Comorbidity of chronic kidney disease, diabetes and lower glycated hemoglobin predicts support/care-need certification in community-dwelling older adults

U-shaped link of health checkup data and need for care using a time-dependent cox regression model with a restricted cubic spline

We explored risk indicators likely to result in older adults needing certified long-term care in Japan and ascertained whether this relationship forms a U-shaped link. We analyzed a community-based cohort of residents in Kitanagoya City, Aichi Prefecture, Japan. Participants were 3718 individuals aged 65 years and above who underwent health examinations between April 1, 2011 and March 31, 2012. For continuous clinical variables, we applied a time-dependent Cox regression model. Two types of models were applied-a linear and nonlinear model with restricted cubic splines-to assess the U-shaped association. Statistical significance (set at 0.05) for the nonlinearity was tested by comparing the spline and linear models. Among the participants, 701 were certified as needing Level 1 care or higher during a follow-up. Among the continuous clinical variables, the nonlinear model for body mass index, systolic blood pressure, high-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase revealed significant U-shaped associations as compared with the linear model in which the outcome was a certification of the need for nursing care. These results provide an important insight into the usefulness of nonlinear models for predicting the risk of such certification.

HbA1c and physical performance in older adults from different aging epidemiological contexts: Longitudinal findings of the International Mobility in Aging Study (IMIAS)

OBJECTIVE

This study aimed to assess the longitudinal predictions between glycated hemoglobin A1c (HbA1c) and physical performance scores in different epidemiological contexts of aging.

MATERIAL AND METHODS

Longitudinal data of 1,337 older people from three countries (Canada, Brazil and Colombia) of the International Mobility in Aging Study (IMIAS) were used to assess the relationship between HbA1c and Short Physical Performance Battery (SPPB) scores between 2012 and 2016. Linear Mixed Models grouped by sex and adjusted by Age, Study site, Chronic Conditions, Anthropometric Measures, and Inflammatory Level were used to estimate the influence of HbA1c and covariates on SPPB scores.

RESULTS

At the IMIAS baseline, Latin American (LA) cities had higher HbA1c averages compared to Canadian cities, with Natal (Brazil) being the city with the highest HbA1c averages in men and women (6.32 ± 1.49; 6,56 ± 1.70 respectively). SPPB scores were significantly lower in LA cities, and older people in Natal had lower SPPB averages in men (9.67 ± 2.38; p-value < 0.05) and women (8.52 ± 2.33; p-value <0.05). In the multivariate mixed linear models of longitudinal analyses, HbA1c was significantly associated with lower SPPB scores in men (β = -0.25, 95% CI: -0.39 to -0.12, p-value = 0.02) but not in women.

CONCLUSION

High HbA1c levels at baseline were longitudinally associated in older adults from different countries, and this association was observed only in men and not in women. This study highlights a possible influence of gender on this relationship.

Risk Factors of Long-Term Care Insurance Certification in Japan: A Scoping Review

This study aimed to review evidence on future long-term care associated with pre-existing factors among community-dwelling Japanese older adults. We systematically searched cohort and nested case-control studies published between 2000 and 2019 that assessed long-term care certification using the PubMed, CINAHL, and EMBASE databases. The relationship between long-term care insurance information and risk factors was investigated. The protocol was registered with the Open Science Framework. We extracted 91 studies for synthesis, including 84 prospective cohort studies, 1 retrospective cohort study, and 6 nested case-control studies. Certification for long-term care was classified into two endpoints: onset of functional disability and dementia. There were 72 studies that used long-term care certification as a proxy for functional disability, and 22 used long-term care information to indicate the onset of dementia. Common risk factors related to functional disability were physical function, frailty, and oral condition. Motor function and nutritional status were common risk factors for dementia. We found consistent associations between premorbid risk factors and functional disability and dementia. The accumulation of evidence on the incidence of long-term care and associated factors can aid the development of preventive measures. Future studies should aim to integrate this evidence.

Non-participation in health checkup and Kihon Checklist predicts loss of certification-free survival in community-dwelling older adults

AIM

Despite efforts toward health promotion and preventive care for older adults, including health checkups and postal Kihon Checklist survey, one fifth of community-dwelling older adults do not participate in them. The aim of the present study was to examine the relationship between this non-participation and the end of certification-free survival in older adults.

METHODS

In a cohort of 4120 older adults with no prior history of Long-Term Care Insurance certification, the associations of non-participation with risk of later death without certification and support/care-need certification for 72 months were evaluated using Cox proportional hazards analysis.

RESULTS

Of them, 4022 (mean age 72.7 years, 54.7% women) were followed up (97.6%). At baseline, 1072 received health checkups, 2085 replied to the Kihon Checklist alone and 865 did not participate. During 72 months, 310 deaths without certification and 701 certifications occurred. After adjustment, non-participating individuals had significantly higher hazard ratios for death up to 72 months and for certification up to 36 months, compared with the other two groups. The Kruskal-Wallis test showed associations of increasing incidence of certification due to stroke in pre-old (aged 65-74 years) men for 72 months, and due to arthralgia/fracture and dementia in old (aged ≥75 years) women for 24 months, with non-participation in health promotions. Certified non-participating individuals incurred higher estimated Long-Term Care Insurance expenditure per person for 72 months, especially in pre-old men and old women.

CONCLUSIONS

Health promotion by health checkup and even Kihon Checklist survey increases certification-free survival in older residents, and decreases Long-Term Care Insurance expenditure. Geriatr Gerontol Int 2019; 19: 1206-1214.