Taketo Furuna

Walking Patterns and Finger Rhythm of Older Adults

Walking patterns and rhythmic movement of the fingers were examined in a total of 1,134 male and female community residents 65 years of age and over. Walking patterns were characterized according to the ratio of step length divided by step rate (cadence), called the Walk Ratio, during level walking at preferred and maximum speeds. The walking pattern tended to change according to age; older subjects walked with shorter steps (smaller Walk Ratio). Rhythmic movement was examined using the finger-tapping test in time to the sound of a 4-Hz metronome. Hastened tapping or finger festination, in which the subject tapped faster than requested (constant error of 3 msec. and over in the intertap interval), was characteristic of aging; 16.8% of the subjects exhibited finger festination and the occurrence increased with age, especially among those in their eighties (29.3%). Finger festination was accompanied by walking patterns with an increased step rate, or a smaller Walk Ratio. These characteristics of aging were discussed as similar to extrapyramidal symptoms of walking and rhythm production in patients with Parkinsons disease.

Walking speed as a good predictor for maintenance of I‐ADL among the rural community elderly in Japan: A 5‐year follow‐up study from TMIG‐LISA

Background  A population‐based prospective cohort study was undertaken to examine the predictors of functional decline in instrumental activities of daily living (I‐ADL) among non‐disabled older Japanese subjects living in a rural community during a five‐year interval from 1992 to 1997.

Longitudinal Change in the Physical Performance of Older Adults in the Community

The primary purposes of this study were 1) to confirm age-related deterioration of physical performance in older adults longitudinally, and 2) to predict future functional status and mortality by initial level of physical performances. The subjects were 517 older adults examined both in 1992 and 1996 in the Tokyo Metropolitan Institute of Gerontology, Longitudinal Interdisciplinary Study on Aging. The same battery consisting of muscle strength, balance, walking, and manual speed was administered to the subjects in the baseline and follow-up examinations. A significant longitudinal decline was observed in all physical performances except for grip strength. The age-related decline accelerated with aging for preferred walking velocity. Inter-subject variability in walking velocity significantly increased for 4 years period. Maximum walking velocity was a common predictor for functional status and mortality. The results suggest that physical performance measures, especially maximum walking velocity, is a valid means for physical therapy to evaluate physical functioning of community-living older persons.

A physical fitness model of older adults

Physical fitness for young people is viewed as a multidimensional construct, in that it consists of specific components such as strength, mobility, balance, flexibility, and stamina. This study examined whether this structure underlying physical fitness is also relevant to older adults. A 10- item performance test, which was assumed to assess six components of physical fitness, was administered to 69 healthy volunteers ranging in age from 61 to 83 years. A covariance structure model was applied to the test data: the second- order factor was Physical Fitness, and the first- order factors were Strength, Walking, Balance, Flexibility, Stamina, and Manual Speed which were assumed to be measured based on the ten observed variables. Goodness- of- fit index (GFI) of the model was acceptable (GFI=0.93). While four factors relating to basic motor performances (Strength, Walking, Balance, and Manual Speed) had loadings more than 0.62 to Physical Fitness, Flexibility and Stamina had less than 0.35. It was suggested for elderly people that strength, mobility, balance, and speed components of physical fitness were highly correlated and explainable by a single factor, while flexibility and cardiorespiratory endurance were to be measured by use of specific measures.

Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial

BackgroundThe fastest growing age group globally is older adults, and preventing the need for long-term nursing care in this group is important for social and financial reasons. A population approach to diet and physical activity through the use of social services can play an important role in prevention. This study examined the effectiveness of a social health program for community-dwelling older adults aimed at introducing and promoting physical activity in the home at each individual’s pace, helping participants maintain good dietary habits by keeping self-check sheets, and determining whether long-standing unhealthy or less-than-ideal physical and dietary habits can be changed.MethodThis cluster randomized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years. The intervention group (3 community centers; n = 57) participated in the social health program “Sumida TAKE10!” which is an educational program incorporating the “TAKE10!® for Older Adults” program, once every 2 weeks for 3 months. The control group (3 community centers; n=35) was subsequently provided with the same program as a crossover intervention group. The main outcome measures were changes in food intake frequency, food frequency score (FFS), dietary variety score (DVS), and frequency of walking and exercise. The secondary outcome measures were changes in self-rated health, appetite, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score.ResultsCompared to baseline, post-intervention food intake frequency for 6 of 10 food groups (meat, fish/shellfish, eggs, potatoes, fruits, and seaweed), FFS, and DVS were significantly increased in the intervention group, and interaction effects of FFS and DVS were seen between the two groups. No significant differences were observed between baseline and post-intervention in the control group. Frequency of walking and exercise remained unchanged in both groups, and no significant difference in improvement rate was seen between the groups. Self-rated health was significantly increased in the intervention group. Appetite and TMIG Index of Competence score were unchanged in both groups.ConclusionsThe social health program resulted in improved dietary habits, as measured by food intake frequency, FFS, and DVS, and may improve self-rated health among community-dwelling older adults.Trial registration numberUMIN000007357

The structure underlying physical performance measures for older adults in the community.

A 6- item physical performance test assessing hand strength/speed, mobility, and balance was administered to 678 elderly people from a Japanese community (age 65–89). A second- order covariance structure model applied to the data revealed that three factors in observed variables (Hand Power, Walking, and Balance) had loadings more than 0.8 on a single higher- order factor, Basic Motor Ability (BMA). The BMA score, or “Physical Performance Age (PPA)”, of the individual was calculated on the basis of this model as a unidimensional summary score of physical performances. The PPA predicted the self- reported levels of competence and physical activity with greater accuracy than age alone. The PPA also differentiated those at the high end of the functional spectrum, and thereby not identifiable by use of ordinary self- reported functional measures. The results suggest that a short physical performance battery assessing physical functioning is useful in community- based studies of aging.

Predictive Validity of the Classification Schema for Functional Mobility Tests in Instrumental Activities of Daily Living Decline Among Older Adults

OBJECTIVE To determine predictive validity for cut points of the Timed Up & Go (TUG) test and life-space assessment (LSA) on decline in instrumental activities of daily living (IADLs) among older adults. DESIGN Cross-sectional and 1-year follow-up study. SETTING Preventive health care services. PARTICIPANTS In a cross-sectional study, 2404 older adults (65-100 y) were recruited to determine cut points for the TUG and LSA for IADLs limitation. For longitudinal analysis, 436 older adults (65-100 y) were followed over 1 year to explore the validity of a classification model using the cut points to predict incident IADLs decline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The TUG, LSA, and Tokyo Metropolitan Institute of Gerontology index of IADLs measurement. RESULTS The cut points associated with IADLs limitations for the TUG and LSA were 12 seconds and 56 points, respectively. Participants were classified into fast/high (most able; TUG <12 and LSA >56), fast/low, slow/high, and slow/low (vulnerable; TUG > or =12 and LSA < or =56) groups; there were 813 (34%), 385 (16%), 246 (10%), and 960 (40%) participants in each group, respectively. The proportions of participants with IADLs limitation in the most able, fast/low, slow/high, and vulnerable groups were 19%, 64%, 61%, and 89%, respectively. The vulnerable group included significantly more participants with IADLs limitation than any other group (P<.001). Compared with a most able group, the odds ratios of IADLs decline for the fast/low and vulnerable groups were 2.52 (95% confidence interval 1.15-5.53, P<.05) and 2.87 (95% confidence interval 1.38-5.96, P<.01), respectively. CONCLUSIONS The combination of TUG and LSA identifies persons with future IADLs decline and has the potential to be used by community health care services to target individualized interventions.

Association between change in bone mineral density and decline in usual walking speed in elderly community-dwelling Japanese women during 2 years of follow-up.

OBJECTIVES: To investigate the association between change in bone mineral density (BMD) and change in usual walking speed in elderly community‐living Japanese women during 2 years of follow‐up.

Declines in Physical Performance by Sex and Age Among Nondisabled Community-Dwelling Older Japanese During a 6-Year Period

Background Few studies have examined whether declines over time in hand-grip strength (HGS) and fast walking speed (FWS) differ by sex and age among non-Western community-dwelling older adults. This study aimed to quantify changes in HGS and FWS over the 6-year period from 1994 to 2000 and examine whether these changes differed by sex and baseline age among older individuals in a Japanese community. Methods We conducted a community-based prospective cohort study. The participants were 513 nondisabled men and women aged 67 to 91 years at the 1994 survey. Independent variables regarding time since baseline, in addition to various time-dependent and time-independent covariates, were obtained in 1994, 1996, 1998, and 2000. The outcome variables were HGS and FWS assessed at each survey. All data on independent and dependent variables that were collected at each survey were simultaneously analyzed using a linear mixed-effects model. Results The linear mixed-effects model revealed significant declines in both HGS (−0.70 kg/year, P < 0.001) and FWS (−0.027 m/sec/year, P < 0.001) among nondisabled older participants who had analyzable data in any survey during the 6-year period. Sex was significantly associated with the rate of decline in HGS (P < 0.001), but not FWS (P = 0.211). Conclusions In this analysis of nondisabled older Japanese, a mixed-effects model confirmed a significant effect of aging on declines in HGS and FWS and showed that men had a significantly steeper decline in HGS than did women during a 6-year period.

A mortality comparison of participants and non-participants in a comprehensive health examination among elderly people living in an urban Japanese community

Background and aims: Recent studies have revealed that there are critical differences between participants and non-participants in health examinations. The aim of this study was to examine mortality differences between participants and non-participants in a comprehensive health examination for prevention of geriatric syndromes among community-dwelling elderly people, using a three-year prospective cohort study. Methods: The study population included 854 adults aged 70 to 84 at baseline. The following items were all studied: the status of participation in the comprehensive health examination as an independent variable, age, gender, number of years of education, living alone, presence of chronic diseases, experience of falls over one year, history of hospitalization over one year, self-rated health, body mass index, instrumental activities of daily living, and subjective well-being as covariates; and all-cause mortality during a three-year follow-up as a dependent variable. Results: In an adjusted Cox’s proportional hazard regression model, the mortality risk for participants in the comprehensive health examination was significantly lower than that of non-participants (Risk Ratio (for participants)=0.44, 95% confidence interval=0.24 to 0.78). Conclusions: The present study shows that there is a large mortality difference between participants and non-participants. Our findings suggest two possible interpretations: 1) There is a bias due to self-selection for participation in the trial, which was not eliminated by adjustment for the covariates in the statistical model; 2) There is an intervention effect associated with participation in the comprehensive health examination which reduces the mortality risk.