Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

AIMS/INTRODUCTION: We aimed to clarify the effectiveness of the Diabetic Nephropathy Aggravation Prevention Program in Japan by comparing the diabetes-related medical visit behavior of individuals under the municipal national health insurance according to insurers' effort levels. MATERIALS AND METHODS: We assessed changes in medical visit behavior according to insurers' effort levels, "Full Efforts," "Some Efforts" and "No Effort," using longitudinal data from the National Database of Health Insurance Claims and Specific Health Checkups before 2015 and after 2018 regarding the national health insurance programs in Japan. We analyzed the effect of the Diabetic Nephropathy Aggravation Prevention Program using a generalized linear mixed model for 208,388 participants with diabetes. RESULTS: The additive effect on medical visit behavior was significantly higher for insurers with "Full Efforts" than for those with "No Effort;" the coefficient (log odds ratio) was 0.159 (95% confidence interval 0.063-0.256). The additive effects on medical visit behavior sizes for the people with hemoglobin A1c ≥7.0%, positive urinary protein and systolic blood pressure ≥140 mmHg were 0.508, 0.402 and 0.232, respectively, which were larger than the overall effect size (0.159) for insurers with "Full Efforts." CONCLUSIONS: Our findings showed that insurer efforts had an additive effect on the increase in the number of medical visits, suggesting that this national program could reduce the number of end-stage renal failures or dialysis in Japan.

DOI： 10.1111/jdi.14006

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1111/ggi.14571

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.14571

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system ("Tokuteikenshin" program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the "Tokuteikenshin" program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.

DOI： 10.1038/s41440-023-01185-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1111/ggi.14537

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1002/1348-9585.12389

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/1348-9585.12389

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

AIM: The purpose of this study was to examine the relationship between glycemic control and mental health in community-dwelling older people with diabetes mellitus (DM) from insights that contribute to the management of diabetes in consideration of quality of life (QOL). METHODS: We used the data of the Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC) study, a prospective cohort study of community-dwelling older people. The present study included 2,051 older subjects of 70±1 years, 80±1 years and 90±1 years of age. We conducted medical interviews, blood sampling, and the subjects were asked to complete a questionnaire (WHO-5-J) at the venue. Three hundred sixty-eight people were diagnosed with DM. The subjects of this study were 192 people who were undergoing drug therapy for glycemic control. A multiple regression analysis was performed to clarify the relationship between glycemic control (divided as follows: HbA1c<7.0%, good control group; HbA1c≥7.0%, poor control group) and the WHO-5-J score, as the dependent variable, after adjusting for any confounding factors. RESULTS: In subjects of 70 years of age, a negative association was found between glycemic control and the WHO-5-J score, with the good control group showing a significantly lower score (β: -0.468, p<0.01) in comparison to the poor control group. In detail, we observed a significant difference in the sub-items of WHO-5-J, question item 3, "I have felt active and vigorous" at 70 years of age (good control group, 2.56±1.37; poor control group, 3.21±1.18; p=0.021) and question item 5, "My daily life has been filled with things that interest me" (good control group, 2.44±1.21; poor control group, 3.11±1.11; p=0.009). As for the two questions, the WHO-5-J scores were lower in the good control group. These associations showed no statistical significance at 80 years of age or 90 years of age. CONCLUSION: The results obtained in this study indicated that strict glycemic control management of diabetes mellitus may lead to a lower mental QOL in younger elderly individuals (70 years of age). Therefore, it is important to pay attention to the mental burdens of the management of glycemic control in older people with DM.

DOI： 10.3143/geriatrics.60.141

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Aim: The purpose of this study was to examine the association among body mass, blood pressure (BP), and cognitive functioning for octogenarians and centenarians. Methods: A total of 300 participants (221 centenarians and 79 octogenarians) from the Georgia Centenarian Study were included in this study. Demographic variables included age, gender, and ethnicity. Body mass was measured with the body mass index (BMI), and systolic and diastolic BP, as well as mean arterial pressure (MAP) and the Mini-Mental Status Examination (MMSE) were assessed. Results: Results showed age differences indicating that centenarians had lower BMI and MMSE scores when compared to octogenarians. Women had lower cognitive functioning scores compared to men. Black Americans had higher BMI and BP as well as lower MMSE scores. Participants with low BMI values (< 18.5 kg/m2) and normal BP had a significantly lower MMSE score when compared to those with elevated BMI values (≥ 25 kg/m2 to < 30 kg/m2) and high BP. Multiple regression analyses determined that age, gender, ethnicity, and BMI were significantly associated with cognitive function in very late life. Conclusions: The results suggest that extreme values of body mass (low and high) in combination with normal BP (< 130 mmHg) are potential risk factors for compromised cognition.

DOI： 10.37349/emed.2023.00165

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Objective: We aimed to determine whether the association of sleep status with frailty differs between age groups of older adults. Method: This cross-sectional study was part of the observational Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Subjects were community-dwelling older adults in their 70s and 80s. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria (J-CHS). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep status. Poor sleep quality was defined as a PSQI global score ≥6. Sleep duration was categorized as short (<6 hr), normal (6-8), and long (>8). We performed multivariable logistic regression to investigate the association between sleep status and frailty separately for each age group adjusted for multiple covariates. Results: In those in their 70s, long sleep duration and sleep medication use were independently associated with frailty. In those in their 80s, poor sleep quality was independently associated with frailty. Conclusions: The association between sleep status and frailty was different between age groups. The findings underscore the importance of incorporating the evaluation of sleep quantity and non-pharmacological therapies in those in their 70s and the evaluation of sleep quality in those in their 80s to help prevent the onset of frailty.

DOI： 10.1177/23337214231205432

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Some studies reported that home blood pressure (HBP) monitoring was conducted by community-dwelling older people themselves, but there have been few studies on HBP including very old populations aged over 90 years old. Thus, the aim of the present study was to clarify the current situation of white-coat and masked phenomena defined by on-site and home BP measurements in community-dwelling old and oldest-old populations. The study subjects were 380 participants from the SONIC study, a cohort study of a community-dwelling old population, who measured their HBP in a series of 3–5 days by themselves and brought their HBP records to the venue on the survey day. Study participants’ characteristics were as follows: female, 185 (48.7%); male, 195 (51.3%); 70s, 95 (25.0%); 80s, 245 (64.5%); and 90s, 40 (10.5%). A total of 344 (90.5%) participants had hypertension. A total of 291 (76.6%) hypertensive participants taking antihypertensive medication were analyzed in the present study. Regarding the types of hypertension defined by home and on-site BP, they showed white-coat phenomenon, 183 (48.2%); masked phenomenon, 115 (30.3%); sustained hypertension, 130 (34.2%); and normotension, 82 (21.6%). On comparison of age groups, there was a tendency for the white-coat phenomenon to be common in young-old people in their 70s and the masked phenomenon to be common in very old people in their 90s. Therefore, since the detection of white-coat and masked phenomena is closely associated with appropriate BP management, it is very important for community-dwelling older populations to self-monitor HBP.

DOI： 10.1155/2022/5359428

Other URL： http://downloads.hindawi.com/journals/ijhy/2022/5359428.xml

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: To answer whether older adults' cognitive function benefits from ICT use, we (1) examined the relationship between ICT use and cognitive decline during the COVID-19 pandemic and (2) explored the potential role of ICT use in mitigating the relationship between loneliness, social isolation, and cognitive decline among community-dwelling older adults. METHODS: From February to March 2021, a mail survey was distributed to 1,400 older adults aged 70-89 years old. Responded participants were 1,003 (71.6% response rate). Subjective cognitive decline (SCD) was the independent variable. ICT use was assessed based on ICT use history and current ICT use activities. Loneliness was based on the Japanese version of the Three-Item Loneliness Scale. Social isolation was a total score of six items. Covariate-adjusted logistic regressions were performed and stratified by age groups (70-79 and ≥ 80 years). RESULTS: During the COVID-19 epidemic, the proportion of people aged ≥ 80 years who reported cognitive decline was twice that of 70s. Non-ICT use was independently associated with a higher risk of cognitive decline in participants aged ≥ 80 years. Furthermore, the significant associations between cognitive decline and interaction items (non-ICT use by loneliness or social isolation) were observed in the ≥ 80 age group. No association was found in the 70-79 age group. CONCLUSIONS: Non-ICT users with high loneliness or social isolation scores were more likely to experience cognitive decline for adults age ≥ 80 years. For older adults who were vulnerable to poor social relationships, ICT use is potentially an efficient intervention. Further longitudinal investigations are needed.

DOI： 10.1186/s12877-022-03061-z

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

AIM: The aim of this study was to clarify the association between dietary protein intake and decline in the estimated glomerular filtration rate (eGFR) among Japanese older adults. METHODS: We used the data of the Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC) study, an ongoing narrow-age range cohort study: 69-71 years, 79-81 years and 89-91 years. The outcome variable, change in eGFR, was estimated from serum creatinine measured at the baseline and 3-year follow up, and the exposure variable, protein intake, was calculated using the brief-type self-administered diet history questionnaire at the baseline. Associations between eGFR change and protein intake were determined by multiple linear regression analysis. RESULTS: The mean eGFR change per year was -1.89 mL/min/1.73 m2 . The mean protein intake was 1.50 g/kg/day. The results of this study showed that there was no significant association between protein or animal protein intake and change in eGFR per year in the entire population of participants, including the very elderly, but there was a significant positive association in those whose renal function fell into chronic kidney disease stage G3 or G4. CONCLUSIONS: Protein intake among community-dwelling older adults was not associated with lower eGFR, and for older chronic kidney disease patients, protein and animal protein intakes were more beneficial in maintaining eGFR. The results provide evidence that protein intake should not be restricted for older patients with chronic kidney disease, including the very elderly. Geriatr Gerontol Int 2022; 22: 286-291.

DOI： 10.1111/ggi.14355

PubMed

Publishing type：Research paper (scientific journal)  

Background:

Older adults were expected to experience a decline in physical activities and an increase in social isolation during the COVID-19 pandemic.

Methods:

We investigated the changes in living conditions of 508 older adults (79.70 years ± 0.88) before (from July to December 2019) and during (in August 2020) the pandemic. We compared the mean score for the same individual instrumental activities of daily living (IADL), frequency of going out, exercise, and social interaction at two-time points. We also examined the influence of living arrangement (living alone or not) on the frequency of exercise and social interaction.

Results:

The frequency of going out decreased during the pandemic (in 2020); however, there was no significant change in IADL. The frequency of exercise and social interaction increased irrespective of the living arrangement. The frequency of exercise increased more in those living alone.

Conclusions:

Although older adults refrained from going out, they compensated for the risks of inactivity in daily life by increasing or maintaining their frequency of exercise and social interactions. The view that “older adults have a poor ability to accommodate the lifestyle changes during the COVID-19 pandemic” may be a stereotypical assumption.

DOI： 10.1177/23337214221116226

Other URL： http://journals.sagepub.com/doi/full-xml/10.1177/23337214221116226

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: The relationship between moderate alcohol drinking or other alcohol drinking patterns such as frequency, beverage type, and situation of drinking and cognitive function is not sufficiently clear in older people. The purpose of this study was to investigate the association between alcohol drinking patterns and cognitive function in community-dwelling Japanese people aged 75 and over. METHODS: This study was a cross-sectional design based on a prospective cohort study called the SONIC study. Subjects were older people aged 75-77 or 85-87 who voluntarily participated in 2016-2017. Drinking information was collected for daily drinking frequency, daily drinking intake, beverage type, and non-daily drinking opportunity. Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Other potential confounding factors evaluated were age, sex, medical factors, and psychosocial factors. An analysis of covariance was performed to evaluate the MoCA-J score relative to drinking frequency or alcohol intake. Multiple regression analysis was performed to investigate the association between beverage type or non-daily drinking opportunity and the MoCA-J score. RESULTS: The final number of participants analyzed was 1,226. The MoCA-J score for participants who reported drinking alcohol 1-6 days/week was significantly higher than that for those who reported drinking none or every day. No significant difference in the MoCA-J score was observed relative to daily alcohol intake. In terms of beverage type, wine was associated positively with the MoCA-J score. Non-daily drinking opportunity was also associated positively with the MoCA-J score. CONCLUSIONS: Moderate-frequency drinking, wine consumption, and non-daily drinking opportunities were associated with higher cognitive function in community-dwelling Japanese aged 75 and over. Further longitudinal studies are needed to clarify the causal relationships.

DOI： 10.1186/s12877-022-02852-8

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

目的:新型コロナウイルス感染症の感染拡大を防ぐため,我が国では2020年4月から5月にかけ緊急事態宣言が発令され,外出自粛や人との接触を減らすことが奨励された.これにより,特に高齢者の心身機能への影響が懸念されたため,後期高齢者を対象に,活動量の主観的な変化について,年代,地域別に把握すること,またその関連因子を検討することを目的とした.方法:高齢者長期縦断疫学研究(SONIC研究)に参加している地域在住高齢者に郵送アンケート調査を実施し,自粛期間中(4,5月頃)の活動量,やる気の低下等について尋ねた.活動量減少についての集計を年齢コホート・地域別に行い,活動量減少に関連する要因についてロジスティック回帰分析を用いて検討した.結果:有効回答が得られた1,785名(回答率75.2%)のうち,分析対象者は70歳コホート753名,80歳コホート496名,90歳コホート293名の計1,542名であった.活動量が減少したと回答したのは70歳コホートで68.1%,80歳コホートで65.3%,90歳コホートで56.0%,地域別には都市部で69.4%,非都市部57.7%であった.活動量減少にはやる気が起きないことと新型コロナウイルスへの不安が強く関連したとともに,70歳・80歳コホートでは都市部で活動量減少が多かった.90歳コホートでは地域の影響は減弱し,経済状況にゆとりがないことと2年前の歩行速度1m/s以上であることが活動量減少に有意な関連を認めた.結論:活動自粛に伴う影響は年代,地域で異なっていた.コロナ禍での生活不活発による健康への悪影響を予防するためのアプローチは都市部においてより重要性が高いことが示唆された.また,90歳以上の超高齢群では元の身体状況や経済状況など70,80代とは異なる要因が活動量低下に関連することが明らかとなった.(著者抄録)

Other URL： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01214&link_issn=&doc_id=20211208220009&doc_link_id=10.3143%2Fgeriatrics.58.591&url=https%3A%2F%2Fdoi.org%2F10.3143%2Fgeriatrics.58.591&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The G allele of FOXO3 gene (Single nucleotide polymorphism - SNP; rs2802292) is strongly associated with human longevity. However, knowledge of the effect of FOXO3 in older populations, men or women, with heart disease is limited. This cross-sectional study in Japan included 1836 older adults in the 70 and 80-year-old groups. DNA samples isolated from buffy coat samples of peripheral blood were used to genotype FOXO3 (rs2802292). Self-reports were used to obtain heart disease data according to physician diagnosis. Multiple logistic regression was used to test the association by adjusting for the traditional risk factor of heart disease. The prevalence of heart disease in women FOXO3 G allele carriers was higher than non-carriers (16.7 vs. 11.6%, p=.022). The prevalence of coronary heart disease was lower for FOXO3 G carriers in the 70-year-old group for both sexes (men: 9.3 vs. 4.3%, p=.042, and women: 10 vs. 9%, p=.079, respectively). The G allele was negatively associated with heart disease after adjusting for diabetes, hypertension, dyslipidemia, and smoking in men (odds ratio (OR)= 0.70, 95%confidence intervals (CI), 0.49-0.99, p=.046), although the association was weaker after full adjustment. In contrast, women carriers of the FOXO3 G allele showed a positive association with heart disease after total adjustment (OR= 1.49, 95%CI, 1.00-2.21, p=.049). In conclusion, the longevity associated G allele of FOXO3 was observed to have contrasting associations with heart disease prevalence according to sex in older Japanese. To further confirm this association, a longitudinal study and a large sample size will be required.

DOI： 10.1093/gerona/glab204

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: Physical function is a strong predictor of the adverse outcomes of cardiovascular disease in older populations. However, studies of healthy older people on the prevention of coronary heart disease (CHD) are very limited. OBJECTIVES: We prospectively examined the association of walking speed and handgrip strength with CHD in the community-dwelling older populations. METHODS: The study cohort in Japan included 1272 older people free from heart disease at the baseline. Physical function was identified based on walking speed and handgrip strength assessment at the survey site. Any new case of CHD was identified based on a self-reported doctor's diagnosis. Cox-proportion hazard models were adjusted for covariate factors to examine the CHD risk. RESULTS: During the 7-year follow-up, 45 new cases of CHD (25 men and 20 women) were documented. Slow walking speed was strongly associated with CHD risk after adjusting for all confounding factors in the total participants and women (hazard ratio (HR)= 2.53, 95%confidence interval (CI), 1.20-5.33, p=0.015, and HR= 4.78, 95% CI,1.07-21.35, p=0.040, respectively), but not in men. Weak grip strength was associated with CHD after age-adjustment (HR= 2.45, 95%CI, 1.03-5.81, p=0.043) only in men. However, after additional multivariate adjustment, the associations were getting weaker.

DOI： 10.1016/j.archger.2021.104386

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Despite clear evidence of the benefits of lowering blood pressure among patients with hypertension, the treatment rate remains <40% worldwide. In the present trial, we aimed to investigate the effects of the early promotion of clinic visits among patients with untreated hypertension detected during annual health checkups. This was a worksite-based, parallel group, cluster-randomized trial with blinded outcome assessment. Employees of 152 Japanese supermarket stores found to have untreated hypertension (blood pressure levels ≥ 160/100 mmHg) during health checkups were assigned to an early promotion group (encouraged to visit a clinic in face-to-face interviews and provided with a referral letter to a physician as well as a leaflet) or a control group (received usual care), according to random assignment. The primary outcome was the completion of a clinic visit within 6 months. Odds ratios with 95% confidence intervals for the early promotion group versus the control group were estimated using multilevel logistic regression with random effects of clusters. A total of 273 participants (mean age 50.3 years, 55% women) from 107 stores were assigned to the early promotion group (138 from 55 stores) or control group (135 from 52 stores). During the 6-month follow-up, 47 (34.1%) participants in the early promotion group visited a clinic, as did 26 (19.3%) in the control group (odds ratio 2.33, 95% confidence interval 1.12-4.84, P = 0.024). Early promotion using a referral letter during health checkups significantly increased the number of clinic visits within 6 months completed by participants with untreated hypertension (UMIN000025411).

DOI： 10.1038/s41440-020-00559-0

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

Aim: We examined the effect of “IkiIki Hyakusai Taiso” as way to prevent the physical decline in community-dwelling elderly in Nose Town, Osaka Prefecture. Methods: Participants were community-dwelling elderly who participated in the Preventive Care program “IkiIki Hyakusai Taiso” from October 2015 to June 2019 in Nose Town, Osaka Prefecture, Japan. They performed exercises once a week. An as-sessment of the physical function, basic health checklist, and questionnaire about daily life were collected. Frailty was determined based on responses to the basic health checklist. Results: A total of 1,028 community-dwelling elderly people participated in this project. There were 766 (74.5%) women. The mean age of the participants was 72.6 ± 8.0 years old, and 506 participants (49.2%) were part of the young-old generation. The physical function measurement values, including the 5-meter walking speed, time up and go test (TUG), 5 times sit to stand, and grip strength all significantly improved. Ninety percent of the participants participated in this program every time it was held. Regarding the self-rated health questionnaire, the rate of “feeling good due to participating in the program” increased from 29.1% to 45.4% after participating in this program for 6 months. The prevalence of partial social activities was mostly an increasing trend among the participants of this program. Conclusion: Our findings showed that “IkiIki Hyakusai Taiso” improves and maintains the physical function and self-rated health among community-dwelling elderly individuals. Therefore, “IkiIki Hyakusai Taiso” seems to be a very useful preventive care program in the community.

DOI： 10.3143/geriatrics.58.459

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1111/ggi.14081

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.14081

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

BACKGROUND: Preventing the need for long-term care (LTC) by identifying physical function risk factors are important to decrease the LTC burden. The objective of this study was to investigate whether grip strength and/or walking speed, which are components of the frailty definition, are associated with LTC in community-dwelling older and oldest people. METHODS: The participants were 1098 community-dwelling older and oldest people who had not received LTC at the baseline. The endpoint was receiving LTC after the baseline survey. The independent variables were grip strength and walking speed, and participants were divided into two groups based on these variables. The confounding factors were age, sex, the Japanese version of the Montreal Cognitive Assessment (MoCA-J), hypertension, diabetes mellitus, stroke, joint diseases, living alone, body mass index, and serum albumin. We calculated the hazard ratio of receiving LTC using the Cox proportional hazard model. RESULTS: Among the 1098 participants, 107 (9.7%) newly received LTC during the follow-up. Regarding the physical function, only slow walking speed was significantly correlated with LTC after adjusting for all confounding factors except the MoCA-J score (HR = 1.74, 95% CI = 1.10-2.75, P = .018). However, slow walking speed was still a risk factor for LTC after adjusting for the MoCA-J score and other confounding factors (HR = 1.64, 95% CI = 1.03-2.60, P = .037). CONCLUSIONS: The findings from this study may contribute to a better understanding of slow walking speed as a factor related to LTC, which might be a criterion for disability prevention and could serve as an outcome measure for physical function in older people.

DOI： 10.1186/s12199-020-00884-3

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

【目的】特定健康診断を受検し、特定保健指導積極的支援に該当した者の中で、中性脂肪(TG)の基準に該当した対象者(TG≧150mg/dl)の特徴とTG値に対する特定保健指導の効果を検討することを目的とした。【方法】医療保険者155施設から収集したデータを用いた。2011年度に特定健診を受検して特定保健指導の積極的支援に割り付けられ、さらに翌年の特定健診を受診し、かつ服薬なしであった52,958名(男性82.8%)を解析の対象とした。TG基準該当者のうち、TG500mg/dl未満をTG高値者、500mg/dl以上をTG異常高値者とした。男女別に、TG基準非該当者と該当者、TG高値者と異常高値者の特性を比較した。また、それぞれの翌年のTG値を比較した。【結果】積極的支援該当者の中でTG基準該当者は男女ともに約半数を占めており、生活習慣としてはエネルギー過剰摂取につながるような、早食い、夕食後間食という食習慣がある男性が多く、運動習慣(男性のみ)・身体活動習慣がある者の割合が低いという特徴が明らかとなった。さらにTG異常高値者においては、高値者と比較して男性のみに高い喫煙率とハイリスク飲酒、就寝前夕食が関連していることが明らかとなった。保健指導のTGに対する効果は、減量達成した場合には特にTG減少量が大きくなることが認められた。またTG150ml/dl以上である場合は、BMI低下と独立したTG低下効果が認められ、さらに異常高値群では喫煙・飲酒の改善がTG減少量と関連を示した。【結論】保健指導積極的支援において、TG高値者およびTG異常高値者の特徴が明らかとなった。また特定保健指導にはTG低下効果があり、減量達成や喫煙・飲酒の改善が得られることによって、よりTG低下を促進する可能性が示唆された。今後は生活習慣の変化を踏まえた更なる検討が必要である。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Despite the clinical usefulness of self-measured home blood pressure (BP), reports on the characteristics of home BP have not been sufficient and have varied due to the measurement conditions in each study. We constructed a database on self-measured home BP, which included five Japanese general populations as subdivided aggregate data that were clustered and meta-analyzed according to sex, age category, and antihypertensive drug treatment at baseline (treated and untreated). The self-measured home BPs were collected after a few minutes of rest in a sitting position: (1) the morning home BP was measured within 1 h of waking, after urination, before breakfast, and before taking antihypertensive medication (if any); and (2) the evening home BP was measured just before going to bed. The pulse rate was simultaneously measured. Eligible data from 2000 onward were obtained. The morning BP was significantly higher in treated participants than in untreated people of the same age category, and the BP difference was more marked in women. Among untreated residents, home systolic/diastolic BPs measured in the morning were higher than those measured in the evening; the differences were 5.7/5.0 mmHg in women (ranges across the cohorts, 5.3-6.8/4.7-5.4 mmHg) and 7.3/7.7 mmHg in men (ranges, 6.4-8.5/7.0-8.7 mmHg). In contrast, the home pulse rate in women and men was 2.4 (range, 1.5-3.7) and 5.6 (range, 4.6-6.6) beats per minute, respectively, higher in the evening than in the morning. We demonstrated the current status of home BP and home pulse rate in relation to sex, age, and antihypertensive treatment status in the Japanese general population. The approach by which fine-clustered aggregate statistics were collected and integrated could address practical issues raised in epidemiological research settings.

DOI： 10.1038/s41440-020-0530-1

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1038/s41440-020-0499-9

Other URL： http://www.nature.com/articles/s41440-020-0499-9

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

AIM: The incidence of anemia increases with aging, and it is considered to affect mortality through complex pathophysiological outcomes. Although it has been suggested that self-rated health may also contribute to the prognosis of anemia in older people, the relationship between anemia and self-rated health is not well understood. This study thus examined the actual status of anemia in older community-dwelling Japanese people and clarified the relationship between anemia and self-rated health. METHODS: We conducted medical interviews, physical measurements and blood testing in 2083 people aged 69-91 years who participated in the long-term observational Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Subjects were divided into two groups according to whether they had anemia. Logistic regression analyses were used to assess the relationship between anemia and self-rated health after adjusting for possible confounding factors. RESULTS: The prevalence of anemia was 22.3% in all participants, 7.2% in men and 11.6% in women aged 69-71 years, 27.4% in men and 26.3% in women aged 79-81 years, and 55.8% in men and 44.9% in women aged 89-91 years. Multivariate analysis revealed a correlation between the presence of anemia and poor self-rated health in all (odds ratio 0.67, 95% confidence interval 0.48-0.93) and aged 69-71 years (odds ratio 0.47, 95% confidence interval 0.25-0.86). CONCLUSIONS: Anemia was associated with self-rated health in older Japanese people, suggesting that careful management of anemia may contribute to health and longevity. Geriatr Gerontol Int 2020; ••: ••-••.

DOI： 10.1111/ggi.13945

PubMed

Publishing type：Research paper (scientific journal)  

AimIn recent years, support for coexisting diabetes treatment and work (Ryoritsu Shien) has become increasingly important for employees with diabetes. It is important to identify factors associated with dropout from outpatient visits for diabetes treatment among employees with diabetes to determine appropriate support to prevent dropout. Therefore, we explored work-related, personal, and diabetes-related factors relevant for dropout from outpatient diabetes treatment visits among Japanese employees with diabetes.MethodsThis cross-sectional study was conducted in 2018. Participants were 140 full-time employees with type 2 diabetes aged over 40 years. Participants were classified into two groups: a dropout group and a continuation group. Work-related, personal, and diabetes-related factors were evaluated using a self-administered questionnaire and specific health checkup data.ResultsOf the 140 employees with diabetes, 12 (8.6%) were classified in the dropout group. Multivariable logistic regression analysis revealed three factors associated with a lower risk for dropout from diabetes treatment outpatient visits. These were: high supervisor support, as measured by the Job Content Questionnaire (multivariable-adjusted odds ratio [OR] 0.71, 95% confidence interval [CI] 0.52-0.97, per 1 score); older age (multivariable-adjusted OR 0.79, 95% CI: 0.66-0.95, per 1 year); and presence of metabolic syndrome (multivariable-adjusted OR 0.04, 95% CI 0.01-0.28, presence vs. absence).ConclusionsOur findings suggest that supervisor support, age, and metabolic syndrome are important factors related to dropout from outpatient diabetes treatment visits among Japanese male employees with diabetes.

DOI： 10.1007/s13340-019-00420-x

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85-87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = -0.36, p = 0.034) and diastolic BP (b = -0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.

DOI： 10.1038/s41440-019-0377-5

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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.

DOI： 10.1186/s12877-020-1423-5

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Despite the wide use of automated devices for the self-measurement of home blood pressure (BP), no evidence is available regarding the accuracy of such devices in oldest-old populations. The aim of this study was to validate the accuracy of the automated oscillometric upper arm-cuff BP-monitoring device according to an international protocol in oldest-old individuals. In 35 participants aged over 85 years old, BP was measured on the same arm sequentially using a mercury sphygmomanometer (by two observers) and an Omron HEM-7080IC. The difference between the test device and observer measurements and associated factors were evaluated according to the International Organization for Standardization (ISO) 81060-2:2013 protocol. A total of 105 pairs (three pairs per participant) of the test device and observer BP measurements were obtained. The mean (±standard deviation: SD) differences in systolic BP (SBP) and diastolic BP (DBP) between the methods were -0.7 ± 7.1 and -1.1 ± 4.5 mmHg, respectively, and those for each participant were -0.7 ± 5.8 mmHg for SBP and -1.1 ± 4.1 mmHg for DBP; the device therefore fulfilled the requirements of the ISO protocol. In the multivariate analysis with the linear mixed model, the difference was associated with the cuff size for SBP and pulse pressure for DBP. The Omron HEM-7080IC passed the ISO requirements for oldest-old individuals aged 85 years or older. This device can be recommended for clinical and self/home use in oldest-old populations.

DOI： 10.1038/s41440-019-0330-7

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

© 2020 Japan Geriatrics Society Aim: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. Methods: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. Results: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13–2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75–0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81–0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72–0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82–0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. Conclusions: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2020; ••: ••–••.

DOI： 10.1111/ggi.14002

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Aim Understanding work-related factors associated with regular exercise in employees could be useful for determining appropriate interventions to prevent the onset and aggravation of diabetes. This study aimed to assess the associations among work-related stress and mental fatigue, and regular exercise in Japanese employees with or without diabetes. Methods This cross-sectional study was conducted in 2018, and included 2916 full-time employees aged older than 40 years without cardiovascular disease, cancer, respiratory disease, kidney disease, disc herniation, and depression. Work-related stress was measured by the Job Content Questionnaire and work-related mental fatigue was measured using the Numerical Rating Scale (NRS). Results Regular exercise was present in 23.9% of 117 employees with diabetes and in 21.3% of 2799 employees without diabetes. In employees with diabetes, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for regular exercise were 0.26 (0.07-0.96) in those with an NRS score of 4-6 (moderate) and 0.22 (0.06-0.85) in those with an NRS score of 7-10 (severe) compared with those with an NRS score of 0-3 (none or mild), after adjusting for confounding factors. Similarly, in employees without diabetes, the multivariable-adjusted ORs (95% CIs) for regular exercise were 0.77 (0.62-0.97) in those with an NRS score of 4-6 and 0.75 (0.59-0.94) in those with an NRS score of 7-10 compared with those with an NRS score of 0-3. Conclusions Work-related mental fatigue was negatively associated with regular exercise in employees with and without diabetes.

DOI： 10.1007/s13340-019-00410-z

<title>Abstract</title>
Objectives Physical frailty is geriatric syndrome and can increase the risk of adverse outcome in the older population. Heart diseases are associated with physical frailty but a few studies in community-dwelling old population. Therefore the aim of this study was to examine the association between heart diseases, social factors, and physical frailty in community-dwelling older populations including the oldest old people. Methods The cross-sectional study included 1882 participants in community-dwelling older and oldest-old people in three age groups: 73 (±1), 83 (±1), and 93(±1) from both urban and rural areas of Japan. Questionnaires on medical history, psycho-social factors, blood samples, physical examinations, the hand grip strength test, and gait speed were measured at the venue. Physical frailty was defined based on a slow gait speed or weak grip strength. Heart diseases were assessed by self-reported questionnaires. Social interaction was based on the frequency of going outdoors and direct social contact. Analyses were conducted mainly using multiple logistic regression with adjustments for physical frailty risk factors. Results Heart disease subjects had a higher prevalence of physical frailty than those without heart disease (slow gait speed: 69.6 vs. 56.2%, p&lt;.001; slow gait speed or weak grip strength: 80 vs. 69.6%, p=.002). After adjusting the covariate factors, heart diseases were associated with a slow gait speed (OR=1.5; 95%CI: 1.03-2.20, p=.035). Social interaction was associated with a slow gait speed (frequency of going outdoors: OR=0.87, 95%CI 0.79-0.9, p=.008; frequency of direct social contact: OR=0.88, 95%CI 0.82-0.95, p=.001), a weak grip strength (frequency of going outdoors: OR=0.86, 95%CI 0.77-0.96, p=.005), and with physical frailty (frequency of going outdoors: OR=0.84, 95%CI 0.75-0.94, p=.002; frequency of direct social contact: OR=0.89, 95%CI 0.82-0.97, p=.007). Living alone and frequency of direct social contact were associated with physical frailty among heart disease patients. Conclusions Our findings indicate that in community-dwelling older people, heart diseases and social interaction were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct social contact were associated with physical frailty. Future research must involve a longitudinal study to clarify the causal relationship.

Other Link： https://www.researchsquare.com/article/rs-13772/v1.html