of exercising alone and with others. Cognitive impairment was assessed using the nationally standardized dementia scale proposed by the Ministry of Health, Labour and Welfare of Japan. Adjusted Cox proportional-hazard models were used to examine the association between the exercise forms and the development of cognitive impairment, and calculate population-attributable fractions (PAFs).

RESULTS

The cumulative incidence of cognitive impairment throughout the study was 7.7%. Participants who exercised ≥ 2 times/week alone (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.61-0.998) had a lower risk of developing cognitive impairment than those who did not exercise alone. Similarly, participants who exercised ≥ 2 times/week with others (HR = 0.66; 95% CI = 0.47-0.94) showed a lower risk of developing cognitive impairment than those who did not exercise with others. The scenarios involving PAFs demonstrated that, if all participants exercised alone or with others ≥ 2 times/week, the risk of cognitive impairment decreased by 15.1% and 29.2%, respectively.

CONCLUSION

Both forms of exercise reduced the development of cognitive impairment, with exercising with others potentially being highly effective in preventing cognitive impairment.

Associations between apathy and comprehensive frailty as assessed by the Kihon Checklist among community-dwelling Japanese older adults

BACKGROUND

Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment.

METHODS

We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders.

RESULTS

Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22-2.64; frailty: OR 3.24, 95% CI 1.63-6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001).

CONCLUSIONS

Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health.

Association between white matter alterations on diffusion tensor imaging and incidence of frailty in older adults with cardiometabolic diseases

Diffusion tensor imaging (DTI) can be used for the early detection of abnormal changes in the integrity of cerebral white matter tracts, and we have previously reported that these changes are associated with indices of early atherosclerotic lesions. Although these changes have been demonstrated to be associated with the incidence of frailty in older adults, no studies have investigated this relationship in patients at high risk for vascular disease. In this longitudinal study, we followed outpatients with cardiometabolic diseases for a maximum of 6 years (median, 3 years) and evaluated the association of baseline DTI data of seven white matter tracts with the incidence of frailty. The modified version of the Cardiovascular Health Study criteria and the Kihon Checklist were used as indices of frailty; fractional anisotropy (FA) and mean diffusivity (MD) were used as indices of white matter changes. Patients who developed frailty based on both indices had low FA and high MD in many of the tracts tested, with the most significant difference found in the MD of the anterior thalamic radiation (ATR). Cox proportional hazard model analysis revealed a significantly high risk of frailty defined by both indices in the groups with high MD values in the left ATR. Similar results were found in patients with diabetes mellitus but not in those without diabetes mellitus. Therefore, abnormalities in the integrity of the left ATR could be associated with the progression of frailty in older adults with cardiometabolic disease, particularly those with diabetes mellitus.

Association of Oral Function and Dysphagia with Frailty and Sarcopenia in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Studies investigating the associations of oral function and dysphagia with frailty and sarcopenia in community-dwelling older adults are increasing; however, they have not been systematically summarized. We conducted a systematic review to investigate these associations. We searched electronic databases and synthesized relevant data using conventional (frequentist-style) and Bayesian meta-analyses. Twenty-four studies were found to be eligible for our review, including 20 cross-sectional and four prospective cohort studies. Older adults with frailty or sarcopenia had lower tongue pressure, according to the results of conventional meta-analysis (mean difference [95% confidence interval or credible interval]: −6.80 kPa [−10.22 to −3.38] for frailty and −5.40 kPa [−6.62 to −4.17] for sarcopenia) and Bayesian meta-analysis (−6.90 kPa [−9.0 to −4.8] for frailty, −5.35 kPa [−6.78 to −3.89] for sarcopenia). People with frailty had a higher odds ratio (OR) for dysphagia according to the results of conventional meta-analysis (3.99 [2.17 to 7.32]) and Bayesian meta-analysis (1.38 [0.77 to 1.98]). However, the results were inconclusive for people with sarcopenia. A prospective association could not be determined because of the lack of information and the limited number of studies. Decreased oral function and dysphagia can be important characteristics of frailty and sarcopenia in community-dwelling older adults.