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International Journal of Geriatric Psychiatry 01/2013; 28(1):109-10. · 2.42 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) for detecting early-stage dementia in the elderly Japanese population.
A total of 280 clinical participants (180 with mild Alzheimer's disease, 43 with amnestic mild cognitive impairment, 32 with non-amnestic mild cognitive impairment and 25 control subjects) and 22 community-dwelling elderly individuals without dementia were recruited. The Clinical Dementia Rating, the Mini-Mental State Examination, and AQT were administered to all participants. The Neurobehavioral Cognitive Status Examination was also administered to clinical participants.
The intraclass correlation coefficient for the test-retest reliability of colour-form naming time on AQT was 0.88 (95% CI, 0.74-0.95, P < 0.001). AQT colour-form naming time was significantly correlated with the Clinical Dementia Rating, the total score on the Mini-Mental State Examination, and the total score on the Neurobehavioral Cognitive Status Examination and most of its subscales. AQT colour-form naming time was significantly longer in elderly individuals with mild Alzheimer's disease, amnestic mild cognitive impairment, and non-amnestic mild cognitive impairment than in control subjects. The receiver operating characteristic curve analysis indicated that AQT colour-form naming time significantly distinguished subjects with early-stage dementia (mild Alzheimer's disease, amnestic mild cognitive impairment, and non-amnestic mild cognitive impairment) from controls. The area under the curve was estimated to be 0.88 (95%CI = 0.82-0.95). A cut-off of 71/72 seconds yielded the best sensitivity/specificity trade-off: sensitivity = 85% and specificity = 76%.
AQT is a useful brief screening tool for detecting early-stage dementia in elderly Japanese individuals.
Psychogeriatrics 06/2012; 12(2):75-82. · 1.21 Impact Factor
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Yoshinori Fujiwara,
Hiroyuki Suzuki,
Masashi Yasunaga,
Mika Sugiyama,
Mutsuo Ijuin,
Naoko Sakuma, Hiroki Inagaki,
Hajime Iwasa,
Chiaki Ura,
Naomi Yatomi,
Kenji Ishii,
Aya M Tokumaru,
Akira Homma,
Ziad Nasreddine,
Shoji Shinkai
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ABSTRACT: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects.
Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls.
The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test-retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = -0.79, P < 0.001) scores. The areas under receiver-operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90-1.00) and 0.99 (95% CI = 0.00-1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75-0.95) and 0.97 (95% CI = 0.00-1.00), and 0.86 (95% CI = 0.76-0.95) and 0.97 (95% CI = 0.00-1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI.
The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community.
Geriatrics & Gerontology International 02/2010; 10(3):225-32.
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Hiroki Inagaki,
Yasuyuki Gondo,
Nobuyoshi Hirose,
Yukie Masui,
Koji Kitagawa,
Yasumichi Arai,
Yoshinori Ebihara,
Ken Yamamura,
Michiyo Takayama,
Susumu Nakazawa,
Ken-ichiro Shimizu,
Akira Homma
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ABSTRACT: We examined the effect of aging on cognitive function at the limit of human life expectancy by characterizing state of cognition in centenarians without clinical cognitive impairment.
Participants were 68 centenarians without cognitive impairment (Clinical Dementia Rating (CDR) 0), 96 controls 60 to 74 years old, and 46 controls 75 to 89 years old. We visited the places where centenarians were living and administered the Mini-Mental State Examination (MMSE) individually. Control subjects came to the assembly hall within their dwelling area, to be administered the MMSE.
Mean total scores of centenarians (22.3) were lower than for either 60-74 (27.2) or 75-89 (26.2). Comparison of scores in each of five cognitive domains measured by MMSE showed a significant age-group effect upon orientation, memory, and attention. Centenarians' scores were lower than for younger groups in every domain except for the language and praxis, concentration, and for repetition.
The centenarians' scores in memory and orientation declined as in earlier studies of normal aging. Centenarians' scores for attention and concentration differed from those in previous studies. The present result suggests that even primary memory is influenced by advanced age in centenarians, while ability to store information declines, ability to process is maintained.
Dementia and Geriatric Cognitive Disorders 08/2009; 28(1):6-12. · 2.14 Impact Factor
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ABSTRACT: In recent years, the advancements in aging research have led to a deeper understanding of the aging process and have also greatly changed our perception towards aging. In addition, the Human Genome Project has provided information on the human genome and has provided a study base for the elucidation of the molecular mechanisms underlying aging. It is interesting to note that the causative gene of Hutchinson-Gilford progeria syndrome was identified at the same period of the Human Genome Project completion, and it was expected that all the genes related to the human aging process would be identified. However, many phenomena regarding the molecular mechanisms underlying aging still remain unknown. Understanding these mechanisms is necessary in order to control aging process.
Nippon rinsho. Japanese journal of clinical medicine 08/2009; 67(7):1271-5.
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ABSTRACT: The aim of this study is to examine the relationship between personality traits and participation in mass health checkups among Japanese community-dwelling elderly.
A data set of 327 men and 519 women aged 70 years and over was used in the analysis. The NEO Five-Factor Inventory was administered to assess the "big five" personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.
In multivariate logistic regression analysis adjusted for gender, age, number of years of education, living alone, presence of psychiatric diseases, presence of chronic diseases, and history of hospitalization during a 1-year period, openness was independently associated with participation in mass health checkups [odds ratio (OR)=1.51, 95% confidence interval (CI)=1.08-2.12, P<.01 and OR=1.38, 95% CI=0.96-1.97, P=.07 for the middle and highest tertile, respectively]. No other domains of personality were related to participation in the checkups.
The results of the present study suggest that older individuals high in openness are likely to take part in checkups for the elderly. Our findings could help improve the participation rate in mass health checkups for the prevention of long-term care dependence in later life.
Journal of Psychosomatic Research 03/2009; 66(2):155-9. · 3.30 Impact Factor
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Kenichiro Shimizu,
Nobuyoshi Hirose,
Michiyo Takayama,
Yasumichi Arai,
Yasuyuki Gondo,
Yoshinori Ebihara,
Ken Yamamura,
Susumu Nakazawa, Hiroki Inagaki,
Yukie Masui,
Koji Kitagawa
Geriatrics & Gerontology International 01/2009; 8(4):300-2.
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Yasumichi Arai,
Michiyo Takayama,
Yasuyuki Gondo, Hiroki Inagaki,
Ken Yamamura,
Susumu Nakazawa,
Toshio Kojima,
Yoshinori Ebihara,
Kenichirou Shimizu,
Yukie Masui,
Koji Kitagawa,
Toru Takebayashi,
Nobuyoshi Hirose
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ABSTRACT: Observational studies have demonstrated similarities between the underpinning of frailty and biological features of centenarians, suggesting that adaptability to age-related multiple physiological decline may be a core component of successful aging. The aim of this study is to determine whether hormonal pathways potentially involved in energy homeostasis contribute to survival beyond 100 years of age.
We assessed a total of 252 centenarians (mean [standard deviation (SD)] age, 101.5 (1.8) years, range 100-108 years) using a complete set of biomarkers of adipose endocrine function and the insulin-like growth factor-1 (IGF-1) axis. Conventional risk factors at baseline were also assessed. The participants were followed up for all-cause mortality every 12 months by telephone contact.
During 2253 days of follow-up, 208 centenarians (82.5%) died. The lowest tertile of leptin and the highest tertile of tumor necrosis factor-alpha were associated with higher mortality risk among centenarians after adjusting for age (per 6-month increase), sex, education, smoking, activities of daily living (ADL), cognitive function, and comorbidities (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.14-2.35; and HR 1.45; 95% CI, 1.00-2.08, respectively). The lowest tertiles of both IGF-1 and IGF binding protein 3 (IGFBP3) were also associated with increased mortality. The adipose risk score, indicating cumulative effects of adipokine dysregulation, was strongly associated with increased mortality risk; ADL; cognitive function; and levels of albumin, cholinesterase, high-density lipoprotein-cholesterol, C-reactive protein, interleukin 6, and IGF-1 at baseline.
The results suggested that preservation of adipose endocrine function and the IGF-1 axis may be potentially important for maintaining health and function and promoting survival at an extremely old age.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 12/2008; 63(11):1209-18. · 4.60 Impact Factor
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ABSTRACT: Personality is an important factor in determining longevity. It has been reported that some personality traits can affect mortality via health-related behaviors, engaging in social interactions, and a tendency to experience negative emotions. The authors examined the relationships between five major domains of personality traits and all-cause mortality among Japanese community-dwelling elderly.
A 5-year prospective cohort study design with mortality surveillance.
Community based.
A total sample of 486 men and 742 women aged 65 years and over at the baseline.
The NEO five-factor inventory was administered to assess the "big five" personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.
During the 5-year follow-up period, 127 persons (73 men and 54 women) died. In Cox multivariate proportional hazards models adjusted for gender, age, number of years of education, living alone, presence of psychiatric problems, and presence of chronic diseases, conscientiousness (risk ratio [RR] = 0.50, 95% confidence interval [CI] = 0.33-0.76 and RR = 0.46, 95% CI = 0.29 to 0.71, for the middle and highest tertiles, respectively), extraversion (RR = 0.58, 95% CI = 0.37 to 0.92, for the highest tertile), and openness (RR = 0.62, 95% CI = 0.41 to 0.96, for the middle tertile) were independently and inversely associated with all-cause mortality. Neither neuroticism nor agreeableness was related to mortality.
Our results suggest that out of the five domains of personality traits, conscientiousness, extraversion, and openness are reliable predictors of all-cause mortality among community-dwelling elderly.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2008; 16(5):399-405. · 3.35 Impact Factor
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Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 05/2008; 45(3):259-65.
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Michiyo Takayama,
Nobuyoshi Hirose,
Yasumichi Arai,
Yasuyuki Gondo,
Kenichiro Shimizu,
Yoshinori Ebihara,
Ken Yamamura,
Susumu Nakazawa, Hiroki Inagaki,
Yukie Masui,
Koji Kitagawa
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ABSTRACT: Research in Western countries has shown most centenarians to be survivors with multiple comorbidities. However, Japanese centenarians' morbidity and its relationship to functional status has yet to be elucidated. The aim of this study is to clarify the association of morbidity with the physical and cognitive function of centenarians. We examined Tokyo-area centenarians to determine their kinds of morbidity profiles and how such morbidity related to their functional status.
We studied 302 centenarians living in Tokyo (101.2+/-1.8 years; 65 men, 237 women), and assessed their physical status, morbidity, and use of medication. Activities of daily living and cognitive function were also assessed using the Barthel Index and the Clinical Dementia Rating.
More than 95% of the centenarians had chronic diseases. Both the physical and cognitive functions were significantly higher in men. The present and previous illnesses most frequently included hypertension, heart disease, stroke, fractures, and cataracts. Fractures were observed significantly more frequently in women. Diabetes mellitus was uncommon. The physical and cognitive function of centenarians with a history of stroke or fracture were particularly poor, whereas those centenarians with hypertension tended to show a high level of physical and cognitive function.
Almost all centenarians had chronic diseases. Stroke and fracture were correlated with poorer function; therefore, we hypothesize that prevention of stroke and fracture might improve functional status in the oldest-old.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 08/2007; 62(7):774-82. · 4.60 Impact Factor
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ABSTRACT: Background: Research has reported a close relationship between subjective well-being and maintenance of physical and psychological health in later life. We explored an intergender difference in subjective well-being, correlates of subjective well-being, and a subjective well-being–mortality association among middle-aged and elderly people, using a prospective population-based study.Methods: The participants were 1034 men and 1413 women aged 52–77 years at the baseline, living in an urban Japanese community. The baseline data on age, number of years of education, hospitalization, chronic conditions, living alone and subjective well-being (measured by the 17-item Philadelphia Geriatric Center Morale Scale) collected in 1993.Results: Analysis of covariance controlling for potential confounders, revealed no intergender difference in subjective well-being. Multiple regression analysis to explore factors related to subjective well-being showed that age in men, and the number of years of education in both genders were significantly, independently and positively associated with subjective well-being, and that hospitalization, chronic conditions and living alone in both genders were significantly, independently and negatively related to subjective well-being. In the Cox’s multivariate hazard model adjusted for the confounders, there was a significant and independent association between a low level of subjective well-being and the risk for all-cause mortality in men (1-standard-deviation decrement; risk ratio [RR] = 1.22, 95% confidence interval [CI]: 1.07–1.46) and women (RR = 1.50, 95% CI: 1.15–1.83).Conclusion: Subjective well-being is a reliable predictor for all-cause mortality among middle-aged and elderly people in both genders.
Geriatrics & Gerontology International 11/2006; 6(4):216 - 222.
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Yuchen Du,
Nobuyoshi Hirose,
Jing Ping,
Yoshiyuki Ishida,
Toshio Kojima,
Yasumichi Arai, Hiroki Inagaki,
Yasuyuki Gondo,
Yoshiyuki Sakaki,
Masataka Haneda,
Sachiko Ito,
Ken-ichi Isobe
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ABSTRACT: Background: Recent studies have demonstrated a significant association between mutations in genes involved in the GHR/IGF1 signaling pathway and extension of the lifespan of model organisms. Exon 3 insertion or deletion is one common polymorphism in the growth hormone receptor (GHR) of humans. The exon 3 deletion allele is reported to have stronger signaling in the GH/GHR pathway, which may correlate to short lifespan.Methods: We investigated the common polymorphic variation in 119 Japanese semisuper centenarians (SSC; older than 105) compared with 104 healthy younger controls via the polymorphism-based polymerase chain reaction method.Results: The frequency of exon 3 deletion variation of GHR in SSC was found to be higher than controls, although this was not significant statistically. Also, the single nucleotide polymorphism genotype frequency and allele frequency exhibited no differences between SSC and controls.Conclusions: These results show that SSC in Japan do not tend to have the allele of GHR, which has a lower signaling capacity.
Geriatrics & Gerontology International 06/2006; 6(2):82 - 86.
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Yasuyuki Gondo,
Nobuyoshi Hirose,
Yasumichi Arai, Hiroki Inagaki,
Yukie Masui,
Ken Yamamura,
Ken-ichirou Shimizu,
Michiyo Takayama,
Yoshinori Ebihara,
Susumu Nakazawa,
Koji Kitagawa
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ABSTRACT: Centenarians are sometimes said to be representative of lifelong healthy aging. Whether they are, in fact, examples of healthy aging remains a subject of debate. The existence of heterogeneity in functional status has been reported repeatedly in previous studies of centenarians. However, there is as yet no standardized classification system with which to describe their functional phenotype.
As part of a dynamic cohort study, we studied 304 centenarians (65 men and 239 women) living in Tokyo. Their functional status (sensory, physical, and cognitive), which we used to represent their phenotype, was assessed and subsequently classified by standard assessment methods (simple questionnaire, Barthel index, Mini-Mental State Examination, and the Clinical Dementia Rating, respectively).
We classified participants into 4 categories according to their functional status. Only 5 (2%) were classified as "Exceptional," with all of their functions graded as excellent, and 56 (18%) were "Normal," exhibiting maintenance of fine cognitive and physical functions. One hundred sixty-seven (55%) were "Frail," exhibiting impairment of either cognitive or physical functions, and the remaining 76 (25%) were "Fragile," exhibiting deterioration of both physical and cognitive functions.
The relationships between biochemical marker, mortality rates, lifestyle, and functional phenotypes demonstrated by this classification method indicate that the system is reliable to address the functional status of extremely old persons. Thus, this framework would be a useful tool for exploring the factors that contribute to exceptional longevity as well as those that help to maintain the functional status of the extremely old population.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 04/2006; 61(3):305-10. · 4.60 Impact Factor
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Yasumichi Arai,
Susumu Nakazawa,
Toshio Kojima,
Michiyo Takayama,
Yoshinori Ebihara,
Ken-ichirou Shimizu,
Ken Yamamura,
Satoki Homma,
Yasunori Osono,
Yasuyuki Gondo,
Yukie Masui, Hiroki Inagaki,
Kohji Kitagawa,
Nobuyoshi Hirose
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ABSTRACT: Background: Evidence from experimental models of longevity indicates that maintenance of energy homeostasis could be indispensable for longevity across various species. In humans, it has been reported that maintenance of glucose homeostasis and vascular stability is one biomedical feature of centenarians, who have reached the maximum life-span. We hypothesized that adiponectin, a novel anti-inflammatory adipocytokine, could be a protective factor against age-related metabolic alteration and atherogeneity in centenarians.Methods: We measured plasma adiponectin concentration in 66 female centenarians and body mass index (BMI)-matched female controls (mean age 28.3 ± 6.3 years), followed by a genetic analysis of adiponectin locus.Results: As compared to BMI-matched female controls, female centenarians had significantly higher plasma adiponectin concentrations. In addition, high concentrations of plasma adiponectin in centenarians was associated with favorable metabolic indicators, and with lower levels of C-reactive protein and E-selectin. In contrast, genetic analysis of 10 single nucleotide polymorphism (SNP) at adiponectin locus did not show significant association between the adiponectin gene variation and longevity.Conclusions: Our results suggested that hyperadiponectinemia in centenarians could play a role in maintenance of energy homeostasis and vascular stability, and may contribute to longevity.
Geriatrics & Gerontology International 02/2006; 6(1):32 - 39.
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Computers Helping People with Special Needs, 10th International Conference, ICCHP 2006, Linz, Austria, July 11-13, 2006, Proceedings; 01/2006
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Yasuyuki Gondo,
Nobuyoshi Hirose,
Yasumichi Arai,
Ken Yamamura,
Ken-Ichirou Shimizu,
Michiyo Takayama,
Yoshinori Ebihara,
Susumu Nakazawa, Hiroki Inagaki,
Yukie Masui,
Koji Kitagawa
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ABSTRACT: Negative affect such as depression and anxiety has been reported to be associated with morbidity and mortality, and polymorphisms of the serotonin transporter (5HTT) gene may be associated with such affect disorders. Hypothesizing that 5HTT gene polymorphisms could influence human longevity via negative affect; we compared the polymorphic variation of the 5HTT gene between 265 Japanese centenarians and control subjects. In addition, we evaluated the relationships between the 5HTT genotype and the physical, cognitive, and biologic status of centenarians, as indicated by the Barthel Index, the Mini-Mental State Examination, and serum albumin concentration, respectively. The frequency of the l/l genotype and the l allele was significantly greater in centenarians than in younger control subjects, particularly women. A significant effect of the 5HTT genotype on serum albumin concentration was observed in both sexes. Although, there was sex optionality, the l allele may carry a longevity advantage possibly through behavioral mechanisms.
Mechanisms of Ageing and Development 12/2005; 126(11):1178-84. · 3.44 Impact Factor
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ABSTRACT: We examined the relationship between subjective well-being and all-cause mortality among middle-aged and elderly people, using a population-based prospective approach (Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging).
The participants were 1,034 men and 1,413 women aged 52 to 77 years, living in an urban Japanese community. The baseline data on age, gender, number of years of education, hospitalization, lifestyle-related illness, subjective health status, living alone and subjective well-being (measured by Philadelphia Geriatric Center Morale Scale) were collected in 1993.
Mean subjective well-being scores for men and women were 12.3 +/- 3.2 and 11.9 +/- 3.5, respectively. Analysis of covariance controlling for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, revealed no inter-gender difference in subjective well-being. Multiple regression analysis to explore factors related to subjective well-being showed that age in men, and the number of years of education in both genders were significantly, independently and positively associated with subjective well-being, and that hospitalization, lifestyle-related illness and living alone in both genders were significantly, independently and negatively related to subjective well-being. From 1993 to 2000, there were 183 deaths and 258 dropouts. In Cox's multivariate hazard model adjusted for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, there was a significant and independent association between a low level of subjective well-being and the risk for all-cause mortality in both genders.
Satisfaction with life is an important factor affecting longevity among middle-aged and elderly people.
Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 12/2005; 42(6):677-83.
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Hajime Iwasa,
Yasuyuki Gondo,
Taketo Furuna,
Erika Kobayashi, Hiroki Inagaki,
Miho Sugiura,
Yukie Masui,
Tsutomu Abe,
Hiromi Imuta,
Akira Homma,
Takao Suzuki
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ABSTRACT: Background: A study was conducted to clarify the characteristics of cognitive function among physically independent very old people dwelling in an urban community in Japan.Methods: Five hundred and thirteen old-old (aged 75–84 years) and 168 oldest-old (aged 85–100 years) adults participated. We carried out the Mini-Mental State Examination (MMSE) for measuring cognitive functions in the elderly. Age-related differences in the total score and subscale scores of the MMSE were analyzed by sex using ancova, controlling for education, vision and hearing problems.Results: Mean MMSE scores for old-old and oldest-old men were 27.5 and 25.9, respectively, and those for old-old and oldest-old women were 27.8 and 25.0, respectively. Age-related differences in the MMSE total score between the old-old and oldest-old were observed in both sexes, suggesting that overall cognitive functions continue to decline over time in very old age. Age-related differences between the old-old and oldest-old in items measuring, registration, calculation and delayed recall were observed in both sexes, and also in those assessing time orientation, place orientation, delayed recognition, writing sentences, and copying figures were observed in women.Conclusion: These findings suggest that the faculties are those most sensitive to normal aging among very old individuals. There were no age group differences in five items: reverse spelling, naming objects, repeating a sentence, listening and obeying, and reading and obeying.
Geriatrics & Gerontology International 11/2005; 5(4):248 - 253.
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Yasuyuki Gondo,
Taketo Furuna,
Erika Kobayashi, Hiroki Inagaki,
Miho Sugiura,
Yukie Masui,
Hajime Iwasa,
Tsutomu Abe,
Hiromi Imuta,
Akira Homma,
Takao Suzuki
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ABSTRACT: It is predicted that the future increase in the oldest-old (85 years and older) population will have a marked influence on society. However, little is known about the features of various functions in the oldest-old. The purpose of this study was to clarify the functional status of the oldest-old. We surveyed all oldest-old residents in a small area of Itabashi ward in metropolitan Tokyo to clarify their living conditions. The oldest-old themselves and their family members were invited to participate, and 235 out of 311 residents (75.6%) agreed to do so. Forty-two percent of the participants were dependent and needed care from others. The ADL status measured by the Barthel Index showed that 30% of independent participants also had some deterioration of physical function. These results are indicative of increased frailty in the oldest-old. Comparison between independent and dependent (need care from others in daily living) showed that the functional status was lower in dependent group. However, the psychological well-being was the same in this two groups. These results indicate progressive functional deterioation and psychological adaptation to it, in the oldest-old. Further research to elucidate the process of psychological adaptation to frailty is necessary in order to promote the well-being among the oldest-old, in whom functional limitation is evident.
Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 04/2005; 42(2):199-208.
