Social Innovation for Healthy Ageing.
DAY 2: Active and Healthy Ageing: Research and Innovation
Responses from Europe and Japan, Wednesday 10 October 2012
Prevention of frailty and healthy aging.
A 10-year community intervention and
outcomes
Shoji Shinkai, MD, PhD, MPH
Tokyo Metropolitan Institute of Gerontology
What I talk will be:
� In Japan, the late onset disability has become a
major causes of loss of healthy aging in old ages.
�For further improving healthy aging, we think it
important to focus on frailty, which precedes the
late onset disability.
�A new social system involving all parts of community
is needed for tackling the issue of frailty.
�A ten-year community intervention showed that
such social system was effective for healthy aging in
community-living older adults. 2
63- 66- 69- 72- 75- 78- 81- 84- 87-
Independent
in IADL&ADL
IADL disability
ADL disability
Males
Age (years)
Akiyama H et al. 『Kagaku』, Iwanami Publisher, 2010
Death
(10.9%)
(70.1%)(19.0%)
Patterns of Functional Decline in Later Life
20-year prospective study on Japanese elderly (N=5717)
late onset disabilityearly onset disability
Successful aging
(87.9%)
(12.1%)
Patterns of Functional Decline in Later Life
20-year prospective study on Japanese elderly (N=5717)
Females
IADL disability
ADL disability
Death
Age (years)
Akiyama H et al. 『Kagaku』, Iwanami Publisher, 2010
63- 66- 69- 72- 75- 78- 81- 84- 87-
late onset disability
early onset disability
Independent
in IADL&ADL
What is frailty?
Frailty is an age-related syndrome of
decreased reserve and resistance to
stressors, resulting from cumulative
declines across multiple physiologic
systems and causing vulnerability to
adverse outcomes (Fried et al, 2001).
8 Can you see things clearly ? (visual impairment)
0. Yes 1. No (have problems)
9 Do you often slip or stumble at home ?
0. No 1. Yes
10Do you ever refrain from going outdoors because of
fear of falling ?
0. No 1. Yes
11 Have you been hospitalized in the last year ?
0. No 1. Yes
12 Do you have appetite these days?
0. Yes 1. No
13 Do you have any difficulty in chewing ?
0. have almost no difficulty 1. have difficulty
14 Did you lose weight of ≥ 3kg in the last 6 months ?
0. No 1. Yes
15Do you feel that you have lost body muscle and/or fat
during the last 6 months ?
0. No 1. Yes
1 Do you usually stay at home all day long?
0. No 1. Yes
2 How often do you usually go outdoors ?
0. more than once per 2-3 days
1. less than once a week
3 Do you have any hobby ?
0. Yes 1. No
4 Do you have neighbors who you can talk friendly ?
0. Yes 1. No
5 Do you have close friends, families, or relatives
you go to meet ?
0. Yes 1. No
6 Do you have an experience of falling in the last year
?
0. No 1. Yes
7 Can you walk continuously over 1 km ?
0. Able to do without any difficulty
1. No, or able to do but with difficulty
A brief questionnair for screening frailty - CL15
0 or 1 score for each item. 1 point is given to answer which indicates “having a risk ”
e.g., have difficulty, low ability, have no friend. Each point of the 15 items is summed up
to produce a composite score with a range of 0-15.
Homeboudness
Falling
Lower nutrition
(Shinkai S et al. Jpn J Public Health 2010; 57: 345-354)
Predictive validity of CL15
Table Relative risk of CL ≥≥≥≥4 compared with CL ≤≤≤≤3
Outcome Crude RR Adjusted RR*
ADL disability
2 years later 7.58 (4.20-13.7) 4.82 (2.54-9.15)
4 years later 4.97 (2.77-8.95) 3.07 (1.59-5.94)
LTCI service use 6.15 (4.39-8.63) 3.37 (2.31-4.91)
Death 3.73 (2.70-5.16) 2.40 (1.67-3.43)
*Adjusted for age, sex, and comorbidity
(Shinkai S et al. Jpn J Public Health, under review)
Independent predictors for
developing frailty
Muscle
Mass((((less)))), Strength((((less)
Nutrition
Hb((((low)))), Alb((((low))))
Vascular health
ABI((((low)))), abPWV((((high)))),
History of HT((((+))))
Sarcopenia
Lower nutrition
Subclinical
vascular
disease
(Yoshida H et al. Jpn J Geriatr 2012; 49: 442-448)
Strategy for Frailty Prevention
1.Establishment of community committee
Public health sector at local government
Senior clubs, NPO, health volunteers,
Other stake holders
→ to discuss how to tackle
frailty prevention
in community
A Research Project under JST-RISTEX, R&D Focus Area: Redesigning Communities for Aged Society
2.Primary prevention of Frailty
Key points:Good nutrition,
Physical activity & fitness
Social participation
Regular exercise classesmanaged by senior volunteers
3.Secondary prevention of Frailty
Health check-up
◆Mass screening in community
Frailty index (CL15)
Nutrition (BMI, Alb, Hb, T-Chol)
Physical performance
(Gait speed, Grip strength,
Standing balance)
Vascular health(BP, ABI, baPWV)
◆Individual screening by mail survey
Frailty index (CL15)
4.Tertiary prevention of Frailty
Development of effective programs for improving
frailty
with randomized controlled trials
Feasibility
as to provision of programs
in collaboration with health
volunteers.
Strength exerciseStrength exercise Nutritional educationNutritional education Learn our communityLearn our community
Enjoy lunch!In memory of their participation,
Geographical location of study siteGeographical location of study siteGeographical location of study siteGeographical location of study site
Kusatsu Town, Gunma Prefecture
Population, 7,200 (≥65 y, 29.4%)
Main industry, hot spa& resort
“Can you go outside of town by yourself
using public transportation or car?”Males
Females
Trend in Life Space
15
2001 2003 2005 2007 2009 2011
Year of survey
Pro
po
rtio
n o
f ‘y
es’
(%)
Trend in incidence rate of disability per year
certified under the TLCI program in Kusatsu
Year
≥ 75 years
65-74 years
Inci
de
nce
ra
te o
f d
isa
bil
ity
(%
)
(Shinkai S et al. Jpn J Public Health, submitted)
Trend in proportions of service users
under the LTCI program among senior citizens
Whole nation
Kusatsu town
Pro
po
rtio
n o
f se
rvic
e u
ser
(%)
2002 2003 2004 2005 2006 2007 2008 2009 2010
Gunma prefecture
Whole nation
Kusatsu town
Gunma prefecture
≥ 75 years
65-74 years
(Shinkai S et al. Jpn J Public Health, submitted)
Trend in active life expectancy
at 70 years of age in Kusatsu
Females
Males
Year of survey
Act
ive
lif
e e
xpe
cta
ncy
(y
ea
rs)
(Shinkai S et al. Jpn J Public Health, submitted)