Association Between Subjective Masticatory Ability Decrease and Stroke Incidence by Physical Function in Japanese Community-Dwelling Older Adults: A 4-Year Prospective Longitudinal Study

Omega-3 Long-Chain Polyunsaturated Fatty Acids: Are They Beneficial for Physical and Cognitive Functioning in Older Adults?

APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.

We read with great interest the study by Kubo et al. on physical activity associations with physical function and body composition among community-dwelling older adults in Japan: The Kyotango Longevity Cohort Study [1]. This research confirmed that the community-dwelling older adults can maintain good physical function and favorable body composition by engaging in physical activity. This study features innovative design, reliable data, and conclusions providing guiding value for clinical diagnosis and treatment practice. Here, we would like to focus on the following aspects. First, we should fully recognize the benefits that physical activity brings to the elderly in the community. The China Health and Retirement Longitudinal Study (CHARLS) confirmed that physical activity not only directly improves mental health but also indirectly reduces the risk of falls among urban elderly people by reducing stress. Meanwhile, physical activity has an improving effect on depression among the people [2]. Kim et al. found that for the elderly, it was beneficial to engage in physical activities, especially leisure-time sports and resistance exercises. At the same time, physical activity may reduce the prevalence of diabetes in the elderly [3]. Appetite loss among community-dwelling older adults is common and may lead to malnutrition, reduced function, and frailty. A study from Europe showed that regular physical activity among the elderly may help increase their appetite and maintain good health [4]. A systematic review indicated that for the elderly, physical exercise is effective in improving physical and mental health. Tai Chi, aerobic training, resistance training, and combination training may change the health outcomes of elderly people with gait disorders. Among them, Tai Chi has become the most commonly used and beneficial exercise method [5]. Second, we need to ascertain the factors that hinder older adults from engaging in physical activity and develop long-term plans and intervention measures to overcome these obstacles. The risks of chronic diseases increase among the elderly, which may lead to a reduction in their physical activity levels. A study from China showed that gamification and mobile health (mHealth) technologies may enhance the potential, sustainability, and effectiveness of physical activity among the elderly [6]. Chen et al. pointed out that in the community, the main personal factors that hinder elderly people from engaging in physical activity include fear of injury, pain, low motivation, and lack of free time. Interpersonal factors were lack of social support and family obligations. Adverse weather, poor building environment, and high costs of using sports facilities are environmental factors that hinder physical exercise for the community-dwelling older adults [7]. A study from the UK using the Capability, Opportunity, Motivation, and Behavior (COM-B) model analysis found that lower socioeconomic status had adverse effects on physical activity and overall health status among older adults. Evaluation and intervention measures aimed at improving physical activity should be carried out for elderly people with low socioeconomic status [8]. Research from Israel pointed out that the elderly often encounter obstacles to regular exercise, including restricted access, lack of motivation, and financial constraints. Designated outdoor locations and sports activity parks specifically designed for the elderly may eliminate these obstacles [9]. Engaging in physical activity is beneficial for community-dwelling older adults. For the elderly, healthcare decision-makers should provide specific and personalized suggestions for physical activity, develop long-term plans and security measures to overcome various obstacles that restrict the elderly from engaging in physical activity. This study was funded by the special funding for high-level talents in the medical and health industry in Jinan (202412) and Shandong Province Medical and Health Science and Technology Development Plan (202003030878). The authors have nothing to report. The authors have nothing to report. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BackgroundFrailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults.MethodsWe conducted a cross-sectional and longitudinal study using data from the “Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC),” which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs).ResultsAt baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model’s AUC was 0.943 (95%CI 0.913–0.974), indicating good discrimination, with Hosmer–Lemeshow (H–L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model’s AUC was 0.722 (95%CI 0.656–0.788), indicating moderate discrimination, with H–L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%.ConclusionFrailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.

Background Overall spinal curvature is evaluated by calculating the difference between the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) and is expressed as LL minus TK (LL-TK). It is unclear whether LL-TK is associated with physical function in community-dwelling older adults and whether it is more relevant than TK or LL alone. Objective This study aimed to identify whether LL-TK is associated with physical function in community-dwelling older adults, and whether it is strongly associated than TK or LL alone. Methods The participants comprised 1,674 community-dwelling older adults who underwent physical assessments (women, n = 1,099; mean age, 67.4 ± 5.3 years). As spinal alignment indices, TK and LL were measured using skin surface methods, and LL-TK was calculated as the difference between them. Decreased LL-TK indicated increased overall spinal curvature. Physical function was determined by measuring single-leg standing, five-times chair-stand, and usual gait speed. Stepwise multiple regression analyses were performed with each physical function as the dependent variable and spinal alignment indices as the independent variables, with adjustments. Results Multiple regression analyses showed that single-leg standing (β = 0.092, 95% confidence interval [CI] = 0.071 to 0.214, p < .001) and five-times chair-stand (β=-0.142, 95% CI = −0.037 to −0.019, p < .001) were significantly associated with LL-TK, but not LL. Both LL-TK (β = 0.121, 95% CI = 0.001 to 0.004, p < .001) and LL (β = 0.087, 95% CI = 0.001 to 0.003, p = .003) were significant determinants of usual gait speed. Conclusions This study showed that decreased LL-TK may be associated with poor physical function. This association may be stronger than that observed for TK or LL alone.

Introduction Aging is often accompanied by decreased muscle mass, strength, and physical function. Resistance exercise may mitigate this loss; however, data are lacking that compare physical function of younger and older community-dwelling adults who do or do not include resistance training in their health and fitness routine. Therefore, the purpose of this study was to determine how skeletal muscle mass, strength, and physical function differ by age and resistance training status in community-dwelling adults. Methods For this cross-sectional study, healthy younger (23.8 ± 0.4 yr) and older (68.7 ± 1.2 yr) adults (n = 76) were categorized into four groups based on resistance training status: younger resistance trained (YRT; n = 22), younger not resistance trained (YNT; n = 16), older resistance trained (ORT; n = 17), and older not resistance trained (ONT; n = 21). Participants performed stair climb, 30-s sit-to-stand, 6-min walk, and grip strength tests and had dual energy x-ray absorptiometry scans to measure skeletal muscle mass. Results For stair climb, YRT, YNT, and ORT were faster than ONT (P ≤ 0.05). For 30-s sit-to-stand, YRT and ORT completed more reps than ONT and YNT (P ≤ 0.05; ORT vs ONT: d = 1.468; YRT vs YNT: d = 1.767). For 6-min walk, ORT, YRT, and YNT walked farther than ONT (P ≤ 0.05; ORT vs ONT: d = 1.007), and YRT walked farther than YNT (d = 0.764). Thirty-second sit-to-stand and 6-min walk were not different between ORT and YRT, 6-min walk and stair climb were not different between ORT and YNT, and grip strength and lean leg mass were not different between ONT and ORT (P &gt; 0.05). Conclusion Older adults who engage in regular resistance training can maintain physical function levels similar to that of younger adults. Additionally, these data provide evidence-based support that resistance training performed by community-dwelling adults on their own based on American College of Sports Medicine guidelines translates to real-world benefits to mitigate age-related functional decline.

This study determined whether tooth loss was associated with the development of functional disability and estimated the population attributable fraction (PAF) of functional disability due to tooth loss, along with risk factors for functional disability such as physical function and cognitive impairment. The participants were 838 community-dwelling older adults aged ≥70 years living in the Tsurugaya district in Japan in 2003. The exposure variable was the number of remaining teeth (counted by trained dentists). Other variables were age, sex, depressive symptoms, cognitive impairment, educational attainment, physical function and social support. The Cox proportional hazards model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the incidence of functional disability for each risk factor, such as tooth loss. The functional disability PAF due to tooth loss was estimated, and risk factors for functional disability were identified. In total, 619 (73.9%) participants developed functional disability during follow-up. A multivariable model showed that those with <20 teeth (HR, 1.28; 95% CI, 1.08-1.53) were more likely to develop functional disability than those with 20 teeth or more. PAF estimation for functional disability was shown to have decreasing values in the following order: age, female sex, tooth loss and reduced physical function. Tooth loss was associated with the development of functional disability in community-dwelling older Japanese adults. While retaining teeth may be a potential strategy for avoiding functional disability, clinical studies on the effect of dental treatment on preventing functional disability are warranted.

Older adults have highly heterogeneous aging rates. To explore the association of biological age (BA) and accelerated aging with frailty in community-dwelling older adults. We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using Fried's phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥ 0) with frailty at baseline and characterized the body composition and physical function phenotype of accelerated aging in non-frail/frail participants. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up. Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (β = 0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed sex-based differences in body composition and physical function linked to accelerated aging in non-frail participants; however, these differences were absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75). Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults.

Older adults have heterogeneous aging rates. Here, we explored the impact of biological age (BA) and accelerated aging on frailty in community-dwelling older adults. We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using both Fried's phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥0) with frailty at baseline and characterized the impact of both on body composition and physical function. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up. Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (β=0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed a sexual dimorphism in body composition and physical function linked to accelerated aging in non-frail participants; however, this dimorphism was absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75). Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults.

Physical function (PF) impairment and elder mistreatment (EM) are alarming public health issues facing by many older adults. Prior studies have not generated uniform findings on the associations between PF and EM. This study aimed to address the research gap of this association among U.S. Chinese aging population. Three thousand one hundred fifty-eight community-dwelling Chinese older adults in the Greater Chicago Area were surveyed. Independent variables included both self-reported and performance-based PF measurements. Dependent variable was EM, assessed by a 10-item instrument that has been widely used in social studies. The mean age of study participants was 76.3 years (SD ± 8.4) and 58.0% were female. After adjusting for potential covariates, higher scores of activities of daily living (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.73-0.98), instrumental activities of daily living (OR = 0.87, 0.82-0.92), and Rosow-Breslau reversely coded (OR = 0.85, 0.75-0.96) were associated with lower risk of EM. Also, lower scores of observed PF performance measurements, including tandem stand (OR = 0.78, 0.70-0.88), measured walk (OR = 0.84, 0.77-0.91), and the overall measurement (OR = 0.93, 0.89-0.97) have significant associations with lower risk of EM. Findings from this study suggested that greater levels of PF impairment were associated with lower risk of EM among U.S. Chinese older adults in the Greater Chicago Area. Longitudinal studies are needed to obtain a more comprehensive understanding of the pathways between PF and EM and its subtypes among Chinese aging populations.

Few studies have investigated whether dual sensory impairment (DSI) adversely affects the deterioration of physical function in older adults compared to single sensory impairment (SSI, visual or auditory). We studied the association between DSI and declining physical function by analyzing the data of 2780 Korean community-dwelling adults aged 70–84 years. Sensory impairment was assessed through pure tone audiometry and visual acuity testing. Muscle strength (handgrip strength) and physical performance (timed up and go test and short physical performance battery (SPPB)) were evaluated. In the cross-sectional analysis, DSI was associated with higher odds of having low muscle strength (odds ratio (OR), 1.78; 95% confidence interval (CI), 1.27–2.48) and poor physical performance (SPPB: OR, 2.04; 95% CI, 1.38–3.00) than SSI. Among all sensory impairment groups in the longitudinal analysis, DSI at baseline increased the risk of deteriorating physical performance during the follow-up period (OR, 1.94; 95% CI, 1.31–2.88; p < 0.01) the most. DSI showed a more severe adverse effect on the decline in physical function among community-dwelling older adults than SSI. More comprehensive care is needed to prevent the deterioration of physical function in older adults due to DSI.

ATEMPTing to navigate between “lower is better” and “less is more”

The Association Between Decline in Physical Functioning and Atrophy of Medial Temporal Areas in Community-Dwelling Older Adults With Amnestic and Nonamnestic Mild Cognitive Impairment

Combination of self-management strategies for reducing sedentary behavior with multicomponent exercise on sedentary behavior patterns and physical function in community-dwelling older adults: a randomized, blinded clinical trial with 40-week follow-up.

The deterioration of oral function to a state of oral hypofunction (OHF) is reportedly associated with malnutrition and frailty. Thus, we Investigated the association of OHF with physical characteristics and function and test the effects of a programme including comprehensive oral and physical exercises and textured lunch gatherings (COPE-TeL programme) on oral and physical function in older adults with OHF. Eighty-six community-dwelling older adults were randomly assigned into control (n=43) or intervention (n=43) groups. The participants were further divided into OHF and normal oral function (NOF) sub-groups based on initial oral examinations. The intervention group participated in the 12-week COPE-TeL programme, while the control group performed the physical exercise regimen only. The differences in measured variables for physical and oral function between the OHF and NOF groups were statistically tested, and changes in the proportion of participants with OHF were examined. Physical function, such as hand grip strength and walking speed, was significantly lower in the OHF group at the initial assessment. The proportion of participants with OHF was 56% in the intervention group and 67% in the control group before the trial, which became significantly reduced after completing the COPE-TeL programme in the intervention group (26%, P=.002), but not in the controls (61%, P=.549). Older adults with OHF may have diminished physical function. The COPE-TeL programme of oral and physical exercises along with textured lunch gatherings may be effective for older adults with OHF.