key: cord-1020010-ry6wn30h authors: Yamada, Minoru; Arai, Hidenori title: Implication of frailty and disability prevention measures during the COVID‐19 pandemic date: 2021-11-07 journal: Aging Med (Milton) DOI: 10.1002/agm2.12182 sha: 2d392f433b858e5fc20df5cc8197a0dc2bbc2bbc doc_id: 1020010 cord_uid: ry6wn30h nan In Japan, a state of emergency was declared in April 2020, which called for major lifestyle changes, such as wearing masks, maintaining physical distancing, avoiding enclosed spaces without ventilation, and practicing thorough hand-washing hygiene. In addition, people of all ages were forced to live in an unprecedented environment; office work was replaced with remote work, restaurants and commercial facilities were closed, schools were closed, and online lectures were promoted, although complete lockdown measures were not adopted in Japan. Older people may have been the ones who felt the most confused by these adjustments and found it difficult to fully adapt to such environmental changes. From the beginning, when the virus was first confirmed, it was reported that older people were more likely to become seriously sick; thus, their activities were severely restricted. In addition, older people were forced to cancel or request the cancellation of frailty and disability prevention programs nationwide, which had been emphasized in the past; this resulted in a significant loss of opportunities for them to be active and socially interactive. Herein, we summarize the impact of the COVID-19 pandemic on older people in Japan, which is a country with advanced longevity. In Japan, a disability prevention program has been implemented as a public service since 2006. The purpose of this program is to prevent or postpone the need for long-term care, and it is currently being implemented within a program called the Comprehensive Program, which consists of a disability prevention and lifestyle support service program and a general frailty prevention program. 1,2 Disability prevention and life support service programs include home-visit and day-care services, whereas general frailty prevention programs include public awareness programs and community programs to support preventive activities for frailty. In recent years, the government has been promoting the establishment of a "community salon" where residents can proactively engage in frailty prevention. These salons are held once a week or every 2 weeks and include exercises, hobby activities, coffee breaks, and meals. The effects of participating in such places have been shown to be effective in preventing the need for long-term National Center for Geriatrics and Gerontology (NCGG) has issued an online application that mimics community salons; thus, the pandemic is changing the way community salons are organized. gathering of people, as typified by avoiding closed spaces, crowded places, and close-contact settings. On the other hand, in the latter case, "social participation" is considered to be important, and human interaction is considered to be the basis of measures against frailty. In other words, there is a trade-off; if one is emphasized, then the other is forfeited. However, in Japan, the protection of human life through infection control has been given priority, and countermeasures for frailty have become insufficient. We surveyed the physical activity time of older people living in the community in January 2020, before the pandemic, and again in April 2020, during the pandemic. As a result, we found that the physical activity time of older people decreased by approximately 30% during the pandemic 4 ( Figure 1 ). This is similar to the result obtained in another study, 5 in which it was thought that thorough infection control measures and a fear of unknown emerging infectious diseases caused physical activity restriction. It has also been shown that such physical activity limitations have varied depending on the region of residence. Japan is a long island nation, and the size and culture of its cities vary greatly in each region. Older people in central Tokyo have been greatly affected by the change in physical activity, probably due to a large number of infections and local government policies, whereas those in other areas have been less affected. 6 This is also evident in the rates of change in physical activity time reported from January to April 2020, which classify Japan into eight regional categories. The Kanto region, including Tokyo, showed a decrease of more than 30%, whereas Kyushu, Tohoku, and Hokkaido showed only a decrease of approximately 15% (Figure 2 ). In June 2020, when the first emergency restrictions were lifted and society gradually started moving on, it was confirmed that the lives of older people had gradually recovered to their normal state. In Japan, the first declaration of a state of emergency was issued during the first wave of infection, the second wave followed in August 2020, and the third wave occurred in January 2021; however, the spread of infection continued intermittently. The physical activity of older people, which had temporarily recovered, was suppressed again in response to these waves of infection, which resulted in a continuation of low levels of physical activity throughout 2020. 11 In addition, the continuation of such a state led to a higher rate of new cases of frailty than those reported in ordinary times (Figure 3 ). 12 These effects were more pronounced among older people who lived F I G U R E 1 Influence of the coronavirus disease 2019 (COVID-19) pandemic on physical activity time in older people. We compared physical activity times in January 2020, before the COVID-19 pandemic, with those in April 2020, during the first wave of the pandemic in Japan. An online survey was conducted among 1600 older people. Physical activity time was assessed using the Short Version of the International Physical Activity Questionnaire. The results showed that the weekly physical activity time decreased from 245 minutes in January 2020 to 180 minutes in April 2020, which reflects a decrease of 26.5% (ref. 4) F I G U R E 2 Impact of the pandemic on physical activity time of older people in each area of Japan. Japan can be divided into eight major regions: Hokkaido, Tohoku, Kanto, Chubu, Kinki, Chugoku, Shikoku, and Kyushu. In each of these eight regions, the percentage values of decrease in physical activity time from January to April 2020 were compared. An online survey was conducted among 5000 older people in various regions of Japan. Physical activity time was assessed using the Short Version of the International Physical Activity Questionnaire. The results showed that the Kanto region, including Tokyo (the capital), had the largest decrease with more than 30%, whereas Kyushu, Tohoku, and Hokkaido had only a 15% decrease ( of the population but is rather caused by the increase in the percentage of older people aged 75 years old or over. However, in the future, there is a possibility that the certification rate will increase even more than the increase in the percentage of older people aged 75 years old or over; thus, the promotion of anti-frailty measures is required more than ever. Herein, we have summarized the impact of the COVID-19 pandemic on older people. The spread of COVID-19 infection has changed our lives and deprived us of many important things. However, it has also given us new ideas and bold strategies. As a gerontologist who has lived through this period, I argue that we must make use of this experience to help better realize long and healthy lives in the future. This work was partly supported by JSPS KAKENHI Grant Number Nothing to disclose. 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