Explore the vast range of titles available.

Background It has not been clarified whether physical frailty symptoms predict social. frailty. The purpose of this study was to elucidate the effect of physical frailty on social frailty, and to determine which domains of physical frailty predict the development of social frailty. Methods We employed a two-year prospective cohort study. A total of 342 socially robust community-dwelling older adults were recruited. We used a modified social frailty screening index consisting of four social domains including financial difficulties, living alone, social activity, and contact with neighbors. Physical frailty status was also assessed at baseline. At the two-year follow-up, we assessed the development of social frailty. Social status was assessed using four social subdomains for the primary analysis. Social status was assessed using the two social subdomains of social activity and contact with neighbors, which would be affected by the physical frailty component, for the secondary analysis. The risk ratios (RR) of physical frailty for the development of social frailty were estimated. Results Although physical frailty symptoms were not a significant risk factor for future development of social frailty as assessed by four social subdomains (adjusted RR 1.39, 95% CI 0.95–2.15), it became significant when development of social frailty was assessed by the two social subdomains (adjusted RR 1.78, 95% CI 1.10–2.88). An analysis using the physical frailty subdomain showed that slow gait speed (adjusted RR 3.41, 95% CI 1.10–10.53) and weakness (adjusted RR 1.06, 95% CI 1.01–1.12) were independent risk factors for development of social frailty as assessed by two social subdomains. Conclusions Physical frailty symptoms predict the development of social frailty. Among physical frailty subdomains, gait speed and muscle strength are critical independent risk factors for future decline in the social aspect. The prevention of physical frailty, especially by maintaining gait ability and muscle strength, may be effective for avoiding social frailty.

BackgroundSarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in the estimated glomerular filtration rate (eGFR).MethodsWe examined the relationships between cystatin C-based GFR (eGFRcys), creatinine-based GFR (eGFRcre), their ratio (eGFRcys/eGFRcre) and sarcopenia in community-dwelling older adults in Japan. This cross-sectional study included 302 men aged 73.9 ± 6.2 years and 647 women aged 72.9 ± 5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, and sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) 2019 criteria was evaluated.ResultseGFRcys and the eGFRcys/eGFRcre ratio were significantly correlated with grip power and gait speed (p < 0.001). The eGFRcys/eGFRcre ratio was also correlated with skeletal muscle mass index (SMI) (p < 0.01). Univariate logistic regression analysis showed eGFRcys and eGFRcys/eGFRcre ratio but not eGFRcre were associated with sarcopenia (p < 0.01). The presence of low eGFRcys (CKDcys) and low eGFRcys/eGFRcre ratio (< 1.0) but not that of low eGFRcre (CKDcre) were associated with sarcopenia (p < 0.01). In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre ratio was added as a covariate to the basic model, it was significantly associated with sarcopenia in women (p < 0.05). Moreover, low eGFRcys/eGFRcre ratio (< 1.0) was associated with a higher risk of sarcopenia in men (p < 0.01).ConclusionIn conclusion, CKDcys but not CKDcre is associated with sarcopenia. A lower eGFRcys/eGFRcre ratio may be a practical screening marker of sarcopenia in community-dwelling older adults.

To develop effective nutritional interventions for preventing frailty, the specific problems associated with the dietary habits of individuals based on sex differences must be identified. The purpose of this study was to evaluate the association between dietary habits and frailty in rural Japanese community-dwelling older adults. We recruited 800 participants, aged 65 and older, who underwent a comprehensive health examination between November 2015 and December 2017. Dietary habits were assessed by a brief self-administered dietary history questionnaire. Frailty was determined using either the Kihon Checklist (KCL) or the Japanese version of the Cardiovascular Health Study (J-CHS). The percentage of frail older adults was 8.4% according to KCL and 4.0% according to J-CHS. Various kinds of nutrient intakes, including three major nutrients, minerals, and vitamins in frail men, according to KCL, were the lowest. By contrast, there were no differences in nutrient intake between the robust, prefrail, and frail female groups according to KCL. We found significant associations of the intakes of soluble dietary fiber, potassium, folate, and vitamin C with a frail status in men (p = 0.035, 0.023. 0.012, and 0.007, respectively), and an association of the intake of vitamin C with a frail status in women (p = 0.027) according to J-CHS. Attention should be paid to the diagnostic criteria of frailty and to sex differences, when nutritional interventions for the prevention of frailty are planned.

Background The association between functional capacity and the subsequent risk of nutritional deterioration is yet to be understood. The purpose of this study was to elucidate the relationship between functional capacity, comprising instrumental activities of daily living (IADL), intellectual activity, and social function, and future decline in nutritional status. Methods The current study is a two-year prospective cohort study. A total of 468 community-dwelling older adults without nutritional risks were enrolled. We used the Mini Nutritional Assessment Screening Form. Functional capacity, including IADL, intellectual activity, and social function, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline. The nutritional status was reassessed at a 2-year follow-up. Risk ratios (RR) of functional capacity for the incidence of nutritional decline were estimated. Results Low functional capacity was significantly associated with future deterioration of nutritional status (RR 1.12, 95% confidence interval [CI] 1.02–1.25). Of the subdomains of functional capacity, IADL decline (adjusted RR 2.21, 95% CI 1.18–4.13) was an independent risk factor for the incidence of nutritional risk. Intellectual and social activities were not significant. Conclusion Decline in functional capacity, especially IADL, is a risk factor for future deterioration in nutritional status. Further studies are required to elucidate the effect of interventions for IADL decline on maintaining nutritional status in older adults.

This study aimed to evaluate the relationship between timed up-and-go (TUG) test time and changes in frailty status in a longitudinal cohort study of rural Japanese older adults. This prospective cohort study included 545 community-dwelling older adults. Initial and 2-year follow-up surveys were conducted. We compared the number of the Japanese version of the Cardiovascular Health Study components during the follow-up period and classified the participants into three groups: the favorable change, unchanged as prefrail, and unfavorable change groups. Associations between changes in frailty status and TUG time in the first survey were examined. The predictive ability of the TUG test was determined using the receiver operating characteristic (ROC) curve. The favorable change group comprised 315 individuals (57.8%), the unchanged as prefrail group 105 (19.2%), and the unfavorable change group 125 (22.9%). TUG time was associated with the favorable and unfavorable changes after adjustment for covariates (OR 0.79, 95% CI 0.68-0.92, =0.001 and OR 1.27, 95% CI 1.09-1.49, =0.002). The ROC curve of TUG time as a predictor of unfavorable changes showed an area under the curve of 0.59. A cut-off point of TUG was calculated as 6.3 s with 49.6% sensitivity and 66.0% specificity. TUG time in the first survey was significantly associated with changes in frailty status 2 years later. However, its predictive value as a stand-alone test is limited and has the potential to predict future changes in the frailty status in older adults in combination with other tests.

In the assessment of skeletal muscle strength, rate of force development (RFD) is clinically identified as a functional index that reflects the effects of aging, but there are few reports on RFD of the tongue. The purpose of this study was to examine the relationship between RFD of tongue pressure (RFD-TP) and oral and whole-body physical performance in older adults, and to clarify its characteristics. We enrolled adults aged ≥65 years with pathological occlusal contact in premolar and molar regions of teeth in the Tamba-Sasayama area, Japan, from 2017 to 2018. Maximum tongue pressure (MTP) and the speed to reach the maximum tongue pressure (RFD-TP) were evaluated as measures of tongue function. Oral functions related to objective measures of tongue function, such as repetitive saliva swallowing test, oral diadochokinesis, and physical status or performance, such as mini mental state examination, body mass index, skeletal mass index, knee extension force, one-leg standing time, grip strength, walking speed, timed up-and-go test, and five-time chair stand speed was evaluated. No significant correlation was found between MTP and age, but RFD-TP had a significant negative correlation with age. Neither RFD-TP nor MTP showed a significant correlation with oral function. RFD-TP was associated with physical performance, such as knee extension force and one-leg standing time. RFD-TP is more sensitive to aging than MTP. In addition, RFD-TP is related to physical performance and may be useful for the early detection of frailty.

This article examines what I call a “rhetorical” interpretation of counterfactual conditionals. The standard interpretation of counterfactual conditionals implies that “there is a possibility that such and such proposition would/might be true.  The rhetorical reading of counterfactual conditionals implies that “such and such proposition would NEVER be true.” The subjunctive conditional with a rhetorical interpretation will be called “rhetorical counterfactual.” The examples of rhetorical counterfactuals are found in the emphatic construction (“koso –e construction”) in Early Japanese. I argue that rhetorical counterfactuals are best represented by the semantics of the logical connective only-if, and that the rhetorical reading results from the rhetorical implication that the antecedent is not going to be true with respect to what the speaker considers “conceivable.” 

Recently, isotemporal substitution has been developed to substitute activity time for an equivalent amount of another activity. This study employed this method to demonstrate the effects of replacing sedentary behavior (SB) time with an equivalent amount of light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) on the risk for different severities of frailty. A total of 886 older adults (average age 73.6 years, female 70%) participated in this cross-sectional study. Frailty status was assessed according to the cardiovascular health study criteria. Wrist-worn accelerometers were used to measure SB, LPA, and MVPA. Isotemporal substitution models were applied to show the estimated effects of substituting 30 min of SB with an equal amount of time spent in LPA or MVPA on the risk for pre-frailty and frailty. The physical activity level and SB were not associated with the incidence of pre-frailty. However, a 16% (OR: 0.84; 95% CI: 0.78-0.90) and 42% (OR: 0.58; 95% CI: 0.37-0.92) decrease in frailty risk was noted when SB was substituted with LPA and MVPA, respectively, in the crude model. In the adjusted model, the significant effect was sustained for LPA (OR: 0.86; 95% CI: 0.80-0.92) but not for MVPA (OR: 0.74; 95% CI: 0.47-1.17). This study indicates that replacing 30 min of SB with an equivalent amount of LPA decreases the risk for frailty in older adults. Moreover, increasing LPA seems more feasible than increasing MVPA in older adults, with substantial benefit.

There is an interesting emphatic construction (called a koso –e construction) in Old Japanese, in which the focus particle koso concords with the exclamatory (–e) sentence ending form. When koso focuses on an irrealis/subjunctive conditional clause, the overall sentence expresses a peculiar counterfactual-like conditional, which I call “rhetorical counterfactuals.” This interpretation is different from the standard counterfactual interpretation in that the speaker’s intention of stating a subjunctive conditional is a strong denial of the consequent. The strong denial of the consequent follows from the speaker’s belief that the proposition in the antecedent is inconceivable. The thesis addresses the problems concerning the truth conditions of counterfactuals with inconceivable antecedents. The problem is whether the rhetorical reading of subjunctive conditional can be assigned a non-vacuous truth by the truth conditions of counterfactuals. I argue that the rhetorical counterfactual expressed in koso –e has the truth conditions of only if counterfactuals; and the rhetorical/non-rhetorical readings are derived from the speaker’s assumption as to whether the closest world(s) in which the antecedent holds is/are among what the speaker considers conceivable in the context. The causal interpretation of koso –e is obtained when koso focuses on a realis conditional (i.e. – ba ‘whenever/when’) clause. Data suggest that conditional and causal interpretations of koso –e are morphologically distinct in the modal context. The thesis argues that the indicative subordinate clauses are semantically selected by epistemic/ evidential modals. In the non-modal context, I claim that both causal and conditional interpretations are variants of temporal subordinating conjunctions. To show that this is the case, I presented that not only –ba clauses but also other antecedent forms such as temporal adverbial clauses and gerundive clauses in koso –e exhibit the semantic variability of conditional/causal interpretations. The causal/conditional/temporal interpretations are inferred from the context, depending on whether the antecedent is true or not true with respect to the context.

Among the non-standard counterfactuals is a \"rhetorical counterfactual\" found in the old Japanese literature, which has a different interpretation from the standard counterfactuals. The rhetorical counterfactual was defined as a group of counterfactuals which suggest or assert the strong denial of the consequent by the speaker. The purpose of this study was to investigate the semantics of rhetorical counterfactual conditionals; especially what elicits the rhetorical interpretation. The thesis examined (1) the syntactic and semantic properties of -koso -e construction where the rhetorical counterfactual was found, referring to the descriptive old Japanese grammar, and (2) the logical relation between the antecedent and the consequent of rhetorical counterfactual by applying the definition of necessary/sufficient conditions as defined in logic. It was found that the rhetorical counterfactual is located where (1) the emphatic construction -koso -e is applied to the conditional sentence, and (2) the antecedent of rhetorical counterfactual is a necessary condition. It was concluded that the rhetorical counterfactual of the form \"-koso -e\" is truth-functionally closest to English counterfactual of the form \"only if, would\". Another factor that is crucial to the rhetorical reading is the impossibility (unimaginability) of the antecedent. The antecedent is not just false but impossible (unimaginable) proposition. The unimaginable proposition was defined as an accessible proposition such that the speaker believes there is no possible world at which it is true. To conclude, the rhetorical counterfactual is a marked interpretation of the counterfactual of the form \"only if, would\", which becomes available when the speaker chooses to use unimaginable proposition as its antecedent.