BACKGROUND:The new position paper on the definition and diagnosis of respiratory sarcopenia defines respiratory sarcopenia as a decrease in respiratory muscle strength and mass. It recommends using a decrease in limb muscle mass as a substitute for respiratory muscle mass, which is difficult to measure, and recommends that such cases be diagnosed as "probable respiratory sarcopenia" with appropriate interventions. This study aimed to determine the physical characteristics of older adults with probable respiratory sarcopenia based on current criteria. METHODS:A total of 496 community-dwelling older adults were enrolled in this study, completing an evaluation of respiratory and physical function in 2023 as part of a comprehensive health check-up program called the Otassha study. The respiratory and physical functions, comorbidities, instrumental activities of daily living, and lifestyles of the participants were measured. "Probable respiratory sarcopenia" was compared to non-respiratory sarcopenia with respect to respiratory and physical functions. Probable respiratory sarcopenia was determined using low maximal mouth pressure (< 80% of predicted value) and low appendicular skeletal muscle mass (ASM)/height2 (7.0 kg/m2 for men and 5.7 kg/m2 for women). The association between probable respiratory sarcopenia (as the independent variable) and physical and peak expiratory flow rate (PEFR) (as dependent variables), adjusted for covariates, was evaluated using a multivariate linear regression model. A 2:1 matched pair of individuals with non-respiratory sarcopenia and probable respiratory sarcopenia was compared using propensity score matching (PSM) to account for confounders. RESULTS:The prevalence of probable respiratory sarcopenia was 33 out of 185 (17.8%) in men and 65 out of 311 (20.9%) in women. Grip strength, knee extension strength, and PEFR were significantly associated with probable respiratory sarcopenia (p = 0.001 to p < 0.01). In the PSM data set, compared to non-respiratory sarcopenia, those with probable respiratory sarcopenia showed significantly lower values for respiratory function, grip strength, and knee extension strength, cognitive function, as well as a higher prevalence of whole-body sarcopenia (p = 0.028 to p < 0.001). CONCLUSION:Probable sarcopenia is characterized by low limb muscle strength and impaired respiratory and physical function. Understanding this aspect of suspected respiratory sarcopenia can aid in early detection and treatment management, leading to improved future health outcomes.

BACKGROUND:The Japanese Working Group on Sarcopenic Obesity (JWGSO) recently published diagnostic criteria for sarcopenic obesity specific to Asian populations. This study aimed to estimate the prevalence and evaluate the characteristics and validity of sarcopenic obesity as defined by the JWGSO. METHODS:We analysed longitudinal data from 736 community-dwelling older adults aged ≥65 years from the 2012 Otassha Study. Sarcopenic obesity was diagnosed using JWGSO and European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (ESPEN/EASO) criteria. Physical function, body composition, gonalgia, and mobility were compared between participants with and without sarcopenic obesity according to each criterion. Agreement between JWGSO-defined sarcopenic obesity and conventional sarcopenia with obesity or ESPEN/EASO definitions was evaluated using Cohen's kappa coefficient. Survival over approximately an 8-year follow-up was evaluated using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models were applied, and when the proportional hazards assumption was violated, analyses were stratified into early and late follow-up periods. RESULTS:Sarcopenic obesity was present in 57 participants (7.7%) per JWGSO criteria and 55 participants (7.5%) per ESPEN/EASO criteria. Regardless of definition, participants with sarcopenic obesity were older; had lower walking speed, grip strength, and balance; and exhibited higher prevalence of conventional sarcopenia, knee osteoarthritis, and reduced mobility function (p = 0.022 to p < 0.001). Agreement between JWGSO and conventional sarcopenic obesity and ESPEN/EASO definitions was fair (K = 0.345) and substantial (K = 0.671), respectively. JWGSO-defined sarcopenic obesity was not significantly associated with mortality in the early follow-up but was linked to increased mortality risk in the late period (HR 3.75, 95% CI 1.66-8.50, p = 0.002). CONCLUSION:Sarcopenic obesity defined by the JWGSO is distinct from conventional sarcopenia with obesity and ESPEN/EASO-defined sarcopenic obesity. This population-specific criterion may improve identification of older Japanese adults at higher risk of poor physical function and mortality, although further validation is warranted.

Background:Increasing life expectancy has increased focus on the health-related consequences of aging, such as sarcopenia and frailty. Given the prevalence of these conditions among older individuals and the frequent resulting long-term care needs, early detection and intervention are crucial. Objective:This study aimed to validate a novel smartphone-based system measuring acceleration during the sit-to-stand movement to detect sarcopenia and frailty. Methods:Participants were 587 individuals from the Otassha study cohort who underwent health assessments in 2023, of whom 569 (96.9%) completed 2 supervised sit-to-stand trials while holding a smartphone on the lower abdomen. Sarcopenia and frailty were diagnosed using the Asian Working Group for Sarcopenia 2019 criteria and the revised Japanese Cardiovascular Health Study criteria, respectively. Peak force, rising time (T1), and stabilization time (T2) were extracted from acceleration signals, and reproducibility was examined using the intraclass correlation coefficient (ICC(2,1)). Predictive models were developed using elastic net penalized logistic regression, and model performance was evaluated using 500 bootstrap resamples. Benchmark models using age and sex, walking speed, and grip strength were also constructed for comparison. Results:Sarcopenia and frailty were identified in 16.7% (95/569) and 9% (51/569) of the participants, respectively. Peak force demonstrated excellent reliability (ICC=0.863), whereas T1 and T2 showed lower reproducibility (ICC<0.30). For sarcopenia, the smartphone model achieved a bootstrap area under the receiver operating characteristic curve (AUC) of 0.800 and an optimism-corrected AUC of 0.781 (95% CI 0.733-0.826), outperforming walking speed (0.663) and age and sex (0.656) and ranking second only to grip strength (0.845). For frailty, the smartphone model showed moderate discrimination, with an optimism-corrected AUC of 0.659 (95% CI 0.587-0.736), exceeding age and sex (0.604), whereas walking speed remained the strongest predictor (0.751). Conclusions:Smartphone-derived sit-to-stand acceleration provides a practical and scalable approach for screening for sarcopenia and frailty in community-dwelling older adults. While traditional indicators such as grip strength and walking speed remain the most accurate predictors, smartphone-based measurements offer meaningful complementary information and may support large-scale functional screening and early detection initiatives in superaged societies.

OBJECTIVES:Living alone is potentially associated with cardiovascular mortality; however, the effects of social interactions have not been fully considered. This study examined whether social isolation and living alone were independently associated with cardiovascular mortality and whether living alone modified the association between social isolation and cardiovascular mortality in community-dwelling older adults. STUDY DESIGN:Community-dwelling older adults residing in Itabashi Ward, Tokyo, who participated in the postal survey, were enrolled. Social isolation was defined based on the frequency of interaction with others. MAIN OUTCOME MEASURES:The main outcome was cardiovascular mortality, obtained from the Itabashi Ward office database. Cox proportional hazards models were used to examine the association between social isolation and living alone, independently of cardiovascular mortality, and to test whether living alone modified the association between social isolation and cardiovascular mortality. RESULTS:In total, 4144 older adults (mean age 72 years; 46% men) were included in the analyses. During follow-up (median 96 months), 95 cardiovascular deaths occurred. Social isolation was independently associated with cardiovascular mortality (hazard ratio 2.20; 95% confidence interval 1.43-3.39), although living alone was not (hazard ratio 0.88; 95% confidence interval 0.52-1.49). Living alone did not significantly modify the association between social isolation and cardiovascular mortality (p for interaction = 0.06). CONCLUSIONS:Social isolation was associated with cardiovascular mortality in older adults, independent of living arrangements. These results highlight the importance of considering social interactions in addition to living arrangements when stratifying cardiovascular risks for older adults.

Aim Early detection of dementia is crucial for effective intervention. The computer-based cognitive assessment tool (CompBased-CAT) was designed to assess cognitive function using a tablet computer. While its predictive validity for mild cognitive impairment (MCI) is established, its test–retest reliability remains unclear. This study aimed to evaluate the test–retest reliability of CompBased-CAT among older Japanese adults in a community setting. Methods This is a methodological study that examined the test–retest reliability of CompBased-CAT. Community-dwelling older adults aged 65 years or older who participated in both the pre-test and post-test were included. Pre-test assessments were conducted during the 2023 Otassha study from 28 September to 8 October 2023, with the post-test administered 62 days (±14 days) later. Subtest scores were normalized to z -scores, and the total CompBased-CAT score was computed by summing these z -scores. Test–retest reliability was assessed using paired t -tests and intraclass correlation coefficient (ICC) two-way random-effects models, with analyses stratified by age, sex, and MCI status. Results A total of 80 participants (mean age: 76.8 years; 27.5% male) were analyzed. Paired t -tests showed no significant difference in total scores between the pre-test (mean = −0.75; standard deviation [SD] = 3.73) and the post-test (mean = −0.42; SD = 4.45). The total score exhibited an ICC of 0.64 (95% confidence interval [CI] = 0.49–0.75) for all participants, increasing to 0.74 (95% CI = 0.48–0.88) among those with MCI. Conclusion CompBased-CAT demonstrated good test–retest reliability, with an ICC of 0.64 among all participants, which increased to 0.74 among participants with MCI over a 2-month period, indicating its potential for monitoring cognitive function through repeated assessments.

Background/Purpose: Walking speed is an important parameter of physical health in older adults. In previous studies, walking speed was measured by walking in the laboratory and using a global positioning system (GPS) on the smartphone. However, because walking with a GPS is mostly an outdoor activity, the validity of walking speed measurement in older adults, who mainly live indoors, has not been adequately verified. This study aimed to examine the validity of measuring walking speed using an ankle-band accelerometer in older individuals by comparing it to the walking speed measured using a stopwatch in a laboratory setting, which is the gold standard for measuring walking speed. Methods: In total, 509 subjects (mean age: 73.8 years; female: 62.9%) participated in a comprehensive health examination as part of the Otassha Study 2011 Cohort Follow-up Survey in 2022. Walking speed was measured as usual walking speed and maximum walking speed. The validity of walking speed measurement with an ankle-band accelerometer was evaluated using the intraclass correlation coefficient (ICC) (2,1), and systematic bias was observed using Bland-Alman plots. Results: The mean usual walking speeds with the stopwatch and ankle-band accelerometer were 1.38 (SD: 0.24) m/s and 1.30 (0.27) m/s, respectively, and the mean maximum walking speeds were 2.09 (0.39) m/s and 2.09 (0.49) m/ s, respectively. ICCs were 0.78 for usual walking speed and 0.85 for maximal walking speed, and Bland-Altman plots showed a proportional bias for maximal walking speed. Conclusion: We evaluated the accuracy of an ankle-band accelerometer for walking speed measurements.

OBJECTIVE:To examine associations among the self-perception of age-related walking-speed decline, perception gap (discrepancy between objective and subjective walking-speed assessments), and frailty in older adults. METHODS:We included 467 older adults (age: 74.7 ± 6.3 years; female: 62 %) who participated in the 2019 (T1) and 2020 (T2) comprehensive health-checkup surveys conducted among community-dwelling adults aged ≥ 65 years. As a subjective walking-speed assessment, participants rated their perception of walking-speed change at T2 compared to before (negative/positive). As an objective assessment, they were classified as having a decline in or maintaining a stable walking speed based on whether their walking speed at T2 declined by > 0.1 m/s compared to T1. Accordingly, participants were grouped into negative+decline (ND), negative+stable (NS), positive+decline (PD), and positive+stable (PS) groups. NS and PD groups had a perception gap. Frailty was assessed using the Kihon Checklist at T2. Covariates included sex, age, health conditions, and mental status. Associations between self-perception, perception gap, and frailty were examined using analysis of covariance and binary logistic regression analysis. RESULTS:Prevalences of negative self-perception and a perception gap were 66.6 % and 58.7 %, respectively. Negative self-perception groups had higher frailty scores and prevalence than those in the positive groups; no significant difference was observed between perception-gap and no-gap groups. In the four-group comparison, ND and NS groups had higher KCL scores than PD and PS groups. CONCLUSIONS:Negative self-perception was associated with frailty, regardless of a perception gap. Addressing negative perceptions may help prevent frailty. Further research is needed on perception-related factors.

OBJECTIVE:To describe age-group differences in oral function in middle-aged and older Japanese adults. BACKGROUND:To facilitate oral function management, it is essential research spanning a wider age range. MATERIALS AND METHODS:We conducted a secondary analysis of data in 2023 from two distinct populations. The Otassha Study included community-dwelling adults aged ≥ 65 years in Tokyo. The second sample consisted of middle-aged workers aged ≥ 40 years employed at municipal offices in Fukuoka. Survey items included tongue coating index, mucosal wetness, occlusal force, oral diadochokinesis, tongue pressure, masticatory function, swallowing function and the prevalence of oral hypofunction. Trend tests and binary logistic regression analysis were conducted. The dependent variable was the presence of oral hypofunction, and the independent variable was the age group. RESULTS:Our analysis included 645 participants (275 men and 370 women, aged 40-89 years). The prevalence of oral hypofunction and low oral function in six elements, except mucosal wetness, showed a significant linear association by age group. The prevalence of oral hypofunction was higher in the 80s (adjusted odds ratio: 3.4, 95% confidence interval: 1.4-8.3) than in the reference category (60s). CONCLUSION:Expanding middle-aged participant data and conducting longitudinal studies are essential for understanding age-related changes in oral function. These efforts will help inform effective strategies to address oral functional decline.

AIM:The Japan Science and Technology Agency Index of Competence (JST-IC) was developed to measure competence at much higher levels than the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which evaluates higher-level functional capacity necessary for independent living. This study explored the JST-IC aging trajectories and their associations with instrumental activities of daily living (IADL) impairment in community-dwelling older Japanese individuals. METHODS:Participants were 665 adults who responded to the 2014 baseline survey and at least one follow-up survey (2015-2019) of the Otassha study. The JST-IC and TMIG-IC aging trajectories were identified using group-based trajectory modeling. The association with nine-year IADL impairment onset was investigated using Cox proportional hazards models. RESULTS:Three JST-IC trajectory groups were identified: high (29.5%), medium (53.1%), and low (17.3%), with scores decreasing by one to two points with increasing age over the follow-up period. High-stable (50.6%), late-onset decrease (41.1%), and early-onset decrease (8.3%) TMIG-IC trajectory groups were identified with a one- to three-point decrease in late- and early-onset groups. The low JST-IC trajectory group had an adjusted hazard ratio of 2.90 (95% confidence interval, 1.60-5.24) for IADL impairment (reference: high group). Low technology usage, information practices, and social engagement trajectories were significantly associated with IADL impairment. CONCLUSIONS:The JST-IC scores gradually declined in all groups, even among those who maintained their TMIG-IC scores. The low JST-IC trajectory group-particularly low technology usage, information practices, and social engagement-was associated with the onset of IADL impairment.

AIM:The availability of diverse assessment methods, based on different devices and conditions, for respiratory sarcopenia is crucial for developing community health initiatives. Thus, in this study, we aimed to compare the concordance in diagnosing respiratory sarcopenia based on the maximal respiratory pressure (MRP) and peak expiratory flow rate (PEFR), which are specific indicators of respiratory-muscle strength, in a community-dwelling older adult population. METHODS:In the Otassha Study conducted in 2023, 499 community-dwelling adults aged >65 years in Itabashi Ward (184 men and 315 women) were evaluated for MRP, PEFR, walking speed, grip strength, and appendicular skeletal muscle mass (ASM). We determined two respiratory-sarcopenia models using low skeletal muscle mass and low MRP/PEFR (both <80% for predicted values). Pearson correlation coefficients were used to compare each measurement; the agreement between respiratory sarcopenia diagnosed using low MRP and PEFR was evaluated using kappa coefficients (κ). RESULTS:PEFR was correlated with MRP (maximal expiratory pressure: r = 0.415; maximal inspiratory pressure: r = 0.380; P < 0.01, respectively). A moderate level of agreement was found between respiratory sarcopenia diagnosed using MRP and that diagnosed using PEFR (κ = 0.597, match rate = 87.2%), suggesting a fair consistency level between the methods. CONCLUSIONS:Although PEFR had a moderate correlation with MRP, the concordance of respiratory sarcopenia diagnosed using the two methods was moderate, suggesting that the two approaches are partially interchangeable and are complementary. The findings showed that PEFR, proposed as an alternative to MRP, is valid for diagnosing respiratory sarcopenia, supporting its role as an alternative to the gold standard for evaluating respiratory-muscle strength. Geriatr Gerontol Int 2025; 25: 1253-1259.

Background: Daily-life walking speed (DWS), which is a critical health indicator in older adults, can be measured using smartphone GPS technology. Although this method is becoming more widely accessible, it is restricted to outdoor walking. In contrast, accelerometers can capture walking speed indoors; however, there is limited information on the comparability of DWS data between these two techniques. Objective: In this study, we aimed to investigate the agreement and systematic error between DWS measured using the built-in GPS of a smartphone and an ankle-band accelerometer. Methods: Participants were recruited from a previously selected cohort of community-dwelling older adults. Their DWS was assessed using both a smartphone app and ankle band accelerometer. Data from the two devices were matched based on simultaneous recordings, and agreement between the walking speeds was evaluated using the intraclass correlation coefficient (ICC) and a Bland-Altman plot. Results: A total of 99 participants (38 men, 61 women; mean [SD] age 71.5 [4.9] y) were included, yielding 3652 paired data points. The mean (SD) DWS as measured by GPS was 1.30 (0.19) m/s, and this was significantly higher than the value of 1.12 (0.23) m/s measured by the accelerometer (P<.001). The ICC(2, 1) (95% CI) value was 0.523 (-0.022 to 0.765), and the ICC(2, k) value was 0.687 (-0.045 to 0.867). The Bland-Altman plot revealed a fixed error of 0.18 m/s with 95% limits of agreement ranging from-0.49 m/s to 0.13 m/s in the GPS-measured walking speed compared to that measured by the ankle-band accelerometer. Conclusions: The GPS app consistently recorded a faster walking speed than the ankle-band accelerometer. The agreement between the measurements of the two devices was poor. The data suggest that a correction is necessary when comparing the DWS between these two devices.

BACKGROUND:Prevention of dementia is crucial for reducing its social burden. Social isolation is a known risk factor for dementia. The use of information and communication technology is associated with reduced cognitive decline. However, longitudinal associations of the use of information and communication technology with cognitive function remain unknown, especially for older adults who are socially isolated and at a high risk of cognitive decline. OBJECTIVES:To investigate the association between the use of information and communication technology and changes in cognitive function among older adults with and without social isolation. DESIGN:Longitudinal observational study SETTING: Data was obtained for two cohorts of community-dwelling older adults aged 65 years with no cognitive impairment (Mini-Mental State Examination score ≥24) at baseline. PARTICIPANTS:Participants were defined as those who completed baseline assessments of the use of information and communication technology, social isolation, and cognitive function and underwent at least one follow-up assessment of cognitive function in a follow-up survey conducted annually through 2023. MEASUREMENTS:The use of information and communication technology was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Cognitive function and social isolation were assessed using the Mini-Mental State Examination and the six-item Lubben Social Network Scale, respectively. Data from the two cohorts were combined to examine the association between the use of information and communication technology and changes in cognitive function, as well as the association between the use of information and communication technology and the incidence of cognitive decline (Mini-Mental State Examination <24), using mixed effects models and Cox proportional hazards models, respectively. These analyses were conducted separately based on social isolation. RESULTS:A total of 1,322 participants (mean age: 72.3 years, 39 % male) were included in the final analysis. The median follow-up period was 3.9 years. Individuals who used information and communication technology experienced a slower rate of cognitive decline than non-users (-0.09, 95 % confidence interval: -0.11 to -0.07 vs. -0.18, 95 % confidence interval: -0.21 to -0.15). In addition, information and communication technology use was associated with a significantly lower risk of cognitive decline (hazard ratio: 0.73, 95 % confidence interval: 0.70-0.76). This association remained consistent among older adults with social isolation (hazard ratio: 0.91, 95 % confidence interval: 0.85-0.97). CONCLUSIONS:The use of information and communication technology was associated with a reduced risk of cognitive decline, even among socially isolated older adults. Creating an environment that enables effective ICT use with appropriate support may help preserve cognitive function in aging populations.

BACKGROUND:Living alone has been associated with cognitive impairment; however, findings have been inconsistent. Social isolation among older adults who live alone may contribute to cognitive impairment. This study was carried out to examine the association of social isolation and living alone with cognitive impairment in community-dwelling older adults. METHODS:In this cross-sectional study, data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which comprises pooled data from five community-based geriatric cohorts, was used. Social isolation was defined as infrequent interactions with others. Participants were categorized into four groups based on their social isolation and living alone statuses. Cognitive function was assessed using the Mini-Mental State Examination, with a score <24 indicating cognitive impairment. The association between social isolation combined with living alone and cognitive impairment was analyzed using logistic regression. RESULTS:Of the 4362 participants included in the analysis (mean age 75.6 years, 44.3 % male), 11 % had cognitive impairment. Regardless of living alone, social isolation was associated with cognitive impairment (no social isolation x not living alone: reference, social isolation x not living alone; odds ratio (OR): 1.74, 95 % confidence interval (CI): 1.29-2.33, social isolation x living alone; OR: 2.10, 95 % CI: 1.46-3.01). CONCLUSIONS:Social isolation is associated with cognitive impairment; however, living alone is not intrinsically associated with cognitive impairment in older adults. Healthcare providers must focus on social interactions to prevent cognitive impairment in older adults rather than simply focusing on living arrangements.

AimThe Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height2) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations.MethodsParticipants of our cohort study in 2015 of 468 community-dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height2, and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut-off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut-off values for each parameter, including ASM/height2, from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut-off values for ASM/height2 and PEFR or %PEFR on a three-dimensional chart to observe the relationship between the different cut-off values and HR.ResultsA total of 31 people died during the 5-year observation period. With ASM/height2 cut-off values of approximately 7.0 kg/m2 for men and 5.7 kg/m2 for women and %PEFR cut-off values of 66-75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36-3.27, point estimation range).ConclusionsThe definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; center dot center dot: center dot center dot-center dot center dot. The definition of respiratory sarcopenia by the four professional organizations(Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition) is related to future health outcomes, and this definition is valid. image

IntroductionSocial isolation is associated with increased mortality risk. On the other hand, some older adults prefer to be alone. Additionally, predictors of isolation are mostly unchanged across interventions. Therefore, knowledge of how to prevent negative health outcomes in isolation would be beneficial. One of the factors that reduces the risk of mortality is regular exercise. However, to date, no studies to our knowledge have examined whether regular exercise reduces mortality among socially isolated individuals. This study aimed to determine the effects of the combination of social isolation and regular exercise on mortality among community-dwelling older adults.MethodsThis prospective cohort study was part of the larger Otassha Study of community-dwelling older adults living in Itabashi Ward, Tokyo, Japan. In October 2012, 835 individuals (males = 350, females = 485; mean age 73.1 years) completed a comprehensive baseline health survey. Individuals were considered socially isolated if their frequency of interactions with others averaged less than once per week. Regular exercise was defined as exercise performed at least twice a week. The participants were assigned to one of the following four groups: (1) not isolated with regular exercise, (2) not isolated without regular exercise, (3) isolated with regular exercise, and (4) isolated without regular exercise. All-cause mortality information was obtained from the ward office database. Follow-ups were conducted until 1 November 2020. A Cox proportional regression analysis was performed.ResultsA final analysis was performed on a complete dataset of 735 participants (males = 303, females = 432; mean age 72.9 years). A total of 132 (18.0%), 426 (58.0%), 27 (3.7%), and 150 (20.4%) participants were assigned to groups 1, 2, 3, and 4, respectively. The mortality rates in groups 1, 2, 3, and 4 were 6.1%, 9.2%, 7.4%, and 19.3%, respectively. Compared with group 1, isolated individuals who did not perform regular exercise had a significantly higher mortality rate [adjusted hazard ratio (aHR), 2.48; 95% confidence interval (CI), 1.12–5.52]. However, no significant association was noted in isolated individuals who performed regular exercise (aHR, 1.25; 95% CI, 0.26–5.91).ConclusionRegular exercise was associated with a decrease in mortality risk, regardless of social isolation status. Thus, our results indicate that encouraging isolated older adults to exercise regularly may reduce their negative health outcomes.

IntroductionSocial isolation has been recognized as a contributing factor to negative health outcomes. Although living alone is associated with health-related outcomes, existing findings are inconsistent. It is not the act of living alone that may predict poor health, but rather social isolation that can lead to increased mortality risk. This study investigated the combined associations of social isolation and living alone with mortality among community-dwelling older adults.MethodsWe included older adults from Itabashi ward, Tokyo, who participated in comprehensive health checkups. Participants were categorized into four groups based on their social isolation status and living alone. The primary outcome was all-cause mortality, analyzed using Cox proportional hazards models.ResultsOf the 1,106 participants (mean age 73, 42% male), 4.5% experienced both social isolation and living alone. This combination was associated with a worse prognosis regarding all-cause mortality (hazard ratio (HR): 2.08 [95% confidence interval (CI), 1.08–4. 00]). Those who were socially isolated but not living alone also showed a trend towards higher mortality risk (HR: 1.41 [95% CI, 0.90–2.20]). Contrastingly, those who were not socially isolated and lived alone did not show an increased mortality risk (HR: 0.81 [95% CI, 0.44–1.49]).Discussion and conclusionLiving alone is not inherently associated with a poor prognosis in older adults; however, social isolation was associated with a higher mortality risk. Healthcare providers should focus on enhancing social interactions and support for older adults because of their effects on health rather than solely addressing living arrangements to prevent adverse health events.

Purpose Muscle atrophy progresses with age. The motor function may be estimated by measuring the muscle mass; however, if muscle quality deteriorates due to an increase in connective tissue within the muscle, a decline in motor function may be missed by measuring muscle mass alone. Therefore, it is important to understand the relationship between muscle mass, muscle quality, and motor function. This study aimed to clarify how changes in muscle thickness, measured using ultrasound imaging, in older people are related to motor function and echo intensity. Patients and methods The thickness and echo intensity of the four quadriceps muscles were measured using an ultrasound imaging device in 110 community-dwelling older individuals. Correlations between muscle thickness, motor functions such as walking and muscle strength, and echo intensity were analyzed in each sex. Partial correlation analysis was conducted using age as a control variable. Results A significant correlation was observed between muscle thickness and motor function in both men and women. There was no significant negative correlation between muscle thickness and echo intensity of the same muscle in men, except between each muscle thickness and the vastus medialis (p < 0.001 or p = 0.007), between the sum of the four muscle thicknesses and vastus medialis thickness (p = 0.02), and between the vastus medialis thickness and echo intensity (p < 0.006). In women, a significant correlation was observed for all muscles. Partial correlation analysis revealed a similarly significant correlation between muscle thickness and echo intensity in men and women. Conclusion We observed sex differences in the relationship between muscle thickness and echo intensity. This suggests that, even after adjusting for age-related factors, women may show more pronounced changes in muscle quality than men, with increased echo intensity due to increased intramuscular connective tissue with muscle atrophy.

BACKGROUND:Maintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear. AIMS:This study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese. METHODS:Participants were 3,169 community-dwelling older Japanese who participated in the 2012-2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65-90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined. RESULTS:Three patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable. DISCUSSION:The instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped. CONCLUSIONS:To maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented.

This study examined the ability of a computer-based cognitive assessment tool (CompBased-CAT) to predict mild cognitive impairment (MCI) in community-dwelling older adults. A two-year longitudinal study was conducted using data from 2016 to 2018 from the Otassha study cohort of community-dwelling older adults. MCI was defined as a Mini-Mental Status Examination (MMSE) score of <27. The CompBased-CAT was used at baseline, with each subtest score converted into a Z-score. Subsequently, the total Z-scores were calculated. Participants were divided into robust and MCI groups, and all variables were compared using the t-test or χ2 test. Receiver operating characteristic (ROC) curves and logistic regression analyses were conducted, with MCI and total Z-scores as dependent and independent variables, respectively. Among the 455 participants (median age, 72 years; range, 65-89 years; 282 women and 173 men), 32 developed MCI after two years. The participants in the MCI group were significantly older. They had lower maximal gait speed, baseline MMSE scores, subtest Z-scores, and total Z-scores than those in the robust group. The area under the ROC curve was 0.79 (95% confidence interval: 0.70-0.87; P <0.01). The sensitivity was 0.76, and the specificity was 0.75. The logistic regression analysis showed an odds ratio of 1.34 (95% confidence interval: 1.18-1.52; P <0.01). This study showed that CompBased-CAT can detect MCI, which is an early stage of dementia. Thus, CompBased-CAT can be used in future community health checkups and events for older adults.