Biomedical subjects

Shu Kumagai

Publications and source records attributed to Shu Kumagai.

18 recordsLinked to original sources

PubMed2006

[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].

OBJECTIVE: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community. METHODS: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification. RESULTS: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females. CONCLUSIONS: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

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PubMed2006

[Physical activity level and physical, mental and social factors in community-dwelling elderly people].

PURPOSE: This study was conducted to examine the relationship between physical activity level (PAL) and physical, mental and social factors in community-dwelling elderly people. METHODS: The subjects comprised 428 residents aged 70 or over living in Kusatsu-machi, Gunma, who took part in an interview and tests of physical fitness as part of the "NIKKORI-KENKOSODANJIGYO". Data for 330 out of the 428 residents were adopted for this study. The PAL was evaluated with a questionnaire developed by Naito et al. (2003). Subjects were interviewed on physical, mental and social functioning including the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence and cognitive function (Mini Mental State Examination: MMSE). Physical fitness tests included assessment of handgrip strength, usual and maximal walking speed, and one-leg standing balance with eyes open. RESULTS: Correlations between PAL and the TMIG Index of Competence, physical (e.g. physical fitness), mental (e.g. depression) and social (e.g. roles at home) factors, and smoking status were significant by ANCOVA adjusted for age and sex. Analysis using a general linear model indicated that smoking status, usual walking speed, depression, roles at home, frequency of going outdoors and visual impairment all together explained 13.5% of the PAL variance. CONCLUSION: The findings indicate that PAL in the community-dwelling elderly aged 70 years or over is associated with physical, mental and social factors.

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PubMed2005

Arterial pulse wave velocity as a marker of poor cognitive function in an elderly community-dwelling population.

BACKGROUND: Knowledge about potentially modifiable risk factors for cognitive decline is limited at this time. The aim of this study was to determine the cross-sectional relationship between a low level of cognitive function and brachial-ankle pulse wave velocity (baPWV) in a community-dwelling elderly population. METHODS: The study population included 352 community-dwelling Japanese persons ages 70 years and older who participated in a comprehensive health examination in April 2003. None had any history of cardiovascular disease. In addition to conventional medical examinations such as blood pressure and routine blood analyses, cognitive function was tested using the Mini-Mental State Examination (MMSE), and baPWV was determined using a recently developed noninvasive and automatic arterial waveform analyzer (AT-Form). This measure, with well-established validity and reproducibility, reflects both central and peripheral arterial flow. A multivariate logistic regression model tested the possible association between poor cognitive function (an MMSE score < 24) and baPWV. RESULTS: Poor cognitive function was independently associated with the middle tertile of baPWV (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 1.15 to 80.93), age (1-year increment; OR = 1.12, 95% CI = 1.04 to 1.22), and the highest tertile of pulse pressure (OR = 4.70, 95% CI = 1.08 to 20.48) even after multivariate adjustment of data for the effects of age, educational level, and hemodynamic and metabolic antecedents of atherosclerosis. CONCLUSIONS: A high baPWV may be a potent risk factor for poor cognitive function in an elderly community-dwelling population, and this effect is independent of another marker of arterial stiffness: pulse pressure.

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PubMed2005

Glycated hemoglobin levels and intellectual activity in an aged population.

OBJECTIVES: To examine the association between glycated hemoglobin (GHb) and aspects of daily activities in an elderly population. DESIGN: Cross-sectional population-based survey. SETTING: Nangai village, an agricultural community with a population of about 5,000 located in Akita prefecture in the north of Japan. PARTICIPANTS: Nine hundred thirty-five people aged 65 and older. MEASUREMENTS: GHb percentages, self-reported measures of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), intellectual activity (IA), and social role (SR). RESULTS: An exploratory analysis indicated that nondiabetic subjects in the lowest tertile of GHb tend to have lower IA than those in the middle tertile, if they were aged 70 and older. No consistent association appeared between GHb and ADLs, IADLs, or SR. Linear and logistic regression analyses, controlling for other risk factors, indicated significantly lower IA scores in the low and high GHb tertiles (P<.001 and P=.04, respectively) than in the middle in nondiabetic subjects aged 70 and older and without stroke history or IADL impairments. The value of GHb related to the maximal IA score was 5.0% to 5.2% as the middle tertile; or 5.2%, assuming a logistic regression model including a squared term with GHb as a continuous variable. A similar relationship was observed in the whole nondiabetic sample aged 70 and older but not in the younger counterpart. CONCLUSION: There is an inverted U-shaped relationship between GHb and intellectual activity in older people without diabetes mellitus. One possible interpretation is that suboptimal blood glucose could contribute to intellectual inactivity in older people.

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PubMed2005

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

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PubMed2005

[Prognosis of different types of homeboundness among community-living older adults: two-year prospective study].

PURPOSE: This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders. METHODS: Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n = 1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline. RESULTS: At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%) . As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE < 20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05[0.54-7.75] in the fully adjusted model). CONCLUSIONS: Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

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PubMed2005

[Predictors for the onset of different types of homeboundness among community-living older adults: two-year prospective study].

BACKGROUND: Little is known about predictors for the onset of different types of homeboundness among community-living older adults. PURPOSE: This 2-year prospective study examined predictors for the onset of "type 1" and "type2" homeboundness (see definitions below) among community-living older adults. METHODS: Study subjects comprised all residents aged 65 years and over living in Yoita town, Niigata, Japan, who answered the baseline (2000) and follow-up (2002) surveys. Persons were defined as being homebound if he/she went outdoors once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e., level 3 or over). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., level 1 or 2). A stepwise, multiple logistic regression model was used to identify the most parsimonious combination of risk factors for each type of homeboundness. RESULTS: Out of 1,322 persons who were level 1,2 non-homebound at the baseline, 77.6% remained as level 1,2 non-homebound (n = 1,026), but 1.7% were "type 1" homebound (n = 22), and 4.8% were "type 2" homebound (n = 66) at follow-up. The final model for prediction of "type 1" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 2.10; 95%CI: 1.36-3.24), not having a job (OR: 4.42; 95%CI: 1.21-16.2), unable to walk 1 km (OR: 4.24; 95%CI: 1.37-13.1), and a low cognitive function identified as MMSE <24 (OR: 5.22; 95%CI: 1.98-13.8). The final model for prediction of "type 2" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 1.65; 95%CI: 1.32-2.06), a depressive mode indicated by a GDS short version score >5 (OR: 2.18; 95%CI: 1.23-3.88), a low cognitive function (OR: 2.72; 95% CI: 1.47-5.05), not having close friends (OR: 2.30; 95%CI: 1.08-4.87), and not having a walking or calisthetics habit (OR: 2.21; 95%CI: 1.26-3.86). CONCLUSIONS: Reduced physical and mental functioning contribute to the subsequent occurrence of "type 1" homeboundness. Additionally, psychosocial factors are independent predictors of "type 2" homeboundness. These results suggest that different public health strategies might be required for prevention of the different types of homeboundness in Japanese older adults.

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PubMed2004

Relationships between brachial-ankle pulse wave velocity and conventional atherosclerotic risk factors in community-dwelling people.

BACKGROUND: A simple instrument has been developed to measure brachial-ankle pulse wave velocity (baPWV). The aim of the present study was to use this instrument to study the relationship between baPWV and conventional atherosclerotic risk factors. METHODS: Community-dwelling Japanese (632) living in a rural area (234 men and 398 women) participated in a municipal medical health survey that included baPWV measurement and a traditional clinical examination, conducted in June, 2002. RESULTS: Men had a significantly higher baPWV than women. No interaction between gender and age on baPWV was identified. Multiple linear regression analysis indicated that age, hemodynamic factors (diastolic blood pressure, pulse pressure, and heart rate), hemoglobinA1c, current drinking and smoking status, and mild retinal changes had significant independent influences on higher baPWV. CONCLUSIONS: In this rural population, age, gender, and hemodynamic factors were independently associated with baPWV, along with traditional atherosclerotic risk factors, although no significant associations between baPWV and histories of atherosclerotic diseases or subclinical atherosclerosis except for mild retinal changes were demonstrated.

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PubMed2004

[The frequency of going outdoors, and physical, psychological and social functioning among community-dwelling older adults].

PURPOSES: This cross-sectional study examined the relationship between the frequency of going outdoors and physical, psychological, and social functioning among community-dwelling older people. METHODS: Out of all residents aged 65 and over residing in Yoita town, Niigata prefecture (n = 1,673), 1,544 living at home participated in an interview survey held in November 2000. Physical, psychological, and social functioning were compared among four groups defined by the frequency of going outdoors: (1) at least once a day, (2) about once per 2-3 days, (3) about once a week, and (4) seldom. To examine the independent association between the frequency of going outdoors and potential factors, we used multiple logistic regression analysis. RESULTS: Overall distribution of the frequency of going outdoors among the subjects was 76.3% for at least once a day, 13.1% for about once per 2 or 3 days, 3.7% for about once a week, and 6.9% for seldom. The frequency of going outdoors did not differ between genders, but showed significant decrease with advancing age in both sexes. Elderly going outdoors more often were less functionally impaired, scored less for depression and were more socially active than their counterparts going outdoors less often. Multiple logistic regression analysis with the forced entry method identified walking difficulty and fear of falls as the most powerful independent factors associated with going outdoors less than or equal to once a week, while low social activity and a more depressed score were important factors associated with going outdoors about once per 2-3 days. CONCLUSIONS: The frequency of going outdoors may be regarded as a generic health indicator among community-dwelling elderly people.

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PubMed2004

[Present state of social participation and associated factors among middle-aged and older people--a survey in Hatoyama Town, Saitama Prefecture].

BACKGROUND: Many studies have documented that social participation is beneficial for maintaining autonomy and quality of later life. However, little is known about present state of social participation in the Japanese elderly and effective means for its promotion. PURPOSE: To establish what factor might promote social participation in later life, this study was performed to examine the present state of social participation and a number of parameters among middle-aged and older people living in a Japanese community. METHODS: The subjects comprised 1,568 residents aged 55 to 79 years, a 1/3 random sample selected from the total population of this age group in H town, Saitama Prefecture. They were requested to answer the questionnaire delivered by mail. We examined the level of social participation from four aspects: work, social and volunteer activities, individual pursuits and study activities, and analyzed possible associations with demographic, socio-economic, health-, and community-related variables by multiple regression analysis. RESULTS: A total of 964 persons answered the questionnaire (61.5% response rate). Age and gender were associated with each of four social activity domains. Living arrangements (with or without spouse) were independently associated with social and volunteer activity, and study. Educational attainment positively correlated with work and individual pursuits. Residents in a newly constructed town-region were less likely to engage in work, social and volunteer activities, and study than their counterparts living in an older town-region. Those who had a stronger sense of co-living in the community, and who would like to keep their social activity level, were more likely to participate in social and volunteer, as well as study activities and also individual pursuits. People feeling that the municipality should support social activities among residents had a higher level of study activity. CONCLUSIONS: These results show that cultivating a sense of co-living in the community among residents and maintaining their motivation are needed for promoting social participation among older residents. To what extent public support should meet potential needs of social participation remains for further study.

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PubMed2004

[Risk factors associated with onset of urinary incontinence in a community-dwelling elderly population: a 4-year follow-up study].

OBJECTIVE: To estimate the risk factors associated with onset of urinary incontinence in a rural community-dwelling elderly population. METHODS: The study area, village N in Akita Prefecture, is a rural community in which a baseline survey of TMIG-LISA (Tokyo Metropolitan Institute of Gerontology, Longitudinal and Interdisciplinary Study on Aging) was undertaken in 1996. Among the baseline subjects, 760 (314 males and 446 females) community-dwelling elderly people aged over 65, who did not suffer from urinary incontinence at entry of the survey were selected. This cohort has been followed for four years by multi-dimensional medical examination including interviews and physical performance tests, conducted on a yearly basis using similar methods to these for the baseline survey. RESULTS: After the 4-year follow-up, the incidence of urinary incontinence was 7.0% (22/314) in men and 12.3% (55/446) in women. The urinary incontinence group (UIG) had a significantly higher age and lower level of functional fitness at baseline for both sexes. In the UIG, the men but not the women had significantly lower serum levels of albumin and total cholesterol. By the logistic model, age (per 1-year increase: OR = 1.23, 95%CI: 1.11-1.38), and serum albumin (per 0.1 g/dl increase: OR = 0.70, 95%CI: 0.54-0.88) in men; and grip strength (per 1-kg increase: OR = 0.92, 95%CI: 0.86-0.98), social role (per 1-point decrease: OR = 1.81, 95%CI: 1.19-2.73), BMI (per 1-kg/m2 increase: OR = 1.10, 95%CI: 1.01-1.20) and smoking status (never smoker = 1.00, 3 = current smoker: OR = 7.53, 95%CI: 1.36-41.63) in women were independent variables significantly associated with onset of urinary incontinence. CONCLUSIONS: Lifestyle and functional fitness are significantly associated with onset of urinary incontinence in this population. Our findings suggest that intervention programs are needed to improve pelvic floor muscle and to provide social support for the elderly.

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PubMed2003

[Factors related to discrepancy in evaluation on functional capacity between reports by community-dwelling older people with cognitive decline and their family members].

Overestimation or underestimation of functional capacity in community-dwelling older people with cognitive impairment was evaluated between the responses of subjects and family members (proxies) by cognitive function level. Out of all the residents aged 65 years and over living in Yoita town, Niigata Prefecture in 2000 (n = 1,673), 1,544 voluntarily participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items (2000/11). According to the age of the subject and MMSE score, we defined cognitive decline (MMSE scores < 1 SD below age-specific means, n = 371). 158 pairs among 371 subjects with cognitive decline and their proxies participated in a follow-up survey (2001/11). The subjects themselves underwent MMSE again. 136 subject-proxy pairs reported any complaints of memory-related problem and evaluated higher-level functional capacity (TMIG-IC, Tokyo Metropolitan Institute of Gerontology Index of Competence). We established criteria at follow-up survey as follows: control (n = 29), MMSE scores > 1 SD below age-specific means and CDR (Clinical Dementia Rating) = 0: mild cognitive decline (MCD) (n = 54), 21 < or = MMSE scores < 1 SD below age-specific means or CDR = 0.5); and severe cognitive decline (SCD) (n = 53), MMSE scores 20 < or = CDR > 0.5. SCD subjects significantly overestimated total and Instrumental Self-Maintenance scores in TMIG-IC more than control or SCD subjects. Multiple logistic regression analyses indicated that complaints of memory by the proxy, response by spouse, and higher levels of education were extracted as significantly independent variables affecting overestimation for functional capacity. On the other hand, aging affected underestimation.

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PubMed2003

[Comprehensive health examination ("Otasha-Kenshin") for the prevention of geriatric syndromes and a bed-ridden state in the community elderly. 1. Differences in characteristics between participants and non-participants].

PURPOSE: We conducted a comprehensive mass health examination for elderly subjects aged 70 or above, living in the community, to assess early deterioration to long-term care conditions and promote healthy and successful aging ("Otasha-Kenshin"). In this study, we clarified characteristic differences between participants and non-participants. SUBJECTS & METHODS: A mass health examination was offered in October 2001 to 863 community elderly, including individuals suffering from falls (and fractures), incontinence, malnutrition, depression, mild cognitive impairment and less of functional capacity. Among the total, 438 (50.8%) opted for the "Otasha-Kenshin" examination. Differences in characteristics between the participants and non-participants were examined, parameters including sex and age distribution, self-rated health, functional capacity by the TMIG Index of Competence, depressed status by the General Health Questionnaire (GHQ), subjective well-being by the Philadelphia Geriatric Center Morale Scale: A revision (PGC-MS), frequency of falls, and prevalence of chronic diseases. The comparison was based on the results of measurements from the final survey conducted in 2000. RESULTS: 1) The participation rate in the "Otasha-Kenshin" was 49.0% in males and 51.0% in females. The average age was 75.3 year olds in participants and 76.4 in non-participants, the difference being significant (t = 3.97, P < 0.0001). 2) Non-participants had a significantly lower level of self-rated health than participants. 3) There was no significant difference in hand grip strength between participants and non-participants. 4) Non-participants showed significantly lower level of functional capacity and subjective well-being, and they were more likely to be in a depressed state than participants. 5) There was no significant difference in fall rate between participants and non-participants. 6) The prevalence of hypertension and diabetes (found in more than 5% among the subjects surveyed in 2000) was not significantly different between participants and non-participants. CONCLUSION: With aging of society, new and specialized health maintenance systems for the elderly are essential, both for the prevention of deterioration to a long-term care condition (a bed-ridden status) and for the promotion of successful aging with autonomy. Participants in "Otasha-Kenshin" appear to be healthier and more independent than non-participants who were more frail and at higher risk group of a long-term care condition and a bed-ridden status. The major reason for non-participation in the health examination found in this study was subjective or mental deterioration rather than the presence of chronic illness or any geriatric syndrome per se. Frail elderly people like the non-participants in this study should be encouraged and mentally supported to avoid aggravation of their health status through intensive or specialized health surveillance system such as home-visit nursing.

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PubMed2003

[Test-retest variation in the Tokyo Metropolitan Institute of Gerontology Index of Competence in community-dwelling older people independent in daily living toward individual assessment of functional capacity].

OBJECTIVES: To assess individual variation in the functional capacity of community-dwelling older people who are almost independent in daily living, using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-Index of Competence). METHODS: Out of 74 elderly outpatients showing a total score of TMIG-Index of Competence above 10 points at baseline, 61 who remained stable during subsequent two months in terms of medical and social aspects were assessed for their functional capacity with the test-retest method using the TMIG-Index of Competence. We assessed individual variation between the tests of one month interval with correspondence rate. RESULTS: The ranges for score differences within which correspondence rates of 95% and over applied were as follows: within 1 point for the total score of the Index (95.1%), 0 point in the Instrumental Self-Maintenance subscale (IADL) (95.1%), and 1 point in the Intellectual Activity subscale (Intellectual Activity) (98.4%) and the Social Role subscale (Social Role) (98.3%). CONCLUSIONS: The variation of 1 point for the total score of the Index, and subscales of Intellectual Activity and Social Role was regarded as a possible measurement error. In other words, variations of 2 points and over for total score, subscales of Intellectual Activity and Social Role, and variations of 1 point and over for IADL should not be ignored in screening of functional capacity among older people.

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PubMed2003

[Toward constructing a system for detecting and coping with senile dementia in early stages among community-dwelling older people].

OBJECTIVES: To establish a community health care system for screening community-dwelling older people with mild cognitive decline (MCD) and early diagnosis by a medical specialist. METHODS: Out of all the elderly residents aged 65 years and over living in Yoita town in 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent a Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires covering socio-demographic, psychological, physical and medical, and social activity items (2000/11). We defined cognitive decline as an MMSE < or = 1 SD below the age-specific mean (n = 371). Out of a total eligible population of 332, 158 pairs of subjects and their proxies participated in a follow-up survey (2001/11). The subjects themselves underwent MMSE again, and were asked for complaints of memory-related problems. Proxies answered about functional capacity and memory-related problems of subjects, for which we assessed the level of dementia with the Clinical Dementia Rating (CDR). We established criteria for encouragement to undergo detailed examination by a medical specialist as follows. 1) MMSE scores < or = 1 SD below age-specific means at both baseline and follow-up surveys, or 2) CDR > or = 0.5, and 3) not due to mental retardation. RESULTS: Non-participants had significant higher MMSE scores but were younger in the follow-up survey. Out of 96 subjects eligible for the detailed examination, 47 participants showed a tendency for older age with lower MMSE scores or younger age with higher MMSE scores than the average in the follow-up survey. The detailed examinations confirmed dementia of Alzheimer's type in 22 and vascular dementia in 13 on DSM-IV or magnetic resonance imaging. During our screening, 8 community care saloons were opened and the number of facilities for older people with cognitive decline is increasing. CONCLUSIONS: To establish a community health care system to screen and cope with community-dwelling older people with MCD in earlier stages, increased awareness of residents with slight MCD is especially important. Our attempt also suggested the importance of educational lectures, methods for testing cognitive function, and dementia care activity.

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PubMed2003

[Cognitive function as the factor determining higher-level competence in community-dwelling elderly: comprehensive health examination for the community elderly for the prevention of the geriatric syndrome and a bed-ridden state ("otasha-kenshin")].

PURPOSE: This study was conducted to examine age-related differences in cognitive function, and their relation to higher-level competence of elderly living in an urban community. METHOD: Participants were 438 individuals (males 168, females 270) aged 70 to 84 years living in an urban community in Tokyo. Three cognitive performance tests, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol, Word Fluency Test, and the WAIS-R Digit Span, were employed for estimating cognitive function, and the TMIG Index of Competence for measuring higher-level competence. In the Index, three constructions: "Instrumental Self-Maintenance", "Intellectual Activity", and "Social Role" were involved. RESULTS AND CONCLUSIONS: Age-related differences in the cognitive tests were analyzed using ANCOVA controlling for educational year. Age-related differences between younger elderly (70-79 years old) and older elderly (80-84 years old) were observed with the WAIS-R Digit Symbol, Word Fluency Test and the WAIS-R Digit Span. The results indicate that information processing speed, executive function and primary memory in community-dwelling elderly continue to decline in old age, and this trend is salient in the old-old. We carried out partial correlation analysis and multiple regression analysis for exploring the relationships between cognitive function and the sub-scales in the TMIG Index of Competence, controlling for age and educational year. Cognitive function was significantly and positively related with the sub-scales in the Index, this being especially robust for "Intellectual Activity". The results suggest that higher-level competence can be modestly determined with reference to cognitive function, and "Intellectual Activity" may have a stronger relation with cognitive function than the other two sub-scales in the Index.

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PubMed2003

[Effects of dietary variety on declines in high-level functional capacity in elderly people living in a community].

OBJECTIVE: The purpose of the investigation was to assess effects of dietary variety on declines in high-level functional capacity in community dwelling elderly, based on a 5-year longitudinal study (from 1992 to 1997). SUBJECTS AND METHOD: Subjects were a representative sample comprising 235 men (mean age 70.8 years) and 373 women (71.7 years) aged 65 years and above, living in Nangai village in Akita prefecture. Baseline and follow-up surveys were undertaken by the interview method. For assessing dietary variety, we introduced the dietary variety score (DVS), counting the number of 10 food-groups consumed daily from food frequency questionnaires: meat, fish and shellfish, eggs, milk, soybean products, potatoes, green yellow vegetables, fruits, seaweed, and fat and oil. The DVS ranged from 0 to 10 with higher score indicating a higher dietary variety. We also evaluated higher-level functional capacity using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence). Effects of dietary variety on declines in TMIG Index of Competence were analyzed by multiple logistic regression analysis. RESULTS: The average TMIG Index of Competence score for men and women were 12.1 and 10.8 at baseline, respectively. The mean baseline DVS was 6.3 for men, and 6.2 for women. Relative to the reference groups with DVS in 1-3, the groups with 4-8 and 9-10 scores had lower risks for decrease in TMIG Index of Competence scores over the study period. Relative risks (95% confidence interval) of the groups with a DVS of 4-8 and 9-10 were 0.92 (0.50-1.67) and 0.71 (0.34-1.48) regarding instrumental self maintenance, 0.50 (0.29-0.86) and 0.40 (0.20-0.77) for intellectual activities, and 0.44 (0.26-0.75) and 0.43 (0.20-0.82) for social roles of sub-scales of TMIG Index of Competence, adjusting for age, sex, educational attainment, and the baseline TMIG Index of Competence scores. CONCLUSION: Higher dietary variety is associated with a reduced risk of higher-level functional decline in community dwelling elderly.

Activities of Daily Living↗

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Longitudinal changes in higher-level functional capacity of an older population living in a Japanese urban community.

This study examined the present state and longitudinal changes in higher-level functional capacity in a Japanese urban community. Persons aged 65-84 years living in a suburb of central Tokyo participated in a baseline survey held in 1991 (n = 814) and followed-up for 8 years. Outcome measures were disabilities in: instrumental self-maintenance (IADL), the intellectual activity scale (intellectual activity) and the social role scale (social role), as measured by subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-index of competence). At baseline among the three subscales, both older men and women had the highest prevalence of disability in social role, followed in turn by intellectual activity and IADL disability. The 8-year longitudinal survey on subjects who had no initial disability (229 men and 235 women) in all three subscales of TMIG-index of competence demonstrated that they were most likely to lose social role function with advancing age, followed in turn by intellectual activity and IADL. The Cox proportional hazard model analysis for all 814 participants revealed that baseline level of social role and intellectual activity significantly predicted the new onset of IADL disability during the 8-year follow-up period even after controlling for gender, age, and chronic medical conditions. In summary, disability in social role and intellectual activity do not only likely precede IADL disability, but also predict significantly the future onset of IADL disability in a Japanese urban community older population.

Activities of Daily Living↗