Relation between walking fluctuation and physical fitness in the middle-aged and elderly

This study examined the relationship between walking fluctuation and physical fitness in 21 middle-aged and elderly healthy women (65.95 ± 6.6 years). Walking data was gained during a typical six-minute walk by using sensors in the participantsʼ shoes. Stride time (ST), the coefficient of variation of stride time (STCV), and the fractal-scaling index (α) were calculated. Also measured were the ten-meter usual walking time, functional reach, one-leg standing time with eyes open, vertical jump height, and grip strength, and a fitness age score (FAS) was then calculated by using these results. In addition, twenty-second stepping frequency, thirty-second chair standing frequency, and isometric knee extension strength were measured. There was a significant negative correlation between age and FAS (r=-0.590, p=0.005). When participants were divided into two groups by a median of ST, STCV and α, significantly superior physical fitness were observed in higher ST and higher STCV groups, whereas significantly longer step length were observed in higher α groups.This study therefore suggests that STCV is more affected by musculoskeletal function than α.論

地域在住自立高齢者を対象にした体力測定会への参加希望者における閉じこもりリスクと孤独感との関連

　Purpose：This study was conducted for the purpose of examining the risk of becoming homebound and the correlation of loneliness in the community-dwelling older adults volunteering to participate in a physical f itness measurement program．　Method：The subjects of this study consisted of 638 older adults dwelling in Kameoka City who volunteered to participate in a physical fitness measurement program in 2012 and desired also to participate in a similar program held roughly one year and a half years later．A survey was conducted in the form of a questionnaire survey that was mailed to the subjects．The contents of the survey consisted of questions relating to gender，age，household composition，frequency of meetings with separately dwelling family members，number of neighbors they can rely on，tasks within the home，presence of a hobby，participation in group activities，subjective view of health，subjective physical strength，risk of depression，risk of becoming homebound，assessment using the Japanese language version of the UCLA loneliness scale（ 3rd edition）（ to be simply referred to as ""loneliness""） and assessment using the Life Satisfaction Index K（ to be abbreviated as LSIK）．Analyses consisted of an intergroup comparison of loneliness scores for each parameter．This was followed by an analysis of covariance using those parameters for which there was a correlation with loneliness as covariates in order to examine the correlation between risk of becoming homebound and loneliness．　Results：539 of the subjects submitted valid responses to the survey （response rate：84.5%）．The analysis of the risk of becoming homebound indicated that 20 subjects were homebound（ 3.7%），90 subjects were at risk of becoming homebound （16.7%） and 429 subjects were not homebound （79.6%）． According to the results of an intergroup comparison of loneliness scores for each survey parameter，signif icant differences（ p ＜0.001） were observed for gender，number of neighbors the subjects can rely on，subjective view of health，subjective physical strength，risk of depression， tasks within the home，presence of a hobby，participation in group activities and LSIK score． The average loneliness scores of each risk of becoming homebound were 36.2 ± 8.9 in the nonhomebound group，41.9 ± 9.8 in the group at risk of becoming homebound，and 45.8 ± 8.7 in the homebound group，with scores becoming higher as the tendency to become homebound worsened． The correlation between the two was such that significant differences （ p =0.007） were observed when the above parameters were used as covariates，and loneliness was greater in the group at risk of becoming homebound than in the non-homebound group（ p =0.047）．　Discussion：This study demonstrated that persons at risk of becoming homebound are present even among relatively healthy older adults expressing a strong desire to continue to participate in physical f itness measurement programs like the subjects of this study，and that there is already a strong sense of loneliness among subjects of the group at risk of becoming homebound． Efforts to eliminate this sense of loneliness targeted at older adults at risk of becoming homebound who are already demonstrating a decrease in frequency of leaving their homes are expected to lead to effective countermeasures for preventing these persons from becoming homebound．　目　的：地域在住自立高齢者を対象とした体力測定会への参加希望者における閉じこもりリスクの程度と孤独感との関連を明らかにすることを目的とした。　方　法：亀岡市在住高齢者で2012 年の体力測定会に参加し，その約1 年半後の体力測定会に参加を希望した638 名を対象とした。調査は郵送法による質問紙調査を行った。質問項目は性別，年齢，世帯構成，別居家族と会う頻度，近所に頼れる人の人数，家庭内の仕事，趣味の有無，グループ活動への参加，主観的健康感，主観的体力，うつのリスク，閉じこもりリスク，日本語版UCLA 孤独感尺度（第3 版）（以下，孤独感），生活満足度尺度K（以下，LSIK）である。分析は各調査項目において孤独感得点の群間比較を行った。次に，孤独感と関連のあった項目を共変量とした共変量分散分析を行い，閉じこもりリスクと孤独感の関連を明らかにした。　結　果：有効回答者539 名（有効回答率84.5%）であった。閉じこもりリスクの分布は，閉じこもり群20 名（3.7%），閉じこもり予備群90 名（16.7%），非閉じこもり群429 名（79.6%）であった。調査項目ごとの孤独感得点の群間比較では性別，近所に頼れる人の人数，主観的健康感，主観的体力，うつのリスク，家庭内の仕事，趣味の有無，グループ活動への参加，LSIK に有意差が認められた（ p ＜ 0.001）。閉じこもりリスク別の孤独感得点の平均は，非閉じこもり群36.2 ± 8.9 点，閉じこもり予備群41.9 ± 9.8点，閉じこもり群45.8 ± 8.7 点と閉じこもり傾向に伴い高まった。両者の関連では先の項目を共変量としても有意差があり（ p =0.007），閉じこもり予備群の孤独感が非閉じこもり群に比べて有意に高かった（ p =0.047）。　考　察：体力測定会に継続参加可能な意欲の高い比較的健康な高齢者においても，閉じこもりリスク保有者が存在し閉じこもり予備群で孤独感が高いことが示された。閉じこもり予備群のうちから，孤独感を解消させるような働きかけを行うことが閉じこもり予防対策につながると期待される。原

A 2-year follow-up study on falls and related factors among community-dwelling elderly individuals

　Purpose：We conducted a 2-year follow-up study on falls and related causes experienced by localregion, independent elderly citizens．　Method：We analyzed a total of 533 subjects, all independent elderly citizens living in Kameoka City in Kyoto Prefecture who participated in both the 2011 Everyday Life Sphere Needs Assessment and the 2013 Physical Strength Measurements studies． Our study focused on the 25 items included as basic attributes in the 2011 Everyday Life Sphere Needs Assessment．After performing an analysis of the relationships between gender, age, and fall experience, we employed the existence of falls as a subordinate variable, age as a covariant, and each of the 25 basic-attribute items as independent variables in a multivariate logistic regression analysis to grasp the causes related to falls． Furthermore, we used 7 determinate items and a batch-input logistic regression analysis method to analyze the effect of an independent life style on falls．　Results：In the 2-year follow-up study, 35.5% of the subjects experienced at least one fall．The age of the subjects experiencing falls was slightly higher in the female group, compared with the males, but no significant difference was demonstrated．A significant difference was demonstrated in the ratio of falls in the highly-aged elderly group, compared with the lower-aged elderly group． In regard to the relationship between falls and each of the determinate items, in the male group, significant differences were demonstrated for motility, oral functions, memory lapses, and the tendency for depression, and especially the motility function showed a strong causal relationship, even with suppression of the other causes． In the female group, a significant relationship was demonstrated between subjects with a tendency for depression and subjects with a high instrumental activities of daily living index, and with suppression of the other causes in the analysis, a significant relationship was demonstrated between subjects with a low oral function index and a high instrumental activities of daily living index．　Conclusion：It was suggested that even the independent elderly citizens were predisposed to fall down by aging． In addition, sex deference of factor related to falls was observed, and thus sexspecific support policy for fall prevention that considered a characteristic and a background by sex is necessary．　目的：地域在住の自立高齢者を対象に2 年間の追跡調査を行い，転倒経験の有無とその関連要因を分析した。　方法：京都府亀岡市在住の自立高齢者で，2011 年の日常生活圏域ニーズ調査と2013 年の体力測定の両方に参加した533 人について分析した。調査内容は，基本属性の他，日常生活圏域ニーズ調査25項目を用いて，①運動機能，②低栄養，③口腔機能，④閉じこもり，⑤物忘れ，⑥うつ傾向，⑦手段的日常生活動作（IADL）の7 つの判定項目を設定した。分析は，性，年齢と転倒経験との関連を分析した後，転倒有無を従属変数，年齢を共変量，各判定項目それぞれを独立変数とするロジスティック回帰分析により転倒に関連する要因を把握した。また，7 つの判定項目を一括投入するロジスティック回帰分析により転倒への独立した影響を分析した。　結果：追跡2年間において，少なくとも1回以上転倒のあった者は35.5%であった。女性は男性より転倒した者がやや高率であったが有意差はなく，後期高齢者は前期高齢者より有意に高率であった。転倒と各判定項目との関連は，男性では，運動機能，口腔機能，物忘れ，うつ傾向において有意差がみられ，とくに運動機能は，他の要因の影響を調整しても強い関連を示した。女性では，うつ傾向とIADLの高い者に有意な関連がみられ，他の要因の影響を調整した分析では口腔機能の低い者，IADL の高い者に有意な関連がみられた。　考察：地域在住の自立した高齢者であっても，加齢により転倒しやすくなることが示唆された。また，転倒に関連する要因において，男性と女性とで異なった様相を呈し，性による特性や背景を考慮した転倒予防対策が必要であると推察された。原

看護学部における地域住民参画型教育の取り組みと今後の課題 : 模擬患者の養成と看護OSCEへの参画支援を通して

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Verbal counting while walking stabilize gait rhythm? : application to lower-physical-fitness elderly

本研究では、19名の介護認定者を含む低体力高齢者を対象に歩行中の自らの掛け声が歩行リズムを改善するか否かを検討した。参加者は自身で決めたペースで４分間連続して歩行するように案内された。ストライド間隔は参加者の靴の中に設置されたフットスイッチで得られ、フラクタル指数が計算された。低体力高齢者の掛け声なし歩行の平均αは0.69であった。この値は健常な成人を対象とした我々の先行研究の値よりも低く、低体力高齢者の歩行リズムが不安定であることを意味している。参加者全体では、歩行中の掛け声の有無におけるαに有意な差はなかった。本研究では、参加者をαの中央値で二群に分けて、二元配置分散分析を実施した（交互作用：p = 0.055）。α低値群では、自身の掛け声により歩行におけるαが増加した（0.57 ± 0.08 → 0.63 ± 0.18）。したがって、歩行中の自らの掛け声は低体力高齢者の歩行リズムを安定させるかもしれない。This study was conducted on 19 lower-physical-fitness elderly including people with long-term care certification (76.7 ± 8.5 years), investigating whether their own verbal count while walking improves their gait rhythm. Participants were instructed to walk continuously at a self-determined pace for 4 min. Stride interval was obtained using footswitches set in the participants\u27 shoes, and then fractal scaling index (α) were calculated. The mean α while walking without verbal counting in lower-physical fitness elderly was 0.69. This value was lower than that of our previous study for healthy adults (0.84), indicating that gait rhythm in the lower-physical fitness elderly was unstable. There was no significant difference in α between walking with and without own verbal counting in all participants. In the present study, participants were divided into two groups by median α, and two-way analysis of variance was carried out (interaction: p = 0.055). In the lower α group, own verbal counting increased α while walking (0.57 ± 0.08 → 0.63 ± 0.18). Therefore, own verbal counting while walking may stabilize gait rhythm in lower-physical fitness elderly