Yasuko Okayama

[Fall risk factors and sex differences among community-dwelling elderly individuals in Japan. A Kameoka study].

OBJECTIVES Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city. METHODS A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role. RESULTS Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men. CONCLUSION One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

Ten-Year Longitudinal Evaluation of Physical Fitness in the Elderly

Of a local group of aged individuals who were followed up for 10 years, the results of physical fitness tests were reviewed in 11 men (aged 65–81 years, mean 69.5 years, at the initial examination) and 49 women (aged 65–79 years, mean 69.3 years, at the initial examination), in whom all the data from these 10 years were available, to longitudinally evaluate the physical fitness of the elderly. When the data from the 10 years in these subjects were compared with our previous cross-sectional data, (1) the changes in the muscle strength, muscle power, and equilibrium were nearly in agreement with those shown by the cross-sectional study, and the performance declined markedly after 75–80 years; (2) the changes in agility and flexibility showed different patterns from the cross-sectional results; and (3) comparison of the total fitness scores in these subjects with those of the cross-sectional study indicated that the former belonged to a relatively unfit group at the initial examination, but their fitness level deteriorated insignificantly during the 10 years. Although none of our subjects practiced any sport, they were interested in exercise such as gymnastics and walking and were participating in various social activities including our fitness evaluation program. Such an active lifestyle is considered to contribute to prevention of the age-associated decline of physical fitness.

About 90% of injuries under school supervision occur during exercise and sports in high school (A review of accident reports of Kyoto prefectural high schools in 2007)

In Japan, there is a mutual aid organisation participated in by nearly all children from kindergarten to high school that compensates for damage inflicted under school supervision. In this study, individual cases of damage at high schools in Kyoto Prefecture compensated for by this system in 2007 were reviewed to evaluate measures to reduce injuries under school supervision at high schools. Two thousand seven hundred and forty-nine injuries except those caused by traffic accidents reported by 47 high schools in Kyoto Prefecture in 2007 were analysed. Injuries occurred (1) 1.6 times more frequently in males than in females, (2) more frequently in children of lower grades and (3) about 90% of them occurred during exercise or sports (60% during extracurricular activities, 20% during gym classes and 10% at other times). (4) About half the injuries involved the lower limbs, (5) sprain and fracture each accounted for about 20% of the injuries, (6) About 30% of the injuries were mild, requiring less than 2 weeks until cure, but 38 injuries required 3 months or longer until cure. (7) A high percentages of the injuries that occurred during extracurricular activities were related to ball games and (8) were caused by overwork or accidents. From these data, improvements in the contents and environment of exercise and sports, during which about 90% of all injuries occurred, are considered necessary to reduce injuries under school supervision at high school. Particularly, measures to prevent injuries during extracurricular activities should be evaluated.