Yoriko Kasahara

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.

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.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China IV: Comparison of food diversity and its relation to health of Han and Tibetan elderly

Aim:  To examine the association between food diversity and health status of Han and Tibetan elderly highlanders in Qinghai Plateau, China.

COMMUNITY-DWELLING ELDERLY FALLERS IN JAPAN ARE OLDER, MORE DISABLED, AND MORE DEPRESSED THAN NONFALLERS

To the Editor: We read with interest the article published by Somadder et al. The authors document a correlation between depressive symptoms and self-reported numbers of falls in older subjects attending a day hospital in the United Kingdom. They reported that there were no significant differences in age, comorbidities, or performance on activities of daily living (ADLs) between fallers and infrequent fallers in their small population. We reexamined this important issue in community-dwelling elderly people in Japan and found findings different from those of Somadder et al. The study population consisted of 1,261 people aged 65 and older (men 529, women 732, mean age 75.4 7.2) living in T town, Kochi Prefecture, Japan. Fallers were screened using self-reported questionnaires, along with additional tests of ADLs and subjective quality of life (QOL) for community-dwelling older people in 2006. The question ‘‘Do you have any history of a fall within the past year?’’ was used for detecting fallers. Subjects who answered yes to the question were considered to be fallers. For the assessment of basic ADLs, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) to obtain a basic ADL score (0–21). For advanced ADLs, the Tokyo Metropolitan Institute of Gerontology index of competence rating scale of 0 to 13 was used. This scale includes instrumental self-maintenance (0–5), intellectual activity (0–4), and social role (0–4). Five indicators of QOL (sense of subjective health, relationship with family, relationship with friends, financial satisfaction, and subjective happiness) were rated on a 100-mm visual analogue scale (worst QOL on the left end of the scale, best to the right). The 15-item Geriatric Depression Scale (GDS15) was used for the assessment of depression; a score of 10 or more was considered to indicate depression. A fall risk index with a score ranging from 0 (low risk of fall) to 21 (high risk of fall) was added to those and used for the assessment of risk of falls. Statview version 5.0 (SAS Institute, Inc., Cary, NC) was used for calculating chi-square tests for categorical variables, unpaired t-test for continuous variables, and Spearman correlation (rs) between number of falls and GDS-15 and between fall risk index and GDS-15. The proportion of fallers was 31.6% in this population. Fallers were significantly older (76.9 vs 74.7) and had significantly lower scores for each item of the ADLs and QOLs than nonfallers, even after the adjustment for age (Table 1). The proportion of subjects with depression was significantly

Community‐dwelling elderly with chewing difficulties are more disabled, depressed and have lower quality of life scores

Since 2006, the Japanese Ministry of Health, Welfare and Labor has recommended to screen swallowing and chewing abilities with the community-based comprehensive health-check examination to prevent disability of the elderly population. However, nationwide data of the actual condition of chewing disability in the community-dwelling elderly in Japan remains to be collected and be put in order. To address this important issue in a cross-sectional study in a community in Japan, we analyzed prevalence of elderly subjects with chewing difficulty associated with comprehensive geriatric assessment. The study population consisted of 877 people aged 65 years and older (309 men, 568 women; mean age, 75.6 years; standard deviation, 6.7) living in Tosa, Kochi Prefecture, Japan (the response rate of questionnaire was 59.3% and the complete answering rate was 50.0% of the eligible population in the town). Using self-reported questionnaires, chewing difficulty was screened along with additional assessment of activities of daily living (ADL), depression and subjective quality of life (QOL) in community-dwelling elderly subjects in 2007. Each elderly subject was asked, “In the past 6 months, do you feel chewing difficulty when you eat hard foods?” to identify the deterioration in chewing ability on a yes/no basis. For the assessment of basic ADL, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 3 to 0 (3, completely independent; 2, need some help; 1, need help much; 0, completely dependent) into a basic ADL score (0–21). For assessing higherlevel ADL, each subject rated his/her independence in the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). This assessment consists of a 13-item index including three sublevels of competence: instrumental self-maintenance (0–5), intellectual activity (0–4) and social role (0–4). We screened for depressive symptoms using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). Quantitative QOL were assessed using a 100 mm visual analog scale (worst QOL on the left end of the scale, best on the right) in the following five items: subjective sense of health, relationship with family, relationship with friends, financial satisfaction and subjective happiness. SPSS statistical software package ver. 16.0 (SPSS, Chicago, IL, USA) was used for statistical analysis with a significance of P < 005. Table 1 shows the comparison of scores in ADL, GDS-15 and subjective QOL between elderly subjects with and without chewing difficulty. The proportion of elderly who had chewing difficulty was 35.2% in this population. The elderly subjects with chewing difficulty were significantly older than those without chewing difficulty (77.5 vs 75.5 years). Mean scores in each ADL were significantly lower in the elderly with chewing difficulty than those without chewing difficulty after the adjustment for the effect of age. Mean score in GDS15 was significantly higher and subjective QOL were lower in the elderly with chewing difficulty than those without. A significantly close association between Correspondence: ••. Email: •• 1

Self-rated happiness is associated with functional ability, mood, quality of life and income, but not with medical condition in community-dwelling elderly in Japan

Subjective views of well-being, defined as emotional contentment and happiness, have been reported to decrease the risk of mortality in older adults. Factors such as economics and health have been shown to correlate with self-rated happiness (SRHa) in the general population. Kudo et al. reported that subjective health condition and some lifestyles influenced life satisfaction in older people. To our knowledge, however, little is known about the association between SRHa and healthrelated factors in older adults in Japan. We considered happiness to be a state of mind or feeling characterized by contentment, love, satisfaction, pleasure or joy. In this study, we examined SRHa-related factors in health check-ups, including comprehensive geriatric function, in community-dwelling Japanese elderly. The study population consisted of 236 communityliving people aged 75 years and older (male : female = 86:150; mean age, 81.0 1 4.6 years), who participated in annual geriatric examinations in T town, Kochi Prefecture, Japan. SRHa was assessed with the question “How would you rate your level of subjective happiness?” using a 100-mm visual analog scale (worst = 0 to best = 100). Using the median SRHa score of 64, we defined participants with a score of 64 or more as a high SRHa group and those with a score less than 64 as a low SRHa group. To assess basic activities of daily living (ADL), participants rated their independence in performing seven items (walking, ascending and descending stairs, eating, dressing, using the toilet, bathing, and grooming), based on a 3 to 0 scale (3 = completely independent, 2 = need some assistance, 1 = need much assistance, 0 = completely dependent). Sub-item scores were summed to obtain a basic ADL score (0–21), in which low scores indicated disability. Elderly participants scoring 21 were considered functionally independent in basic ADL. To assess advanced functional ability, the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) rating scale of 0–13 was used. The TMIG-IC scale includes scores for instrumental selfmaintenance (0–5), intellectual activity (0–4) and social role (0–4). Walking ability and physical balance were assessed using the Timed Up and Go Test. The MiniMental State Examination was used to assess cognitive status. Assessment of medical conditions involved selfreported medication use and physician-based diagnosis of chronic conditions, including hypertension, diabetes *Present address: Faculty of Health and Well-being Kansai University, 1-11-1 Kaorigaoka-cho, Sakai-ku, Sakai-shi, Osaka 5908515, Japan. Author contributions: M. H., data collection, data analysis and writing the manuscript; Y. I., Y. K., A. K., Y. K., E. F., C. W. L., M. N., M. F., R. S., data collection and discussion; and M. I., K. O., K. O., T. W., K. M., study concept. Sponsor’s role: None. Geriatr Gerontol Int 2011; 11: 531–533

Community-dwelling elderly Japanese people with hobbies are healthier than those lacking hobbies.

factors in adults with bacterial meningitis. N Eng J Med 2004;351:1849–1859. 3. Weisfelt M, van de Beek D, Spanjaard L et al. Community-acquired bacterial meningitis in older people. J Am Geriatr Soc 2006;54:1500–1507. 4. Gjini AB, Stuart JM, Cartwright K et al. Quality of in-hospital care for adults with acute bacterial meningitis: A national retrospective survey. Q J Med 2006;99:761–769. 5. Fuglsang-Damgaard D, Pedersen G, Schnheyder HC. Positive blood culture and diagnosis of bacterial meningitis in cases with negative culture of cerebrospinal fluid. Scandi J Infect Dis 2008;40:229–233. 6. Proulx N, Frechette D, Toye B et al. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Q J Med 2005;98:291–298. 7. Kanegaye JT, Soliemanzadeh P, Bradley JS. Lumbar puncture in pediatric bacterial meningitis: Defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pre-treatment. Pediatrics 2001;108: 1169–1174. 8. Ragunathan L., Ramsay M., Borrow R et al. Clinical features, laboratory findings and management of meningococcal meningitis in England and Wales: Report of a 1997 survey. J Infect 2000;40:74–79.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China, III: Oxidative stress and aging in Tibetan and Han elderly highlanders

Background:  Although there are several factors which may contribute to oxidative stress at high altitude, little is known about the association between oxidative stress and aging in the community‐dwelling elderly in the Tibetan Plateau.

AGE AND SEX SIGNIFICANTLY INFLUENCE FALL RISK IN COMMUNITY-DWELLING ELDERLY PEOPLE IN JAPAN

and would be classified as LBV from a clinico-pathological point of view. Although the main limit of this study was the lack of a pathological diagnosis, it reflects the common clinical situation. These results underscore the difficulty of a DLB diagnosis in the elderly population in which the prevalence of AD lesions is high and might alter the occurrence of clinical signs of DLB, as well as the pattern of episodic memory impairment. Further research with pathological diagnosis is needed in this age group.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China II: The association of polycythemia with lifestyle‐related diseases among the three ethnicities

Aim:  The objective of this study is to disclose the association of polycythemia with lifestyle‐related diseases (hypertension, obesity and glucose intolerance) among the three ethnicities in Qinghai, China.