井手 一茂

Serviced Housing for Older People (SHOP) is a community-based housing model in Japan that provides barrier-free apartments and support services for residents. Whether the SHOP model has positive effects on residents' health remains unclear. This follow-up study examines the association between living in SHOPs and functional decline. Using data from the Japan Gerontological Evaluation Study, we compared functional decline risks at one-year follow-up between older adults living in conventional housing (n = 2202) and SHOP residents (n = 160). Functional decline risk was assessed using the Kihon Checklist (KCL) and Care-Need Risk Assessment Scale (CNRAS). SHOPs residents had lower KCL and CNRAS scores than older adults living in conventional housing. In sensitivity analyses, these associations remained unchanged. The results, thus, showed that residing in SHOPs was associated with reduced functional decline; therefore, SHOPs designed to support residents' physical and social health could be important for supporting aging in place.

OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS: A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

BACKGROUND: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. OBJECTIVE: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, "Shakai Sanka no Susume;" Hitachi) in promoting social participation and physical activity among community-dwelling older adults. METHODS: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. RESULTS: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95% CIs that did not encompass zero. CONCLUSIONS: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. TRIAL REGISTRATION: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055781.

BACKGROUND: The integration of the Internet into daily life has potential implications for public health, especially in promoting preventive healthcare measures like annual health checkups. This study explores the association between Internet use and the likelihood of participating in these checkups among older Japanese citizens. METHODS: Participants aged 65 and older were randomly selected from 37 municipalities in Japan, ensuring they required no long-term care. Out of 24,313 responses to a postal questionnaire, 11,495 participants were deemed eligible for analysis, achieving a valid participation rate of 70.1%. We applied propensity score matching to balance Internet users and non-users, resulting in 6,504 matched cases. Poisson regression analysis was then used to adjust for demographic, socioeconomic, and behavioral variables that could act as potential confounders. RESULTS: Our findings show that 55.1% of participants used the Internet several times a month, and among these, 63.5% had attended an annual health checkup in the preceding year. After adjusting for potential confounders, Internet users were found to be 9% more likely to participate in annual health checkups compared to non-users (95% Confidence Interval: 1.02-1.15). CONCLUSIONS: This study concludes that there is a positive association between Internet use and participation in annual health checkups among older individuals in Japan. The results suggest that Internet use may serve as a tool to promote preventive healthcare practices in older populations. However, the study underscores the need for further investigation to understand the underlying mechanisms of this association and to establish a causal relationship.

There is inconsistent evidence on the association between community-level social capital and the health or well-being of older adults. This study examined the association between community-level social capital and multidimensional health and well-being outcomes using an outcome-wide approach. We used data from the Japan Gerontological Evaluation Study, a nationwide cohort study of Japanese older adults (analytic samples: 47,227 for outcomes obtained from the long-term care insurance registry and 34,183 for other outcomes). We assessed three aspects of school-district-level community social capital in 2016 (civic participation, social cohesion, and reciprocity) and 41 subsequent health and well-being outcomes through 2019. We performed either a modified multilevel Poisson regression or a multilevel logistic regression analysis. We adjusted for pre-baseline characteristics, prior outcome values, and individual-level social capital from the 2013 wave. Even after Bonferroni correction, we found that community-level social capital was associated with some subsequent social well-being and physical/cognitive health. For example, community-level reciprocity was associated with a higher prevalence of taking a social role (Prevalence ratio [PR] = 1.03, 95% confidence interval [CI] = 1.02, 1.04) and undergoing health screening (PR = 1.03, 95% CI: 1.01, 1.04). There was modest evidence that community-level civic participation was associated with a higher competency of intellectual activity (PR = 1.01, 95% CI: 1.01, 1.02) and community-level social cohesion was associated with a reduced onset of functional disability (PR = 0.94, 95% CI: 0.90, 0.98). Community-level social capital may promote social well-being and some physical/cognitive health outcomes.

Internet use influences social interactions in society. However, there is no consensus on whether and what kind of Internet use increases face-to-face communication (FFC). This study investigated the mode of Internet use that increases FFC among older adults after three years. Participants were 8734 adults aged 65 or older who responded to the Japan Gerontological Evaluation Study (JAGES) surveys in 2016 and 2019. The exposures were the purposes of Internet use in 2016. The outcome was the frequency of FFC with friends or acquaintances in 2019. The confounders included 13 demographic, socioeconomic, and psychological variables. We performed modified Poisson regression analyses and found that Internet use for communication in 2016 increased FFC in 2019, especially for low-frequency FFC in 2016. Internet-based non-FFC may help promote FFC and prevent social isolation among older adults who are less likely to interact with others.

Abstract Aim Housing has a significant impact on the health, safety, and social participation of older individuals. Japan’s Serviced Housing for Older People (SHOPs) is one such model that provides supportive services and accessible living spaces. Method This cross-sectional study examined the relationship between living in SHOPs with social activity programs (SAPs) and levels of social participation. We conducted a self-reported survey of SHOP residents and compared the proportions of participants who participated in social activities in the SHOP with a control group of community-dwelling older people selected from the Japan Gerontological Evaluation Study using propensity score matching. Results The survey obtained responses from 189 eligible participants. SHOP residents were primarily female, older, educated, unmarried, and had a better financial status than the control group. SHOP residents (n = 143) were 2.57 times more likely to exercise (p < 0.001), 1.62 times more likely to participate in hobbies (p = 0.004), and 4.37 times more likely to participate in learning activities (p < 0.001) than the control group (n = 398). However, volunteering, senior citizen clubs, neighborhood associations, and community gathering places participation did not differ significantly between the SHOP and control groups. Conclusion The findings suggest that SHOPs with SAPs have the potential to promote social participation and healthy aging among older people.

BACKGROUND: Japan, which has the world's longest life expectancy, has been reporting rejuvenation of physical function among its older adult population. However, evidence for the incidence of functional disability is limited. This study aimed to investigate the comparison in the incidence of functional disability. DESIGN: We used data from the Japan Gerontological Evaluation Study. SETTING AND PARTICIPANTS: The participants were 2 nonoverlapping cohorts of 22,522 (2010-2013 cohort) and 26,284 (2016-2019 cohort) individuals aged 65 years from 5 municipalities who were followed for 3 years each. METHODS: The incidence rates of functional disability during the 3-year follow-up period were compared between cohorts. To examine the incident differences between the cohorts, we adjusted for social participation and 9 additional factors that would be expected to improve with social participation using the Weibull survival models adjusting for municipalities as random effects. The analysis was stratified by age groups (65-74 years old and ≥75). RESULTS: The incidence rate of functional disability per 10,000 person-years decreased from 68.6 (2010-2013 cohort) to 51.4 (2016-2019 cohort) in the 65 to 74 years old group and 380.0 (2010-2013 cohort) to 282.6 (2016-2019 cohort) in the ≥75 group; the hazard ratios (95% CIs) were 0.75 (0.64-0.89) and 0.74 (0.67-0.80), respectively. However, these significant decreases disappeared with adjustments for social participation and additional factors. CONCLUSIONS AND IMPLICATIONS: The incidence of functional disability decreased in a recent cohort, which may be explained by social participation and possibly related factors. Promoting social participation could contribute to a decreasing incidence of functional disability among older adults.

OBJECTIVES: The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset. METHODS: This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated. RESULTS: We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously. CONCLUSIONS: All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

BACKGROUND: No municipal-level study has elucidated the social determinants associated with multimorbidity prevalence (MP). OBJECTIVE: This article aimed to determine the differences in MP among municipalities and investigate factors associated with such differences through an ecological study of data obtained from a nationwide survey. This article focused on social participation and household income, which are associated with single chronic diseases, such as hypertension. METHODS: Study design was a cross sectional study, which used the data from the Japan Gerontological Evaluation Study, a population-based gerontological study among functionally independent older adults aged ≥65 years in Japan. Overall, 152 212 participants from 2016 to 2017 across 91 municipalities were included in the final analysis. Multiple regression analysis was performed with MP as objective variable; social participation or household income were explanatory variables, and education, population density, and health check-ups were adjustment variables. RESULTS: Intermunicipal differences in MP were 28.4% to 43.1% and 23.2% to 38.8% among men and women, respectively. Significant negative correlation was observed between MP and proportion of social participation (non-standardized coefficient [B] = -.18 for men and women). A significant positive correlation was noted between MP and equivalent household income of ≤2 million yen in women (B = .21). CONCLUSION: Considerable differences in MP existed among municipalities. Areas with high proportion of social participation showed significantly lower MP. Considering the difficulty in managing multimorbidity within the primary care field and limited evidence on effective interventions, community-level interventions encouraging social participation among older individuals might reduce MP. Primary care physicians should consider a community health approach for multimorbidity.

BACKGROUND: Participating in groups with diverse members is associated with improved health among older adults. The study examined the relationship between diversity of group members and needed support or long-term care. METHODS: We conducted a longitudinal study for the Japan Gerontological Evaluation Study with 61,281 participants aged ≥ 65 years who were surveyed in 2013 and followed-up for six years. We assessed three dimensions of the diversity of the participating members (sex, age, and region of residence). We then graded the diversity level into four categories: level 0 (not in any group), level 1 (in a group without diversity or in a group with diversity in one of the three factors), level 2 (in a group with diversity in two of the three factors), or level 3 (in a group with diversity across all factors). We adjusted for 12 covariates using Cox hazard survival analysis models with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated for the association between group members' diversity levels and needed support or long-term care. The same study was conducted when stratified by employment status at baseline. RESULTS: Participants in social participation groups with more diverse group members had a lower incidence of needed support or long-term care as compared to their counterparts. Compared to those with no participation group, HR decreased by 14% to 24% with increasing levels of diversity. The HR for the level of care needed for participants in the social participation group with high residential diversity was 0.89 (95% CI: 0.84-0.94). For participants who were currently unemployed, HR reductions ranged from 16%-28% with increasing levels of diversity compared to the non-participating group. No association was found for employed participants. CONCLUSIONS: The reason the HRs of Japanese elderly people certified as needing support or care are lower when the diversity of participating groups is higher could be owing to the presence of a variety of people and the diversification of social networks, which facilitates the building of bridging social relational capital. Public health policies that encourage participation in diverse organizations will be important in the future.

BACKGROUND: Frailty is the highest risk factor for incident disability and mortality. Social participation is a modifiable factor for reducing adverse outcomes among independent older adults. However, the association between social participation and incident disability and mortality among frail older adults remains unclear. Therefore, we examined the association between various social activities and incident disability and mortality. METHODS: This nationwide prospective cohort study (The Japan Gerontological Evaluation Study) recruited older adults with frailty, aged 65 years and older (N = 9090) who were followed up for 6 years (2010-2016). We examined incident disability and all-cause mortality at the end of the follow-up period. Frailty was assessed using the Kihon Checklist. The independent variable was social participation in 2010, grouped into the following seven categories: hobby groups, sports groups or clubs, volunteer groups, senior citizens' clubs, industries, neighborhood communities, and paid work. RESULTS: The incidence of disability among participants was 19.5% (1770) and that of mortality was 19.2% (1753). Belonging to sports groups or clubs (Hazard Ratios [HR] = 0.74; 95% Confidence Interval [CI] = 0.57, 0.98) or hobby groups (HR = 0.77; 95% CI = 0.60, 0.98) was significantly associated with a lower risk of incident disability. Meanwhile, hobby groups (HR = 0.68; 95% CI = 0.56, 0.83), sports groups or clubs (HR = 0.71; 95% CI = 0.57, 0.88), volunteer groups (HR = 0.69; 95% CI = 0.54, 0.88), and senior citizens' club (HR = 0.75; 95% CI = 0.61, 0.90) were associated with lower risk of incident mortality. CONCLUSIONS: Social participation was associated with a lower risk of incident disability and mortality, not only in healthy older adults but also in frail older adults who are at higher risk of incident disability and mortality. This suggests that frail older adults should be encouraged to participate in all the seven types of social participation examined in this study, as this may lower the risk of subsequent disability and mortality.

BACKGROUND AND OBJECTIVES: Evidence remains inadequate regarding the benefits of participation in community gathering places, which is Japan's primary strategy for preventing functional disability in older adults, in other domains of health and well-being. This longitudinal study examined the associations of participation in community gathering places with an array of subsequent health and well-being outcomes among older adults. RESEARCH DESIGN AND METHODS: We used 3-wave data (2013, 2016, and 2019) from Japan Gerontological Evaluation Study (n = 5 879 or 4 232 depending on the outcome). Our exposure was participation in community gathering places in 2016. We assessed 34 health/well-being outcomes in 2019 across 6 domains. We adjusted for pre-baseline covariates including prior outcome values in 2013. RESULTS: Compared with nonparticipation, participation in community gathering places was associated with some outcomes in the following 3 domains: physical/cognitive health (better higher-level functional capacity), social well-being (more frequent participation in hobby groups, senior citizens clubs, learning or cultural groups, and seeing more friends within a month), and prosocial/altruistic behaviors (more frequent participation in volunteering; after Bonferroni correction as p < .0015, .05/34). DISCUSSION AND IMPLICATIONS: Evidence was mixed and more modest for the outcomes in three other domains, mental health, psychological well-being, and health behaviors. Promoting participation in community gathering places may not only fulfill its original goal (ie, preventing functional disability) but also enhance other domains of human well-being, potentially by increasing social interactions.

目的 高齢者の歩行量を維持・増加させることには多くの健康上望ましい効果が期待できる。しかし，健康日本21（第二次）中間評価では，高齢者の歩数が目標値まで達成できなかったことが報告されている。そのため，従来とは異なるアプローチに建造環境（街路ネットワーク，施設や居住密度，土地利用など人工的に造られる環境）を通じた身体活動量や歩数の維持・増加をもたらすゼロ次予防が注目されている。本研究では，建造環境の1つである生鮮食料品店の変化と歩行時間の変化との関連を明らかにすることを目的とした。 方法 日本老年学的評価研究（JAGES）が27市町の要介護認定を受けていない65歳以上を対象に実施した自記式郵送調査データを用いた2016・2019年度の2時点での縦断パネル研究である。目的変数は，歩行時間の2時点の変化（増加あり・なし）とし，説明変数は追跡前後の徒歩圏内にある生鮮食料品（肉，魚，野菜，果物など）が手に入る生鮮食料品店の有無の2時点の変化を5群にカテゴリー化（なし・なし：参照群，なしとわからない・あり，あり・あり，あり・なしとわからない，その他）したものである。調整変数は2016年度の人口統計学的要因，健康行動要因，環境要因，健康要因の計14変数とした。統計分析は，ロバスト標準誤差を用いたポアソン回帰分析（有意水準5％）で歩行時間の増加なしに対する歩行時間の増加ありとなる累積発生率比（cumulative incidence rate ratio：CIRR）と95％信頼区間（confidence interval：CI）を算出した。分析に使用する全数のうち，無回答者などを欠測として多重代入法で補完した。 結果 歩行時間の増加ありが13,400人（20.4％）だった。追跡前後で徒歩圏内の生鮮食料品店の有無の変化が「なし・なし」（6,577人，10.0％）と比較した場合，「なしとわからない・あり」（5,311人，8.1％）のCIRRは1.12（95％CI：1.03-1.21）だった。 結論 徒歩圏内の生鮮食料品店が増加していた者で，高齢者の歩行時間が増加した者の発生が12％多かった。暮らしているだけで歩行量が増える建造環境の社会実装を目指す手がかりを得られたと考える。

Abstract Background it remains unclear how family relationships could affect stability of end-of-life care preferences. Objective to describe change patterns of preferred place of death (POD) among older people and to examine associations between family social support and stability of preferences regarding POD. Methods this longitudinal study of 1,200 noninstitutionalized independent Japanese older people aged over 65 years used panel data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Preference stability was defined as the congruence of preferred POD based on questionnaires between baseline and follow-up. We performed multiple logistic regression analysis and gender-stratified analysis to examine associations between social support (spouse, children living together and children living apart) and preference stability. Results only 40.9% of participants had stable preferences. For a spouse, both receiving and providing social support was associated with less stable preferences (OR: 0.63, 95% CI: 0.43–0.93; OR: 0.55, 95% CI: 0.38–0.80, respectively), and providing social support to children living apart was associated with more stable preferences (OR: 1.35, 95% CI: 1.03–1.76). In gender-stratified analysis, significant associations between preference stability and providing social support to a spouse among women (OR: 0.53, 95% CI: 0.34–0.82) and providing social support to children living apart among men (OR: 1.72, 95% CI: 1.16–2.55) were observed. Conclusions family social support was associated with the stability of preferences, and the associations differed by support resources and gender. Incorporating family members in the process of end-of-life care discussion may be necessary for establishing stable preferences.

Mental health is important in older age; neighborhood environment is considered a protective factor of depression. Research has established that a critical indicator of neighborhood environment, street connectivity, is related to older people's health. However, little is known about the relationship between street connectivity and depression. We examined the relationship between street connectivity and depression among older people. Using Japan Gerontological Evaluation Study 2013-2016, the target population comprised 24,141 independent older people without depression (Geriatric Depression Scale scores below 5) in 2013. The outcome variable was depression in 2016; the explanatory variable was street connectivity calculated by intersection density and space syntax within 800 m around the subject's neighborhood in 2013. We used logistic regression analysis to calculate the odds ratio and 95% confidence interval for the new occurrence of depression among participants in 2016. This analysis demonstrated incidence of new depression after 3 years that is 17% and 14% lower among participations living in high-intersection density and high-street-connectivity areas, respectively, than those living in low-intersection density and low-street-connectivity areas. The association held after adjusting for physical activities and social interaction. Given the established connection between street connectivity and mental health, the findings can contribute to healthy urban planning.

Ascertaining progress in building age-friendly cities (AFCs) requires community diagnostic indicators. This study examines the relationship between social participation and happiness at the municipal level. The data from the Japan Gerontological Evaluation Study (JAGES) from 2013, 2016, and 2019, comprising 442,079 older people from 289 municipalities, are used. We also employ linear mixed-effects models to evaluate the association between social participation and happiness. In these models, we adjust for seven variables as potential confounders. This study reveals that the higher the social participation, except for neighborhood association, the higher the state of happiness (B = 0.14–0.30). Our study suggests that social participation is useful, as a community diagnostic indicator, for monitoring the progress of building AFCs, developing strategies, and creating evidence.

As smoking cessation is crucial for both individual and public health, this study aimed to elucidate the association between changes in social capital and in terms of smoking at the level of municipal units in Japan. Using repeated cross-sectional data from the Japan Gerontological Evaluation Study, we analyzed data from adults aged 65 years or older from 69 municipal units that participated in two survey waves. We received valid responses from 91,529 and 86,403 older people in 2013 and 2019, respectively, and aggregated all variables by municipal units. For the dependent variable, we used the units’ prevalence of smoking for both years. The independent variables were the percentages of social capital indicators, such as social participation, social cohesion, and reciprocity for each of the 69 municipal units. The mean prevalence of smoking increased from 9.7% in 2013 to 10.2% in 2019. Multiple regression analysis revealed that increases in the percentages of sports group participation, receiving emotional and instrumental social support, and reciprocity were significantly associated with decreased prevalence of smoking, after we adjusted for confounding variables. This study indicates that building social capital might be useful in promoting smoking cessation and that its indicators could be useful in monitoring efforts.

Few studies consider socioeconomic status when assessing mortality risk in dyslipidemia cases. This study used cohort data from the 2010 Japan Gerontological Evaluation Study (JAGES), which contains data on older Japanese people, to associate socioeconomic status with mortality risk in patients treated for dyslipidemia. In this 6-year longitudinal study, we examined 47,275 older Japanese people aged ≥ 65 years who could independently perform activities of daily living. Patients' background characteristics were classified based on their dyslipidemia treatment status and were assessed using the chi-squared test. The mortality risk was assessed using the Cox proportional hazards model, wherein the objective and explanatory variables were total mortality and self-report of dyslipidemia treatment, respectively. The participants were stratified by sex and age into younger (aged 65-74 years) and older (aged ≥ 75 years) groups of men and women. The results were adjusted, with health condition, health behavior, and socioeconomic status as confounding factors. The adjusted hazard ratios of 5514 people who died during the follow-up who had self-reported dyslipidemia treatment were 0.49 [95% confidence interval (CI) 0.35-0.69] for younger men; 0.57 (95% CI 0.42-0.76) for older men; 0.52 (95% CI 0.34-0.80) for younger women; and 0.47 (95% CI 0.33-0.67) for older women. Older people undergoing treatment for dyslipidemia had factors beneficial for health, such as good socioeconomic status. Despite considering these factors, individuals undergoing dyslipidemia treatment had a negative association with mortality risk.

Abstract Background Among all physical activities, walking is one of the easiest and most economical activities for older adults’ mental and physical health. Although promoting social participation may extend the walking time of older adults, the longitudinal relationship is not well understood. Thus, this study elucidates the relationship between nine types of social participation and change in walking time during a 3-year follow-up of older adults. Methods We conducted a 3-year community-based longitudinal study of independent older adults in Japan. From the 2016 and 2019 surveys, we extracted 57,042 individuals. We performed multiple regression analyses, estimating associations between change in walking time after three years and nine types of social participation in 2016: volunteer, sports, hobby, senior, neighborhood, learning, health, skills, and paid work. We conducted subgroup analysis stratified by walking time in 2016 (i.e., &lt; 60 or ≥ 60 min/day). Results The mean (standard deviation) change in walking time for 3 years was − 4.04 (29.4) min/day. After adjusting potential confounders, the significant predictors of increasing or maintaining walking time (min/day) were participation in paid work (+ 3.02) in the &lt; 60 min/day subgroup; and volunteer (+ 2.15), sports (+ 2.89), hobby (+ 1.71), senior (+ 1.27), neighborhood (+ 1.70), learning (+ 1.65), health (+ 1.74), and skills (+ 1.95) in the ≥ 60 min/day subgroup compared with non-participants. Conclusions Paid work and community activities may be effective for maintaining or increasing walking time among older adults with less (&lt; 60 min/day) and sufficient (≥ 60 min/day) walking time, respectively.

目的:高齢者の運動習慣定着に有効な運動プログラムのあり方を検討するために,民間スポーツクラブを利用する高齢者を対象にグループでの運動の実践と運動の継続との関連を明らかにすることを目的とした.方法:2017年6月から2019年3月にかけてリソルの森の健康増進プログラム(ウェルネスエイジクラブ)に6ヵ月以上参加した65歳以上の227人(女性117人,男性110人)を分析対象とした.半年に1回の質問紙調査,体力測定,年1回の健康診断,及び個人の参加プログラムや参加日時のデータを分析に用いた.24週以上に渡る平均週2日以上の運動プログラム参加を「運動プログラム継続」,平均週1回以上のグループプログラムへの参加を「グループプログラム参加」と定義し,グループプログラム参加と運動プログラム継続との関連をポアソン回帰分析により検証した.結果:グループプログラム参加者は,非参加者に比べて運動プログラムを継続する可能性が高かった(Prevalence ratio=3.63[95%CI:1.98〜6.65],p<0.01).性で層化しても,女性(8.08[1.94〜33.56],p<0.01),男性(2.84[1.39〜5.78],p<0.01)ともにグループプログラム参加と運動プログラム継続に有意な正の関連が認められた.結論:本研究は,民間スポーツクラブに通う高齢者において,グループによる運動プログラムは参加者同士の社会的交流やつながりを増やし運動継続を促進する可能性があることを明らかにした.高齢者のグループ運動への参加を促進することで運動継続者が増加する可能性が示唆された.(著者抄録)

＜文献概要＞[目的]千葉県松戸市が取り組む通いの場(元気応援くらぶ)事業またはその他の通いの場(グループ活動や会)への1年間参加による介護予防効果を検証すること.[方法]対象は2017年と2018年の日本老年学的評価研究の調査に回答した高齢者3,111名.目的変数を1年後の「要支援・要介護リスク尺度」3点以上悪化,説明変数を通いの場それぞれへの参加あり,参加なしの3群,調整変数を世帯構成,外出頻度,主観的健康感,主観的経済状況,手段的日常生活動作,要介護リスク点数としたポアソン回帰分析を行った.[結果]参加なし群(1,081名)と比べて元気応援くらぶ参加群(158名)の1年後の要介護リスク尺度3点以上悪化のincidence rate ratioは,75歳以上で0.54(95%信頼区間0.32〜0.90),女性で0.65(0.44〜0.97)であった.その他の社会参加者(1,748名)では有意な関連を認めなかった.[結語]狭義の通いの場に参加している後期高齢者と女性で,1年後の要介護リスク尺度3点以上の悪化は有意に少なく,介護予防効果が示唆された.

目的 地域診断により要介護リスクを抱えた高齢者が多く居住する地域を特定し,モデル地区として重点的に通いの場の立ち上げや運営を支援することで,地域レベルの指標が改善し地域間の健康格差が縮小するかを検証することを目的とした。方法 神戸市と日本老年学的評価研究は,要介護認定を受けていない高齢者を対象に全市で実施したサンプリング郵送調査データを用い,市内78圏域(1圏域≒中学校区)の地域診断を行った。複数の要介護リスク指標で不良な値を示し,重点的な支援が必要と判断された16圏域を2014～19年度にかけてモデル地区として指定し,市・区・地域包括支援センター・研究者らが連携して通いの場の立ち上げや運営を支援した。さらに,4回(2011,13,16,19年度)の同調査データ(各8,872人,10,572人,10,063人,5,759人)を用い,モデル地区(16圏域)と非モデル地区(62圏域)との間で,中間アウトカム9指標(社会参加3指標,社会的ネットワーク2指標,社会的サポート4指標)と健康アウトカム5指標(運動器の機能低下,低栄養,口腔機能低下,認知機能低下,うつ傾向)の経年推移を,線形混合効果モデルにより比較した。結果 2011,13年度調査では,全14指標中13指標でモデル地区は非モデル地区より不良な値を示していた。その差が2016,19年度調査にかけて縮小・解消し,年度×群の有意な交互作用が確認された指標は,中間アウトカム4指標(スポーツ・趣味関係のグループ参加,友人10人以上,情緒的サポート提供),健康アウトカム3指標(口腔機能低下,認知機能低下,うつ傾向)であった。たとえば,2011年度の趣味関係のグループ参加はモデル地区29.7%/非モデル地区35.0%であったが,2019年度には35.2%/36.1%と地域差が縮小した(P=0.008)。同様に,情緒的サポート提供は83.9%/87.0%が93.3%/93.3%(P=0.007),うつ傾向は31.4%/27.2%が18.6%/20.3%(P<0.001)となり,差が解消した。結論 地域診断により要介護リスクを抱えた高齢者が多く住む地域を特定し,住民主体の通いの場づくりを重点的に6年間推進することで,社会参加やネットワーク,サポートが醸成され,ひいては地域間の健康格差の是正に寄与したことが示唆された。(著者抄録)

サロン、スポーツ、趣味、ボランティアグループ参加は、どの社会経済階層に多いのか明らかにすることを目的とした。2016年度の日本老年学的評価研究(JAGES)のデータを用い、38市町の65歳以上の高齢者20,972人を対象とした。目的変数は各グループへの参加有無とした。説明変数は、教育歴、等価所得、最長職、調整変数は、人口統計学的要因など計11要因とした。変数の欠損値は多重代入法で補完し、男女別にポアソン回帰分析を実施した。サロンはどの社会経済階層とも有意な関連を示さなかった。スポーツは、男性で低所得層の参加が少なく(出現割合比0.90)、趣味は、男女とも低学歴層の参加が少なかった(男0.92、女0.81)。最長職は、スポーツ・趣味で、管理職以外の社会経済階層が低い人たちの参加が少なかったが、ボランティアで参加が多かった。介護予防事業の評価では、社会経済階層に着目した評価も重要と考えられる。(著者抄録)