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Longitudinal study on frailty and its prevention strategy

Members

Leader :
Akihiko Kitamura
Members (TMIG or TMGH-IG) :
Satoshi Seino, Yuri Yokoyama, Mariko Nishi, Hidenori Amano, Yu Nofuji, Miki Narita, Tomoko Ikeuchi, Sho Kaito, Takumi Abe, Mari Yamashita, Yoshinori Fujiwara, Hiroyuki Suzuki, Ryota Sakurai (Research Team for Social Participation and Community Health) Hunkyung Kim, Yutaka Watanabe, Ayako Edahiro, Keiko Motokawa, Yosuke Osuka (Research Team for Promoting Independence and Mental Health) Tatsuro Ishizaki, Shuichi Obuchi, Seigo Mitsutake (Research Team for Human Care) Shoji Shinkai (Vice-director, Social and Human Sciences), Akihito Ishigami (Research Team for Functional Biogerontology) Masafumi Ito, Yasunori Fujita (Research Team for Mechanism of Aging), Kazuhiro Shigemto (Vice-director, Biology and Medical Sciences), Heying Zhou (Research Team for Geriatric Medicine) Hirohiko Hirano, Takashi Takei, Mitsuyo Itabashi (Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology)
Members (Other Institutes) :
Takuo Kuboki, Katsushi Tamaki (Japan Prosthodontic Society), Katsuya Iijima (The University of Tokyo), Hiroyasu Iso (Osaka University), Masahiko Kiyama (Osaka Center for Cancer and Cardiovascular Disease Prevention), Takeshi Tanigawa (Juntendo university), Tomonori Okamura (Keio University), Hiroshige Jinnouchi (Nippon Medical School), Kazumasa Yamagishi (University of Tsukuba)

Keywords

Frailty, Preventive Strategy, Longitudinal Study, Predictor, Body composition, Nutritional epidemiology

Major Research Titles

  1. 1.Establishing method of continuous follow up survey
  2. 2.Evaluation of long-term care prevention in community
  3. 3.Collaborative study on prevention of frailty

Profile

Frailty is an important health issue in old age. It denotes the age-associated functional state with decreased reserve and increased vulnerability to stressors, eventually leading to adverse health outcomes such as falls, disability, institutionalization and death. The main purpose of our longitudinal study on frailty and its prevention strategy is to scientifically clarify outcomes and causes of frailty and suggest plans and strategies to prevent frailty. We have been conducting two cohort studies of community-dwelling older adults in Kusatsu and Hatoyama areas. We have also conducted joint studies with other research groups using combined datasets as well as collaborative studies on biomarkers developed by other research teams of TMIG. Brief introductions of our three projects are listed below.

1. Establishing method of continuous follow up survey
One of our projects comprises two studies: Hatoyama cohort study and Kusatsu longitudinal study on aging and health. In the Hatoyama cohort study, 750 older persons who lived in Hatoyama, Saitama Prefecture and participated in the baseline survey in 2010 have been followed up every year with in-depth health examinations and/or mail survey. The target population of the Kusatsu longitudinal study is all the residents aged 65 and older (N=2,500) of Kusatsu town, Gunma Prefecture. They have been followed up since 2002 with annual health check-ups and biannual home-visit interview surveys.
In both studies, we have also been collaborating on frailty/care prevention at the community level with the local governments of Kusatsu and Hatoyama towns. In the town of Hatoyama, the increase in the long-term care needs certification rate has been suppressed since 2010, and the healthy life expectancy has been attained first place in the Saitama Prefecture. Similarly, in the town of Kusatsu, the increase in the long-term care needs certification rate has been suppressed, a curb on nursing care consumption has been seen, and the healthy life expectancy for adults over 70 years old has been growing steadily. In the coming years, we will re-examine the design of these studies and ultimately marshal different elements in order to establish a method of continuous follow up survey and develop a model of preventive measures for long-term care/frailty. We expect it would be an informative guide to other areas as well.


2. Evaluation of long-term care prevention in community
This study is composed by the following three elements. The study findings will be used as proposals for "prevention tactics of long-term care/frailty" that can be applicable in other communities

(1) Trend survey on frailty outcomes and the relative factor of frailty
Frailty denotes the age-associated functional state with decreased reserve and increased vulnerability to stressors, eventually leading to adverse health outcomes such as falls, disability, institutionalization and death. Although an increasing number of studies on frailty have been documented in the past years mostly in Western countries, many issues have remained unsolved. More studies, particularly from Japan, are needed to elucidate these unsolved issues.
We will examine the related factors of frailty epidemiologically by analyzing our longitudinal data. Moreover, we have been monitoring the long-term care needs certification rate and healthy life expectancy as outcomes of frailty in our research fields for the past years (i.e., trend survey). We will continue this survey and explore the trends in more detail.

(2) The evaluation of community intervention programs / action research
With our research studies, we have contributed to establish an effective strategy for healthy aging which is urgently needed in Japan. In the past years, we have been implementing numerous efforts to collaborate with the local government and address healthy aging and social participation for community-dwelling older adults in several communities. In the coming years, we will be evaluating the process and outcomes of the community intervention programs, as part of our action research project.

(3) Social and economic evaluation
In Japan’s super-aged society, researches for suppressing medical and long-term care expenses are critical. Our research team reported the suppression of increase in medical and long-term care costs in Kusatsu town and the association between trajectories in higher-level functional capacity and medical and long-term care costs. We will perform further analysis with a focus on the breakdown of medical and long-term care costs by collaborating with Research Team for Human Care.


3. Collaborative study

(1) Elucidation of the risk factors for developing frailty
We have proceeded with the research project using data obtained from the Kusatsu longitudinal study and the Hatoyama cohort study and pooled data from cohort studies of older Japanese by collaborating with other research teams and institutions.

Collaboration with research teams and institutions:
Research Team for Mechanism of Aging, Research Team for Geriatric Medicine, Japan Prosthodontic Society, Japan Arteriosclerosis prevention fund, The Ito Foundation, University of Tsukuba, Osaka University, Otsuka Pharmaceutical Co., Ltd., The Research Fund for Longevity Sciences, Health Labour Sciences Research Grant, etc.

(2) Development and Implementation tools for early detection of frailty
We previously developed tools for early detection of frailty. The tools include an assessment system of physical performance, a brief questionnaire for screening frailty (The Check—List15), and a screening tool for the early detection of malnutrition risk. We will implement these tools in various settings and perform further validation studies.

References

  1. 1. Kitamura A, Shinkai S, Taniguchi Y, Amano H, Seino S, Yokoyama Y, Nishi M, Fujiwara Y. Impact of frailty and metabolic syndrome on the incidence of loss of independence in community-dwelling older Japanese: the Kusatsu-town study. Nihon Koshu Eisei Zasshi,64(10):593-5606, 2017. (in Japanese)
  2. 2. Taniguchi Y, Kitamura A, Nofuji Y, Ishizaki T Seino S, Yokoyama Y, Shinozaki T, Murayama H, Mitsutake S, Amano H, Nishi M, Matsuyama Y, Fujiwara Y, Shinkai S. Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese. J Gerontol A Biol Sci Med Sci, in press
  3. 3. Seino S, Nishi M, Murayama H, Narita M, Yokoyama Y, Nofuji Y, Taniguchi Y, Amano H, Kitamura A, Shinkai S. Effects of a multifactorial intervention comprising resistance exercise, nutritional, and psychosocial programs of frailty and functional health in community-dwelling older adults: A randomized, controlled, crossover trial. Geriatr Gerontol Int, 17(11):2034-2045, 2017.
  4. 4. Seino S, Sumi K, Narita M, Yokoyama Y, Ashida K, Kitamura A, Shinkai S. Effects of low-dose dairy protein plus micronutrient supplementation during resistance exercise on muscle mass and physical performance in older adults: A randomized, controlled trial. J Nutr Health Aging, 22(1):59-67, 2018.
  5. 5. Takagi D, Watanabe Y, Edahiro A, Ohara Y, Murakami M, Murakami K, Hironaka S, Taniguchi Y, Kitamura A, Shinkai S, Hirano H. Factors affecting masticatory function of community-dwelling older people: Investigation of the differences in the relevant factors for subjective and objective assessment. Gerodontology. 34:357-364, 2017.
  6. 6. Shinkai S, Yoshida H, Taniguchi Y, Murayama H, Nishi M, Amano H, Nofuji Y, Seino S, Fujiwara Y. Public health approach to preventing frailty in the community and its effect on healthy aging in Japan. Geriatr Gerontol Int. 16 Suppl 1:87-97, 2016.
  7. 7. Fujita Y, Taniguchi Y, Shinkai S, Tanaka M, Ito M. GDF15 as a biomarker for aging and age-related disorders. Geriatr Gerontol Int. 16 Suppl 1:17-29, 2016.
  8. 8. Seino S, Shinkai S, Iijima K, Obuchi S, Fujiwara Y, Yoshida H, Kawai H, Nishi M, Murayama H, Taniguchi Y, Amano H, Takahashi R : Reference values and age differences in body composition of community-dwelling older Japanese men and women: A pooled analysis of four cohort studies. PLoS ONE. 10(7): e0131975, 2015.
  9. 9. Seino S, Shinkai S, Fujiwara Y, Obuchi S, Yoshida H, Hirano H, Kim HK, Ishizaki T, Takahashi R ; TMIG-LISA Research Group : Reference values and age and sex differences in physical performance measures for community-dwelling older Japanese: A pooled analysis of six cohort studies. PLoS ONE. 9(6), e99487, 2014.
  10. 10. Taniguchi Y, Shinkai S, Nishi M, Murayama H, Nofuji Y, Yoshida H, Fujiwara Y. Nutritional Biomarkers and Subsequent Cognitive Decline Among Community-Dwelling Older Japanese: A Prospective Study. J Gerontol A Biol Sci Med Sci, 69(10):1276-1283, 2014.
  11. 11. Seino S, Taniguchi Y, Yoshida H, Fujiwara Y, Amano H, Fukaya T, Nishi M, Murayama H, Nofuji Y, Matsuo E, Hoshikawa N, Tsuchiya Y, Shinkai S. A 10-year community intervention for disability prevention and changes in physical, nutritional, psychological and social functions among community-dwelling older adults in Kusatsu, Gunma Prefecture, Japan. Nihon Koshu Eisei Zasshi, 61(6):286-298,2014. (in Japanese)
  12. 12. Shinkai S, Yoshida H, Fujiwara Y, Amano H, Fukaya T, Ri S, Watanabe N, Watanabe S, Kumagai O, Nishi M, Murayama H, Taniguchi Y, Kousa Y, Ooba H, Shimizu Y, Nofuji Y, Okabe T, Hoshikawa N, Tsuchiya Y. A 10-year community intervention for disability prevention and its effect on healthy aging in Kusatsu town. Nihon Koshu Eisei Zasshi, 60(9):596-605, 2013. (in Japanese)
  13. 13. Shinkai S, Watanabe N, Yoshida H, Fujiwara Y, Nishi M, Fukaya T, Lee S, Kim MJ, Ogawa K, Murayama H, Taniguchi Y, Shimizu Y. Validity of the "Kaigo-Yobo Check-List" as a frailty index. Nihon Koshu Eisei Zasshi, 60(5):262-274, 2013. (in Japanese)
  14. 14. Murayama H, Nishi M, Shimizu Y, Kim MJ, Yoshida H, Amano H, Fujiwara Y, Shinkai S. The Hatoyama cohort study: design and profile of participants at baseline. J Epidemiol, 22(6):551-558, 2012.