Geriatrics & Gerontology International最新文献

Incorporating tongue pressure as an indicator of oral frailty allows for a comprehensive approach to frailty management in older adults.

Unno et al. [1] recently highlighted the importance of preoperative intramuscular adipose tissue content (IMAC) in early functional recovery after hip fracture.

In daily rehabilitation practice, we frequently encounter patients who demonstrate preserved systemic stability—adequate nutritional indices and stable vital parameters—yet remain unable to initiate effective gait despite intensive therapy. The findings by Unno et al. provide a compelling physiological explanation for this clinical discrepancy: a dissociation between “systemic metabolic reserve” (reflected by PhA) [2] and “locomotor mechanical integrity” (reflected by IMAC) [1].

The authors' observation that IMAC independently predicts walking recovery, while PhA does not, raises a critical question regarding our current therapeutic strategies: Are conventional resistance-based rehabilitation paradigms sufficient for patients with high IMAC? [3] The presence of myosteatosis implies a qualitative deficit in motor unit recruitment and force transmission. Consequently, we propose that patients identified with high preoperative IMAC might require distinct interventions, such as targeted neuromuscular re-education or high-velocity power training, rather than standard strengthening protocols alone.

Finally, while the authors acknowledge the 2-week follow-up limitation, this early period is often just the beginning of the functional journey. In models like Taiwan's nationwide Post-Acute Care (PAC) program, patients undergo high-intensity rehabilitation for several weeks to months [4]. Whether IMAC retains its strong predictive value for ambulatory recovery during such prolonged, high-intensity rehabilitation remains an important and clinically actionable question that warrants further investigation.

The authors have nothing to report.

The authors have nothing to report.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Research into the relationship between Satoyama activities and the health status of older people should be conducted scientifically based on the biopsychosocial model, with appropriate control groups and neuroscience-based monitoring of changes in brain function.

Aim: Cerebral small vessel disease (CSVD)-related MRI findings, including white matter hyperintensities (WMHs), are not rare in general elderly populations. The aim of this study was to elucidate the contribution of hereditary CSVD-related genes to CSVD-related MRI findings in a general Japanese population.

Methods: We analyzed datasets from 324 individuals aged ≥ 50 years in Tohoku Medical Megabank (TMM), focusing on MRI markers and variants of NOTCH3, ABCC6, COL4A1, COL4A2, GLA, HTRA1, and TREX1 genes. Background factors included age, sex, hypertension, diabetes, dyslipidemia, hyperuricemia, alcohol drinking, and smoking.

Results: Pathogenic variant carriers were identified within ABCC6 (n = 20), but not other genes. To compare with previous studies including rare NOTCH3 variants regardless of pathogenicity, we included 24 rare functional variants of NOTCH3. We performed a gene-based analysis using the burden test and sequence kernel association test (SKAT) adjusted for background factors, between WMH/lacune and ABCC6/NOTCH3. The only significant finding was the correlation between WMH volume and rare NOTCH3 variants by SKAT, both with the basic model, adjusted for age, sex, and hypertension (p = 0.045), and full model, adjusted for all background factors (p = 0.027). We also analyzed the association between intracranial major artery stenosis/occlusion (ICASO) and RNF213 p.Arg4810Lys, the East Asian-specific variant susceptible to ICASO; however, we failed to identify a significant correlation.

Conclusions: This study suggests that NOTCH3 may contribute to WMH volume in a general Japanese population.

Aim: During the COVID-19 pandemic, some patients experienced difficulty attending regular in-hospital cardiac rehabilitation (CR) after discharge. This study investigated the impact of CR in older patients with cardiovascular disease (CVD) by comparing outcomes before, during, and after the COVID-19 pandemic.

Methods: In this post hoc analysis of a single-center registry, 505 patients aged ≥ 65 years (mean age 82) were included. Outcomes were compared between participants in a 4-month outpatient CR program after discharge and non-participants. Patients were categorized into three periods: before the COVID-19 pandemic (n = 173), during the COVID-19 pandemic (n = 217), and after the COVID-19 pandemic (n = 105). Cardiovascular (CV) events and non-CV events were followed.

Results: As the primary endpoint, cumulative hospitalization for worsening HF was significantly lower in the CR group across all time periods (p < 0.001, p < 0.001, and p = 0.019, respectively). Cumulative non-CV event-free survival was significantly higher in the CR group before and after the COVID-19 pandemic (p < 0.001, p = 0.030, respectively) but showed no significant differences during the pandemic. Before the pandemic, participation in CR was significantly associated with hospitalization for worsening HF (hazard ratio [HR], 0.538; 95% confidence interval [CI], 0.294-0.982; p = 0.043). During and after the pandemic, this association was not.

Conclusion: CR appears to have a protective effect against CV events in older patients with CVD. Although the COVID-19 pandemic disrupted this positive trend, the findings support CR as a cornerstone of recovery in this population.

Aim: Preventing and mitigating frailty across physical, cognitive, social, and oral domains is vital for extending healthy life expectancy in older adults. Although apathy and depressive symptoms are reportedly associated with frailty domains, their domain-specific relationships remain unclear. This study aimed to compare the associations of apathy and depressive symptoms with frailty domains in older adults.

Methods: This cross-sectional study included 465 community-dwelling adults aged ≥ 75 years (median age, 78 years; interquartile range, 76.0-82.0; 49.7% women) from the 2024 Shimane CoHRE Study. Apathy and depressive symptoms were defined as scores of ≥ 16 on the Japanese version of the Starkstein Apathy Scale and ≥ 40 on the Self-rating Depression Scale, respectively. Frailty domains across physical, cognitive, social, and oral domains were assessed using the Questionnaire for Medical Checkup of the Old-Old. Logistic regression analyses adjusted for age, sex, and body mass index.

Results: The prevalence of apathy, depressive symptoms, and their coexistence was 30.8%, 29.9%, and 14.6%, respectively. Both apathy and depressive symptoms were significantly associated with a higher prevalence of physical frailty (lack of exercise), cognitive frailty (memory impairment), and social frailty (lack of interaction with others). Their coexistence was additionally associated with oral, physical, cognitive, and social frailty.

Conclusions: Apathy and depressive symptoms share some frailty domains but also exhibit domain-specific associations. Their coexistence may be associated with multidimensional frailty. These findings highlight the importance of assessing emotional function and tailoring frailty prevention to individual emotional profiles.

Aim: Recent studies have suggested that masticatory function may influence frailty progression. However, the relationship between posterior occlusal support and frailty remains underexplored. We aimed to evaluate the association between the loss of posterior occlusal support and frailty in a large cohort of Japanese adults.

Methods: This retrospective cohort study used data from the JMDC Claims Database. We included 386 270 individuals aged ≥ 40 years who underwent both specific health checkups and dental visits in 2016, with follow-up data available through 2020. We categorized posterior occlusal support using the Eichner classification (A, all support zones intact; B, partial support zones; C, no functional support zones). We assessed frailty annually using the claims-based frailty index (CFI) (a deficit accumulation-type frailty measure). We used generalized estimating equations to evaluate the association between occlusal support and frailty after adjusting for potential confounders.

Results: At baseline, the mean age was 49.6 (standard deviation, 7.2) years, and 47.4% of the participants were women. The prevalence of frailty was 4.9%, 9.5%, and 12.1% in the Eichner A, B, and C groups, respectively. Compared to Eichner A, the adjusted odds ratios (ORs) for frailty were 1.21 (95% confidence interval [CI], 1.13-1.30) for Eichner B and 1.39 (95% CI, 1.21-1.59) for Eichner C. This relationship was stronger among women than men.

Conclusions: Reduced posterior occlusal support is independently associated with an increased risk of frailty. These findings underscore the importance of oral health in preventing physical debilitation and suggest incorporating early dental interventions into health strategies for older populations.