研究者詳細 - 牧迫　飛雄馬

牧迫飛雄馬, 赤井田将真 . 加齢に伴う心理の変化 . 理学療法学48 ( 2 ) 242 - 247 2021年

中井雄貴, 富岡一俊, 谷口善昭, 竹中俊宏, 牧迫飛雄馬 . COVID-19対策に伴う外出自粛時期の地域在住高齢者における身体活動量変化:─運動教室に参加していた高齢者を対象とした調査─ . 理学療法科学36 ( 1 ) 35 - 40 2021年

記述言語：日本語出版者・発行元：理学療法科学学会

〔目的〕新型コロナウイルス感染症（COVID-19）の感染拡大予防対策に伴う外出自粛時期前後での運動教室に参加していた地域在住高齢者における身体活動量の変化を調べた．〔対象と方法〕対象は地域在住高齢者15名，2019年9月（緊急事態宣言前）と2020年4月（緊急事態宣言中）における身体活動量と生活空間（LSA）の変化を比較した．身体活動量は3軸加速度計を用いて計測した．〔結果〕緊急事態宣言前に比べて緊急事態宣言中は2割の者で町外への外出（生活空間レベル5）をしておらず，LSAスコアが低下傾向であったが，有意な変化ではなかった．身体活動量も有意な変化はなかった．〔結語〕2020年4月中旬時点において運動教室に参加していた高齢者は，生活範囲の顕著な変化および身体活動量の低下は認められなかった．

DOI： 10.1589/rika.36.35

J-GLOBAL

KAIMOTO Kaori, YAMASHITA Mikako, SUZUKI Taro, MAKIZAKO Hyuma, KORIYAMA Chihaya, KUBOZONO Takuro, TAKENAKA Toshihiro, OHISHI Mitsuru, KANOUCHI Hiroaki, theTarumizuStudyDietGroup . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women . Ｊｏｕｒｎａｌ　ｏｆ　Ｎｕｔｒｉｔｉｏｎａｌ　Ｓｃｉｅｎｃｅ　ａｎｄ　Ｖｉｔａｍｉｎｏｌｏｇｙ67 ( 1 ) 39 - 47 2021年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般財団法人学会誌刊行センター

We examined the association between nutrient intake and prefrailty. Data from 815 older people (63% women) who participated in a community-based health check survey (Tarumizu Study) were analyzed. Prefrailty were defined using five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). Participants with one or more components were considered to belong to the prefrailty group. Nutrition intake was estimated from a validated brief-type self-administered diet history questionnaire. Among the participants, 154 men (52%) and 278 women (54%) were found to be in a status of prefrailty. In men, there were no significant associations between nutrient intake and prefrailty. In women, carbohydrate intake was slightly higher in prefrailty group. Vitamins K, B1, B2, folic acid, pantothenic acid, phosphorus, potassium, calcium, magnesium, iron, zinc, and copper intake was significantly lower in the prefrailty group. Among the nutrients, magnesium was identified as a significant covariate of prefrailty using a stepwise regression method. In women adjusted ORs (95%CI, p value) for prefrailty in the first, second, third, and fourth quartiles of magnesium intake were 1.00 (reference), 0.52 (0.29–0.92, 0.024), 0.51 (0.28–0.95, 0.033), and 0.38 (0.19–0.74, 0.005), respectively, by multivariate logistic regression analysis (variates: age, body mass index, energy intake, supplement use, osteoporosis, magnesium, and protein intake). Protein intake did not related to prefrailty. Protein intake might be sufficient to prevent prefrailty in the present study. We propose magnesium to be an important micronutrient that prevents prefrailty in community-dwelling older Japanese women.

DOI： 10.3177/jnsv.67.39

Maruta M. . Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population-based cross-sectional study . International Journal of Geriatric Psychiatry36 ( 7 ) 1065 - 1074 2021年査読国際誌

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Geriatric Psychiatry

Objectives: This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI). Methods: We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Results: Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44–0.88, p = 0.008). Conclusions: Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.

DOI： 10.1002/gps.5544

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/gps.5544

Makino K. . Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition . Journal of the American Medical Directors Association22 ( 9 ) 1912 - 1918 2021年国際誌

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of the American Medical Directors Association

Objectives: Diabetes and prediabetes contribute to an increased risk of cognitive decline and dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal cognition. This study, therefore, aimed to examine the prospective associations of diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling older adults. Design: Longitudinal cohort study with a 4-year follow-up. Setting and Participants: Community-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787). Methods: Participants’ medical history of diabetes and blood HbA1c levels at baseline were assessed, and they were classified as control, prediabetes, and diabetes. Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up. Reversion from MCI to normal cognition over 4 years was determined. In the longitudinal analysis, we performed multiple imputations to adjust for a selection bias and loss of information. Results: The reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%, 55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%, and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression showed that diabetes decreases the probability of MCI reversion both before and after multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18–0.74 for before imputation, OR 0.37; 95% CI 0.19–0.72 for after imputation]. Furthermore, prediabetes also showed significantly decreased probabilities of MCI reversion both before and after multiple imputations (OR 0.57; 95% CI 0.34–0.94 for before imputation, OR 0.60; 95% CI 0.37–0.97 for after imputation). Conclusions and Implications: Diabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may be effective in enhancing the reversion from MCI to normal cognition in a community setting.

DOI： 10.1016/j.jamda.2021.02.033

Kiuchi Y. . The association between dietary variety and physical frailty in community-dwelling older adults . Healthcare (Switzerland)9 ( 1 ) 2021年国際誌

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Healthcare (Switzerland)

The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried’s component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84–0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60–7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults.

DOI： 10.3390/healthcare9010032

Makizako H. . Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS . Gerontology67 ( 6 ) 1 - 10 2021年国際誌

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Gerontology

Introduction: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. Objective: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. Methods: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. Results: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were Currency sign6,434 ($63.1) for robust, Currency sign19,324 ($189.5) for pre-frail, and Currency sign147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. Discussion/Conclusion: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

DOI： 10.1159/000514679

Makizako H. . TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J . The Journal of frailty & aging10 ( 3 ) 211 - 218 2021年

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：The Journal of frailty & aging

Objective: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. Design: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. Setting: The ILSA-J studies were conducted on community-living older adults. Participants: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. loss: Results: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. Conclusions: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

DOI： 10.14283/jfa.2020.68

牧迫飛雄馬 . COVID-19と地域理学療法:─特別チームの活動と地域における課題─ . 理学療法学Supplement48 ( 0 ) B - 46-B-46 2021年

記述言語：日本語出版者・発行元：公益社団法人日本理学療法士協会

新型コロナウイルス（COVID-19）感染拡大に伴う緊急事態宣言発令以降，外出の自粛要請をはじめとする多くの対策がなされた。その結果，地域・在宅で生活する高齢者や要介護者は活動の制限を余儀なくされ，諸機能の低下を招いた者も認められた。このような状況の中，本学会では感染予防や自粛中の関わり方など，COVID-19に関する情報共有をはじめ，実務に有益な情報の発信や調査・報告などを行うため，有志による特別チームを立ち上げ，活動を行ってきた。　緊急事態宣言の解除以降は，地域の通いの場の再開や医療・介護サービスの実施にあたって，感染予防の徹底を図るとともに，新しい日常生活様式を踏まえた介入方法を模索しながら活動を行っている。また，第2波，第3波への備えや新たな地域交流・社会参加を目指すために必要な情報，事例を提示するとともに，アンケート調査の結果などから得られた臨床の課題についても取り組み始めている。　この特別シンポジウムでは，特別チームの活動について報告するとともに，現状の課題を踏まえ，その解決に向けた対策など，何かしらの情報提供や方向性を提示できれば幸いです。

DOI： 10.14900/cjpt.48S1.B-46

J-GLOBAL

佐藤菜々, 大石充, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 和田あゆみ, 木山良二, 窪園琢郎, 竹中俊宏 . 地域在住高齢者における筋量および筋力と歩行パラメータとの関連性 . 理学療法学Supplement48 ( 0 ) E - 69_2-E-69_2 2021年

牧迫飛雄馬 . 日常生活での運動を再考する:─運動量さえ増えればいいのか？─ . 理学療法学Supplement48 ( 0 ) C - 61-C-61 2021年

記述言語：日本語出版者・発行元：公益社団法人日本理学療法士協会

日常生活において，運動によって身体活動を促進することは，全世代を通して心身に効果的であることはおそらく疑いの余地はないであろう。身体活動の減少は，喫煙，高血圧に次いで日本人の死亡に及ぼす危険因子とされており，さまざまな疾患の発症リスクを増大させる（Ikeda N, et al. 2011）。とくに，高齢期の日常生活における身体活動（physical activity）を促進することは，健康寿命の延伸を目指すうえでの重要な課題のひとつと考える。　習慣的な運動や積極的な身体活動は，認知症の発症リスクを低減させることにも寄与するとされている。週3回以上の運動習慣（15分以上の運動：ウォーキング，ハイキング，サイクリング，スイミング，水中運動，有酸素運動や柔軟体操，筋力トレーニングやストレッチングなど）を有する者では，週3回未満の者に比べて認知症を発症する危険が約38％低かったことが報告されている（Larson EB, et al. 2006）。さらに，運動習慣が認知症の発症に及ぼす影響は，軽度から中等度の運動機能の低下を認めた高齢者ほど顕著であった。つまり，やや運動機能の低下が生じ始めた時期に，より意識的に身体活動を維持・向上しておくことの重要性を示している。また，日常的な運動習慣は，加齢による脳萎縮の抑制に対しても効果的であることが期待されている（Cabral DF, et al. 2019）。　しかしながら，身体的活動を増加させるほどに望ましいかについては慎重になるべきである。高齢女性16,741名を対象に1日の歩数と死亡発生との関連を縦断的に調べた報告によると，約7,500歩に達するまでは1日歩数の増加は死亡リスク低減と関連したが，1日10,000歩に達することの付加的な利得は認められなかった（Lee IM, et al. 2019）。　一般的に健康的な心身機能を維持するためには週150分（1日30分，週5日間）程度の中強度程度（やや速歩き相当）の運動の実施が推奨されている（Nelson ME, 2007）。しかし，高齢者にとっては中強度以上の負荷を伴う運動はさまざまな障壁やリスクを抱えることも少なくない。低強度から中強度の運動による身体活動（週3回程度）であっても，将来の認知障害の発生が有意に低くなることが報告されており（Sofi F, et al. 2011），たとえ低強度から中強度程度の負荷の運動であっても習慣化することが高齢期の認知機能低下の予防に有効であるかもしれない。さらに，アルツハイマー病を発症する9～10年程度前から身体活動量が低下し始めるとされている（Sabia S, et al. 2017）。そのため，一時的に運動習慣を習得して身体活動量を高めるだけではなく，高めた身体活動量を維持する生活スタイルをいかにして確立するかがさらに重要である。　日常におけるさまざまな活動には，身体的活動（physical activity）の他，知的活動（cognitive activity），社会的活動（social activity）などがあり，これらが高齢期における健康関連指標へ影響を及ぼすことが示唆されている。日常でこれらの活動をいかに多面的に促進していくかが健康長寿の鍵になると考えられ，理学療法には対象者の活動の多様性と継続性を支援することも重要な対策のひとつと考えられる。

DOI： 10.14900/cjpt.48S1.C-61