Kiyohito Okumiya

Arterial stiffness independently predicts cardiovascular events in an elderly community : Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.

Evaluation of chewing ability and its relationship with activities of daily living, depression, cognitive status and food intake in the community‐dwelling elderly

The aim of this study was to assess chewing ability using color‐changeable chewing gum and to show the association between chewing ability and geriatric functions, as well as dietary status in the community‐dwelling elderly.

High Morning Home Blood Pressure Is Associated with a Loss of Functional Independence in the Community-Dwelling Elderly Aged 75 Years or Older

To elucidate the relationship between home systolic blood pressure (SBP) and functional impairment in the elderly 75 years or older, 461 community-dwelling subjects (192 men, 269 women, mean age: 80 years) were studied. Home blood pressure was measured twice in the morning and twice in the evening for 5 consecutive days with an automatic cuff-oscillometric device. Total/high-density lipoprotein cholesterol and several functional assessments were evaluated. A subject was determined to exhibit a loss of independence according to the activities of daily living (ADL) score in a study conducted in 2001. Based on the mean home SBPs (mSBP) and morning–evening SBP differences (dSBP), the subjects were classified into 4 groups as follows: hypertensive/morning-dominant (HM; mSBP≥135 mmHg, dSBP≥15 mmHg), hypertensive/sustained (HS; mSBP≥135 mmHg, dSBP<15 mmHg), normotensive/morning-dominant (NM; mSBP<135 mmHg, dSBP≥15 mmHg), and normotensive/controlled (NC; mSBP<135 mmHg, dSBP<15 mmHg). There were no differences in sex, cholesterol levels, history of stroke, other cardiovascular diseases (CVDs), and cognitive function, but there were significant differences in age, antihypertensive medications, the neurobehavioral test scores, and ADL scores. There were no significant differences in terms of mortality and CVD events. In the survivors, HM and HS were independent risk factors for a loss of independence, after adjustments were made for onset of stroke, age, antihypertensive therapy, history of CVD, as well as neurobehavioral test scores and ADL scores (odds ratio [OR]: 12.2 and 3.78, respectively). After the same adjustments as those mentioned above were made, HM and HS were found to be negative determinants of survival and maintenance of independence (OR: 0.082, 0.270, respectively). In conclusion, high home SBP (≥135 mmHg) and high dSBP (≥15 mmHg) were found to be important in determining the levels of disability for the very elderly.

Relationships between each category of 25‐item frailty risk assessment (Kihon Checklist) and newly certified older adults under Long‐Term Care Insurance: A 24‐month follow‐up study in a rural community in Japan

The 25‐item Kihon Checklist (KCL) is the official self‐administered questionnaire tool to screen frail older adults, consisting of seven categories: physical strength, nutritional status, oral function, houseboundness, cognitive function, depression risk and a score of more than 9 out of 1–20 items. The aim of the present study was to evaluate the relationships between each category of the KCL and newly certified cases under the Long‐Term Care Insurance (LTCI) in Japan during 24 months.

Importance of cognitive assessment as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2‐year follow up

To investigate which category in the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare can predict functional decline for community‐dwelling elderly people at a 2‐year follow up.

A CLOSE ASSOCIATION BETWEEN HEARING IMPAIRMENT AND ACTIVITIES OF DAILY LIVING, DEPRESSION, AND QUALITY OF LIFE IN COMMUNITY‐DWELLING OLDER PEOPLE IN JAPAN

1. Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia. A systematic review. J Am Geriatr Soc 2002;50:1723–1732. 2. Williams MA, Campbell EB, Raynor WJ et al. Predictors of acute confusional states in hospitalized elderly patients. Res Nurse Health 1985;8:31–40. 3. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263:1097–1101. 4. Rockwood K. Acute confusion in elderly medical patients. J Am Geriatr Soc 1989;37:150–154. 5. Rockwood K, Cosway S, Carver D et al. The risk of dementia and death after delirium. Age Ageing 1999;28:551–556. 6. Borson S, Scanlan J, Brush M et al. The Mini-Cog: A cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000;15:1021–1027. 7. Borson S, Scanlan JM, Chen P et al. The Mini-Cog as a screen for dementia: Validation in a population-base sample. J Am Geriatr Soc 2003;51:1451–1454. 8. Wind AW, Schellevis FG, Van Staveren G et al. Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. Int J Geriatr Psychiatry 1997;12:101–108. 9. Scanlan JM, Borson S. The Mini-Cog: Receiver operating characteristics with expert and naive raters. Int J Geriatr Psychiatry 2001;16:216–222. 10. Inouye SK, van Dyck C, Alessi C et al. Clarifying confusion: The confusion assessment method. Ann Intern Med 1990;113:941–948.

Eating alone among community-dwelling Japanese elderly: Association with depression and food diversity

AbstractEating alone is an emerging social concern these days along with the background of serious aging population growth and increasing number of single-dwellers in Japan. However, little study is focused eating alone and its relation to the health status of community-dwelling elderly.ObjectivesTo clarify the relations between eating alone and geriatric functions such as depression, quantitative subjective quality of life (QOL), activities of daily living (ADL) and dietary status of community-dwelling Japanese elderly.DesignA cross-sectional study.SettingsTosa town, one of the “super-aged” towns in Japan.ParticipantsThe study population consisted of 856 communitydwelling elderly aged ≥65 living in Tosa town.MeasurementsEating alone and living arrangement was defined by the questionnaire. Geriatric functions were assessed by measuring activities of daily living (ADL), depressive symptom using 15-item Geriatric Depression Scale (GDS-15), and quality of life (QOL). Food diversity was investigated as a measure of dietary quality using 11-item Food Diversity Score Kyoto (FDSK-11). Body mass index (BMI) was calculated using height and body weight during a medical assessment.ResultsThe proportion of the elderly who usually eat alone was 33.2% in this study population. Even among 697 elderly subjects who live with others, 136 persons (19.5%) ate alone. The participants who ate alone were significantly depressed according to the assessment using GDS-15 score (5.7±4.3 vs. 4.4±3.8, P<0.001). Those who ate alone have lower scores of QOL items than those who ate with others (Subjective sense of health; 52.5±21.9 vs. 55.7±20.2 P=0.035, Relationship with family; 74.1±23.5 vs. 78.9±18.6 P<0.001, Subjective happiness; 58.5±22.7 vs. 62.2±21.1 P=0.019). A significant close association was found between eating alone and lower food diversity (FDSK-11 score 9.9±1.3 vs. 10.2±1.3, P=0.002). BMI was lower in the elderly subjects who ate alone than those with others. By the multivariate analysis, depression was independently associated with eating alone in the logistic regression model adjusted for age, sex, BMI and food diversity as confounding factors (OR; 1.42, Cl; 1.00–2.11, P=0.043). Food diversity was also significantly associated even after the adjustment of these confounding factors.ConclusionEating alone is an important issue related to depression and QOL as well as dietary status of community-dwellingl elderly in Japan. This study shows the simple and inexpensive way “eating together” may contribute to improve depressive mood of elderly persons, with a strong message that supports of family, friends and neighbors are very important.

Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan : VII. Khon Khen in Thailand

Background:  The objective of the present study is to compare the findings of comprehensive geriatric assessment between community‐dwelling elderly people in Korea and in Japan.

Food diversity is closely associated with activities of daily living, depression, and quality of life in community-dwelling elderly people.

The authors are grateful to Ms. Ng Ada Fong Ting for her support during the study. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contributions: Mr. Wong, Prof. Masters, Dr. Maxwell, and Prof. Abernethy were responsible for study design, data analyses, interpretation of the results, and finalization of the letter. Mr. Wong was responsible for recruitment of participants, data collection, and drafting the letter. Sponsor’s Role: None.

Chronoecological health watch of arterial stiffness and neuro-cardio-pulmonary function in elderly community at high altitude (3524 m), compared with Japanese town

Effects of high altitude on arterial stiffness and neuro-cardio-pulmonary function were studied. Blood pressure (BP) and heart rate (HR) were measured in a sitting position on resting Ladakhis, living at an altitude of 3250-4647 m (Phey village, 3250 m: 17 men and 55 women; Chumathang village, 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). The neuro-cardio-pulmonary function, including the Kohs block design test, the Up and Go, the Functional Reach and the Button tests, was examined in 40 elderly subjects (19 men and 21 women, mean age: 74.7 +/- 3.3 years) in Leh, Ladakh (altitude: 3524 m), for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7 +/- 4.7 years) of Tosa, Japan (altitude: 250 m). Cardio-Ankle Vascular Index (CAVI) was measured as the heart-ankle pulse wave velocity (PWV) in these subjects using a VaSera CAVI instrument (Fukuda Denshi, Tokyo). SpO(2) decreased while Hb and diastolic BP increased with increasing altitude. At higher altitude, residents were younger and leaner. Women in Leh vs. Tosa had a poorer cognitive function, estimated by the Kohs block design test (3.7 +/- 3.6 vs. 16.4 +/- 9.6 points, P < 0.0001) and poorer ADL functions (Functional Reach: 13.7 +/- 7.0 cm vs. 25.3 +/- 8.7 cm, P < 0.0001; Button test: 22.5 +/- 4.8 vs. 14.8 +/- 5.7 s, P < 0.0001). Time estimation was shorter at high altitude (60-s estimation with counting: 41.1% shorter in men and 23.0% shorter in women). A higher voltage of the QRS complex was observed in the ECG of Leh residents, but two times measurement of CAVI showed no statistically significant differences between Leh and Tosa (two times of CAVI measures; 9.49 vs. 10.01 m/s and 9.41 vs. 10.05 m/s, respectively), suggesting that most residents succeed to adapt sufficiently to the high-altitude environment. However, correlation of CAVI with age shows several cases who show an extreme increase in CAVI. Thus, for the prevention of stroke and other adverse cardiovascular outcomes, including dementia, CAVI may be very useful, especially at high altitude. In conclusion, elderly people living at high altitude have a higher risk of cardiovascular disease than low-latitude peers. To determine how these indices are associated with maintained cognitive function deserves further study by the longitudinal follow-up of these communities in terms of longevity and aging in relation to their neuro-cardio-pulmonary function.