JAR life最新文献

Purpose: We constructed and validated a frailty-intrinsic capacity (FR-IC) index for predicting disability in community-dwelling older Japanese adults.

Methods: This longitudinal cohort study included 1179 participants aged ≥60 years (mean age: 71.3 ± 7.4 years, 51 % men). A multidisciplinary geriatric team constructed a 35-item FR-IC index (score range: 0: robust to 1: severe frailty, accumulation model) comprising 15 domains incorporating the intrinsic capacity concept (IC-Vision, IC-Hearing, IC-Locomotor capacity, IC-Cognition, IC-Vitality, and IC-Psychological capacity) based on questionnaires widely used in Japan. To test predictive validity, age- and sex-adjusted Cox proportional hazard models estimated hazard ratios (HRs) for incident disability (care need levels ≥1) by FR-IC index quartiles using the cohort study's existing data.

Results: The mean FR-IC index score (32 items, three missing) was 0.08±0.05 (range: 0.00-0.31). During a mean follow-up of 9.0 ± 2.8 years, 284 (24 %) adults developed a disability. Compared with the lowest quartile, the adjusted HRs for developing an incident disability in the second to fourth quartiles were 2.32 (95 % confidence interval: 1.15-5.33), 3.18 (1.64-7.15), and 4.15 (2.14-9.32), respectively. The area under the curve of the FR-IC index for incident disability was 0.86. Among healthy participants, defined as robust by the baseline phenotypic physical frailty assessment (n = 437), sex- and age-adjusted HRs for incident support care through the second to third tertiles were 1.72 (0.79-4.30) and 2.51(1.17-6.22), respectively (trend P = 0.028).

Conclusions: The novel FR-IC index can predict future disability among community-dwelling older Japanese adults. Integrating IC into frailty assessments provides a more comprehensive measure of aging.

Objectives: Adherence to the Mediterranean diet (MedDiet) and engagement in physical activity (PA) are associated with a lower risk of chronic disease, yet their relationship with medication use in older adults is less clear. This study examined cross-sectional associations between MedDiet adherence, PA levels, and medication use, including polypharmacy, in independently living older Australians.

Design: A cross-sectional observational study.

Setting and participants: Baseline data were drawn from the MedWalk trial, including 161 participants (119 females, 42 males; aged 60-90 years) residing in independent living facilities in Adelaide and Melbourne, and the wider Melbourne community.

Measurements: Adherence to the MedDiet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). PA was objectively measured via accelerometry and categorized as low (<150 min/week), moderate (150-<300 min/week), or high (≥300 min/week) of moderate-to-vigorous PA. Medication use was self-reported and coded using Anatomical Therapeutic Chemical (ATC) classifications. Polypharmacy was defined as use of ≥5 medications. Logistic and negative binomial regression analyses were adjusted for age, sex, education, and BMI.

Results: Moderate and high PA were associated with significantly lower odds of polypharmacy compared with low PA (AOR=0.37, p = 0.047; AOR=0.08, p = 0.022, respectively). High PA was also associated with a reduced total number of medications (exp(B)=0.44, p = 0.018) and fewer cardiovascular medications (AOR=0.29, p = 0.042). Each additional point in MedDiet adherence was associated with reduced use of alimentary tract and metabolism medications (AOR=0.78, p = 0.016), though no association was found with total medication use or polypharmacy.

Conclusion: In this cross-sectional study, higher PA was consistently associated with reduced polypharmacy and fewer medications, while greater MedDiet adherence was linked to reduced use of metabolic medications. Lifestyle practices may influence medication use patterns in later life. Larger longitudinal studies are needed to clarify causality and inform strategies to reduce polypharmacy through promotion of healthy lifestyle behaviors.

Introduction: Dementia affects over 55 million people globally, with numbers expected to double in the coming decades. Early detection is critical, yet traditional risk assessments relying on age, family history, and basic cognitive tests often fall short. This study explores whether combining structural brain imaging with brief cognitive assessments can more accurately predict dementia risk.

Method: Using data from 312 older adults enrolled in the KU Alzheimer's Disease Center cohort, researchers evaluated two modeling approaches: one based on a single clinic visit and another using longitudinal data across multiple visits. Participants underwent cognitive testing and MRI scans, including measures of hippocampal volume, gray matter, and Alzheimer's disease signature regions. Depressive symptoms were also assessed using the Geriatric Depression Scale (GDS).

Results: Results showed that models incorporating neuroimaging significantly outperformed those using demographics or cognitive scores alone. The best-performing model combined imaging and cognitive data, achieving 77.6% accuracy in predicting dementia status. Longitudinal models further improved prediction by capturing changes over time, with imaging features contributing most to explained variance. Key predictors included reduced hippocampal volume, lower gray matter, and higher GDS scores. These findings align with known patterns of neurodegeneration and suggest that depression may interact with brain changes to influence dementia risk.

Conclusion: Importantly, the study demonstrates that a compact, multimodal approaching standard MRI scans with brief cognitive tests-can generate individualized risk profiles suitable for clinical use. This method offers a scalable path to early intervention, trial enrollment, and personalized care planning. Future work will focus on validating these models in more diverse populations and integrating fluid biomarkers to enhance precision. Ultimately, this research supports the development of practical tools for forecasting dementia risk and advancing preventive strategies in aging populations.

Background: Evidence on the effectiveness of exercise interventions for nursing home residence with dementia is scarce, with considerable practice variation with respect to their contents and dosage. This study aimed to evaluate the feasibility of an adequately dosed, personalized exercise intervention with respect to the assessment instruments, participants' adherence and the occurrence of serious adverse events (primary feasibility outcomes) as well as the participant recruitment and participants' and supervisors' perceptions and experiences (secondary feasibility outcomes).

Design: Single-arm observational study.

Setting: Two nursing homes in Haarlem, the Netherlands.

Participants: Nursing home residents with a confirmed diagnosis of dementia who were able to walk 50 meters (with or without walking aid), without expected resistance to the intervention.

Intervention: 10-week program, with two group-based sessions including strength and balance exercises, and two individual exergaming cycling sessions per week. The sessions were tailored to the participant via standardized assessments and supervised by a physical therapist.

Results: Of 59 residents screened, 11 enrolled. Four of six clinical assessments were completed by all, and two by nine and ten participants, respectively. Nine participants completed both components, one only the individual exergaming part, and one participant dropped out. Adherence rates were 92 % for the group and 87 % for the individual sessions. Among 137 reported adverse events, nine were possibly related to the intervention, all minor and transient. The median participant appraisal score was 4.3 (out of five). Supervisors highlighted dementia-specific knowledge, individualized communication, and tailored approaches as facilitators, while scheduling conflicts posed challenges.

Conclusion: A 10-week, personalized, physical therapist-led exercise program for nursing home residents with dementia is feasible, with high adherence and positive evaluations. A pilot study to refine the recruitment and intervention procedures as well as pre-and post-intervention outcome measurements is needed prior to scaling up to a larger clinical trial assessing effectiveness.

[This corrects the article DOI: 10.1016/j.jarlif.2025.100003.].

Background: Semi-solid foods are widely consumed by older adults, yet the influence of their physical properties on swallowing remains unclear.

Objectives: To examine how variations in shape retention and spreadability affect swallowing in adults aged ≥75 years.

Design: An open-label randomized crossover trial with two food tests.

Setting: Controlled experimental setting.

Participants and numbers analyzed: Test 1 enrolled 21 adults and Test 2 enrolled 28; after exclusions, 14 and 16 were analyzed (mean ages 81.6 and 78.6 years).

Interventions: Participants ingested three semi-solid foods (P, Q, S) differing in physical properties.

Outcomes: Primary outcomes were oral processing time (OPT) and swallowing duration (SD), measured by a neck-worn electronic stethoscope and synchronized video. Secondary outcomes were subjective ratings of swallowing ease and food properties. Medians of five bites were analyzed, and first-fifth bite differences assessed.

Results: Subjective ratings differed only in collectability in Test 2. In Test 1, OPT was longer for P than Q (median difference 1.04 s, 95 % CI 0.15-2.04; p = 0.030). In Test 2, OPT was longer for S than P (median difference -1.88 s, -2.81 to -0.74; p = 0.001). SD did not differ significantly. With repeated swallows, OPT variance increased and SD variance decreased for P and Q, while both increased for S.

Harms: None observed.

Conclusions: Semi-solid food properties affect swallowing in older adults. Shape retention contributes to distinct swallowing patterns, supporting individualized food selection to promote safe intake.

Trial registration: UMIN000053442, UMIN000056840.

Introduction: In the absence of consensus on the diagnostic criteria for undernutrition in the elderly, there is a significant number of missing cases of disease in this target, particularly in areas with limited resources, including Senegal. We wanted to contribute to a better diagnostic approach to undernutrition in the elderly, by determining the relevance of body composition assessment using BIA.

Design: Cross-sectional and prospective study.

Setting and participants: Individuals aged ≥ 60 years old, attending outpatient consultations at Fann University Hospital and the Retirement Provident health Center (IPRES), who were able to stand for 3 min without technical and/or human assistance were included.

Methods: We used the Mini Nutritional Assessment (MNA) and Body Mass Index (BMI) to determine the prevalence of undernutrition and a Tanita BC 601® brand body composition monitor to assess body composition. Data were analyzed using SPSS version 29.0.

Results: We included 73 individuals with a mean age of 72.48 ± 7.23 years old, predominantly male, with a sex ratio of 1.43. Undernutrition, the main geriatric syndrome, affected 46.6 % of the study subjects according to the MNA and/or BMI, including two- thirds in men. The mean lean mass index was 16.07 ± 3.03 kg/m² in men and 15.53 ± 2.51 kg/m² in women. It was significantly lower in cases of malnutrition, with an average of 14.38 ± 2.82 kg/m² among malnourished elderly individuals.

Conclusion: Malnutrition in the elderly is best assessed early by a combination of diagnostic tools including MNA, BMI and lean mass index assessed by BIA.

Background: Models for dementia prediction in primary care are necessary to identify individuals at risk for developing dementia, but their implementation in clinical practice is partly limited due to lack of external validation or use of high-cost variables. We externally validated the predictive performance of a simple yet promising dementia risk prediction model.

Methods: We assessed discriminative ability with a c-statistic with 95 % confidence interval, using age, history of stroke, subjective memory complaints and need for assistance with a relatively complex task as predictors. This was done on 10,007 individuals that participated in the Lifelines-cohort study. Assessment of dementia in the Lifelines Cohort Study is self-reported in the follow-up questionnaires.

Results: Mean follow-up at LifeLines timepoint 1b was 1.5 years, mean follow-up at LifeLines timepoint 2a was 3.3 years and mean follow-up at LifeLines timepoint 3a was 9.1 years. Overall, 36 participants self-reported dementia development. Discriminative ability of the model overall dementia development yielded a c-statistic of 0.62 [95 % CI=0.48-0.70], and performed slightly better at follow-up 2a 0.67 [95 % CI=0.57-0.78]. However, calibration of the model in this external validation cohort was poor, with systematic overestimation of the predicted risk.

Conclusion: In this study the basic dementia risk prediction model overestimated the risk of dementia, but had reasonable discriminative ability in the Lifelines cohort. Within this validation cohort the potential of the model is underestimated due to low incidence of reported dementia. Further validation is required to determine the true value of the model. Studies assessing its implementation feasibility in primary care should also be conducted.

Objectives: To estimate the potential health and economic impact of regular multivitamin and mineral (MVM) supplementation in reducing dementia risk among Taiwanese adults aged ≥ 60 years old.

Methods: A population-based health economic model was developed to project dementia-related health and economic outcomes over a 10-year period (2024-2033) under two scenarios: current lack of MVM use versus expanded regular use (≥3 times/week). Model inputs were derived from Taiwanese demographic, epidemiological, and cost data, supplemented by published trials and expert validation. Outcomes included dementia cases prevented, premature deaths averted, years of life lost (YLL) averted, years lived with disability (YLD) averted, quality-adjusted life years (QALYs) gained, and societal cost savings from reductions in direct medical, non-medical, and caregiver-related costs.

Results: Regular MVM use was projected to prevent 204,250 dementia cases and 23,649 premature deaths, gain 407,910 QALYs, avert 115,943 YLL and 597,978 YLD. Total cost savings were estimated at NT$1.41 trillion, comprising NT$1.19 trillion in direct costs and NT$220 billion in indirect costs. Sensitivity analysis identified dementia risk reduction of MVM supplementation as the most influential parameter, but benefits remained robust under conservative assumptions.

Conclusion: Regular MVM supplementation among older Taiwanese adults without prior MVM use could meaningfully reduce dementia burden and generate substantial healthcare and societal cost savings. These findings highlight regular MVM use as a pragmatic strategy to support cognitive health in aging populations and provide a transferable modelling framework for other Asia-Pacific settings.