Combined Prevalence of Frailty and Mild Cognitive Impairment in a Population of Elderly Japanese People

doi:10.1016/j.jamda.2013.03.010

Journal of the American Medical Directors Association

Volume 14, Issue 7, July 2013, Pages 518-524

https://doi.org/10.1016/j.jamda.2013.03.010 Get rights and content

Abstract

Objective

Preventive strategies for frailty and mild cognitive impairment (MCI) are important for avoiding future functional decline and dementia in older adults. The purpose of this study was to use a population-based survey to ascertain the single and combined prevalence of frailty and MCI and to identify the relationships between frailty and MCI in older Japanese adults.

Design

Cross-sectional study.

Setting

General community.

Participants

A total of 5104 older adults (aged 65 years or older, mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE).

Measurements

Each participant underwent detailed physical and cognitive testing to assess frailty and MCI. We considered the frailty phenotype to be characterized by limitations in 3 or more of the following 5 domains: mobility, strength, endurance, physical activity, and nutrition. Screening for MCI included a standardized personal interview, the Mini-Mental State Examination, and the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT), which included 8 tasks used to assess logical memory (immediate and delayed recognition), word list memory (immediate and delayed recall), attention and executive function (tablet version of Trail Making Test-part A and B), processing speed (tablet version of digit symbol substitution test), and visuospatial skill (figure selection).

Results

The overall prevalence of frailty, MCI, and frailty and MCI combined was 11.3%, 18.8%, and 2.7%, respectively. We found significant relationships between frailty and MCI (the odds ratio adjusted for age, sex, and education was 2.0 (95% confidence interval 1.5–2.5).

Conclusions

Using the OSHPE criteria, we found more participants with MCI than with frailty. The prevalence of frailty and MCI combined was 2.7% in our population. Future investigation is necessary to determine whether this population is at increased risk for disability or mortality.

Section snippets

Participants

Our national study assessed 5104 individuals 65 years and older (mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE). Each individual was recruited from Obu, Japan, which is a residential suburb of Nagoya. Inclusion criteria required each participant to be 65 years or older at the time of examination (2011 or 2012), and to reside in Obu city. Based on previous reports, we excluded participants with a history of Parkinson disease, stroke, or

Results

The OSHPE identified 538 (11.3%) elderly participants who had symptoms of frailty and 945 (18.8%) who had MCI (Table 1). Fig. 1, Fig. 2 show our findings regarding the prevalence of frailty and MCI, respectively. We found that the prevalence of frailty increased with advancing age. Of the 538 participants who were classified as frail, 192 (34.9%) were 80 years and older. The prevalence of frailty was higher in women than in men (P < .05), and a lower level of education was significantly

Discussion

This study presents original data regarding vulnerability for physical and cognitive decline in a sample of 5104 elderly community dwellers in Japan. To our knowledge, this is the first study about frailty and MCI in this region of the world. Japan has a rapidly aging population in comparison with North, Central, and South America, as well as Europe. An examination of the differences in levels of frailty and MCI between countries may be useful in developing health care policies, especially in

Acknowledgments

We thank the Obu city office for assistance with participant recruitment.

References (51)

L.P. Fried et al.
Physical disability in older adults: A physiological approach. Cardiovascular Health Study Research Group
J Clin Epidemiol
(1994)
M.S. Albert et al.
The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease
Alzheimers Dement
(2011)
J.A. Yesavage et al.
Development and validation of a geriatric depression screening scale: A preliminary report
J Psychiatr Res
(1982)
M.F. Folstein et al.
“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975)
T.W. Auyeung et al.
Physical frailty predicts future cognitive decline—a four-year prospective study in 2737 cognitively normal older adults
J Nutr Health Aging
(2011)
P. Dargent-Molina et al.
Fall-related factors and risk of hip fracture: The EPIDOS prospective study
Lancet
(1996)
G. Abellan van Kan et al.
Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force
J Nutr Health Aging
(2009)
C. Cano et al.
Frailty and cognitive impairment as predictors of mortality in older Mexican Americans
J Nutr Health Aging
(2012)
K.E. Ensrud et al.
Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures
J Gerontol A Biol Sci Med Sci
(2007)
N.F. Woods et al.
Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study
J Am Geriatr Soc
(2005)

Gnjidic D, Stanaway FF, Cumming R, et al. Mild cognitive impairment predicts institutionalization among older men: A...

J.M. Guralnik et al.

The Women's Health and Aging Study: Health and Social Characteristics of Older Women With Disability

(1995)

L. Ferrucci et al.

Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report

J Am Geriatr Soc

(2004)

R.C. Petersen et al.

Mild cognitive impairment: Clinical characterization and outcome

Arch Neurol

(1999)

B. Winblad et al.

Mild cognitive impairment—beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment

J Intern Med

(2004)

L.P. Fried et al.

Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

(2001)

O.L. Lopez et al.

Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: Part 1

Arch Neurol

(2003)

L.P. Fried et al.

Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care

J Gerontol A Biol Sci Med Sci

(2004)

A.B. Mitnitski et al.

The estimation of relative fitness and frailty in community-dwelling older adults using self-report data

J Gerontol A Biol Sci Med Sci

(2004)

A.S. Buchman et al.

Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly

Psychosom Med

(2007)

P.A. Boyle et al.

Physical frailty is associated with incident mild cognitive impairment in community-based older persons

J Am Geriatr Soc

(2010)

B. Santos-Eggimann et al.

Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries

J Gerontol A Biol Sci Med Sci

(2009)

S. Jungwirth et al.

VITA: Subtypes of mild cognitive impairment in a community-based cohort at the age of 75 years

Int J Geriatr Psychiatry

(2005)

K. Yaffe et al.

Mild cognitive impairment, dementia, and their subtypes in oldest old women

Arch Neurol

(2011)

T. Hanninen et al.

Prevalence of mild cognitive impairment: A population-based study in elderly subjects

Acta Neurol Scand

(2002)

Cited by (351)

Combined impact of physical frailty and social isolation on use of long-term care insurance in Japan: A longitudinal observational study
2024, Maturitas
The combined effect of physical frailty and social isolation on the need to make use of long-term care insurance (LTCI) among older adults remains unknown. Thus this study investigates the association between physical frailty, social isolation, and the use of LTCI among older adults in Japan.
This is a prospective observational study.
Physical frailty is defined as limitations in strength, mobility, and physical activity, as well as exhaustion and weight loss. People with one or two indicators were categorized as pre-frail. Participants with a score of 1 point or more on the social isolation scale were defined as being socially isolated. Participants were followed up monthly for two years to check whether incident certification of care had been required.
Data on 4576 community-dwelling independent older adults (mean age, 73.9 ± 5.5 years, 2032 men, 2544 women) were analyzed. A time-dependent Cox proportional hazards regression model showed that individuals with pre-frailty without social isolation (hazard ratio [HR] 2.02, 95 % confidence interval [CI] 1.40–2.91), pre-frailty with social isolation (HR 2.36, 95 % CI 1.62–3.43), frailty without social isolation (HR 2.98, 95 % CI 1.83–4.85), and frailty with social isolation (HR 3.19, 95 % CI 2.07–4.91) had significantly higher risks of needing to make use of LTCI than those with no frailty and without social isolation. This higher risk was non-significant among individuals with no frailty and social isolation (HR 1.28, 95 % CI 0.78–2.10).
Combined frailty and social isolation among older adults should be addressed to prevent adverse health outcomes, including use of LTCI.
Prevalence of physical and oral frailty in geriatric patients in Kerala, India
2024, Journal of Oral Biology and Craniofacial Research
Physical frailty is a condition where a person has decreased physical reserve and resilience to stressors. Oral frailty, on the other hand, refers to a decline in oral function in conjunction with reductions in cognitive and physical functioning. Poor oral health, encompassing factors such as functional, physiological, psychosocial, and therapeutic aspects, can lead to physical frailty.
Assess the prevalence of physical and oral frailty in geriatric patients attending health centres in Kerala, India.
.
Cross-sectional study.
Amrita Institute of Medical Sciences (Kochi), Amrita Kripa Charitable Hospital (Wayanad) and Amrita Urban Health Centre in (Kaloor).
250 geriatric participants above 60 years.
The participants' physical frailty was evaluated using Fried's Frailty Phenotype, the Reported Edmonton Frail Scale, and sarcopenia screening. The assessment of oral frailty was based on several factors such as current dental status, chewing ability, tongue pressure, the Repetitive Saliva-Swallowing Test, Oral Diadokinetic rates, Xerostomia, and the Oral and Maxillofacial Index. The evaluation was using a questionnaire and clinical examination. Bivariate analysis was performed for additional variables, and multivariate analysis was utilized to examine the relationship between oral and physical frailty.
56 % of study participants were males, and the mean age was 68 ± 6.02 years. 34.4 % were physically frail, and the remaining were pre-frail using Fried Frailty Phenotype. 67 % showed oral frailty using the Oral and Maxillofacial Frailty Index (OMFI). Using six domains of the oral frailty status (Tanaka) showed that 74 % of individuals had an increased risk of new onset of physical frailty. In the adjusted model, individuals with mild oral frailty had lesser chances of being frail (OR = 0.509, 95 % CI = 0.274–1.946, p-value = 0.033).
The prevalence of physical frailty was 34.4 %, and oral frailty status was 74 %. The findings implied a need to include oral frailty assessments in the comprehensive general health screening for geriatric patients.
Lifetime Physical Activity and Late-Life Mild Cognitive Impairment in Community-Dwelling Older Adults
2024, Journal of the American Medical Directors Association
Regular physical activity throughout life is generally recommended to prevent dementia; however, there is little evidence regarding the association between lifetime physical activity and mild cognitive impairment (MCI), which often precedes dementia. This study aimed to examine the association of lifetime physical activity and their transitions with late-life MCI.
A population-based case-control study.
A total of 2968 Japanese community-dwelling older adults aged ≥70 years without dementia.
We evaluated the participants’ early-, mid-, and late-life physical activity habits and categorized their transitions across life stages. Cognitive functions in late life were assessed for memory, attention, executive function, and processing speed; functional impairment in one or more cognitive domains was defined as MCI.
Regular physical activity in early life was not significantly associated with late-life MCI [odds ratio (OR), 0.80; 95% CI, 0.63–1.02], although those in mid-life (OR, 0.64; 95% CI, 0.51–0.81) and late-life (OR, 0.74; 95% CI, 0.59–0.91) were associated with lower odds of late-life MCI. Compared with nonexercisers, participants who acquired new habits of physical activity during mid- or late-life (OR, 0.71; 95% CI, 0.55–0.91) and those who maintained physical activity throughout their life span (OR, 0.61; 95% CI, 0.42–0.87) had lower odds of late-life MCI; those who stopped regular activity during mid- or late-life did not (OR, 0.79; 95% CI, 0.58–1.06).
While physical activity throughout the life span is associated with the lowest odds of MCI, starting regular physical activity, even later in life, confers a benefit and should be encouraged as a "lifelong approach" to MCI risk reduction.
Classification of social isolation and factors related to loneliness and life satisfaction among socially isolated individuals
2023, Geriatric Nursing
To operationally divide social isolation into four categories and examine the factors associated with social isolation and its relationship with loneliness and life satisfaction.
The participants were community-dwelling older adults aged ≥ 60 years who underwent functional health examinations in Chita City, Aichi, Japan. Multiple regression analysis was used to examine the associations between social isolation, loneliness, and life satisfaction.
A total of 5,066 participants (mean age 72.0 ± ± 6.3 years, female: 55.4 %) were included in the study. Multiple regression analysis showed that the number of experiences of social isolation, classified into four categories, was positively correlated with loneliness (β = 0.188, ΔR2 = 0.244, p < 0.001) and negatively correlated with life satisfaction (β = -0.076, ΔR2 = -0.178, p < 0.001).
Multiple experiences of social isolation classified into four categories were found to be associated with higher loneliness and lower life satisfaction.
Advanced brain age in community-dwelling population with combined physical and cognitive impairments
2023, Neurobiology of Aging
We investigated whether advanced brain biological age is associated with accelerated age-related physical and/or cognitive functional decline: mobility impairment no disability (MIND), cognitive impairment no dementia (CIND), and physio-cognitive decline syndrome (PCDS). We constructed a brain age prediction model using gray matter features from the magnetic resonance imaging of 1482 healthy individuals (aged 18–92 years). Predicted and chronological age differences were obtained (brain age gap [BAG]) and analyzed in another 1193 community-dwelling population aged ≥50 years. Among the 1193 participants, there were 501, 346, 148, and 198 in the robust, CIND, MIND, and PCDS groups, respectively. Participants with PCDS had significantly larger BAG (BAG = 2.99 ± 8.97) than the robust (BAG = −0.49 ± 9.27, p = 0.002; η² = 0.014), CIND (BAG = 0.47 ± 9.16, p = 0.02; η² = 0.01), and MIND (BAG = 0.36 ± 9.69, p = 0.036; η² = 0.013) groups. Advanced brain aging is involved in the pathophysiology of the co-occurrence of physical and cognitive decline in the older people. The PCDS may be a clinical phenotype reflective of accelerated biological age in community-dwelling older individuals.
Changes in Satisfaction with Meaningful Activities and Onset of Depressive Symptoms among Community-Dwelling Japanese Older Adults: A Population-Based Study Before and During the COVID-19 Pandemic
2023, Journal of the American Medical Directors Association
This study aimed to clarify the association between changes in satisfaction with meaningful activities and the occurrence of depressive symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic.
A population-based prospective cohort study (Tarumizu Study).
A total of 231 community-dwelling older adults aged ≥65 years without depressive symptoms at baseline.
The participants completed baseline (June to December 2018, before the COVID-19 pandemic) and follow-up (September to December 2021, during the COVID-19 pandemic) assessments. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, and their satisfaction levels were evaluated. Satisfaction with the most meaningful activities was assessed as to whether it was maintained/improved or decreased at follow-up.
In the follow-up survey, 31 (14.3%) participants reported the occurrence of depressive symptoms. Compared with before the COVID-19 pandemic, the rates of meaningful activities during the COVID-19 pandemic decreased for interpersonal interaction and social life and increased for leisure, sports, self-care, and domestic life. Logistic regression analysis revealed that changes in satisfaction with meaningful activity were associated with the occurrence of depressive symptoms after adjusting for demographic variables, baseline GDS scores, cognitive and physical status, and instrumental activities of daily living (odds ratio, 2.78; 95% confidence interval, 1.17–6.59, P = .020).
To avoid decreasing satisfaction with meaningful activities, supporting older adults may be protective against the occurrence of depressive symptoms. Our findings highlight the need for health care professionals to not only encourage older adults to participate in activities for their mental health but also consider whether the activities are meaningful or satisfying for them.

View all citing articles on Scopus

: This work received financial support from a grant from the Japanese Ministry of Health, Labour, and Welfare. The funding source played no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

View full text

Original StudyCombined Prevalence of Frailty and Mild Cognitive Impairment in a Population of Elderly Japanese People

Abstract

Objective

Design

Setting

Participants

Measurements

Results

Conclusions

Section snippets

Participants

Results

Discussion

Acknowledgments

J Clin Epidemiol

Alzheimers Dement

J Psychiatr Res

J Psychiatr Res

J Nutr Health Aging

Lancet

J Nutr Health Aging

J Nutr Health Aging

Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures

J Gerontol A Biol Sci Med Sci

Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study

J Am Geriatr Soc

The Women's Health and Aging Study: Health and Social Characteristics of Older Women With Disability

Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report

J Am Geriatr Soc

Mild cognitive impairment: Clinical characterization and outcome

Arch Neurol

Mild cognitive impairment—beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment

J Intern Med

Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: Part 1

Arch Neurol

Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care

J Gerontol A Biol Sci Med Sci

The estimation of relative fitness and frailty in community-dwelling older adults using self-report data

J Gerontol A Biol Sci Med Sci

Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly

Psychosom Med

Physical frailty is associated with incident mild cognitive impairment in community-based older persons

J Am Geriatr Soc

Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries

J Gerontol A Biol Sci Med Sci

VITA: Subtypes of mild cognitive impairment in a community-based cohort at the age of 75 years

Int J Geriatr Psychiatry

Mild cognitive impairment, dementia, and their subtypes in oldest old women

Arch Neurol

Prevalence of mild cognitive impairment: A population-based study in elderly subjects

Acta Neurol Scand

Original Study
Combined Prevalence of Frailty and Mild Cognitive Impairment in a Population of Elderly Japanese People