Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan

The Life-Space Mobility of Community-Dwelling Older Adults is Associated With Personality Traits

Life-space mobility (LSM) in older adults is influenced by physical, cognitive, and psychological states. However, the relationship between LSM and personality traits remains unclear. Thus, our cross-sectional study investigated this correlation, which included 144 participants aged ≥60 years. LSM was assessed using the life-space assessment (LSA), and personality traits were evaluated using the Japanese version of the Ten-Item Personality Inventory (TIPI-J). Physical data were also collected. Univariate analyses revealed that among young-older adults, extroversion in the TIPI-J showed a significant association with LSA scores in addition to handgrip strength. Among old-older adults, openness to experience in the TIPI-J demonstrated a significant association with LSA scores in addition to quadriceps strength. This study revealed correlations between personality traits (extroversion and openness to experience) and LSM, in addition to physical function. Considering older adults' personality traits is crucial for designing support and interventions to maintain and expand LSM.

Do measures of physical capacity and walking self-efficacy relate to frailty in older adults with difficulty walking outdoors? A secondary data analysis

PURPOSE

Measures of physical capacity and self-efficacy may help rehabilitation professionals better understand and detect frailty in older adults. We aimed to characterize frailty, walking self-efficacy, physical capacity, and their inter-relationships in older adults with difficulty walking outdoors.

MATERIALS AND METHODS

A secondary analysis of baseline data from 187 older adults (age ≥ 65 years) with mobility limitations was performed. Frailty was evaluated using the cardiovascular health study frailty index. Physical capacity was measured using the 10-meter walk test (10mWT), 6-min walk test (6MWT), 30-second sit-to-stand test (30STST), mini balance evaluation systems test (mini-BESTest), and hand dynamometry. Self-efficacy was assessed using the ambulatory self-confidence questionnaire (ASCQ). We evaluated associations between scores on physical capacity and walking self-efficacy measures and frailty level using an ANOVA or the Kruskal Wallis H-test.

RESULTS

The percentage of participants not frail, pre-frail, and frail was 33.7%, 57.2%, and 9.1%, respectively. Median score on the 10mWT-comfortable pace, 10mWT-fast pace, 6MWT, 30STST, mini-BESTest, grip strength, and ASCQ was 1.06 m/s, 1.42 m/s, 354.0 m, 9.0 repetitions, 22 points, 23.0 kg, and 8.1 points, respectively. Scores on physical capacity and walking self-efficacy measures were associated with frailty level (p < 0.01).

CONCLUSIONS

Findings provide insight into the utility of rehabilitation measures to indicate frailty among older adults with mobility limitations.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Homebound older adults who live independently in rural Japan: Prevalence and contributing factors during the COVID-19 pandemic

Being homebound is a phenomenon of confining older adults to their homes owing to health, social, and psychological factors. During the COVID-19 pandemic, people were requested to refrain from going out to prevent infection. Consequently, the homebound status of older adults was influenced by social and environmental factors, resulting in an increase in the number of homebound older adults during the pandemic. This study aimed to determine the homebound prevalence and related factors among homebound older adults during the COVID-19 pandemic. In 2021, a cross-sectional study conducted in rural Saitama, Japan, included 1,020 participants aged 65 years and above who did not have long-term care insurance certification and were independent in instrumental activities of daily living. Herein, homebound individuals were defined as those who went out once a week or less. The relationships of homebound status with demographic, health, social, and psychological factors in older adults were examined. The prevalence of homebound independent older adults was estimated as 10.4 % (6.6 % males, 13.8 % females). Homebound status was significantly associated with one or more medical histories (odds ratio [OR] = 1.98, 95 % confidence interval [CI] = 1.00-3.90), no social or family roles (OR = 1.95, 95 % CI = 1.09-3.48), and no hobbies (OR = 1.84, 95 % CI = 1.02-3.34). Establishing social or family roles and promoting participation in hobbies may prevent older adults from being homebound. The social environment, which changed during the pandemic, should be improved to encourage older adults to go out.

Individual and environmental variables related to outdoor walking among older adults: Verifying a model to guide the design of interventions targeting outdoor walking

OBJECTIVE

To estimate the relationships between individual and environmental variables and outdoor walking (OW) in older adults with OW limitations through verifying a conceptual model.

METHODS

Baseline data from 205 older adults participating in a randomized trial of a park-based OW program were analyzed using structural equation modeling. We evaluated a three latent factor model: OW (accelerometry and self-report); individual factors (balance; leg strength; walking self-confidence, speed and endurance; mental health; education; income; car access); and environmental factors (neighbourhood walkability components).

RESULTS

Mean age was 75 years; 73% were women. Individual factors was significantly associated with OW (β = 0.39, p < .01). Environmental factors was not directly associated with OW but was indirectly linked to OW through its significant covariance with the individual factors (β = 0.22, p < .01). The standardized factor loadings from the individual factors on walking self-confidence and walking capacity measures exceeded 0.65.

CONCLUSIONS

Better walking capacity and more confidence in the ability to walk outdoors are associated with higher OW in older adults. Better neighbourhood walkability is indirectly associated with more OW. The conceptual model demonstrates an individual and environment association; if the capacity of the individual is increased (potentially through walking interventions), they may be able to better navigate environmental challenges.

Community ambulation in older adults and people with OA - a model verification using Canadian Longitudinal Study on Aging (CLSA) data

BACKGROUND

There are health and well-being benefits of community ambulation; however, many older adults do not regularly walk outside of their home. Objectives were to estimate the associations between latent constructs related to community ambulation in older adults aged 65-85 (65+), and in adults with osteoarthritis (OA) aged 45-85.

METHODS

Secondary data analysis of the comprehensive baseline and maintaining contact questionnaire data from the Canadian Longitudinal Study of Aging (CLSA) was completed. Based on a previous model of community ambulation post-stroke, structural equation modeling (SEM) was used to develop measurement and structural models for two groups: older adults 65+ and people with OA. Multi-group SEM was conducted to test measurement invariance across sex and age groups. Measurement models were developed for the following latent factors: ambulation (frequency of walking outside/week, hours walked/day, ability to walk without help, frequency and aids used in different settings); health perceptions (general health, pain frequency/intensity); timed functional mobility (gait speed, timed up-and-go, sit-to-stand, balance). Variables of depression, falls, age, sex, and fear of walking alone at night were covariates in the structural models.

RESULTS

Data were used from 11,619 individuals in the 65+ group (mean age 73 years ±6, 49% female) and 5546 individuals in the OA group (mean age 67 ± 10, 60% female). The final 65+ model had a close fit with RMSEA (90% CI) = 0.018 (0.017, 0.019), CFI = 0.91, SRMR = 0.09. For the OA group, RMSEA (90% CI) = 0.021 (0.020, 0.023), CFI = 0.92, SRMR = 0.07. Health perceptions and timed functional mobility had a positive association with ambulation. Depression was associated with ambulation through negative associations with health perceptions and timed functional mobility. Multi-group SEM results reveal the measurement model was retained for males and females in the 65+ group, for males and females and for age groups (65+, < 65) in the OA group.

CONCLUSIONS

The community ambulation model post-stroke was verified with adults aged 65+ and for those with OA. The models of community ambulation can be used to frame and conceptualize community ambulation research and clinical interventions.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.

METHODS

GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.

RESULTS

All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.

CONCLUSIONS

This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

One-year changes in activities of daily living and social life in elderly patients undergoing home-based rehabilitation within 1 year of stroke onset

[Purpose] In this study, we investigated changes in activities of daily living and social participation over 1 year in elderly patients with stroke, who underwent home-based rehabilitation. [Participants and Methods] This 1 year, multicenter cohort study included patients aged ≥65 years with diagnosis of the first onset of stroke within 1 year. Variables recorded included the functional independence measure and performance qualifiers for "d6 domestic life" and "d9 community, social, and civic life" (social life) based on the International Classification of Functioning, Disability and Health framework. [Results] Of the 44 partients recruited at baseline, 19 completed the study over 1 year. We observed significant improvements in the functional independence measure-motor, functional independence measure-cognitive, and functional independence measure-total and in the performance qualifiers ("domestic life" and "social life") of the International Classification of Functioning, Disability and Health tool. We also observed that the functional independence measure-total scores improved over 3 months and "domestic life" and "social life" scores gradually improved over 1 year. [Conclusion] Our results showed that activities of daily living improved earlier than other variables, including social participation, which gradually improved over 1 year and that home-based rehabilitation may effectively improve activities of daily living and social participation.

A Randomized, Double-Blind, Controlled Trial Assessing If Medium-Chain Triglycerides in Combination with Moderate-Intensity Exercise Increase Muscle Strength in Healthy Middle-Aged and Older Adults

An adequate nutritional intake is recommended for the prevention of physical frailty and sarcopenia. In particular, medium-chain fatty acids (MCFAs) are reportedly important for muscle strength in nursing home residents. However, the effects of MCFAs on healthy adults at risk for frailty remain unknown. Hence, a randomized, placebo-controlled study was conducted to investigate the effects of 12 weeks of medium-chain triglycerides (MCTs) intake and walking on muscle mass and function in healthy, sedentary, middle-aged and older adults with a low body mass index. Three MCT intake groups with different amounts of octanoic and decanoic acid intake were compared with a control group. After 12 weeks, knee extension strength increased in all groups, with the increases in all MCT intake groups being significantly higher than those in the control group (p < 0.05). Grip strength significantly increased from baseline in the MCT 6 g/day intake group (p < 0.05). The combination of aerobic exercise and MCT intake may be effective in preventing decline in muscle strength and promoting increase in muscle strength as they can improve muscle energy production, thereby contributing to the maintenance of good health for middle-aged and older adults at high risk for frailty and sarcopenia.

Association between meaningful activities at home and subjective well-being in older adults with long-term care needs: A cross-sectional study

For this study, we examined whether engaging in meaningful activities at home is associated with subjective well-being (SWB) in older adults with long-term care needs according to their preference for going out. We distributed a self-administered questionnaire to long-term care facilities in Japan and performed a linear mixed-effects model regression analysis of the responses. The dependent variable was SWB, and the independent variables were the number of meaningful home activities, preference for going out, and the interaction between them. In our survey (n = 217), we found that both number of meaningful home activities (B = 0.43; 95%CI: 0.17, 0.70) and its interaction with preference (B = -0.43; 95%CI: -0.79, -0.08) were associated with SWB. These results suggest the importance of engaging in meaningful activities at home for older adults who do not prefer going out. We should encourage older adults to participate in activities that match their preference.

Characteristics of people seeking consultation after progressing to severe dementia: A mixed-method analysis

OBJECTIVES

This explores the characteristics of patients with worsening dementia who did not receive a specialized medical examination or care.

METHODS

This study utilized a mixed methods analysis. Of the 2712 people who received the Mini Mental State of Examination (MMSE) at the Community Consultation Center for Citizens with MCI and Dementia between December 2007 and December 2019, 1413 people who scored 23 points or less were included. Participants were categorized into mild, moderate, and severe groups, based on their MMSE scores. Participants' characteristics-gender, age, presence or absence of an escort, demographics, family type, and presence or absence of a family doctor-were compared between the groups. To further understand the severe group's characteristics, clinical psychologists recorded consultation forms were categorized.

RESULTS

More than 80% of the patients in each group had a family doctor. Moreover, all the severe groups had escorts, and the role of family members and supporters was important for the consultation. In the severe group, 29 patients had never received specialized medical care. Their characteristics were coded "non-existence" (fewer people or opportunities to notice their needs), "connection failure" (a lack of access or connections to consultations), and "evaluation failure" (not recognized as a problem requiring consultation).

CONCLUSIONS

It is necessary to improve primary physician education, disseminate knowledge, and raise awareness about dementia, besides building and strengthening networks to alleviate the isolation of dementia patients and their families. The psychological aspects of family members' denial regarding their family members with dementia must be addressed through intervention.

Older Adults' Frequency of Going Outside during the COVID-19 Pandemic: Associations with Physical Distancing, Health Status, and Fall Risk Factors

Research shows significant health benefits of going outside in late life. Using the 2019 and 2020 National Health and Aging Trend Study and its 2020 COVID-19 supplemental survey (N = 3,857, age 70+), we examined changes in the past-month frequency of going outside one's home/building during the COVID-19 pandemic in 2020 compared to the same time in 2019. We found that 57.0% reported no change in the frequency of going outside, 32.0% went out less frequently, and 11.0% went out more frequently. Logistic regression models showed that decreased frequency was associated with higher frequency of going outside in 2019, avoidance of contact with those outside their household (AOR = 1.51, 95% CI = 1.10, 2.06), dementia diagnosis, mobility device use, self-rated health (AOR = .85, 95% CI = .75-.97), and being 90+ years of age, female, non-Hispanic Black or Hispanic, divorced/separated. Older adults are likely to benefit from going outside more often when they can safely do so.

Association between instrumental activities of daily living frequency and clinical outcomes in older patients with cardiovascular disease

AIMS

Impairment in activities of daily living (ADL) is an independent predictor of poor prognosis in older patients. Nevertheless, the effects of instrumental ADL (IADL) frequency on prognosis in older patients with cardiovascular disease (CVD) are unclear. We investigate the associations between IADL frequency and all-cause mortality and hospital readmission due to cardiovascular events in older patients with CVD.

METHODS AND RESULTS

A total of 638 consecutive outpatients ≥65 years old with CVD were enrolled. A questionnaire, including Frenchay Activities Index (FAI) parameters, was used to determine IADL frequency at the start of the study as the baseline observation. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission for cardiovascular events. We examined the relationship between IADL frequency and each endpoint. Among the 632 patients evaluated {median age 74.0 [interquartile range (IQR) 70.0-78.0] years; 439 males}, there were 39 deaths and 105 cardiovascular events during the median follow-up period of 4.0 (IQR, 2.3-4.0) years. After adjusting for clinical confounding factors, the hazard ratios for all-cause mortality and cardiovascular events in the FAI points were 0.957 [95% confidence interval (CI), 0.920-0.996] and 0.973 (95% CI, 0.950-0.997), respectively.

CONCLUSION

A higher IADL frequency was independently associated with better outcomes in older patients with CVD, suggesting that the preservation of instrumental activities should be focused on as the components of cardiovascular rehabilitation.

Poor Health Behaviors among Housebound Japanese Community-Dwelling Older Adults Due to Prolonged Self-Restraint during the First COVID-19 Pandemic: A Cross-Sectional Survey

BACKGROUND

Prolonged self-restraining behaviors induced by the coronavirus disease 2019 (COVID-19) pandemic's containment measures can limit various positive health behaviors.

OBJECTIVE

We examined the decline in going-out and certain other positive health behaviors and investigated the relationship between excessive decreases in going-out frequency and declining engagement in positive health behaviors among community-dwelling older adults during the self-restraint period.

DESIGN

This study employed a cross-sectional survey design.

SETTING

This study was conducted in Nishi Tokyo City, Tokyo, Japan.

PARTICIPANTS

The participants were 294 respondents (150 women) aged 50 years and older who lived in public housing that were permitted to be surveyed during the self-restraint period.

MEASUREMENTS

Their pre-pandemic going-out frequency around February 2020 and going-out frequency during the self-restraint period starting in April 2020 were reported. We mainly assessed the existence of home health behaviors (i.e., exercise, in-person and phone conversations, and healthy diet). A self-report questionnaire was used to obtain data.

RESULTS

Going-out frequency decreased in 41.2% of the 294 respondents owing to the government's request for self-restraint. In total, 13 individuals had been going out less than one time per week (housebound) before the request. Of the 281 people who were not housebound before the government's self-restraint request, 13.9% were newly housebound. Newly housebound individuals were 5.3 times less likely to exercise, had 2.1 times fewer social contacts, and 2.6 times less balanced or healthy diets than those who maintained their frequency of going out.

CONCLUSIONS

Prolonged self-restraint due to the COVID-19 pandemic may lead to housebound status and poor health behaviors. Public health intervention is needed to prevent excessive self-restraint, along with new measures integrating information and communication technologies to enable older adults to live active lives.

Changes in Older Adults' Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors

OBJECTIVES

To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes.

METHODS

We used the 2019-2021 National Health and Aging Trend Study (NHATS) (N = 3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables.

RESULTS

In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency.

CONCLUSIONS

Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020.

CLINICAL IMPLICATIONS

Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

Acceptable walking and cycling distances and functional disability and mortality in older Japanese adults: An 8-year follow-up study

We prospectively investigated the association between acceptable travel distances (i.e., walking and cycling) and the incidence of functional disability and mortality among older Japanese adults. A baseline survey was conducted in 2013 among 7618 individuals aged ≥65 years in Kasama City, Japan, and they were tracked through the city's database until 2021. Acceptable travel distances were assessed using a questionnaire. Outcomes (i.e., functional disability and mortality) were gathered as binary (incident or not) with survival time. A multivariable-adjusted Cox proportional-hazards model indicated that shorter acceptable walking and cycling distances were markedly linked with higher risks of functional disability and mortality. In conclusion, acceptable distances of ≤500 m for walking and ≤1 km for cycling were associated with higher risks of functional disability and mortality among older adults.

Association between frequency of going out and mild cognitive impairment in community-dwelling older adults: a pilot study in frailty prevention groups

BACKGROUND

Clarifying the role of physical limitations in the relationship between frequency of going out and mild cognitive impairment (MCI) may be useful in supporting early detection and prevention of MCI. However, few studies have explored relatively active populations that are continuously active throughout the year. This study aimed to determine the relationship between frequency of going out and MCI among non-homebound older adults who participated in group activities to prevent frailty.

METHODS

This prospective cohort study used frequency of going out as the exposure and MCI as the outcome. The Touch Panel-type Dementia Assessment Scale and questionnaires about daily life were completed by 153 community-dwelling older adults aged ≥65 years participating in frailty prevention groups in a rural town. The baseline survey was conducted from December 2017 to March 2018 and analysed cross-sectionally. Follow-up surveys were conducted at 1- and 2-years and analysed longitudinally.

RESULTS

Univariate and binomial logistic regression analyses at baseline showed no association between MCI and frequency of going out in older adults with physical limitations. However, there was a significant association in older adults without physical limitations. A binomial logistic regression analysis of the frequency of going out at baseline and cognitive function at the 2-year follow-up showed no association between MCI and frequency of going out in older adults with physical limitations, but there was a significant association in those without physical limitations.

CONCLUSION

Our results suggest that frequency of going out may not be a useful indicator of MCI in older adults with physical limitations, although low frequency of going out may be an indicator of MCI in older adults without physical limitations.

The Effect of Physical Activity Interventions Carried Out in Outdoor Natural Blue and Green Spaces on Health Outcomes: A Systematic Review

In the last few years, interest about the natural environment and its influences on health conditions has been growing. In particular, physical activity interventions carried out in blue and green environment are being investigated as a potential strategy to increase health outcomes in people with and without chronic conditions. Many recent studies reported positive results, but a high number of these studies were focused on people with mental or physical disorders. In this scenario, the present systematic review, conducted according to the PRISMA statement, was aimed at investigating the existing evidence regarding the effects of physical activity interventions carried out in green-blue space settings involving healthy people. A literature search was performed through PubMed, Cochrane, Cinahl, and Psychinfo, and the quality of each study was assessed. Out of 239 identified articles, 75 full texts were screened. Six eligible studies showed an improvement in health outcomes, such as well-being, mood, and physical performance, in the experimental group compared with the control group. No exhaustive conclusion can be drawn based on available evidence. However, this systematic review highlighted the need to extend this kind of intervention to reveal more robust evidence that green and blue exercises benefit health.

Characteristics of Japanese Older Adults Whose Trunk Muscle Mass Decreased during the COVID-19 Pandemic

The coronavirus (COVID-19) pandemic significantly affected the physical and mental functions in older adults, resulting in "corona-frailty". This 2-year prospective study characterized changes in quantitative measures and corona-frailty among a cohort of community-dwelling older women. Changes were evaluated using face-to-face interactions with 39 Japanese women (mean age: 76.1 ± 5.9) in 2019 (pre-pandemic baseline) and 2021 (follow-up during the pandemic). Quantitative measurements of handgrip strength, walking speed, calf circumference, body composition, and background factors were evaluated. Body weight and trunk muscle mass significantly decreased at follow-up. Multiple regression analysis, using change in trunk muscle mass as the dependent variable and background factors as independent variables, identified that decrease in trunk muscle mass was associated with "being robust at baseline" and answering "Yes" to the question of "Do you go out less frequently compared with last year"? The 2-year trunk muscle mass change for each baseline frailty stage showed a significant decrease only in the robust group (-8.0%). The decrease in trunk muscle mass might be related to pandemic-induced lifestyle restraint, suggesting that robust older adults who are healthy and active should take measures that focus on trunk muscles to avoid "corona-frailty".

Social Detachment Influenced Muscle Mass and Strength during the COVID-19 Pandemic in Japanese Community-Dwelling Older Women

Social detachment due to coronavirus disease (COVID-19) has caused a decline in physical activity, leading to sarcopenia and frailty in older adults. This study aimed to compare muscle mass, strength, and function values in older women before and after the first wave of the COVID-19 pandemic (April-May 2020). Furthermore, changes in muscle measures across women who experienced different levels of impact on their social participation due to the COVID-19 pandemic were examined. Muscle mass (total, trunk, and appendicular muscle), grip strength, oral motor skills, social interactions (social network and participation), and social support were assessed in 46 Japanese community-dwelling older women (mean, 77.5 y; range 66-93 y) before and after the first wave of the COVID-19 pandemic. Trunk muscle mass significantly decreased after the first wave of the pandemic. When comparing changed values between the enhanced/maintained and reduced group during the pandemic, significant group difference was observed in trunk muscular mass, grip strength, and oral motor skills. Intriguingly, those who enhanced social participation had a positive change of grip strength values, showing that social participation might influence muscle function during the COVID-19 pandemic.

Outdoor Community Ambulation Interventions to Improve Physical and Mental Health in Older Adults: A Systematic Review and Meta-Analysis

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

A Cross-Sectional Study on the Characteristics of Physical Activity in Pre-Frail Older Adults

This cross-sectional study aimed to characterize the physical activity (PA) of older adults with pre-frail status by examining sedentary behavior (SB) and PA using triaxial accelerometer data, with non-frail older adults as the control group. In this study, we divided the study participants into older adults who regularly participated in self-initiated citizen group exercise activities and those who did not. Data were collected between September and December 2017. We analyzed data from 256 older adults (women: 86.3%) aged ≥65 years. The interaction effect of participation status (participation and non-participation group) and frailty status (pre-frail and non-frail group) for moderate-to-vigorous PA (F = 9.178, p = 0.003) and daily mean number of steps (F = 9.351, p = 0.002) was significant. For the participation group, there was no difference between pre-frail older adults and non-frail older adults regarding length of SB and PA time, indicating that PA level was maintained in the participating pre-frail older adults. In contrast, moderate-to-vigorous PA and daily mean number of steps were low in pre-frail older adults who did not participate in the activities. The opportunity to participate in self-initiated group exercise activities and other PAs in the community may help pre-frail older adults maintain their PA.

Multidimensional factors affecting homebound older adults: A systematic review

PURPOSE

To systematically identify the multidimensional factors affecting homebound older adults.

DESIGN

Systematic review.

METHODS

We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment.

FINDINGS

Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%.

CONCLUSIONS

The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses.

CLINICAL RELEVANCE

This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

Prevalence of and factors related to homebound and semi-homebound older adults in a rural area in Japan

AIM

The homebound status is associated with unhealthy factors and physical disability. However, the prevalence of those who may be at an earlier stage of the homebound status ("semi-homebound") is unclear. This study thus examines the prevalence of semi-homebound individuals and identifies the associated physical, psychological, and social factors.

METHODS

A cross-sectional study invited 1,157 participants aged 65 years and more in rural Japan. The mean age was 74.7 ± 6.8. The survey questionnaire accounted for different parameters, such as age, sex, homebound status, morbidity, instrumental activities of daily living (IADL), and mental health. Ordinal regression analysis examined participants' homebound status; socio-demographic characteristics; and physical, psychological, and social variables.

RESULTS

The prevalence of the homebound status was 0.11 (95%CI = 0.99-0.13), and the semi-homebound status was 0.30 (95%CI = 0.28-0.33). In the multivariable analysis, the homebound status was negatively associated with IADL (p < .001), mobility (p < .001), being alone during the day (p < .001), depression and anxiety (p < .05), and self-efficacy for going out (p < .001).

DISCUSSION

The prevalence of semi-homebound individuals was approximately 30%. Homebound and semi-homebound individuals were associated with older, female, IADL, functional fitness, being alone during the day, depression and anxiety, and self-efficacy for going out. In the case of psychical, psychological, and social factors, the semi-homebound individuals revealed that these indicators fluctuated between homebound and non-homebound. Our findings further focused on semi-homebound individuals at elevated risks of disability, thereby emphasizing the need for customized intervention. Geriatr Gerontol Int 2021; 21: 1033-1039.

Higher Activity and Quality of Life Correlates with Swallowing Function in Older Adults with Low Activities of Daily Living

INTRODUCTION

The aim of this study was to clarify the relationship among swallowing function, activity, and quality of life (QOL) in older adults with low activities of daily living (ADL).

MATERIALS AND METHODS

We conducted a cross-sectional study. In total, 271 Japanese adults aged over 65 years who underwent medical intervention at their residence (male: n = 107; female: n = 164; mean age = 84.6 ± 8.3 years) participated. We collected data regarding age, sex, body mass index (BMI), residence (their house/nursing home), activity status, consciousness level (eye response), history of aspiration pneumonia, other medical history, number of medication types, frequency of going out, and time spent away from bed. We judged consciousness level (eye response) using the Glasgow Coma Scale (GCS), calculated the Charlson comorbidity index, measured QOL using the short version of the Quality of Life Questionnaire for Dementia (short QOL-D), and assessed swallowing function using the Functional Oral Intake Scale (FOIS). To examine the relationship between scores for the FOIS and the other variables, we used the Spearman rank correlation coefficient and ordinal logistic regression analysis.

RESULTS

The FOIS was strongly correlated with BMI (ρ = 0.47), activity status (ρ = -0.60), GCS (ρ = -0.41), time spent away from bed (ρ = 0.56), scores for the short QOL-D (ρ = 0.40), weakly correlated with history of aspiration pneumonia (ρ = -0.27), and frequency of going out (ρ = 0.39). Results for the ordinal logistic regression analysis showed that the FOIS was associated with activity status, frequency of going out, time spent away from bed, and scores for the short QOL-D.

CONCLUSION

The swallowing function of older adults with low ADL was related to their QOL and activities, such as time spent away from bed and home. Thus, in rehabilitation programs for swallowing function in older adults, not only functional but also psychological approaches may prove effective.

Self-rated Changes of Health Status during Stay-at-home Orders among Older Adults Using the Long-term Care Insurance System of Japan: A Cross-sectional Study

OBJECTIVES

To reveal self-rated changes of health status during stay-at-home orders among older adults and to verify whether decrease in frequency of going outdoors during these orders was related to self-rated changes in health status.

METHOD

A self-completed questionnaire for older adults was provided in 2 dayservice facilities and a nursing station. We operationally defined health status with 4 domains (motor function, oral and swallowing function, depression, and social networks) and designed the questionnaire to determine self-rated changes in health status using factor analysis. After factor analysis, regression analyses were conducted. Dependent variable was each factor score (self-rated changes of health status), and independent variable was decrease in frequency of going outdoors.

RESULTS

Approximately 80% of participants answered that their health status had "worsened" in motor function (75.0%-87.2%). Moreover, more than 70% of participants answered "worsened" in "Feeling energy" and "Getting together and speaking with friends" (72.3% and 75.7%, respectively). Regression analyses demonstrated that, after adjusting for covariates, the decrease in frequency of going outdoors was related to self-rated changes of motor function and friend network.

CONCLUSION

During stay-at-home orders, older adults felt deterioration in their motor function, in feeling energy, and in their friend network, especially people who had decreased their frequency of going outdoors felt more deterioration in their motor function and in their friend network.

Do Community Social Capital and Built Environment Associate With Homebound in Older Adults? The JAGES Niigata Study

BACKGROUND

Homebound status is one of the most important risk factors associated with functional decline and long-term care in older adults. Studies show that neighborhood built environment and community social capital may be related to homebound status. This study aimed to clarify the association between homebound status for community-dwelling older adults and community environment-including social capital and neighborhood built environment-in rural and urban areas.

METHODS

We surveyed people aged 65 years and older residing in three municipalities of Niigata Prefecture, Japan, who were not certified as requiring long-term care. The dependent variable was homebound status; explanatory variables were community-level social capital and neighborhood built environment. Covariates were age, sex, household, marital status, socioeconomic status, instrumental activities of daily living, the Geriatric Depression Scale-15, self-rated health, number of diseases under care, and individual social capital. The association between community social capital or neighborhood built environment and homebound status, stratified by rural/urban areas, was investigated using multilevel logistic regression analysis.

RESULTS

Among older adults (n = 18,099), the homebound status prevalence rate was 6.9% in rural areas and 4.2% in urban areas. The multilevel analysis showed that, in rural areas, fewer older adults were homebound in communities with higher civic participation and with suitable parks or pavements for walking and exercising. However, no significant association was found between community social capital or neighborhood built environment and homebound status for urban older adults.

CONCLUSIONS

Community social capital and neighborhood built environment were significantly associated with homebound status in older adults in rural areas.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

A Scoping Review of Homebound Older People: Definition, Measurement and Determinants

Being homebound (HB) can affect people's physical and mental health by decreasing movement, which can itself be exacerbated by the deterioration of people's health. To break this vicious cycle of HB and being in poor health, it is necessary to identify and address the factors influencing HB status. Thus, we used a scoping review to identify an HB trend, focusing on the definition, measurements, and determinants of HB status. We analyzed 47 studies according to the five-stage methodological framework for scoping reviews. The common attribute of definitions of HB status was that the boundaries of daily life are limited to the home. However, this varied according to duration and causes of becoming HB; thus, the understanding of HB shifted from the presence or absence of being HB to the continuum of daily activity. Various definitions and measurements have been used to date. Many studies have focused on individual factors to analyze the effect of HB. In the future, it will be necessary to develop a standardized measurement that reflects the multidimensional HB state. In addition, it is necessary to utilize a theoretical framework to explore the social and environmental factors affecting HB.

Becoming One with Nature: A Nature Intervention for Individuals Living with Cancer Participating in a Ten-Week Group Exercise and Wellness Program

Positive outcomes for psychological and physiological health have resulted from a nature experience. However, evidence is limited for nature-based interventions and their effect on a cancer population. The purpose of this mixed-methods study was to determine if incorporating the One Nature Challenge (ONC) into a ten-week group exercise program (WE-Can) for individuals living with cancer could offer additional psychological and/or physiological benefits to those previously observed in WE-Can. For this study, two separate ONCs were implemented throughout two seasons (summer and winter) to formulate a ONC group (n = 18; 60 ± 12yrs). Previous WE-Can graduates were used as a control group (n = 160; 59 ± 11yrs) for this study. Psychological and physiological assessments were administered in a pre- and post-test. In addition, nature relatedness (NR; ones' relationship with nature) was measured at the beginning, middle, and end of WE-Can. Following five weeks, the ONC began and participants tracked the days they experienced nature for at least thirty-minutes (24 ± 6 days), for a thirty-day period. The ONC finished concurrently with WE-Can where post-evaluations and focus groups were administered immediately following. No additional gain in overall health was found between groups. However, aerobic fitness and fatigue significantly improved for the ONC group. This was supported by frequent activities and self-reported restoration of the mind while experiencing nature. In conclusion, the lack of overall improvement could be limited by sample size and the high level of NR prior to ONC, indicating participants were already 'one with nature.'

Association between instrumental activities of daily living with the change in left ventricular function in older patients with cardiovascular disease

Left ventricular dysfunction is a pathophysiologic characteristic of heart failure. Impaired instrumental activities of daily living are associated with an elevated risk of mortality and heart failure in older adults. Nevertheless, the relationship between these activities and left ventricular function changes remains unclear. We determined whether instrumental activities of daily living are associated with subsequent left ventricular function changes in older cardiovascular disease patients. This retrospective cohort study included 383 outpatients with cardiovascular disease (74.5 ± 5.3 years, 273 males). Patients were divided according to the Frenchay activities index tertile and followed for six months after cardiovascular disease diagnosis. The left ventricular ejection fraction and annular early diastolic velocity (e') were measured for left ventricular systolic and diastolic function, respectively, at baseline and after one year. After adjusting for confounders, changes in the left ventricular ejection fraction were not significantly different. However, changes in the e' in the highest tertile group were significantly greater than in other groups. In the general linear model with multiple regression analysis, Frenchay activities index independently predicted the absolute change in the e'. In older cardiovascular disease patients, higher instrumental activities of daily living were associated with preserved left ventricular relaxation.

Impact of Different Types of Physical Activity in Green Urban Space on Adult Health and Behaviors: A Systematic Review

This systematic review aimed to investigate the type of physical activity carried out in green urban spaces by the adult population and to value its impact on the population’s health. Additionally, another purpose was to examine if the presence of outdoor gyms in green urban spaces can promote participation in physical activity among adults. Searches of electronic databases, with no time restrictions and up to June 2020, resulted in 10 studies meeting the inclusion criteria. A quantitative assessment is reported as effect size. Many people practiced walking activity as a workout, which showed improvements in health. Walking is the most popular type of training due to its easy accessibility and it not requiring equipment or special skills. Outdoor fitness equipment has been installed in an increasing number of parks and has become very popular worldwide. Further, outdoor fitness equipment provides free access to fitness training and seems to promote physical activity in healthy adults. However, other studies about outdoor fitness equipment efficiency are needed. People living near to equipped areas are more likely to perform outdoor fitness than those who live further away. The most common training programs performed in green urban spaces included exercises with free and easy access, able to promote physical health and perception.

Changes in self-estimated step-over ability among older adults: A 3-year follow-up study

OBJECTIVES

There is a growing body of literature examining age-related overestimation of one's own physical ability, which is a potential risk of falls in older adults, but it is unclear what leads them to overestimate. This study aimed to examine 3-year longitudinal changes in self-estimated step-over ability, along with one key risk factor: low frequency of going outdoors (FG), which is a measure of poor daily physical activity.

METHOD

This cohort study included 116 community-dwelling older adults who participated in baseline and 3-year follow-up assessments. The step-over test was used to measure both the self-estimated step-over bar height (EH) and the actual bar height (AH). Low FG was defined as going outdoors either every few days or less at baseline.

RESULTS

The number of participants who overestimated their step-over ability (EH>AH) significantly increased from 10.3% to 22.4% over the study period. AH was significantly lower at follow-up than at baseline in both participants with low and high FGs. Conversely, among participants with low FG, EH was significantly higher at follow-up than at baseline, resulting in increased self-estimation error toward overestimation. Regression model showed that low FG was independently associated with increased error in estimation (i.e., tendency to overestimate) at follow-up.

DISCUSSION

The present study indicated that self-overestimated physical ability in older adults is not only due to decreased physical ability but also due to increased self-estimation of one's ability as a function of low FG. Active lifestyle may be critical for maintaining accurate estimations of one's own physical ability.

Outdoor exposure and perceived outdoor environments correlated to fear of outdoor falling among assisted living residents

BACKGROUND

Fear of falling is a major health concern among older adults. Although several studies have addressed general fear of falling in relation to personal factors, little is known about the specific relationship between fear of outdoor falling and perceptions of the outdoor environments.

PURPOSE

This study is to identify perceived environmental factors and outdoor exposure associated with fear of outdoor falling among assisted living residents aged 65 or older stratified by the amount of time spent outdoors.

METHODS

This study used survey data collected from a multiregional study conducted in 2007 that surveyed residents in 68 assisted living facilities in Houston, Texas; Chicago, Illinois; and Seattle, Washington. Out of 1,043 total participants, this study used a subset of 907 residents who used outdoor areas at least five minutes a day. Multivariate logistic regression was used after controlling for covariates.

RESULTS

Approximately 31% of the participants reported having worried about falling while using the outdoor areas in their assisted living community. Multivariate analyses showed that adequately designed walkways (OR = 0.614, 95% CI = 0.405-0.931), comfort levels in using outdoor areas (OR = 0.657, 95% CI = 0.437-0.989), and frequency of outdoor usage (OR = 0.538, 95% CI = 0.368-0.787) were associated with decreased fear of outdoor falling after adjusting for individual factors (i.e. age, sex, health condition, fall history, vision problems, mobility aids).

CONCLUSION

Improved walkways and comfort levels when using outdoor areas, as well as the amount of time spent outdoors, would be helpful in reducing fear of outdoor falling, which can help promote healthy lifestyle among assisted living residents.

Factors associated with social isolation and being homebound among older patients with diabetes: a cross-sectional study

OBJECTIVE

We aimed at investigating factors associated with social isolation and being homebound in older patients with diabetes.

DESIGN

Cross-sectional study.

SETTINGS

Those undergoing outpatient treatments at Ise Red Cross Hospital, Mie Prefecture.

PARTICIPANTS

Patients with diabetes aged ≥65 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Social isolation was defined as indulging in less than one interaction per week with individuals other than cohabiting family members. We defined homebound as going outside home less than once a day. To identify factors associated with social isolation and being homebound, we performed logistic regression analysis. The dependent variable was social isolation or homebound and independent variables were basic attributes, glycaemic parameters, complications and treatment details.

RESULTS

We analysed 558 cases (320 men and 238 women). Among these, 174 (31.2%) were socially isolated; meanwhile, 87 (15.6%) were homebound. The glycoalbumin/haemoglobin A1c ratio (OR 4.52; 95% CI 1.07 to 19.1; p=0.040) and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) scores (OR 0.72; 95% CI 0.57 to 0.90; p=0.006) had significant associations with social isolation. TMIG-IC scores (OR 0.78; 95% CI 0.66 to 0.92; p=0.003) and insulin use (OR 4.29; 95% CI 1.14 to 16.1; p=0.031) were associated with being homebound.

CONCLUSION

In older patients with diabetes, glycaemic fluctuations and insulin use are associated with social isolation and being homebound, respectively. In addition, a decline in higher level functional capacity is a common factor associated with social isolation and being homebound. Thus, it is important to pay attention to social isolation and being homebound when a decline in higher level functional capacity, increased glycaemic fluctuations and insulin use in older patients with diabetes are observed.

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan

Objective

To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults.

Methods

Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model).

Results

Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303−0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338−3.470).

Discussion

Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.

Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

BACKGROUND AND OBJECTIVES

The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories.

RESEARCH DESIGN AND METHODS

The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1-Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories.

RESULTS

Three trajectory groups were identified: the "never" group (65.5%) remained nonhomebound; the "chronic" group were largely persistently homebound (8.3%); and the "onset" group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the "onset" and "chronic" versus the "never" trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the "chronic" trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk.

DISCUSSION AND IMPLICATIONS

The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

Impact of physical, cognitive, and psychological functions on incident homebound status after discharge among hospitalized older patients: A clinical-based prospective study

PURPOSE

Physical and cognitive/psychological functions are risk factors for incident homebound status. However, there are only a few studies exploring the factors related to homebound status in hospitalized older patients. The aim of this study was to determine the relationship between physical, and cognitive/psychological function at discharge among hospitalized older patients and the risk of undergoing homebound status after discharge.

METHODS

We analyzed the cohort data of hospitalized older patients (age ≥65 years) with internal medical problems. The main outcome was the incidence of homebound status a month after discharge. Physical functions were measured by handgrip strength (HG), knee extension strength (KES), one-leg stance (OLS), and walking speed (WS). Cognitive and psychological functions were assessed using the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-5 (GDS-5), respectively. Poisson regression models were used to estimate the risk ratios (RR) and 95 % confidence intervals (CIs) of the relationships between physical, cognitive, and psychological functions as well as the homebound status.

RESULTS

A total of 178 participants who completed the follow-up were analyzed mean age (standard deviation) 76.2 (6.9) years. A month after discharge, 23 participants were deemed homebound, for a cumulative incidence (95 %CI) of 12.9 % (8.0 %-17.8 %). The RR (95 %CI) estimated by Poisson regression were 3.51 (1.30-9.48), 0.15 (0.03-0.72) and 0.11 (0.01-0.92) for low KES, maximum WS and comfortable WS, respectively. However, HG, OLS, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status.

CONCLUSION

Physical functions can predict the incidence of homebound status after discharge among hospitalized older patients.

Frequency of Social Isolation and Homeboundness and Their Relationships with High-Level Functional Capacity in Elderly Diabetic Patients

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.

Physical activity in people with dementia attending farm-based dementia day care - a comparative actigraphy study

BACKGROUND

Despite public focus on the importance of physical activity and findings showing the benefits of such activity, research has shown that people with dementia are less physically active and have more sedentary behaviour compared to others in similar age groups. In Norway, there is a focus on day care services as a means to allow people with dementia to experience social, physical and cultural activities. Farm based services have been highlighted as an innovative and customized day care service, but little research has been done on physical activity and such services. This study therefor aims to investigate the potential of farm-based day care services as services that can promote physical activity for people with dementia.

METHODS

Actigraphy data from people with dementia attending farm-based day care services (n = 29) and people with dementia attending regular day care services (n = 107) was used to assess levels of physical activity in each group and to compare the two groups.

RESULTS

People attending farm-based day care had significantly higher levels of moderate activity, approximately 23 min each day, compared with persons attending ordinary day care (p = 0.048). Time spent in sedentary or light activity were similar for both groups. For the group attending farm-based day care services, days at the service, were significantly associated with less time spent in sedentary activity (p = 0.012) and more time spent in light (p < 0.001) and moderate activity (p = 0.032), and in taking more steps (p = 0.005) compared to days not at the service.

CONCLUSION

The findings indicate that participants in farm-based day care for people with dementia have higher levels of physical activity compared to ordinary day care and that farm-based day care increases levels of physical activity for its attendees. Farm based day care services has the potential to help their participants reach or maintain recommended levels of physical activity. Further research is needed to investigate what facilitates this increase in activity and how such knowledge could be used in all types of day care services.

Changes in social participation and life-space mobility in newly enrolled home-based rehabilitation users over 6 months

[Purpose] This study aimed to examine whether we were able to measure changes in social participation and life-space mobility of newly enrolled home-based rehabilitation (HR) users by using the activities and participation components of the International Classification of Functioning, Disability and Health (ICF) and Life-Space Assessment (LSA) over a 6-months period. [Participants and Methods] We enrolled 47 HR users who had suffered from a stroke or other condition within the previous year. A 6-month prospective cohort study was conducted. The performance qualifiers “d6 domestic life” and “d9 community, social and civic life” in the activities and participation components of the ICF and LSA were used. [Results] We observed significant improvements in the performance qualifier “d9 community, social and civic life” of the ICF over 3 months, and the LSA over a 6-months period. We also identified significant improvements in “d910 community life” and “d920 recreation and leisure” of the ICF. The LSA results showed that HR users had more frequent mobility within the neighborhood. [Conclusion] This study showed that newly enrolled HR users improved their social activities in the community, recreational activities, and life-space mobility over a 6-months period. These were measured using performance qualifiers from the ICF and LSA.

Healthy lifestyle behaviors and transitions in frailty status among independent community-dwelling older adults: The Yabu cohort study

Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events.

The importance of stroke as a risk factor of cognitive decline in community dwelling older and oldest peoples: the SONIC study

Background

Cognitive impairment is a major health concern among older and oldest people. Moreover, stroke is a relevant contributor for cognitive decline and development of dementia. The study of cognitive decline focused on stroke as the important risk factor by recruiting older and oldest is still lagging behind. Therefore, the aim of this study was to investigate the importance of stroke as a risk factor of cognitive decline during 3 years in community dwelling older and oldest people.

Methods

This study was longitudinal study with a 3-year follow-up in Japan. The participants were 1333 community dwelling older and oldest people (70 years old = 675, 80 years old = 589, and 90 years old = 69). Data collected included basic data (age, sex, and history of stroke), vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and current smoking), and social factors (educational level, frequency of going outdoors, long-term care (LTC) service used, and residential area). The Japanese version of the Montreal Cognitive Assessment (MoCA-J) was decline of ≥2 points was defined as cognitive decline. Multiple logistic regression analysis was used to investigate the association between stroke and other risk factors with cognitive decline during a 3-year follow-up.

Results

The fit of the hypothesized model by multiple logistic regression showed that a history of stroke, advanced age, and greater MoCA-J score at the baseline were important risk factors, while the presence of dyslipidemia and a higher educational level were protective factors that were significantly correlated with cognitive decline during the 3-year follow-up.

Conclusions

The cognitive decline after the 3-year follow-up was influenced by the history of stroke and advanced age, while greater MoCA-J score at the baseline was positively associated with subsequent 3 years cognitive decline. The protective factors were the presence of dyslipidemia and a higher educational level. Therefore, these factors are considered important and should be taken into consideration when searching for creative solutions to prevent cognitive decline after stroke in community dwelling older and oldest people.

Effectiveness of community organizing interventions on social activities among older residents in Japan: A JAGES quasi-experimental study

Social activities in the community help older adults maintain functional ability. Community organizing, based on the assessment of health risks, community assets, and fostering intersectoral organizational partnerships, could increase participation opportunities. Supporting municipality staff members in building their capacity to take those actions might benefit them. Nevertheless, the effectiveness of such support remains unclear. This real-world-setting study evaluated the effectiveness of providing support for municipality health sectors in relation to older residents’ social activities.

Based on the Japan Gerontological Evaluation Study (JAGES), a nationwide study of community-dwelling older adults, from 2013 to 2016 researchers collaborated with health sector staff members in 13 participating municipalities (intervention group) in utilizing the JAGES-based community assessment data and building organizational partnerships. The remaining 12 municipalities (control) obtained the data only. We analyzed the longitudinal data of 47,106 older residents, performing a difference-in-differences (DID) analysis, weighted by the inverse of propensity to be selected for the intervention group, allowing for a multilevel (municipality/individual) data structure.

In the intervention group, the estimated group participation prevalence in men increased by 10.4 percentage points from 47.5% to 57.9%, while in the control group, participation increased by 7.9 percentage points from 47.2% to 55.0% (DID estimated = 0.025, P = 0.011). No statistically significant difference between the two groups was observed among women (P = 0.131).

Support for community organizing may improve group participation among older male residents. The community-attributable impact could be large, given that the intervention has the potential to work for all older residents in the municipality.

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Older men participated more where researchers and health sector collaborated well.

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The effects were specifically strong for participation in leisure activity groups.

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Community organizing might encourage older men to engage in social activities.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people

BACKGROUND

As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility.

AIMS

We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people.

METHODS

Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA.

RESULTS

General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations.

CONCLUSIONS

Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

[A homebound status is related to a reduction of meal intake in older outpatients, independent depressive mood and their physical function]

AIM

We aimed to investigate the relationship between the frequency at which patients went out and the reduction of meal intake among older outpatients who did not require care.

METHODS

The subjects were outpatients of ≥65 years of age who visited the department of geriatric medicine in our hospital for the first time. We analyzed 463 subjects (male, n=184; female, n=279), after excluding patients who had dementia, required care, lived in a nursing home, or had an acute disease.The outcome measure was the reduction of meal intake (a moderate or higher decrease in the patient's meal intake in the past 3 months). The independent measure was homebound status (going-out less than once a week). The covariates were sex, age, number of medications, and Kihon Checklist (categories of undernutrition, oral function, physical function, and mood). A logistic regression analysis was performed.

RESULTS

The average age was 79.6±5.9 years in men, 79.9±6.1 years in women. Among the participants, 104 (22.5%) had a homebound status. In the logistic regression analyses, a homebound status was significantly associated with a reduction in meal intake, even after adjustment for potential confounding factors, including depressive mood and a low physical function (OR: 2.0; 95% CI: 1.1-3.6).

CONCLUSIONS

A homebound status in older outpatients was related to a decline in their meal intake, independent of depressive mood and a low physical function. A reduction in meal intake leads to a lack of energy and results in malnutrition. Our results suggest that assessing the frequency at independently living older outpatients go out is important for the early prevention of malnutrition.

Effect of watching professional baseball at a stadium on health-related outcomes among Japanese older adults: A randomized controlled trial

AIM

Watching sports at stadiums can have a favorable impact on health-related outcomes in older adults. We examined the effect of watching professional baseball at a ballpark on older adults' health-related outcomes.

METHODS

A total fo 58 participants aged 65-85 years were randomized into a spectator group (n = 29) and waiting-list group (n = 29). During the 2-month intervention, there were 21 games. The spectator group watched games at the ballpark, and the waiting-list group maintained their daily routines. The health-related outcomes were executive and cognitive functions, health-related quality of life, depression symptoms, subjective happiness and physical activity.

RESULTS

The median days watching baseball games in the spectator group was 6 days (interquartile range 4-10 days). Executive function using the reverse Stroop interference rate showed a non-significant trend of improvement in the spectator group compared with the waiting-list group (P = 0.063). The spectator group showed a significant reduction in depressive symptoms compared with the waiting-list group (P = 0.016).

CONCLUSIONS

Regularly watching professional baseball at a ballpark reduced older adults' depression symptoms. Geriatr Gerontol Int 2019; 19: 717-722.