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Kawai H, Imamura K, Ejiri M, Fujiwara Y, Ihara K, Hirano H, Sasai H, Obuchi S. Aging trajectories of subscales in higher-level functional capacity among community-dwelling older Japanese adults: the Otassha study. Aging Clin Exp Res 2024; 36:137. [PMID: 38904857 DOI: 10.1007/s40520-024-02791-x] [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: 03/25/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Maintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear. AIMS This study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese. METHODS Participants were 3,169 community-dwelling older Japanese who participated in the 2012-2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65-90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined. RESULTS Three patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable. DISCUSSION The instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped. CONCLUSIONS To maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented.
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Affiliation(s)
- Hisashi Kawai
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Keigo Imamura
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Manami Ejiri
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | | | - Hirohiko Hirano
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Hiroyuki Sasai
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Shoji T, Kogure K, Toda N, Hakoshima M, Katsuyama H, Yanai H, Tokunaga S, Tateoka K, Tsuji T, Okura T. Association between comorbidities associated with diabetes and higher-level functional status in older patients with type 2 diabetes mellitus: a cross sectional study. Eur Geriatr Med 2024:10.1007/s41999-024-00937-8. [PMID: 38340284 DOI: 10.1007/s41999-024-00937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To investigate the association between comorbidities associated with diabetes and higher-level functional status as well as the relationship between comorbidities associated with diabetes and higher-level functional status in older patients with type 2 diabetes mellitus who have better social networks. METHODS Participants were outpatients with type 2 diabetes aged ≥ 65 years, excluding individuals with severe cardiovascular or respiratory illness, hyperglycaemic crisis, type 1 diabetes, or diabetic foot. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate the higher-level functional status. A TMIG-IC score of ≤ 9, instrumental activities of daily living (IADL) ≤ 4, intellectual activity or social role ≤ 3 were defined as decline in higher-level functional status. The comorbidities investigated included peripheral neuropathy, retinopathy, nephropathy, cognitive impairment, depression, frailty, sarcopenia, low muscle strength, stroke, heart disease, and arthritis. RESULTS The analysis included 198 patients (mean age 75.9 ± 5.7 years, male 60.1%). After adjusting for potential confounders, depression was associated with TMIG-IC (Prevalence ratio (PR) 2.34, 95% confidence interval (CI) 1.44-3.82), low muscle strength was associated with IADL (PR 2.85, 95% CI 1.30-6.27), and frailty was associated with intellectual activity (PR 1.38, 95% CI 1.10-1.74). In the model with social networks added as a confounder, the relationship between depression or low muscle strength and higher-level functional status was not statistically significant. CONCLUSION Comorbidities of depression and low muscle strength for older patients with type 2 diabetes mellitus increase the risk of malfunctioning of higher-level functional status. Increased interactions with family, friends and neighbours may reduce this event.
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Affiliation(s)
- Takuro Shoji
- Department of Rehabilitation Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Kohnodai 1-7-1, Ichikawa, Chiba, 272-8516, Japan.
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Public Health, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Kenta Kogure
- Department of Rehabilitation Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Kohnodai 1-7-1, Ichikawa, Chiba, 272-8516, Japan
| | - Nagisa Toda
- Department of Rehabilitation Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Kohnodai 1-7-1, Ichikawa, Chiba, 272-8516, Japan
| | - Mariko Hakoshima
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Hisayuki Katsuyama
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Satoshi Tokunaga
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Public Health, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Korin Tateoka
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Physical Education, Health and Sport Sciences, University of Tsukuba, Tuskuba, Ibaraki, Japan
| | - Taishi Tsuji
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomohiro Okura
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kawai H, Ejiri M, Imamura K, Ito K, Fujiwara Y, Ihara K, Hirano H, Obuchi S. Impact of combinations of subscale declines in higher-level functional capacity on 8-year all-cause mortality among community-dwelling older Japanese adults. Arch Gerontol Geriatr 2023; 114:105096. [PMID: 37311368 DOI: 10.1016/j.archger.2023.105096] [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: 04/18/2023] [Revised: 05/18/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The frequency of combined declines in domains of multi-faceted frailty and their impact on adverse health outcomes have not been adequately investigated. We aimed to examine the association between combined subscale declines in higher-level functional capacity and 8-year all-cause mortality among community-dwelling older Japanese individuals and the impact of multi-faceted frailty on mortality. MATERIALS AND METHODS We administered a questionnaire to 7015 community-dwelling older adults aged 65-85 years. The higher-level functional capacity of the 3381 respondents was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Subscale decline was defined as (1) none, (2) only social role (SR), (3) only intellectual activity (IA), (4) SR and IA, (5) only instrumental activities of daily living (IADL), (6) IADL and SR, (7) IADL and IA, and (8) all. Associations between combined subscale declines and mortality were examined using adjusted Cox proportional hazards models. Follow-up was conducted from October 1, 2012, to death or November 1, 2020. RESULTS The mortality rate was 16.7/1000 person-years. Moreover, 44% of respondents had declined SR, and half of them had multiple declines. Compared with no decline, SR (adjusted hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.14-1.93), SR and IA (HR: 1.59, 95% CI: 1.16-2.17), IADL and SR (HR: 1.97, 95% CI: 1.31-2.99), and all-domain (HR: 2.72, 95% CI: 1.98-3.74) declines were significantly associated with higher mortality risks. CONCLUSIONS Overlapping SR and IADL declines increased mortality risk, suggesting the importance of measuring social frailty and overlapping physical and social frailty.
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Affiliation(s)
- Hisashi Kawai
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Manami Ejiri
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Keigo Imamura
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kumiko Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Nagata H, Miura K, Tanaka S, Kadota A, Hayakawa T, Kondo K, Fujiyoshi A, Takashima N, Kita Y, Okayama A, Okamura T, Ueshima H. Relationship of Higher-level Functional Capacity With Long-term Mortality in Japanese Older People: NIPPON DATA90. J Epidemiol 2023; 33:136-141. [PMID: 34248110 PMCID: PMC9909170 DOI: 10.2188/jea.je20210077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Basic and instrumental activities of daily living (BADL and IADL, respectively) are known predictors of mortality. However, the relationship between higher-level functional capacity (HLFC) and mortality and related sex differences have rarely been investigated. METHODS A prospective population-based cohort study was conducted in 1,824 older residents (≥65 years) with independent BADL from 300 randomly selected areas in Japan from 1995, and the participants were followed up until 2010. Using the Cox proportional hazards model, the relationship between HLFC and mortality risk was investigated, with adjustment for possible confounders. HLFC was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Baseline data were collected using a questionnaire or by home-visit interviews. RESULTS During an average 12.2-year follow-up, all-cause death was observed in 836 (45.8%) participants. Impaired HLFC was significantly associated with mortality (hazard ratio [HR] 1.37; 95% confidence interval [CI], 1.13-1.65). Lower social role was significantly associated with higher mortality risk in men (HR 1.38; 95% CI, 1.13-1.68). Lower IADL and intellectual activity were significantly associated with higher mortality risk in women (HR 1.50; 95% CI, 1.15-1.95 and HR 1.46; 95% CI, 1.19-1.79, respectively). The relationship between HLFC and mortality risk showed a similar tendency among cardiovascular diseases, stroke, cancer, and pneumonia. CONCLUSION Impaired HLFC was associated with a high risk of all-cause mortality among community-dwelling older people with independent BADL. In particular, social role in men and IADL and intellectual activity in women were associated with long-term mortality risk.
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Affiliation(s)
- Hideki Nagata
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Rehabilitation, Japanese Red Cross Nagoya Daini Hospital
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Sachiko Tanaka
- Department of Medical Statistics, Shiga University of Medical Science
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community Ritsumeikan University
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | | | | | | | | | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
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Ida S, Kaneko R, Imataka K, Okubo K, Azuma K, Murata K. [Loneliness is associated with a reduced higher-level-function capacity in older diabetic patients]. Nihon Ronen Igakkai Zasshi 2022; 59:536-542. [PMID: 36476702 DOI: 10.3143/geriatrics.59.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The present study examined the relationship between loneliness and higher-level functions in elderly diabetic patients. METHODS The subjects were diabetic patients ≥65 years old who were outpatients at Ise Red Cross Hospital. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a self-administered questionnaire, was used to assess higher-level functions. To evaluate loneliness, we used a shortened version of the Japanese version of the loneliness scale, a self-administered questionnaire. A multiple regression analysis with TMIG-IC scores as the dependent variable, loneliness as the explanatory variable, and adjustment variables was used to calculate the adjusted partial regression coefficients of loneliness on higher-level functions. RESULTS One hundred and seventy patients were included in the present analysis. Ninety-one patients (53.5%) had loneliness, and the mean TMIG-IC score was 11.3. The unadjusted and adjusted partial regression coefficients of loneliness on higher-level functions were -1.61 (95% confidence interval [CI], -2.31 to -0.91; < 0.001) and -0.88 (95% CI, -1.52 to -0.23; P=0.008), respectively. CONCLUSION Loneliness in elderly diabetic patients was found to be associated with lower higher-level functions. It is important to remind patients with diabetes mellitus who have loneliness about the risk of a decline in their higher-level functions.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
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6
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Shoji T, Fujii Y, Tateoka K, Tsuji T, Okura T. The association of the Japan Science and Technology Agency Index of Competence with physical and cognitive function in community‐dwelling older adults. Geriatr Gerontol Int 2022; 22:753-758. [DOI: 10.1111/ggi.14448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Takuro Shoji
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Public Health University of Tsukuba Tsukuba Japan
| | - Yuya Fujii
- Physical Fitness Research Institute Meiji Yasuda Life Foundation of Health and Welfare Hachioji Japan
| | - Korin Tateoka
- Graduate School of Comprehensive Human Sciences, Doctoral Program in Physical Education, Health and Sport Sciences University of Tsukuba Tsukuba Japan
| | - Taishi Tsuji
- Faculty of Health and Sport Sciences University of Tsukuba Tsukuba Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences University of Tsukuba Tsukuba Japan
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7
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Ida S, Kaneko R, Imataka K, Okubo K, Shirakura Y, Azuma K, Fujiwara R, Takahashi H, Murata K. Frequency of Social Isolation and Homeboundness and Their Relationships with High-Level Functional Capacity in Elderly Diabetic Patients. Clin Interv Aging 2020; 15:1439-1447. [PMID: 32904527 PMCID: PMC7457396 DOI: 10.2147/cia.s244529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the frequency of social isolation (hereinafter, isolation) and homeboundness in elderly diabetic patients and to investigate their relationships with high-level functional capacity. PATIENTS AND METHODS Subjects were diabetic outpatients aged 65 years and older who were visiting the Japanese Red Cross Ise Hospital. Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate high-level functional capacity. Isolation was defined as having less than one interaction per week with someone other than co-habiting family members. Homeboundness was defined as leaving the house less than once a day. Multiple regression analysis was performed with the TMIG-IC score as the dependent variable and isolation and homeboundness as independent variables. RESULTS Four hundred fifty-one patients were included in the analysis. The frequency of isolation and homeboundness affected 37% and 13.3% of men and 28.9% and 20.6% of women, respectively. The adjusted partial regression coefficient of the TMIG-IC scores of isolated, homebound, and isolated+homebound men was -0.94 [95% confidence interval (CI), -1.68 to -0.21; P = 0.012], -0.27 (95% CI, -1.93 to 1.39; P = 0.746), and -4.03 (95% CI, -5.37 to -2.68; P < 0.001) in relation to that of the non-isolated and non-homebound group as reference. In women, the respective coefficients to the reference were -1.33 (95% CI, -2.93 to 0.25; P = 0.099), -0.65 (95% CI, -2.56 to 1.26; P = 0.501), and -3.01 (95% CI, -4.92 to -1.1; P = 0.002), respectively. CONCLUSION The frequency of isolation was high in both female and male elderly diabetic patients. In men, there was a significant relationship between isolation and decline in high-level functional capacity. In both men and women, there was a significant relationship between isolation+homeboundness and decline in high-level functional capacity.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Yoshitaka Shirakura
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Hiroka Takahashi
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie516-8512, Japan
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Heshmatollah A, Mutlu U, Koudstaal PJ, Ikram MA, Ikram MK. Cognitive and physical impairment and the risk of stroke - A prospective cohort study. Sci Rep 2020; 10:6274. [PMID: 32286410 PMCID: PMC7156475 DOI: 10.1038/s41598-020-63295-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
The manifestation of cognitive and physical impairment in stroke patients before the acute event suggests accumulating subclinical vascular pathology in the brain. We investigated whether impairments in cognitive and physical functioning were associated with an increased stroke risk. Between 2002 and 2008, 8,519 stroke-free non-demented participants from the population-based Rotterdam Study underwent cognition and physical assessments including Mini-Mental State Examination, 15-word learning test, Stroop test, letter-digit substitution test, verbal fluency test, Purdue pegboard test and questionnaires on basic and instrumental activities of daily living (BADL; IADL). Principal component analysis was used to derive global cognition (G-factor). Incident stroke was assessed through continuous monitoring of medical records until 2016. Among 8,519 persons (mean age 66.0 years; 57.8% women), 489 suffered a stroke during mean follow-up of 8.7 years (SD: 2.9). Worse G-factor was associated with higher stroke risk (Hazard Ratio 1.21, 95% CI: 1.06–1.38), largely driven by unspecified stroke. Likewise, worse scores on 15-word learning test, Stroop test, Purdue pegboard test, IADL, and BADL were associated with higher risk of stroke. Thus both worse cognitive and physical functioning were associated with a higher stroke risk, in particular unspecified stroke and persons with worse memory, information processing, executive function, and motor function.
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Affiliation(s)
- A Heshmatollah
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - U Mutlu
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Taniguchi Y, Kitamura A, Nofuji Y, Ishizaki T, Seino S, Yokoyama Y, Shinozaki T, Murayama H, Mitsutake S, Amano H, Nishi M, Matsuyama Y, Fujiwara Y, Shinkai S. Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese. J Gerontol A Biol Sci Med Sci 2019; 74:211-218. [PMID: 29596617 DOI: 10.1093/gerona/gly024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/05/2018] [Indexed: 12/17/2022] Open
Abstract
Background Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. Methods 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). Results We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. Conclusions People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.
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Affiliation(s)
- Yu Taniguchi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yu Nofuji
- Health Promotion Research Center, Japan Association for Development of Community Medicine, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Satoshi Seino
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yuri Yokoyama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hidenori Amano
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Mariko Nishi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shoji Shinkai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Tomeleri CM, Cavalcante EF, Antunes M, Nabuco HCG, de Souza MF, Teixeira DC, Gobbo LA, Silva AM, Cyrino ES. Phase Angle Is Moderately Associated With Muscle Quality and Functional Capacity, Independent of Age and Body Composition in Older Women. J Geriatr Phys Ther 2019; 42:281-286. [PMID: 29210931 DOI: 10.1519/jpt.0000000000000161] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND PURPOSE There is a growing body of evidence indicating that phase angle (PhA) can be used as an indicator of nutritional status, disease prognosis, and mortality risk; however, it is still unknown whether PhA can be used as an explanator of functional capacity and muscle quality in older women. The main purpose of this cross-sectional study was to explore whether PhA is associated with muscle quality and functional capacity in older women, regardless of total and regional body composition. METHODS A total of 125 older women-66.7 (4.7) years; 65.6 (10.9) kg body mass; 156.1 (5.2) cm height; 26.9 (4.0) kg/m body mass index-participated in this study. Anthropometric, PhA, body composition (whole-body dual-energy x-ray absorptiometry) and muscle quality (defined as total muscular strength per kilogram of appendicular lean soft tissue) were measured. The functional capacity was assessed by 4 tests: 10-m walk test, rising from sitting position, rising from ventral decubitus position, and rising from a chair and walking around the house. The summing z-scores for the 4 tests was used as a continuous functional capacity score. Linear regression analysis was conducted to test whether PhA is related to the dependent variables (muscle quality and functional capacity), after adjusting for potential covariates. RESULTS The PhA presented a small-to-moderate relationship with muscle quality (r = 0.27; P < .01) and functional capacity (r = 0.31; P < .01), respectively. These relationships remained significant after adjustment for age, lower limb lean soft tissue, and total fat mass for muscle quality (β= 0.55; P < .01) and functional capacity (β= 1.38; P < .01). CONCLUSION Our findings suggest that healthy elderly women with higher values of PhA have a better muscle quality and functionality, regardless of age and body composition.
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Affiliation(s)
- Crisieli M Tomeleri
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
| | - Edilaine F Cavalcante
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
| | - Melissa Antunes
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
| | - Hellen C G Nabuco
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
| | - Mariana F de Souza
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
- Department of Physical Education, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Denilson C Teixeira
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
- Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
| | - Luis A Gobbo
- Department of Physical Education, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Edilson S Cyrino
- Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Brazil
- Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
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Ida S, Murata K, Nakadachi D, Ishihara Y, Imataka K, Uchida A, Monguchi K, Kaneko R, Fujiwara R, Takahashi H. Association between dynapenia and decline in higher-level functional capacity in older men with diabetes. Geriatr Gerontol Int 2018; 18:1393-1397. [DOI: 10.1111/ggi.13498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Daiki Nakadachi
- Department of Rehabilitation; Ise Red Cross Hospital; Ise Japan
| | - Yuki Ishihara
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Akihiro Uchida
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kou Monguchi
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Hiroka Takahashi
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
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Home blood pressure predicts stroke incidence among older adults with impaired physical function: the Ohasama study. J Hypertens 2017; 35:2395-2401. [PMID: 28697009 DOI: 10.1097/hjh.0000000000001473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Several observational studies have found modifying effects of functional status on the association between conventional office blood pressure (BP) and adverse outcomes. We aimed to examine whether the association between higher BP and stroke was attenuated or inverted among older adults with impaired function using self-measured home BP measurements. METHODS We followed 501 Japanese community-dwelling adults aged at least 60 years (mean age, 68.6 years) with no history of stroke. Multivariate-adjusted hazard ratios for 1-SD increase in home BP and office BP measurements were calculated by the Cox proportional hazards model. Functional status was assessed by self-reported physical function. RESULTS During a median follow-up of 11.5 years, first strokes were observed in 47 participants. Higher home SBP, but not office SBP, was significantly associated with increased risk of stroke among both 349 participants with normal physical function and 152 participants with impaired physical function [hazard ratio (95% confidence interval) per 14.4-mmHg increase: 1.74 (1.12-2.69) and 1.77 (1.06-2.94), respectively], with no significant interaction for physical function (P = 0.56). Higher home DBP, but not office DBP, was also significantly associated with increased risk of stroke (P ≤ 0.029) irrespective of physical function (all P > 0.05 for interaction). Neither home BP nor office BP was significantly associated with all-cause mortality irrespective of physical function. CONCLUSION Higher home BP was associated with increased risk of stroke even among those with impaired physical function. Measurements of home BP would be useful for stroke prevention, even after physical function decline.
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Tsubota-Utsugi M, Satoh M, Tomita N, Hara A, Kondo T, Hosaka M, Saito S, Asayama K, Inoue R, Hirano M, Hosokawa A, Murakami K, Murakami T, Metoki H, Kikuya M, Izumi SI, Imai Y, Ohkubo T. Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study. J Stroke Cerebrovasc Dis 2016; 26:376-384. [PMID: 28029606 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults. MATERIALS AND METHODS For this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors. RESULTS During the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]). CONCLUSION Silent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.
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Affiliation(s)
- Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Naoki Tomita
- Institute of Development, Aging and Cancer, Department of Geriatrics and Gerontology, Tohoku University, Sendai, Japan
| | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Takeo Kondo
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Miki Hosaka
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Sho Saito
- Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryusuke Inoue
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mikio Hirano
- Department of Community Medical Support, Tohoku University, Sendai, Japan
| | - Aya Hosokawa
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahiro Kikuya
- Tohoku Medical Megabank organization, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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Murakami K, Asayama K, Satoh M, Inoue R, Tsubota-Utsugi M, Hosaka M, Matsuda A, Nomura K, Murakami T, Kikuya M, Metoki H, Imai Y, Ohkubo T. Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study. J Atheroscler Thromb 2016; 24:290-300. [PMID: 27487854 PMCID: PMC5383545 DOI: 10.5551/jat.35766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Few studies have addressed stroke risk factors in older populations, particularly among the old-old. We examined differences in traditional risk factors for stroke among the old-old compared with the young-old in community-dwelling Japanese adults. METHODS We followed 2,065 residents aged ≥ 60 years who had no history of stroke. Traditional risk factors for stroke were obtained from a self-administered questionnaire at baseline. We classified participants into two age categories, 60-74 years (n=1,502) and ≥ 75 years (n=563), and assessed whether traditional risk factors were differentially associated with stroke incidence according to age category. Hazard ratios were calculated by the Cox proportional hazards model, adjusting for confounding factors and competing risk of death. RESULTS During a median follow-up of 12.8 and 7.9 years, 163 and 111 participants aged 60-74 and ≥ 75 years, respectively, developed a first stroke. Hypertension was consistently associated with increased risk of stroke, regardless of age category. Diabetes mellitus was associated with increased risk of stroke in those aged 60-74 years (hazard ratio, 1.50; 95% confidence interval, 1.00-2.25), but not in those aged ≥ 75 years (hazard ratio, 0.65; 95% confidence interval, 0.33-1.29), with significant interaction by age (P=0.035). No traditional risk factor other than hypertension was associated with stroke among those aged ≥ 75 years. CONCLUSION Those with hypertension had significantly higher stroke risk among old people, while diabetes mellitus was differentially associated with stroke according to age category. Our findings indicate the importance of different prevention strategies for stroke incidence according to age category.
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Affiliation(s)
- Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine
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