Introduction: A prevalence of frailty is gradually increasing with the progress of aging in Japan, and critical challenges regarding early diagnosis and prevention of frailty were necessary in community. Although previous studies have well documented the characteristics of physical disability, there is limited information on frail state differences among older adults in Japanese rural areas. The aim of our cross-sectional observational study was to clarify the association of frail status in northern Japanese community-dwellers aged 65 or more. Methods: 345 participants were recruited from 2018 to 2020, and after getting informed consent from each participant, assessments and outcomes were evaluated according to the ORANGE protocol. We applied the frailty index of Gerontology-the Study of Geriatric Syndromes (NCGG-SGS) to classify frailty status by collecting data of demographics and psychosocial status using the Kihon checklist (KCL) and cognitive domains used by the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). Results: Our subjects included 313 older adults divided into 138 robust, 163 prefrail, and 12 frail. For statistical analysis, we found that the frail group had a lower educational duration, worsened KCL items, lower cognitive functions, and a tendency toward depression compared to the other groups. Moreover, physical frailty and cognitive decline were related, and polypharmacy and a lack of joy in daily life were explanatory variables of frail status. Conclusions: We suggest that KCL is important for frail discrimination, and in order to prevent physical frailty, our community should take care of not only exercise and nutrition but also cognitive functioning and depressive tendencies. In particular, polypharmacy and the presence of fun in your life are possible to be related to frailty.

1.
Japanese Ministry of Health, Labour and Welfare. Health and Welfare Bureau for the Elderly. Long-Term Care Insurance System of Japan. 2016. Available from: https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf. Accessed 2020 May 18
.
2.
Shechtman
O
,
Mann
WC
,
Justiss
MD
,
Tomita
M
.
Grip strength in the frail elderly
.
Am J Phys Med Rehabil
.
2004
;
83
(
11
):
819
26
. .
3.
Shimada
H
,
Makizako
H
,
Doi
T
,
Tsutsumimoto
K
,
Suzuki
T
.
Incidence of disability in frail older persons with or without slow walking speed
.
J Am Med Dir Assoc
.
2015
;
16
(
8
):
690
6
. .
4.
Vermeiren
S
,
Vella-Azzopardi
R
,
Beckwée
D
,
Habbig
AK
,
Scafoglieri
A
,
Jansen
B
, et al
Frailty and the prediction of negative health outcomes: a meta-analysis
.
J Am Med Dir Assoc
.
2016
;
17
(
12
):
1163
e17
. .
5.
Haider
S
,
Grabovac
I
,
Dorner
TE
.
Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review
.
Wien Klin Wochenschr
.
2019
;
131
(
11–12
):
244
54
. .
6.
Nakagaichi
M
,
Anan
Y
,
Hikiji
Y
,
Uratani
S
.
Developing an assessment based on physical fitness age to evaluate motor function in frail and healthy elderly women
.
Clin Interv Aging
.
2018
;
13
:
179
84
. .
7.
Zheng
L
,
Li
G
,
Wang
X
,
Yin
H
,
Jia
Y
,
Leng
M
, et al
Effect of exergames on physical outcomes in frail elderly: a systematic review
.
Aging Clin Exp Res
.
2020
;
32
:
2187
200
.
8.
Park
Y
,
Choi
JE
,
Hwang
HS
.
Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial
.
Am J Clin Nutr
.
2018
;
108
(
5
):
1026
33
. .
9.
Jadczak
AD
,
Makwana
N
,
Luscombe-Marsh
N
,
Visvanathan
R
,
Schultz
TJ
.
Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews
.
JBI Database System Rev Implement Rep
.
2018
;
16
(
3
):
752
75
. .
10.
Kidd
T
,
Mold
F
,
Jones
C
,
Ream
E
,
Grosvenor
W
,
Sund-Levander
M
, et al
What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials
.
BMC Geriatr
.
2019
;
19
(
1
):
184
. .
11.
Saji
N
,
Sakurai
T
,
Suzuki
K
,
Mizusawa
H
,
Toba
K
,
investigators
O
.
ORANGE’s challenge: developing wide-ranging dementia research in Japan
.
Lancet Neurol
.
2016
;
15
(
7
):
661
2
. .
12.
Faul
F
,
Erdfelder
E
,
Buchner
A
,
Lang
AG
.
Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses
.
Behav Res Methods
.
2009
;
41
(
4
):
1149
60
. .
13.
Fried
LP
,
Tangen
CM
,
Walston
J
,
Newman
AB
,
Hirsch
C
,
Gottdiener
J
, et al
Frailty in older adults: evidence for a phenotype
.
J Gerontol A Biol Sci Med Sci
.
2001
;
56
(
3
):
M146
56
. .
14.
Satake
S
,
Shimada
H
,
Yamada
M
,
Kim
H
,
Yoshida
H
,
Gondo
Y
, et al
Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria
.
Geriatr Gerontol Int
.
2017
;
17
:
2629
34
.
15.
Masnoon
N
,
Shakib
S
,
Kalisch-Ellett
L
,
Caughey
GE
.
What is polypharmacy? A systematic review of definitions
.
BMC Geriatr
.
2017
;
17
(
1
):
230
. .
16.
Thorell
K
,
Midlöv
P
,
Fastbom
J
,
Halling
A
.
Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study
.
BMC Geriatr
.
2020
;
20
(
1
):
73
. .
17.
Kojima
T
,
Mizukami
K
,
Tomita
N
,
Arai
H
,
Ohrui
T
,
Eto
M
, et al
Screening tool for older persons’ appropriate prescriptions in Japanese: report of the Japan Geriatrics Society Working Group on “Guidelines for medical treatment and its safety in the elderly”
.
Geriatr Gerontol Int
.
2016
;
16
:
983
1001
.
18.
Satake
S
,
Senda
K
,
Hong
YJ
,
Miura
H
,
Endo
H
,
Sakurai
T
, et al
Validity of the Kihon Checklist for assessing frailty status
.
Geriatr Gerontol Int
.
2016
;
16
(
6
):
709
15
. .
19.
Sheikh
JI
,
Yesavage
JA
.
Geriatric depression scale (GDS): recent evidence and development of a shorter version
.
Clin Gerontol: J Aging Ment Health
.
1986
;
5
:
165
73
.
20.
Makizako
H
,
Shimada
H
,
Park
H
,
Doi
T
,
Yoshida
D
,
Uemura
K
, et al
Evaluation of multidimensional neurocognitive function using a tablet personal computer: test-retest reliability and validity in community-dwelling older adults
.
Geriatr Gerontol Int
.
2013
;
13
(
4
):
860
6
. .
21.
Makizako
H
,
Shimada
H
,
Tsutsumimoto
K
,
Lee
S
,
Doi
T
,
Nakakubo
S
, et al
Social frailty in community-dwelling older adults as a risk factor for disability
.
J Am Med Dir Assoc
.
2015
;
16
(
11
):
1003
. .
22.
Imuta
H
,
Yasumura
S
,
Abe
H
,
Fukao
A
.
The prevalence and psychosocial characteristics of the frail elderly in Japan: a community-based study
.
Aging
.
2001
;
13
:
443
53
.
23.
Kojima
G
,
Iliffe
S
,
Taniguchi
Y
,
Shimada
H
,
Rakugi
H
,
Walters
K
.
Prevalence of frailty in Japan: a systematic review and meta-analysis
.
J Epidemiol
.
2017
;
27
(
8
):
347
53
. .
24.
Shimada
H
,
Lee
S
,
Doi
T
,
Bae
S
,
Tsutsumimoto
K
,
Arai
H
.
Prevalence of psychological frailty in Japan: NCGG-SGS as a Japanese national cohort study
.
J Clin Med
.
2019
;
8
:
1554
.
25.
Boyle
PA
,
Buchman
AS
,
Wilson
RS
,
Leurgans
SE
,
Bennett
DA
.
Physical frailty is associated with incident mild cognitive impairment in community-based older persons
.
J Am Geriatr Soc
.
2010
;
58
(
2
):
248
55
. .
26.
Halil
M
,
Cemal Kizilarslanoglu
M
,
Emin Kuyumcu
M
,
Yesil
Y
,
Cruz Jentoft
AJ
.
Cognitive aspects of frailty: mechanisms behind the link between frailty and cognitive impairment
.
J Nutr Health Aging
.
2015
;
19
(
3
):
276
83
. .
27.
Thapa
N
,
Park
HJ
,
Yang
JG
,
Son
H
,
Jang
M
,
Lee
J
, et al
The effect of a virtual reality-based intervention program on cognition in older adults with mild cognitive impairment: a randomized control trial
.
J Clin Med
.
2020
;
9
(
5
):
e1283
. .
28.
Gross
AL
,
Xue
QL
,
Bandeen-Roche
K
,
Fried
LP
,
Varadhan
R
,
McAdams-DeMarco
MA
, et al
Declines and impairment in executive function predict onset of physical frailty
.
J Gerontol A Biol Sci Med Sci
.
2016
;
71
(
12
):
1624
30
. .
29.
McGough
EL
,
Kelly
VE
,
Logsdon
RG
,
McCurry
SM
,
Cochrane
BB
,
Engel
JM
, et al
Associations between physical performance and executive function in older adults with mild cognitive impairment: gait speed and the timed “up & go” test
.
Phys Ther
.
2011
;
91
:
1198
207
.
30.
Lugtenburg
A
,
Oude Voshaar
RC
,
Van Zelst
W
,
Schoevers
RA
,
Enriquez-Geppert
S
,
Zuidersma
M
.
The relationship between depression and executive function and the impact of vascular disease burden in younger and older adults
.
Age Ageing
.
2017
;
46
(
4
):
697
701
. .
31.
Kojima
G
,
Taniguchi
Y
,
Kitamura
A
,
Shinkai
S
.
Are the Kihon checklist and the Kaigo-Yobo checklist compatible with the frailty index?
J Am Med Dir Assoc
.
2018
;
19
(
9
):
797
800
. .
32.
Gutiérrez-Valencia
M
,
Izquierdo
M
,
Cesari
M
,
Casas-Herrero
Á
,
Inzitari
M
,
Martínez-Velilla
N
.
The relationship between frailty and polypharmacy in older people: a systematic review
.
Br J Clin Pharmacol
.
2018
;
84
(
7
):
1432
44
. .
33.
Woo
J
,
Yu
R
,
Wong
M
,
Yeung
F
,
Wong
M
,
Lum
C
.
Frailty screening in the community using the FRAIL scale
.
J Am Med Dir Assoc
.
2015
;
16
(
5
):
412
9
. .
34.
Coelho
T
,
Paúl
C
,
Gobbens
RJ
,
Fernandes
L
.
Determinants of frailty: the added value of assessing medication
.
Front Aging Neurosci
.
2015
;
7
:
56
. .
35.
Gnjidic
D
,
Hilmer
SN
,
Blyth
FM
,
Naganathan
V
,
Waite
L
,
Seibel
MJ
, et al
Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes
.
J Clin Epidemiol
.
2012
;
65
(
9
):
989
95
. .
36.
Moulis
F
,
Moulis
G
,
Balardy
L
,
Gérard
S
,
Sourdet
S
,
Rougé-Bugat
ME
, et al
Searching for a polypharmacy threshold associated with frailty
.
J Am Med Dir Assoc
.
2015
;
16
(
3
):
259
61
. .
37.
Porter
B
,
Arthur
A
,
Savva
GM
.
How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study
.
BMJ Open
.
2019
;
9
(
5
):
e026171
. .
38.
Kume
Y
,
Takahashi
T
,
Itakura
Y
,
Lee
S
,
Makizako
H
,
Ono
T
, et al
Polypharmacy and lack of joy predict physical frailty among northern Japanese community-dwellers from the ORANGE cohort study
. Research Square [Preprint].
2020 Jun 30
. Available from: .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.