Prevention of functional disabilities leading to long-term care and support needs in older population is one of the most urgent social issues facing Japan today. Frailty has been recognized as a pre-stage of functional disabilities leading to long-term care and support needs, and so, it is often treated as a target in their preventive interventions. Furthermore, because reductions of daily physical activities and physical fitness are considered as part of the major causes of physical frailty, their improvements have been also explored in community-based measures to prevent long-term care and support needs. This review paper aimed to summarize present findings regarding associations of frailty, physical activity, and physical fitness with incident long-term care and support needs in community-dwelling older Japanese adults. Through the review of literature, most of the previous prospective cohort studies showed that community-dwelling older Japanese adults who are free from frailty or maintain good physical activities and physical fitness have a reduced risk for the incidence of long-term care and support needs. These findings support an expectation that prevention of frailty and/or improvements of daily physical activities and physical fitness can be effective strategies to prevent older people from undergoing long-term care and support needs. It should be, however, understood that the associations found in the previous studies are not causal. Future prospective cohort studies defining exposure variables based on multipoint observations, as well as well-designed interventional studies are needed to validate the expectation.

Cerebrovascular diseases, dementia or cognitive decline, frailty, and fall are common risk factors for adverse health outcomes including long-term care needs among elderly people. This study aimed to evaluate the effectiveness of exercise and physical activity interventions designed to prevent or improve functional outcomes in people with such adverse events. We searched for eligible studies of randomized controlled trials and meta-analysis until April 2019. The primary outcomes were stroke, cognitive function, frailty, and fall. This review suggests that interventions targeting exercise and physical activity are effective to prevent stroke and fall in long-term care facilities, have positive influence on cognitive function in elderly people with dementia or cognitive impairment, and are able to prevent or reduce frailty status in frail and pre-frail population. However, future clinical and population-based trials are needed to elucidate the most effective exercise programs (type, intensity, duration, frequency, and environment) in community-based settings to prevent or reduce the risk of each sub-clinical condition.

This review aimed to verify the effects of nutritional and dietary interventions in the prevention of long-term frailty. We collected the epidemiological knowledges of nutrition and diet for malnutrition, locomotive syndromes, sarcopenia, and frailty. However, there is a lack of dietary intervention studies on frail elderly, especially in the realm of quality clinical trials. Therefore, we summarized the reasons why it is difficult to obtain the effective results by dietary interventions and took up some effective practice cases. In the context of the prevention of long-term frailty, there are complexed factors leading to malnutrition, locomotive syndromes, sarcopenia, and frailty. According to the risks and individuality of older adults, flexible interventions are needed, and it is desirable to verify the medium- or long-term effects of interventions.

Although multiple disability prevention efforts and interventions for older adults have been implemented in the community, only a limited number of studies have verified whether these efforts have actually reduced the occurrence of disability or frailty. This paper reviewed evidence on the effects of community-based interventions for disability prevention on risks of disability and frailty at both the individual and population levels. Consequently, first, participation in exercise or nutrition programs based on high-risk strategies significantly reduced the risk of disability occurrence and suppressed medical and care costs for frail older adults, compared with nonparticipants. However, the participation rate for elderly populations in such programs was extremely low. Second, the creation of self-management programs based on population strategies, such as exercise groups or community salons, significantly reduced the participant’s risk for disability and frailty. The number of such “gathering places” and the participation rate in the elderly population progressively increased, suggesting it may contribute to disability prevention not only at the individual level, but also at the population level. However, previous studies have required long terms (4–5 years) to confirm significant reduction in an individual’s risk for disability and frailty. Finally, although previous studies that verified the effects of disability or frailty prevention at the population level have been extremely limited, one study demonstrated it is possible to reduce the rate of disability at the population level. Further studies are needed to verify the effects of various community-based disability prevention efforts on individual- and population-level disability and frailty for older adults.

Previous policies for prevention of functional disabilities leading to long-term care in Japan have mainly focused on an individual or a high-risk approach, which aim to prevent health problems by identifying high-risk individuals to target for education and intervention. However, since April 2015, the Japanese government has expanded the approach for preventive healthcare policies from a high-risk approach to a population-based community approach. Specifically, such policies aim to create an environment in which older individuals can easily participate in the society and enrich community- and individual-level social capital by participating in community places or groups. For example, older individuals living in a community area with high prevalence of participation in sports groups were less likely to be depressed or develop cognitive impairment, regardless if they actually participated of not. The purpose of this report is to describe how to administer the management cycle (e.g., plan-do-check-act cycle) to demonstrate the utility of community development in prevention of functional disabilities in older individuals. First, we visualize the issues faced by and resources available in local communities and determine the communities that require intervention on priority. After obtaining clues to the solution of community issues, the strategic deployment of intervention projects is needed. Subsequently, these interventions need to be evaluated for their effectiveness. Previous studies have reported that older individuals participating in such community groups were less likely to develop functional disability and cognitive impairment than those who did not participate. Future research must examine in detail the multi-faceted effect and efficacy of various community intervention programs.

Japan is the only country that has implemented a nation-wide measure for functional disability leading to long-term care needs in old ages. Thus, there are no previous national trials that we can refer to. Whether its disability prevention measure succeeds or not will depend on our own efforts toward the future. In this paper, I will overview a 10-year experience with the disability prevention program launched in 2006, and then will point out the relevant issues in realizing the prevention of functional disability in old ages for exercise and sports scientists.