Yasuyuki Gondo

The Tokyo Oldest Old Survey on Total Health (TOOTH): A longitudinal cohort study of multidimensional components of health and well-being

BackgroundWith the rapid worldwide increase in the oldest old population, considerable concern has arisen about the social and economic burden of diseases and disability in this age group. Understanding of multidimensional structure of health and its life-course trajectory is an essential prerequisite for effective health care delivery. Therefore, we organized an interdisciplinary research team consisting of geriatricians, dentists, psychologists, sociologists, and epidemiologists to conduct a longitudinal observational study.Methods/DesignFor the Tokyo Oldest Old Survey on Total Health (TOOTH) study, a random sample of inhabitants of the city of Tokyo, aged 85 years or older, was drawn from the basic city registry. The baseline comprehensive assessment consists of an in-home interview, a self-administered questionnaire, and a medical/dental examination. To perform a wide variety of biomedical measurements, including carotid ultrasonography and a detailed dental examination, participants were invited to our study center at Keio University Hospital. For those who were not able to visit the study center, we provided the option of a home-based examination, in which participants were simultaneously visited by a geriatrician and a dentist. Of 2875 eligible individuals, a total of 1152 people were recruited, of which 542 completed both the in-home interview and the medical/dental examination, with 442 completed the in-home interview only, and another 168 completed self or proxy-administered data collection only. Carotid ultrasonography was completed in 458 subjects, which was 99.6% of the clinic visitors (n = 460). Masticatory assessment using a colour-changeable chewing gum was completed in 421 subjects, a 91.5% of the clinic visitors.DiscussionOur results demonstrated the feasibility of a new comprehensive study that incorporated non-invasive measurements of subclinical diseases and a detailed dental examination aiming at community-dwelling individuals aged 85 years or older. The bimodal recruitment strategy is critically important to capture a broad range of health profiles among the oldest old. Results form the TOOTH study will help develop new models of health promotion, which are expected to contribute to an improvement in lifelong health and well-being.Trial RegistrationThis study has been registered in the UMIN-Clinical Trial Registry (CTR), ID: UMIN000001842.

Exploring the impact of climate on human longevity

The purpose of this study was to examine the impact of physical geographic factors and climate conditions on human longevity. The centenarian rate (CR) in 2005 was computed for Japans 47 prefectures, whose geography and climate vary greatly. Several pathways, such as excess winter mortality, land use and agricultural production, possibly linking physical and climate factors with extreme longevity, were explored. The probability of becoming a centenarian varies significantly among the Japanese prefectures. In particular, the computation of CR(70) demonstrated that the actual probability for individuals 70 years old in 1975 of becoming centenarians in 2005 was 3 times higher, on average, in Okinawa, both for males and females, than in Japan as a whole. About three quarters of the variance in CR(70) for females and half for males is explained by the physical environment and land use, even when variations in the level of socio-economic status between prefectures are controlled. Our analysis highlighted two features which might have played an important role in the longevity observed in Okinawa. First, there is virtually no winter in Okinawa. For instance, the mean winter temperature observed in 2005 was 17.2°C. Second, today, there is almost no rice production in Okinawa compared to other parts of Japan. In the past, however, production was higher in Okinawa. If we consider that long term effects of harsh winters can contribute to the mortality differential in old age and if we consider that food availability in the first part of the 20th century was mainly dependent on local production, early 20th century birth cohorts in Okinawa clearly had different experiences in terms of winter conditions and in terms of food availability compared to their counterparts in other parts of Japan. This work confirms the impact of climate conditions on human longevity, but it fails to demonstrate a strong association between longevity and mountainous regions and/or air quality.

Personality and participation in mass health checkups among Japanese community-dwelling elderly

OBJECTIVEnThe aim of this study is to examine the relationship between personality traits and participation in mass health checkups among Japanese community-dwelling elderly.nnnMETHODSnA data set of 327 men and 519 women aged 70 years and over was used in the analysis. The NEO Five-Factor Inventory was administered to assess the big five personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.nnnRESULTSnIn multivariate logistic regression analysis adjusted for gender, age, number of years of education, living alone, presence of psychiatric diseases, presence of chronic diseases, and history of hospitalization during a 1-year period, openness was independently associated with participation in mass health checkups [odds ratio (OR)=1.51, 95% confidence interval (CI)=1.08-2.12, P<.01 and OR=1.38, 95% CI=0.96-1.97, P=.07 for the middle and highest tertile, respectively]. No other domains of personality were related to participation in the checkups.nnnCONCLUSIONSnThe results of the present study suggest that older individuals high in openness are likely to take part in checkups for the elderly. Our findings could help improve the participation rate in mass health checkups for the prevention of long-term care dependence in later life.

Validation of the 7-Minute Screen for the Detection of Early-Stage Alzheimer’s Disease

Background/Aims: The 7-Minute Screen (7MS) is a screening battery to identify individuals with a high probability of Alzheimer’s disease (AD). The 7MS consists of four subtests (Temporal Orientation, Enhanced Cued Recall, Clock Drawing, and Verbal Fluency), each measuring a different aspect of cognition. The present study is designed to examine the predictive validity of the 7MS to distinguish between patients with early-stage AD and healthy control subjects. Methods: Sixty-three patients who were diagnosed as having probable or possible AD and 91 community-dwelling elderly individuals of comparable age, sex distribution, and education were administered the 7MS (paper-and-pencil version) and other screening batteries. All patients were rated Clinical Dementia Rating (CDR) 0.5–1, categorized as early-stage AD, and all participants obtained a score of less than 6 for the Geriatric Depression Scale (15-item version). Results: Mean scores for patients and controls on all the four subtests were significantly different. When using the total score of the 7MS, which was calculated by the original logistic regression formula based on all of the four subtests, the sensitivity for early-stage AD was 90.5% with a specificity of 92.3%. Correlation analysis indicated high concurrent validity between the 7MS and existing standard cognitive screening batteries (e.g., MMSE, HDS-R). In correlation analysis and multiple regression analysis, demographic effects (age, sex, and education) were not significantly associated with the total score of the 7MS in controls. Conclusions: The results showed that the 7MS had a high level of sensitivity and specificity. We also found that the 7MS was not affected by demographic characteristics. These findings demonstrated that the 7MS is a useful screening tool for discriminating patients with early-stage AD from intact individuals.

Assessing Physical Performance in Centenarians: Norms and an Extended Scale from the Georgia Centenarian Study

Centenarians display a broad variation in physical abilities, from independence to bed-bound immobility. This range of abilities makes it difficult to evaluate functioning using a single instrument. Using data from a population-based sample of 244 centenarians (M Age = 100.57 years, 84.8% women, 62.7% institutionalized, and 21.3% African American) and 80 octogenarians (M Age = 84.32 years, 66.3% women, 16.3% institutionalized, and 17.5% African American) we (1) provide norms on the Short Physical Performance Battery and (2) extend the range of this scale using performance on additional tasks and item response theory (IRT) models, reporting information on concurrent and predictive validity of this approach. Using the original SPPB scoring criteria, 73.0% of centenarian men and 86.0% of centenarian women are identified as severely impaired by the scales original classification scheme. Results suggest that conventional norms for older adults need substantial revision for centenarian populations and that item response theory methods can be helpful to address floor and ceiling effects found with any single measure.

A New Concept of Successful Aging in the Oldest Old: Development of Gerotranscendence and Its Influence on the Psychological Well-Being

Successful aging is an important concept for older adults. Yet it is difficult to apply existing theories to centenarians and the oldest old. In this chapter, previous successful aging models are introduced, and limitations of these models were discussed.

Cognitive Function in Japanese Centenarians according to the Mini-Mental State Examination

Background/Aims: We examined the effect of aging on cognitive function at the limit of human life expectancy by characterizing state of cognition in centenarians without clinical cognitive impairment. Methods: Participants were 68 centenarians without cognitive impairment (Clinical Dementia Rating (CDR) 0), 96 controls 60 to 74 years old, and 46 controls 75 to 89 years old. We visited the places where centenarians were living and administered the Mini-Mental State Examination (MMSE) individually. Control subjects came to the assembly hall within their dwelling area, to be administered the MMSE. Results: Mean total scores of centenarians (22.3) were lower than for either 60–74 (27.2) or 75–89 (26.2). Comparison of scores in each of five cognitive domains measured by MMSE showed a significant age-group effect upon orientation, memory, and attention. Centenarians’ scores were lower than for younger groups in every domain except for the language and praxis, concentration, and for repetition. Conclusion: The centenarians’ scores in memory and orientation declined as in earlier studies of normal aging. Centenarians’ scores for attention and concentration differed from those in previous studies. The present result suggests that even primary memory is influenced by advanced age in centenarians, while ability to store information declines, ability to process is maintained.

Relationship between physical and cognitive function, blood pressure and serum lipid concentration in centenarians.

The concept of “the lower, the better” has been recently predominant for the management of hypertension and hyperlipidemia. However, is this true with very elderly persons? We started the Tokyo Centenarian Study in 1992 for the purpose of analyzing a variety of phenotypes in the aging process. During the study, we found that the centenarians (persons aged 3100 years) with higher blood pressures seemed to have better physical and cognitive function than those with lower values. Thus, we investigated the relationship between the functional status and medical variable. A total of 253 centenarians in the Tokyo metropolitan area (22% of the total in Tokyo; 56 men and 197 women; age range, 100–108 years; 101.1 1 1.7 years [mean 1 standard deviation]) were included in this study. Activities of daily living (ADL) was assessed with respect to toilet care, eating, dressing, grooming, walking, moving and bathing using the Barthel index (BI), scored on a scale from 0 (completely dependent) to 100 points (completely independent). Cognitive function was classified into five categories based on the Clinical Dementia Rating (CDR) of stages: 0 (normal); 0.5 (subnormal); 1 (mildly demented); 2 (moderately demented); or 3 (severely demented). Serum total cholesterol concentration (TC, mg/dL), serum high-density lipoprotein cholesterol concentration (HDL, mg/dL) and systolic blood pressure (SBP, mmHg) were considered as the medical variables. Fasting blood sampling was not always conducted, so we did not use the plasma glucose and serum triglyceride concentration as variables. The following eight diseases were chosen as the important illnesses that might influence the centenarians’ quality of life (QOL): (i) hypertension; (ii) cardiovascular disease; (iii) stroke; (iv) chronic lung disease; (v) renal disease; (vi) diabetes; (vii) malignancy; and (viii) fractures. Statistical analyses were conducted using the SPSS ver. 15.0J software package (SPSS Software, Chicago, IL, USA). Variables are presented as the mean 1 standard deviation. Differences between groups were compared by the Mann–Whitney U-test or ANOVA with Bonferroni’s correction, where appropriate. The c-test was used to compare the categorical data. P < 0.05 was considered statistically significant. Almost all centenarians have chronic illness. If individuals with important illnesses had a high blood pressure, the BI score would be low in the group with elevated blood pressures. In such cases, it would be impossible to distinguish whether high blood pressure is associated with a reduced ADL or the presence of a significant illness causes low BI scores. We therefore compared the functional status and medical variable between centenarians with and without major illnesses. A total of 208 centenarians (82% of the total) had one or more major diseases: 141 had hypertension; 51 had cardiovascular disease; 38 had stroke; 34 had chronic lung disease; 16 had renal disease; nine had diabetes; 22 had malignancy; and 123 had fractures. Between the centenarians with (n = 208) and without illness (n = 45), however, no significant differences were evident in any of the variables: 1:3.7 versus 1:2.8 for male-to-female ratio (P = 0.42); 101.1 1 1.8 versus 100.8 1 1.5 years for Correspondence: Dr Kenichiro Shimizu, MD, PhD, Shoko Chukin Bank, Health Care Center, 2-10-17 Yaesu, Chuo-ku, Tokyo 104-0028, Japan. Email: shimizu_kenichiro@1986. jukuin.keio.ac.jp Geriatr Gerontol Int 2008; 8: 300–302