Rafael Figueroa

Longitudinal association between habitual walking and fall occurrences among community-dwelling older adults: Analyzing the different risks of falling

The purpose of this longitudinal study was to examine the association between habitual walking and multiple or injurious falls (falls) among community-dwelling older adults, by considering the relative risk of falling. A cohort of Japanese community-dwelling older adults (n=535) aged 60-91 years (73.1±6.6 year, 157 men and 378 women) who underwent community-based health check-ups from 2008 to 2012 were followed until 2013. Incidence rate of falls between walkers and non-walkers was compared separately by the number of risk factors (Groups R0, R1, R2, R3 and R4+). The Cox proportional hazard model was used to assess the association between habitual walking and falls separately by lower- (R<2) and higher- (R≥2) risk groups. In Groups R0 and R1, the incidence of falls was lower in walkers than non-walkers; however, in Groups R2, R3, and R4+, the incidence of falls was higher in walkers. The Cox proportional hazard model showed that habitual walking was not significantly associated with falls (hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.48-1.62) among the lower risk group but that it was significantly associated with increased falls (HR: 1.89, 95% CI: 1.04-3.43) among the higher risk group. The significant interaction between habitual walking and higher risk of falling was found (P<0.05). When individuals have two or more risk factors for falling, caution is needed when recommending walking because walking can actually increase their risk of experiencing multiple or injurious falls.

Obesity and muscle weakness as risk factors for mobility limitation in community-dwelling older Japanese women: A two-year follow-up investigation

OBJECTIVES To examine the combined association of obesity and low muscle strength with mobility limitation in older adults. DESIGN, SETTING AND PARTICIPANTS This two-year follow-up longitudinal study included pooled data from 283 older community-dwelling Japanese women without mobility limitations who were 65 to 87 years of age (mean age 72.2 ± 5.0 years). MEASUREMENTS Muscle strength was measured by hand-grip strength (HGS). The participants were categorized by HGS (high muscle strength: HGS ≥19.6 kg, low muscle strength: HGS <19.6 kg) and body mass index (BMI) (obese: BMI ≥25 kg/m2, normal weight: BMI <25 kg/m2). The main outcome was mobility limitation, assessed by a self-reported questionnaire (difficulty walking one-half mile or climbing 10 steps without resting). Multivariate logistic regression analysis was performed to determine the combined effect of HGS and BMI on mobility limitation, adjusting for age, exercise habits, medications, and knee pain. RESULTS During the follow-up period, 82 of 283 participants (29.0%) developed mobility limitation. The adjusted odds ratios (95% confidence interval) for the incidence of mobility limitation were 1.53 (0.86-2.73) and 2.05 (1.08-3.91) in the obese and low muscle strength groups, respectively. Obesity combined with low muscle strength exhibited a significant and strong association with mobility limitation (odds ratio: 3.88, 1.08-13.91) compared with participants with normal weight and high muscle strength. CONCLUSION Among community-dwelling older Japanese women, obesity alone was not associated with the incidence of mobility limitation, but when combined with low muscle weakness, the risk of developing mobility limitation was 3.9-fold greater than for the reference group.

Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older

To identify whether individual physical performance measures or a combination of measures is a better indicator of multiple geriatric syndromes (MGS) defined as the concomitant presence of more than one geriatric syndrome in an individual.

Association between habitual light‐intensity physical activity and lower‐extremity performance: A cross‐sectional study of community‐dwelling older Japanese adults

Habitual moderate vigorous‐intensity physical activity (MVPA) positively affects lower‐extremity performance. It is unclear whether habitual light‐intensity physical activity (LPA), such as leisurely walking, has similar effects on lower‐extremity performance. The aim of the present study was to identify the associations between habitual LPA and lower‐extremity performance in older adults.

Age Scale for Assessing Activities of Daily Living

The purpose of this study was to develop an age scale for assessing activities of daily living (ADL) among community-dwelling adults aged 75 years or older. Participants were 1006 older Japanese: 312 men (79.6 ± 4.3 years) and 694 women, (79.9 ± 5.5 years). Participants completed a battery of 8 performance tests related to ADL and the Barthel index (BI) questionnaire. Spearman rank-order correlation analysis was applied to obtain the correlation of the 8 ADL performance tests with the total BI score. Three variables were high rank-order correlated with BI, secondly those items were subjected to the principal component analysis. The weighted combination of the principal component scores was summed. Resulting in an ADL score (ADLS), women = 0.075 X 1 – 0.082 X 2 – 0.063 X 3 + 0.124, men = 0.051 X 1 – 0.105 X 2 – 0.099 X 3 + 0.249, where X 1 = hand-grip strength, X 2 = timed up and go, X 3 = five-chair sit to stand. Individual ADLS was transformed to an ADL age scale (ADLA). The estimation was – 5.493 ADLS + 79.90 for women, and – 4.272 ADLS + 79.57 for men. Due to the distortion at the regression edges, the equation was corrected as suggested by Dubina et al . ADLA women after correction was = 0.447 (chronological age: CA) – 5.49ADLS + 44.17, men = 0.519CA – 4.27ADLS + 38.26. ADLA can be used to identify or monitor the characteristics of the ADL levels of physical abilities in older Japanese aged 75 years or older.

Development of the Nutrition and Functionality Assessment (NFA) Among Older Adults in Japan

ObjectiveDevelop and evaluate the feasibility and validity of the Nutrition and Functionality Assessment (NFA) which identifies “target” older adults who could benefit from a personalized program following evaluation of their nutrition status and physical functionality.DesignCross-sectional study.SettingCommunity and geriatric day-care centers and university in Japan.Participants267 older adults aged 65–90.MeasurementsThe “target” individuals were screened based on gait speed (0.6-1.5 m/s). Nutrition (Mini Nutrition Assessment-short form and protein intake), strength (30s chair sit-to-stand and hand-grip strength) and endurance (6-minute walk) were assessed. Physical activity was monitored using a tri-axil accelerometer for a week. Fried frailty phenotype was also assessed.ResultsOut of 267 individuals, 185 (69%) had gait speed between 0.6-1.5 m/s, corresponding to our “target” group from which, 184 (95%) completed the nutrition and physical functionality assessments with the physical activity monitoring. The NFA was completed in approximately 30 minutes. No adverse events directly due to the NFA were reported. NFA physical functionality and global scores were significantly related to frailty phenotype but nutrition score was not related to frailty phenotype.ConclusionThe study demonstrated that the NFA is a safe and feasible tool to screen target older adults and simultaneously evaluate their nutritional status and physical functionality. Validity of the NFA was partially confirmed by the significant association of the global and physical functionality scores with frailty phenotype. More studies are required to validate and maximize the applicability of the NFA in communities and institutions in Japan and elsewhere.

The Applicability of the Activities of Daily Living Age Scale in JapaneseCommunity-Dwelling Adults Aged 75 Years or Older

Our aim is to investigate the applicability of the activities of daily living age scale (ADLA) through the examination of the degree to which physical functionality is enhanced by habitual exercise in older Japanese aged 75 years and older. Participants comprised 598 community-dwellings older Japanese (386 women 79.0 ± 3.5 and 212 men 79.1 ± 3.8), who were divided in 2 groups of a non-exercise (NE) and an active group (A). The ADLA equation is an instrument that estimates participants’ physical functioning regarding ADL using data obtained previously from 1006 subjects. All participants completed a comprehensive battery of 3 physical performance items that formed the basis for the ADLA equation. The developed equations are as follow: ADLA for women = 0.447 (chronological age: CA) – 5.49 (ADL scoreADLS) + 44.17; and ADLA for men = 0.519CA – 4.27ADLS + 38.26. In women the mean of ADLA of NE group (78.9 ± 4.3 years) were significantly lower than their mean of CA (79.4 ± 3.5 years, p<0.05). Meanwhile there were no significant difference among the mean of ADLA of the NE group in men (80.0 ± 5.1 years) and their mean of CA (79.7 ± 4.2). The ADLA mean of A group in women (76.3 ± 3.7 years) and in men (77.3±3.4 years) were significantly lower than their mean of CA (78.6 ± 3.5 and 78.4 ± 3.3 years, p<0.01) respectively. The result indicates that ADLA scale has validity application. Through the responsiveness of the ADLA scale we conclude that exercise habituation affects overall physical function even on people over 75 years and older, possessing significantly higher level of physical fitness than those who do not exercise regularly. They showed a remarkably older ADLA.