Community re-designs for healthy longevity: Japan and Taiwan examples

Vitality attributes and their associations with intrinsic capacity, resilience, and happiness in community-dwelling adults: Results from Gan-Dau Healthy Longevity Plan Wave 2

BACKGROUND

Vitality is a key domain of intrinsic capacity (IC) in healthy aging, but its measurement and relationships with other domains of IC and psychosocial constructs of well-being remain understudied. This study examined associations between different vitality attributes and other domains of IC as well as psychosocial constructs including resilience and happiness in middle aged and older adults, as these associations were fundamental for establishing evidence-based interventions to promote healthy aging.

METHODS

This cross-sectional analysis included 981 participants (75.0% female and 49.2% aged between 65-74 years) from the Gan-Dau Healthy Longevity Plan wave 2 cohort. We assessed four vitality attributes: nutritional status (self-reported appetite loss, self-reported weight loss, Mini Nutritional Assessment-Short Form (MNA-SF)), energy (self-perceived fatigue), neuromuscular function (low grip strength, defined by the Asian Working Group for Sarcopenia (AWGS) 2019 criteria), and circulating biomarkers of metabolism (elevated C-reactive protein (CRP)>0.5 mg/dL). Other IC domains were assessed based on the WHO ICOPE concept and existing literature. Psychosocial constructs were evaluated using the Brief Resilience Scale and Chinese Happiness Inventory. Comparisons of demographics and distribution of vitality attributes were performed with the chi-square or Fisher's tests for categorical variables and t-tests for continuous variables when appropriate. Multivariate logistic regression models and generalized linear models (GLMs) were used to investigate the association between impairments in different vitality attributes and other IC domains as well as psychosocial constructs, respectively.

RESULTS

Among vitality attributes, low grip strength was most prevalent (38.2%), followed by suboptimal nutritional status measured by MNA-SF (15.4%), and self-perceived fatigue (6.7%). Low grip strength was significantly associated with locomotion impairment (adjusted OR 1.70 [95% CI 1.25-2.31], p = 0.001) and psychological impairment (1.85 [1.26-2.73], p = 0.002). Although relatively uncommon, self-perceived fatigue also showed strong associations with impairments in locomotion (2.47 [1.44-4.23], p = 0.001) and psychological domains (8.34 [4.83-14.37], p < 0.001). All vitality attributes except self-reported weight loss and elevated CRP significantly correlated with psychosocial constructs.

CONCLUSIONS

Our findings demonstrate that low grip strength, suboptimal nutritional status and energy as vitality attributes showed strong link to other IC domains (mainly locomotion and psychological) as well as psychosocial constructs. This finding highlights the heterogeneity of the vitality domain for which it might not be evaluated by a single attribute only but by a combination. Importantly, social factors were strongly associated with vitality impairments, emphasizing the critical role of social determinants in IC assessment.

Mapping Normative Muscle Health Metrics Across the Aging Continuum: A Multinational Study Pooling Data From Eight Cohorts in Japan, Malaysia and Taiwan

BACKGROUND

The vigour of our musculature wanes as the years advance, and prognosticating the concomitant trajectories throughout the course of life assumes paramount importance for judicious and timely interventions. In the present study, we aimed to establish age- and sex-specific reference centiles for multiple muscle health metrics and reveal the distributions of these metrics throughout the aging process in the Asian population.

METHODS

By using cross-sectional pooled data of community dwellers aged 20 years or older in eight cohorts from Taiwan, Japan and Malaysia, normative values for muscle health metrics (calf circumference (cm), relative appendicular skeletal muscle (RASM) (kilogram per square metre), body mass index (BMI)-adjusted appendicular skeletal muscle mass (kilogram/(kilogram per square metre)), handgrip strength (kilogram), five-time chair stand (seconds) and gait speed (metre per second)) in men and women, categorized by age groups, are calculated. The mean values, along with the 5th, 25th, 50th, 75th and 95th percentiles of these muscle health metrics, are also delineated for both sexes.

RESULTS

Among 34 265 (16 164 men, 18 101 women) participants from eight cohorts, calf circumference declined in age groups from 60 years onward. RASM values declined from the 50s in men but were stable in women until the 80s. ASM/BMI values showed declines in older age groups for both sexes. Handgrip strength declined similarly from 40 years of age in both sexes. Five-time chair stand performance declined from the 30s. Gait speed peaked at 1.6 m/s in men in their 50s and then declined, while it declined in women in their 60s. The inflection points for decline differed by metric and sex. The 20th percentile cutoffs for individuals aged 65-69 years were as follows: calf circumference, 33.0 cm (men) and 31.5 cm (women); RASM, 7.0 kg/m2 (men) and 5.5 kg/m2 (women); ASM/BMI, 0.78 kg/(kg/m2) (men) and 0.56 kg/(kg/m2) (women); handgrip strength, 30.4 kg (men) and 18.1 kg (women); five-time chair stand, 9.4 s (men) and 10.0 s (women); and gait speed, 0.9 m/s (both). Those in the fifth percentile of all muscle health metrics faced earlier declines than their 95th percentile counterparts did, highlighting the critical roles in identifying these high-risk groups.

CONCLUSION

The pooled analysis of eight Asian cohorts clearly outlined the age-related changes in various muscle health metrics, with the inflection point of accelerated decline showing age- and sex-specific characteristics. Defining trajectories of muscle health metrics across life stages facilitates timely interventions to mitigate age-related risks and promote healthy longevity.

Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan

BACKGROUND

Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.

METHODS

This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.

RESULTS

Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.

CONCLUSION

This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.

The Evolving Landscape of Sarcopenia in Asia: A Systematic review and meta-analysis following the 2019 Asian working group for sarcopenia (AWGS) diagnostic criteria

BACKGROUND

Sarcopenia, characterized by age-related loss of muscle mass and function, poses a significant public health concern, particularly in Asia's rapidly aging population. This systematic review and meta-analysis aimed to evaluate the current epidemiology of sarcopenia in Asia using the 2019 Asian Working Group for Sarcopenia (AWGS) diagnostic criteria.

METHODS

Databases including PubMed, Embase, Web of Science, and Cochrane were systematically searched for studies published until December 7, 2023, involving older adults aged ≥ 60 years diagnosed with sarcopenia using the 2019 AWGS criteria in Asia. Study quality was assessed, and meta-analyses were conducted to estimate the pooled prevalence of sarcopenia, possible sarcopenia, and severe sarcopenia.

RESULTS

A total of 140 studies, collectively involving 156,325 participants (67.1 % community-dwelling older adults with the minimum age for participant inclusion ranging from 60 to 80 years) from various Asian countries, were included. The overall prevalence of sarcopenia among community-dwelling older adults was 16.5 % (95 % CI: 14.7 %-18.4 %). Notably, the prevalence of possible sarcopenia was higher at 28.7 % (95 % CI: 22.0 %-36.5 %), while severe sarcopenia had a lower prevalence of 4.4 % (95 % CI: 3.3 %-5.8 %). Subgroup analyses revealed variations in sarcopenia prevalence based on diagnostic modalities, ranging from 7.5 % (95 % CI: 6.0 %-9.4 %) for assessments using bioelectrical impedance analysis, handgrip strength, gait speed, chair stand and short physical performance battery, to 20.8 % (95 % CI: 18.9 %-23.0 %) when using dual-energy X-ray absorptiometry coupled with muscle strength and physical performance measures.

CONCLUSION

This comprehensive systematic review and meta-analysis highlights the substantial burden of sarcopenia among older adults in Asia, underscoring the need for early identification and intervention strategies to mitigate its adverse consequences on public health.

Safeguarding vitality and cognition: The role of sarcopenia in intrinsic capacity decline among octogenarians from multiple cohorts

BACKGROUND

Sarcopenia and intrinsic capacity (IC) declines pose significant challenges to healthy aging, particularly in the rapidly growing octogenarian population. This study aimed to elucidate the relationship between sarcopenia and declines in IC across multiple cohorts of community-dwelling older adults.

METHODS

Data from four Taiwanese cohorts were analyzed. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (algorithm 1: categorized as either having possible sarcopenia or not (robust); algorithm 2: categorized as robust, possible sarcopenia or sarcopenia). IC was operationalized using the World Health Organization's Integrated Care for Older People (ICOPE) framework (step 1 and step 2), encompassing six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being. Multivariable logistic regression models were adopted to assess the association between sarcopenia and IC decline.

RESULTS

Among 599 octogenarians (median age 82.2 years, 54.8% male), the prevalence of possible sarcopenia (algorithm 1) was 64.6%. When adopting algorithm 2, the prevalence of possible sarcopenia and sarcopenia was 46,2% and 32.1%, respectively. After adjusting for covariates, participants with possible sarcopenia or sarcopenia (algorithm 2) were more likely to exhibit declines in vitality (ICOPE Step 1: possible sarcopenia aOR 3.65, sarcopenia aOR 4.74; ICOPE Step 2: possible sarcopenia aOR 5.11, sarcopenia aOR 14.77) and cognition (ICOPE Step 1: possible sarcopenia aOR 2.40, sarcopenia aOR 2.12; ICOPE Step 2: possible sarcopenia aOR 2.02, sarcopenia aOR 2.51) compared to robust individuals.

CONCLUSIONS

This study underscores the robust association between sarcopenia and declines in vitality and cognition among octogenarians, highlighting the importance of sarcopenia screening and management in promoting healthy longevity in this vulnerable population.

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications

BACKGROUND

Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF-related medications and adverse clinical outcomes (all-cause mortality, all-cause readmissions and HF readmissions) among older HF patients.

METHODS

A total of 38 843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2 years of follow-up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time-varying use of HF-related medications and clinical outcomes among distinct frailty subgroups.

RESULTS

Of 38 843 older HF patients (mean age 80.4 ± 8.5 years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter-quartile range-IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all-cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11-1.21), all-cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16-1.25) and HF-related readmissions (sHR 1.14, 95% CI 1.09-1.20) at 2 years of follow-up. Those who used triple or more HF-related medications were at lower risk for all-cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44-0.54) and HF-related readmissions (aOR 0.42, 95% CI 0.37-0.47) at 2 years of follow-up even in the severe frailty group.

CONCLUSIONS

Frailty is highly prevalent and associated with increased risk of all-cause mortality, all-cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF-related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.

Does Selection for Longevity in Acheta domesticus Involve Sirtuin Activity Modulation and Differential Response to Activators (Resveratrol and Nanodiamonds)?

Sirtuins, often called "longevity enzymes", are pivotal in genome protection and DNA repair processes, offering insights into aging and longevity. This study delves into the potential impact of resveratrol (RV) and nanodiamonds (NDs) on sirtuin activity, focusing on two strains of house crickets (Acheta domesticus): the wild-type and long-lived strains. The general sirtuin activity was measured using colorimetric assays, while fluorescence assays assessed SIRT1 activity. Additionally, a DNA damage test and a Kaplan-Meier survival analysis were carried out. Experimental groups were fed diets containing either NDs or RV. Notably, the long-lived strain exhibited significantly higher sirtuin activity compared to the wild-type strain. Interestingly, this heightened sirtuin activity persisted even after exposure to RVs and NDs. These findings indicate that RV and NDs can potentially enhance sirtuin activity in house crickets, with a notable impact on the long-lived strain. This research sheds light on the intriguing potential of RV and NDs as sirtuin activators in house crickets. It might be a milestone for future investigations into sirtuin activity and its potential implications for longevity within the same species, laying the groundwork for broader applications in aging and lifespan extension research.

Cardiovascular Disease Risk Burden, Cognitive Impairments and Incident Dementia among Community-Dwelling Middle-Aged and Older Adults: An 8-Year Longitudinal Follow-up Study

OBJECTIVES

To evaluate the associations between cardiovascular disease (CVD) risk burden (estimated by the World Health Organization (WHO) algorithm) and cognitive impairments (e.g., incident dementia, global and domain-specific impairments) among CVD-, dementia- and disability-free, community-dwelling middle-aged and older adults during an 8-year follow-up.

DESIGN

A community-based longitudinal cohort study.

SETTING

Yuanshan township in Yi-Lan County, Taiwan.

PARTICIPANTS

A total of 889 community-dwelling residents aged 50 years or older.

MEASUREMENTS

Age, sex, educational level, employment status, alcohol status, body mass index, physical activity, gait speed, depressive symptoms, WHO region-specific CVD risk scores (10-year CV risk, low: <10% vs. moderate-to-high: ≥ 10%), Chinese version of the Mini-Mental State Examination (MMSE), verbal memory by the delay-free recall in the Chinese Version Verbal Learning Test (CVVLT), language function by the Boston Naming Test and the category (animal) Verbal Fluency Test, visuospatial function by the Taylor Complex Figure Test, executive function by the digit backward and the Clock Drawing Test.

RESULTS

Compared to those with low CVD risk, middle-aged and older adults with moderate-to-high CVD risk were at greater risk for cognitive impairments with respect to the MMSE (adjusted odds ratio (aOR) 1.60 [95% confidence interval (CI) 1.19-2.15], P=0.002), verbal memory (aOR 1.97 [1.43-2.70], P< 0.001) and language (aOR 1.99 [1.46-2.70], P< 0.001), as well as incident dementia (aOR 2.40 [1.33-4.33], P=0.004). After adjusting for all covariates, CVD risk was not associated with other domains of cognitive impairment.

CONCLUSIONS

Among healthy, community-dwelling, middle-aged and older adults, those with moderate-to-high cardiovascular risk burden were significantly associated with incident dementia and global and domain-specific cognitive impairments (verbal memory and language), which suggests the existence of a relationship between early cognitive deficits and CVD risk burden. Further studies are needed to elucidate the pathophysiological mechanism of the link between CVD risk burden and cognitive impairment.

Comparative Analysis of Intrinsic Capacity Impairments, Determinants, and Clinical Consequences in Older Community-Dwellers in Japan and Taiwan: Longitudinal Studies Showing Shared Traits and Distinct Presentations

OBJECTIVES

Despite the recognized impact of intrinsic capacity (IC) impairment on healthy aging, international comparisons in different sociocultural contexts are scarce. This study aimed to compare IC impairment among community-dwelling older adults in Japan and Taiwan to explore the context of healthy aging in different countries.

DESIGN

Comparative observational study.

SETTING

National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan and Longitudinal Aging Study of Taipei (LAST) in Taiwan.

PARTICIPANTS

794 individuals (age range, 60.0-86.5 years) from NILS-LSA and 1,358 (60.0-96.7 years) from LAST.

MEASUREMENTS

IC impairment was evaluated across the domains of locomotion, cognition, vitality, sensory capacity, and psychological well-being. Participants were categorized as having impaired IC or healthy. We investigated associations between IC impairment, falls, and all-cause mortality.

RESULTS

IC impairment was present in 54.9% and 37.3% of participants in the NILS-LSA and LAST cohorts, respectively. Male NILS-LSA participants with impaired IC (odds ratio [OR]:1.50, 95% confidence interval [CI]:1.03-2.20), with hearing loss (OR:1.98, 95% CI:1.00-3.90) were more likely to fall. In LAST, impaired locomotion (OR:2.14, 95% CI:1.46-3.14) increased the risk of falls. Men with impaired IC (hazard ratio [HR]; 2.14, 95% CI:1.10-4.15) and visual impairment (HR:2.21, 95% CI:1.15-4.25) and women with impaired psychological well-being (HR:4.94, 95% CI:1.28-18.97) in the NILS-LSA cohort had greater risk for all-cause mortality; however, this was not shown for LAST participants.

CONCLUSION

The prevalence and distribution of IC impairment and associated biomarkers differed significantly between participants in Japan and Taiwan. However, the associations with adverse outcomes remained similar, emphasizing the need for tailored interventions for healthy aging.