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This 3-month multifactorial intervention reduced frailty and improved functional health. These intervention effects persisted for at least 3 months post-intervention. Geriatr Gerontol Int 2017; 17: 2034-2045.

Background There is limited evidence on sarcopenia in Asian populations. This study aimed to clarify the prevalence, associated factors, and the magnitude of association with mortality and incident disability for sarcopenia and combinations of its components among Japanese community‐dwelling older adults. Methods We conducted a 5.8 year prospective study of 1851 Japanese residents aged 65 years or older (50.5% women; mean age 72.0 ± 5.9) who participated in health check‐ups. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Appendicular lean mass index (ALMI) was measured using direct segmental multi‐frequency bioelectrical impedance analysis. A Cox proportional hazards regression model was used to identify associations of sarcopenia and the combinations of its components with all‐cause mortality and incident disability. Results The prevalence of sarcopenia was 11.5% (105/917) in men and 16.7% (156/934) in women. Significant sarcopenia‐related factors other than ageing were hypoalbuminaemia, cognitive impairment, low activity, and recent hospitalization (all P‐values <0.05) among men and cognitive impairment (P = 0.004) and depressed mood (P < 0.001) among women. Individuals with sarcopenia had higher risks of mortality [hazard ratios (95% confidence interval): 2.0 (1.2–3.5) in men and 2.3 (1.1–4.9) in women] and incident disability [1.6 (1.0–2.7) in men and 1.7 (1.1–2.7) in women]. Compared with the individuals without any sarcopenia components, those having low grip strength and/or slow gait speed without low ALMI tended to have an increased risk of disability [1.4 (1.0–2.0), P = 0.087], but not mortality [1.3 (0.8–2.2)]. We did not find increased risks of these outcomes in participants having low ALMI in the absence of low grip strength and slow gait speed [1.2 (0.8–1.9) for mortality and 0.9 (0.6–1.3) for incident disability]. Conclusions Japanese older men and women meeting Asian criteria of sarcopenia had increased risks of all‐cause mortality and disability. There were no significant increased risks of death or incident disability for both participants with muscle weakness and/or low performance without low muscle mass and those with low muscle mass with neither muscle weakness nor low performance. Further studies are needed to examine the interaction between muscle loss, muscle weakness, and low performance for adverse health‐related outcomes.

Slow walking speed, weak grip strength, and poor standing balance predicted all-cause, cardiovascular, and other-cause mortality, but not cancer mortality, independent of covariates. Moreover, these 3 components of physical performance were independently associated with all-cause and cardiovascular mortality and their combined use increased prognostic power.

Effective methods to prevent or delay the onset of frailty are urgently required in aging societies, such as Japan. As a public health approach, we carried out a 10-year community intervention for frailty prevention, and examined its impact on healthy aging among older adults. The target population was all residents aged 65 years or older in the town of Kusatsu, Gunma Prefecture, Japan. For community empowerment, we organized a community forum, and discussed how to address the frailty issue in the community. For primary prevention, we attempted to promote physical activity, nutrition and social participation by means of a health education program to motivate older residents. For secondary prevention, we added a comprehensive geriatric assessment to routine annual health check-ups, which helped older participants improve self-care ability of functional health. High-risk persons were screened and encouraged to participate in a frailty prevention class with a multicomponent program. The attendance rate at annual health check-ups has remained constant at 30-40% of the target population; however, over 80% of the population appeared at least once during the 10 year-period. For evaluation, we carried out biennial health monitoring surveys, and reviewed the records of the local Long-Term Care Insurance system. The functional health of older residents was significantly improved as a result of the interventions; the incidence rate of Long-Term Care Insurance system certification in the old-old population (age ≥75 years) was decreased by one second, and healthy life expectancy at age 70 years was extended by 1.2 years for women and 0.5 years for men. Such trends greatly contrasted with those in the reference area, and Japan as a whole. In summary, the present public health approach to frailty prevention appears to promote healthy aging among older adults. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 87-97.

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Background: Although the Montreal Cognitive Assessment (MoCA) is acknowledged as a promising neuropsychological tool, its normative data for older populations have not been established yet. The purpose of this study was to provide normative data for the MoCA in Japanese community-dwelling older people. Methods: In a Japanese town, 1,977 participants aged 65 years or older (mean age 73.6 years; male 41.3%) completed MoCA tests. After descriptive and regression analyses, normative data were developed for MoCA scores in the population. Results: The mean MoCA score observed (21.8 points) was lower than that for normal controls (27.4 points) in the original validation study of the MoCA. Additionally, 82.6% of MoCA scores fell below the standard cutoff of 26 points for detecting mild cognitive impairment (MCI). The regression analysis showed that higher age and fewer years of formal education were associated with lower MoCA scores (p < 0.001). Normative data for MoCA scores were presented with respect to age and education. Conclusion: This study provided normative data for the MoCA in a Japanese community-dwelling older population. This research also suggests that conventional use of the MoCA as a screening tool for MCI might be problematic in cultures different from that in which the cutoff was developed.

Among older adults, greater dietary variety may help maintain physical performance, such as grip strength and usual gait speed, but not lean mass.