1.Utility of an ADL Index for Institutionalized Elderly People: Examining Possible Applications for Independent Elderly People
Shinichi DEMURA ; Susumu SATO ; Masaki MINAMI
Environmental Health and Preventive Medicine 2001;6(1):33-40
The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.
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2.RELATIONSHIPS BETWEEN PHYSICAL FITNESS ELEMENTS OF HEALTHY OLDER ADULTS : GENDER AND AGE DIFFERENCES
MASAKI MINAMI ; SHINICHI DEMURA ; YOSHINORI NAGASAWA ; NOBUHIKO TADA ; JINZABURO MATSUZAWA
Japanese Journal of Physical Fitness and Sports Medicine 2001;50(5):571-582
The aim of this study was to clarify the relationship between physical fitness elements in healthy older adults, considering the differences between gender and between age. Subjects were 1042 active and non-injured people aged from 60 years to under 90 years. The subjects were classified into two different age groups of under 75 years group and 75 years and over group. A total of 11 variables representing four physical fitness elements (muscular, joint, neural, and respiratory functions) were selected through examination of safety and validity. Two-way ANOVA was used to examine gender and age differences in each physical fitness element. Pearson's correlation coefficient and partial correlation coefficient excluding age factor were calculated for each gender and age group.
As a result of examining the relationship among physical fitness elements, the correlation coefficients within variables consisting of the following each function, muscular function, joint function and agility of extremities, were significant in both age groups, and these tendencies were consistent in both gender groups. Similarly, significant correlation coefficients between standing-reach and muscular function variables, and between trunk twist and foot balance with eyes open and reaction time were found in the under 75 years group, but not in the over 75 years group. On the other hand, different tendencies between genders were found in the relationship between the muscular function variables and trunk twist and foot balance with eyes open, and between the reaction time and stepping and muscular function variables. As the relationships among physical fitness elements tended to decline in the over 75 years group, it is inferred that this tendency is influenced by the change with aging of physical fitness characteristics and environmental factors around the older adults.
3.Activity Groupings Reflecting Functional Characteristics Required in Daily Life in Institutionalized Dependent Females in the Old Old Elderly Group
Shinichi DEMURA ; Susumu SATO ; Masaki MINAMI ; Kohsho KASUGA
Environmental Health and Preventive Medicine 2003;8(5,6):166-172
Objectives: This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics. Methods: The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group. Results: Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups. Conclusions: These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.
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4.Activity groupings reflecting functional characteristics required in daily life in institutionalized dependent females in the old old elderly group.
Shinichi DEMURA ; Susumu SATO ; Masaki MINAMI ; Kohsho KASUGA
Environmental Health and Preventive Medicine 2003;8(5):166-172
OBJECTIVESThis study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics.
METHODSThe participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group.
RESULTSFour activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups.
CONCLUSIONSThese activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.
5.The changind of physique and physical fitness with age and its sex-difference in elderly people.
MASAKI MINAMI ; SHINICHI DEMURA ; SUSUMU SATO ; KOHSHO KASUGA ; JINZABURO MATSUZAWA ; FUMIO GOSHI
Japanese Journal of Physical Fitness and Sports Medicine 1998;47(5):601-615
A study was performed to examine sex and age differences in physique and physical fitness and the sex differences in the change of these parameters with age, and to clarify the relationship between the amount of exercise and fundamental physical fitness in 326 healthy elderly individuals over 60 years of age.
A total of 22 variables consisting of 9 items concerning body linearity, quantitative growth, circumference growth and posture, and 13 items representing 4 domains (muscular, joint, neural, and cardiorespiratory functions) were selected. The exercise performance index (EPI) was calculated as the product of frequency and duration (yr) of exercise. The sex and age differences in physique and physical fitness were examined using two-way ANOVA (sex × age group) . Post hoc tests using Ryan's procedure were carried out when the main effect of these factors proved significant. To examine the characteristics of changes in physique and physical fitness with age, Pearson's correlation coefficient was calculated, and linear regression analysis [test item was the dependent variable (X) and age was the independent variable (Y) ] was applied. Then significant differences in the regression coefficient and intercept between males and females were examined. Furthermore, curved-line regression analysis was executed for the above variables. Applying principal component analysis for 13 physical fitness items, the first principal component was interpreted as fundamental physical fitness for performance, and the above analysis was applied to the fundamental physical fitness score (FPS) . To examine the relationship between EPI and FPS, the difference in FPS among the three EPI groups was examined using analysis of co-variance (ANCOVA) with age as the co-variable.
The main findings of this study can be summarized as follows.
1. With regard to physique, males showed greater body linearity, and females had more skinfold. Sex differences in circumference growth were not as significant as those in body linearity and quantitative growth. Changes in physique with age were greater in females than in males, the change becoming obvious in individuals over 80 years of age.
2. With regard to physical fitness, males had superior muscular function and vital capacity, while females outperformed males in standing-reach. However, there was little sex difference in neural function. The trend for deterioration in physical fitness with age differed between the sexes among 4 domains of physical fitness. For example, in males muscular, neural, and joint functions deterioration significantly with age, while in females, all physical fitness variable did so. In addition, the age-related trends of deterioration in muscular function (grip strength and vertical jump), cardiorespiratory function (duration of breath-holding and vital capacity), and neural function (stepping) were differed between the sexes.
3. The FPS was higher in males than in females. However, FPS decreased significantly with age in both sexes.
4. It was inferred that among active and healthy elderly males and females who exercised regularly, FPS was not influenced by EPI.
6.Examining reproducibility of force-exertion pattern and reliability of force-time parameters in the development phase during static explosive grip exertion.
SHINICHI DEMURA ; SHUNSUKE YAMAJI ; MASAKI MINAMI ; YOSHINORI NAGASAWA ; ICHIRO KITA ; JINZABURO MATSUZAWA
Japanese Journal of Physical Fitness and Sports Medicine 1999;48(4):493-500
The evaluation of muscular power function has been mainly limited to dynamic contraction, but force-time parameters in static explosive contraction may be useful. The purpose of this study was to examine the trial-to-trial differences of exertion pattern and the reliability of the force-time parameters in the development phase of static maximal explosive grip (SEG) using seventy healthy young male subjects (age 18.8±2.3yr) . In SEG measurement, subjects were instructed to exert maximal isometric force with a dominant hand as fast and forcefully as possible. Data was collected from two trials with 3 minutes rest between trials. Eleven variables (time to fixed level, average force, integrated area, maximal rate of force development, and equivalent for mechanical power parameter) were selected as force-time parameters.
The reliability of maximal grip strength (MAX) was very high (ICC=0.944, p<0.05) . In the above-stated instruction condition, the trial-to-trial difference expanded from 0.1- 0.4 sec, then re-duced in the vicinity of MAX during SEG exertion. Significant differences, however, were not found at any exertion time and reproducibility of SEG exertion pattern was very high between the two trials. The trial-to-trial reliability in all force-time parameters was significant (ICC=0.346-0.878, p<0.05) .
Reliability of the parameters measuring the earlier phase (about 0.1-0.5 sec) was low or moderate (ICC<0.7), while reliability of the parameters measuring the MAX vicinity tended to be high. The MAX relationship to force-time parameters in the MAX vicinity is high, but is low or moderate for the other parameters. It was suggested that the force-time parameters in the vicinity of MAX in SEG exertion might be useful for evaluating static power function in a clinical setting.
7.Sex differences in subjective symptoms of fatigue and associated factors in adolescence.
HIDETSUGU KOBAYASHI ; SHINICHI DEMURA ; FUMIO GOSHI ; MASAKI MINAMI ; YOSHINORI NAGASAWA ; SUSUMU SATO ; SHUNSUKE YAMAJI
Japanese Journal of Physical Fitness and Sports Medicine 1999;48(5):619-630
The purpose of this study was to examine sex differences in subjective symptoms of fatigue (SSF) in high school and college students by considering the relationship between subjective feeling of fatigue and life habits.
A questionnaire on SSF (54 items), dealing with subjective feeling of fatigue and life habits (frequency of exercise, going to sleep, waking in the morning and physical condition) was administered to 5622 healthy students aged 15-20 yr, and data of 5335 properly completed questionnaires was analyzed.
The following was determined :
1) Sex differences were confirmed in most SSF items. SSF complaints for females was generally higher than that of males.
2) The relationship between SSF and the age was low in both sexes.
3) Subjective feeling of fatigue is somewhat related to SSF.
4) The going to sleep last night influence on SSF was different in both sexes and related largely to the next day SSF in males.
5) Waking this morning and today's physical condition are related to SSF in both sexes.
6) In males, the influence of exercise habits on SSF regarding drowsiness is relatively large.
8.Development of ADL index for older community people.
SHINICHI DEMURA ; SUSUMU SATO ; MASAKI MINAMI ; HIDETSUGU KOBAYASHI ; YOHEI NODA ; JINZABURO MATSUZAWA ; KANDO KOBAYASHI ; JYUNICHIRO AOKI
Japanese Journal of Physical Fitness and Sports Medicine 2000;49(3):375-384
The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.
9.Effect of linear polarized near-infrared light irradiation on the recovery of isokinetic muscle exertion after strenuous exercise.
SHINICHI DEMURA ; SHUNSUKE YAMAJI ; YOSHINORI NAGASAWA ; HIDETSUGU KOBAYASHI ; MASAKI MINAMI ; YOSHIO TOYOSHIMA
Japanese Journal of Physical Fitness and Sports Medicine 2000;49(4):459-468
This study aimed to examine the effect of linear polarized near-infrared light (PL) irradiation on the recovery of isokinetic muscle exertion and subjective fatigue sensation in muscles after strenuous exercise. Eighteen healthy college students participated in the experiment for all conditions of meridian point irradiation (MPI), femurs muscles irradiation (FMI), and no irradiation (NI) . They all took isokinetic knee extension and flexion tests (IK test) before and after strenuous exercise up to exhaustion. Each subject was irradiated at the meridian point or in femurs muscles after the second IK test. The third IK test was carried out after ten-minutes rest.
The effects of PL irradiation were confirmed on the recovery rate of muscle fatigue in knee extension motion with high load intensity (PT 60 d/s and TW 60 d/s : MPI, FMI> NI, p<0.05 16.2%, 13.4%>8.5%, and 16.1%, 14.1%>8.3%, respectively) . Also, in flexion motion, significant differences in the recovery-degree for each condition were found, and the effect of PL irradiation was suggested. There was no difference between the effect of MPI and FMI. In addition, subjective fatigue sensation in muscles after rest decreased significantly in MPI as compared with NI (MPI: 52.1%>NI : 36.6%, p<0.05) . From the above, it was suggested that PL irradiation is effective on recovery in muscle fatigue after strenuous exercise regardless of irradiation conditions, MPI or FMI.
10.Examination of useful ADL items and scales to assess ADL ability in older community people. Regarding aging, physical fitness level, and interrelationships among ADL items.
SHINICHI DEMURA ; SUSUMU SATO ; JINZABURO MATSUZAWA ; YOHEI NODA ; HISAYOSHI MIYAGUCHI ; NOBUHIKO TADA ; HIDETSUGU KOBAYASHI ; FUMIO GOSHI ; MASAKI MINAMI
Japanese Journal of Physical Fitness and Sports Medicine 2000;49(2):237-246
The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.
As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.
In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.