花里 真道

IMPORTANCE: There are limited data on whether the vulnerabilities and impacts of social isolation vary across populations. OBJECTIVE: To explore the association between social isolation and mortality due to all causes, cardiovascular diseases (CVD), and malignant neoplasms focusing on heterogeneity by sociodemographic factors. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a moderator-wide approach to examine the heterogeneity in the association of social isolation with all-cause, CVD, and malignant neoplasm mortality using baseline data from the Japan Gerontological Evaluation Study in 2010 and 2011. Eligible participants were adults aged 65 years or older without heart disease, stroke, cancer, or impaired activity of daily living across 12 Japanese municipalities. Follow-up continued until December 31, 2017, identifying 6-year all-cause, cardiovascular disease (CVD), and malignant neoplasm mortality. Logistic regression assessed effect modification by age, gender, education, income, population density, marital status, and employment on mortality associations. Data analysis was performed from September 13, 2023, to March 17, 2024. EXPOSURE: Social isolation, determined by a 3-item scale (scores of 2 or 3 indicating isolation) was the primary exposure variable. MAIN OUTCOMES AND MEASURES: Six-year all-cause, CVD, and malignant neoplasms mortality. RESULTS: This study included 37 604 older adults, with a mean (SD) age of 73.5 (5.9) years (21 073 women [56.0%]). A total of 10 094 participants (26.8%) were classified as experiencing social isolation. Social isolation was associated with increased all-cause (odds ratio [OR], 1.20 [95% CI, 1.09-1.32]), CVD (OR, 1.22 [95% CI, 0.98-1.52]), and malignant neoplasm mortality (OR, 1.14 [95% CI, 1.01-1.28]). Stratified analysis showed associations of social isolation with all-cause and malignant neoplasm mortality among people with high income (highest tertile all cause: OR, 1.27 [95% CI, 1.06-1.53]; malignant neoplasm: OR, 1.27 [95% CI, 1.02-1.60]), living in areas with high population density (highest tertile all cause: OR, 1.47 [95% CI, 1.26-1.72]; malignant neoplasm: OR, 1.38 [95% CI, 1.11-1.70]), not married (all cause: OR, 1.33 [95% CI, 1.15-1.53]; malignant neoplasm: OR, 1.25 [95% CI, 1.02-1.52]), and retirees (all cause: OR, 1.27 [95% CI, 1.14-1.43]; malignant neoplasm: OR, 1.27 [95% CI, 1.10-1.48]). Formal testing for effect modification indicated modification by population density and employment for all-cause mortality and by household income and employment for neoplasm mortality. CONCLUSIONS AND RELEVANCE: Social isolation was associated with increased risks of all-cause, CVD, and malignant neoplasm mortality, with associations varying across populations. This study fills an important gap in research on social isolation, emphasizing its varied associations across demographic and socioeconomic groups.

Abstract Background Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. Methods In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. “Participation” was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Results Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0–52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83–0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81–0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82–1.09). Conclusions Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups.

Abstract Housing tenure is an important aspect to determine health. However, even though renters tend to have more socioeconomic disadvantages than homeowners, mortality risk between private and public renters compared with homeowners remains unclear. Japanese public rented housing, such as the Urban Renaissance Agency, has been developed for supplying an adequate living environment since 1950s. This study aimed to examine the mortality risk among older Japanese residents living in private and public rented houses compared with those living in owner-occupied houses using 9-year follow-up data. This study drew upon a 9-year follow-up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese independent adults aged ≥ 65 years. Mortality from 2010 to 2019 was analyzed for 44,007 respondents. Housing tenure was defined by a questionnaire. Cox regression models were used for calculating the hazard ratio for mortality. Bonferroni correction was used to account for multiple testing between rental houses. Overall, 10,638 deaths occurred during the follow-up period. Compared with housing owners, all rental housing groups had a significantly higher risk of mortality. Among renters, participants who lived in public rental housing had the lowest risk of mortality even after adjusting for sociodemographic characteristics, health status, social status, and environmental status. Multiple testing among renters with Bonferroni correction showed that public renters had 0.80 times (95% CI 0.72–0.89) lower mortality risk than private renters. Although Japanese older adults living in public rental housing had a higher mortality risk than homeowners, this risk was lower than that among private renters. A positive neighborhood environment based on well-planned urban development may have contributed to this result. The results suggest that planned urban development lowers the risk of mortality in older renters in Japan.

Japan's population has been aging steadily, evidenced by it spending JPY 11 trillion (USD 110 billion) on annual long-term care (LTC) costs in 2021. In this context, understanding the factors influencing LTC costs has become increasingly vital. Although studies have reported positive relationships between neighborhood environment and health outcomes, the connection between LTC costs and neighborhood environment remains unclear. To address this gap in the literature, this cohort study, conducted from 2010 to 2019 across seven Japanese municipalities and involving 34,982 older people, examined the relationship between eight neighborhood environment elements and the mean monthly cumulate costs (MMCC) of LTC. The results showed that older people who reported the presence of fresh food stores nearby and dangerous places for walking alone at night in the neighborhood had lower MMCC, by JPY 1,367.6 and 1,383.3 per month, respectively, than respondents who did not report the presence of these neighborhood elements. Meanwhile, older people whose neighborhoods had easily accessible facilities had higher MMCC of JPY 739.4. This study's key findings reveal significant relationships between neighborhood environment elements and LTC costs and can be used to support developments in urban design to support healthy aging and reduced LTC costs.

The aim of this study is to identify the potency of land price as a general indicator of the homebound tendency of neighbourhoods. For this purpose, we focus on the associations between land price and older adults' going-out frequency, while considering the similarities and differences from factors associated with walkability. The study targets are 19,270 individuals living in the Tokyo metropolitan area who are aged 65 years or older who are not certified as needing public long-term care insurance. This study uses a two-step procedure: a) the land price of each neighbourhood is estimated using rent price data from 2010 to 2019 collected by an official Japanese realtor organization; b) the associations between older adults' goingout frequency, according to the 2016 Japan Gerontological Evaluation Study, and the estimated land price of their neighbourhoods is identified using multilevel analysis. The results indicate that land price has strong negative associations with older adults' going-out frequency. Associations between land price or other walkability-associated factors, such as population density, ratio of commercial area, and proximity to the nearest train station, only appear when these factors and land price are included within the same model. The results suggest that, when inspecting homebound tendency in some neighbourhoods, factors relating to the built environment must be considered alongside land prices. Furthermore, the homebound status of older adults is a pressing challenge, especially in neighbourhoods with high land prices.

The aim of this study is to identify the potency of land price as a general indicator of the homebound tendency of neighbourhoods. For this purpose, we focus on the associations between land price and older adults’ going-out frequency, while considering the similarities and differences from factors associated with walkability. The study targets are 19,270 individuals living in the Tokyo metropolitan area who are aged 65 years or older who are not certified as needing public long-term care insurance. This study uses a two-step procedure: a) the land price of each neighbourhood is estimated using rent price data from 2010 to 2019 collected by an official Japanese realtor organization; b) the associations between older adults’ goingout frequency, according to the 2016 Japan Gerontological Evaluation Study, and the estimated land price of their neighbourhoods is identified using multilevel analysis. The results indicate that land price has strong negative associations with older adults’ going-out frequency. Associations between land price or other walkability-associated factors, such as population density, ratio of commercial area, and proximity to the nearest train station, only appear when these factors and land price are included within the same model. The results suggest that, when inspecting homebound tendency in some neighbourhoods, factors relating to the built environment must be considered alongside land prices. Furthermore, the homebound status of older adults is a pressing challenge, especially in neighbourhoods with high land prices.

IMPORTANCE Because shopping malls are considered safe places for walking, several mall walking programs have been developed. Research on the association between the use of walking programs and the number of daily steps taken is limited. OBJECTIVE To evaluate the association between use of a smartphone-based shopping mall walking program and daily steps taken after the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated a nationwide longitudinal data set of 217 344 registered smartphone app users at least 18 years of age residing in Japan. Daily step counts were collected from January 1 to December 31, 2021. EXPOSURES The mall walking program Mall Challenge integrated a global positioning system with a smartphone app’s incentive system to reward achieving a goal of 1000 daily steps with lottery-based coupons to win from 0 to 500 shopping points (1 point equaled 1 yen or approximately US $0.01). MAIN OUTCOMES AND MEASURES Daily step records were collected from the smartphone app’s walking program and adjusted for gender and age. Multilevel analyses using mixed-effect linear regression models were used to estimate the coefficients for the association between daily participation in the walking program and daily step counts. Cross-level interaction terms of age and gender by walking program participation were included in one model. RESULTS Among the 217 344 registered mall app users (23 638 110 daily step records; 154 616 [71.1%] women; 18 014 [8.3%] participants 65 years or older, and 199 330 [91.7%] adults younger than 65 years), the mean (SD) daily steps were 7415 (4686) on walking program participation days and 5281 (4339) on days without participation in the program. Walking program participation days were associated with 1219 additional daily steps (95% CI, 1205-1232) compared with nonparticipation days after adjusting for gender and age. By geographic region, participation in the walking program was associated with 1130 (95% CI, 1113-1146) more steps in rural malls, 1403 (95% CI, 1379-1428) more steps in suburban malls, and 1433 (95% CI, 1408-1457) more steps in urban malls than nonparticipation. Moreover, participation in the walking program was associated with 1422 (95% CI, 1405-1439) more steps in large malls and 1059 (95% CI, 1041-1077) more steps in small malls compared with nonparticipation. Regarding cross-level interactions, women were associated with walking 728 (95% CI, 698-758) more steps than men, and older adults were associated with walking 228 (95% CI, 183-273) more steps than younger adults on walking program participation days. CONCLUSIONS AND RELEVANCE This cohort study found that the use of a smartphone-based mall walking program combined with physical shopping mall facilities and lottery-based digital incentive coupons may motivate people to increase their daily number of walking steps.

OBJECTIVES: The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors. DESIGN: This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study. SETTING AND PARTICIPANTS: Participants included 38,829 older adults who were not frail recruited from 22 cities and towns. METHODS: The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated. RESULTS: After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%). CONCLUSIONS AND IMPLICATIONS: We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty.

BACKGROUND: Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health. METHODS: We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828). RESULTS: The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect). CONCLUSIONS: Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.

目的:高齢者の移動支援として試行導入したグリーンスローモビリティ(以下,グリスロ)利用による外出,社会的行動,ポジティブ感情を感じる機会の主観的変化を明らかにした.方法:2市3地域で8週間グリスロを導入し,導入前後の自記式質問紙調査に回答した65歳以上の高齢者599人を分析対象とした.対象者をグリスロ利用群と非利用群の2群に分け,導入後の外出(行動範囲など),社会的行動(地域活動に参加など),ポジティブ感情(気持ちが明るくなるなど)の変化を評価した.ポアソン回帰分析を実施し,累積発生比と95%信頼区間,P値をそれぞれ求めた.P値はボンフェローニ法により補正した(有意水準:P=0.0042).結果:グリスロ利用群は非利用群と比較して外出,社会的行動,ポジティブ感情の機会が2～5割,累積発生比で1.74～5.21倍と有意に高かった.結論:グリスロには移動支援にとどまらず,"動く"通いの場のような心理社会的な変化もあり,健康に資する可能性が示唆された.(著者抄録)

Access to dental clinics is a feature of the neighborhood service environment that may influence oral health care utilization. However, residential selection poses a challenge to causal inference. By studying the involuntary relocation of survivors of the 2011 Great East Japan Earthquake and Tsunami (GEJE), we examined the association between changes in geographic distance to dental clinics and dental visits. Longitudinal data from a cohort of older residents in Iwanuma City directly impacted by the GEJE were analyzed in this study. The baseline survey was conducted in 2010, 7 mo before the occurrence of GEJE, and a follow-up was conducted in 2016. Using Poisson regression models, we estimated the incidence rate ratios (IRR) and 95% confidence intervals (CIs) for the uptake of denture use (as a proxy for dental visits) according to changes in distance from the nearest dental clinic to their house. Age at baseline, housing damage by the disaster, deteriorating economic conditions, and worsened physical activity were used as confounders. Among the 1,098 participants who had not worn dentures before the GEJE, 495 were men (45.1%), with a mean ± SD age at baseline of 74.0 ± 6.9 y. During the 6-year follow-up, 372 (33.9%) participants initiated denture use. Compared to those who experienced a large increase in distance to dental clinics (>370.0–6,299.1 m), a large decrease in distance to dental clinics (>429.0–5,382.6 m) was associated with a marginally significantly higher initiation of denture use among disaster survivors (IRR = 1.28; 95% CI, 0.99–1.66). The experience of major housing damage was independently associated with higher initiation of denture use (IRR = 1.77; 95% CI, 1.47−2.14). Improved geographic access to dental clinics may increase dental visits of disaster survivors. Further studies in non-disaster-affected areas are needed to generalize these findings.

People have a preference for, and feel better in, beautiful natural environments. However, there are no epidemiological studies on the association between neighborhood beauty and neuroimaging measures. We aimed to determine association between neighborhood beauty and regional brain volume. Participants were 476 community-dwelling older adults from the Neuron to Environmental Impact across Generations (NEIGE) study. Subjective neighborhood beauty was assessed through participants' perception of beautiful scenery within 1 km of their home. Objective measures of neighborhood indicators (green spaces, blue spaces, and plant diversity) within 1 km of participants' homes were obtained using a geographic information system. Volumes of brain regions associated with experience of beauty were measured using magnetic resonance imaging. We estimated associations between neighborhood beauty and regional brain volume using linear regression. Of the participants, 42% rated their neighborhoods as very beautiful, and 17% rated them as not at all beautiful. Higher subjective neighborhood beauty was associated with larger bilateral medial orbitofrontal cortex and insula volumes (all p for trend < 0.01). Brain volume was not associated with objective neighborhood measures. Subjective neighborhood beauty was associated with brain regions related to rewards and decision making, suggesting that these brain regions underpin the perception of neighborhood beauty.

Objectives: Elder abuse is a public health issue that is thought to have increased during the COVID-19 pandemic due to lockdowns and behavioral restrictions. This study examines the association between elder abuse and refrainment from daily activities during the pandemic. Methods: We used data from a self-administered mail survey conducted by the Japan Gerontological Evaluation Study (JAGES) from November 2020 to February 2021 in 11 municipalities. Our participants included 18,263 older adults (age ≥65 years) who were independent in their daily lives. Logistic regression analysis was conducted to evaluate the association between elder abuse and refrainment from 10 daily activities, and the total number of refrained behaviors. Results: Experiences of abuse were reported by 288 participants (1.6%). The risk of elder abuse was 1.37 times (95% confidence interval, 1.04-1.81) higher among those who refrained from shopping for food and daily necessities and 1.60 times (1.20-2.13) higher among those who refrained from interaction with neighbors, than those who did not. Also, a dose-response relationship was observed where the risk of abuse increased with the number of restrictions. Conclusion: The risk of elder abuse increased as the number of refrained behaviors increased which suggests that refrainment from multiple behaviors may significantly increase the risk of elder abuse, compared with refrainment from a single behavior. To avoid increasing the risk of abuse in likely future pandemics, it is necessary to maintain social connections without face-to-face contact, or with adequate infection control measures.

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.

Abstract Background Urbanization and population aging may affect prevalence of chronic pain from various causes. This cross-sectional study aimed to investigate the prevalence of chronic musculoskeletal pain, including some subtypes, in independent Japanese older people, and whether population density and population aging rate explained prevalence and differences in pain levels between municipalities. Methods We analyzed data from 12,883 independent older people living in 58 municipalities who completed mailed questionnaires and did not need support for daily living. We identified three types of pain: “chronic musculoskeletal pain” lasting ≥ 3 months (overall and in each part of the body), “chronic widespread-type pain” in the spinal and peripheral area, and “chronic multisite pain” in at least three sites. The latter two were measured using new definitions. These types of pain are correlated with depressive symptoms and we therefore examined the construct validity of the definitions by comparing the Geriatric Depression Scale score. We also used analysis of covariance to compare the prevalence of these three types of pain between municipalities. Odds ratios, median odds ratios, and the municipal variance in prevalence of chronic musculoskeletal pain were estimated by Bayesian multilevel logistic regression analysis using the Markov Chain Monte Carlo method. Results The construct validity of the definitions of chronic widespread-type pain and chronic multisite pain was confirmed. The prevalence of the three types of pain (chronic musculoskeletal, widespread, and multisite pain) was 39.0%, 13.9%, and 10.3%, respectively. Chronic musculoskeletal pain showed a higher prevalence among older people and women. Individuals in underpopulated, suburban, or metropolitan areas tended to have more pain than those in urban areas, but this was not statistically significant (odds ratio [95% credible interval] 1.15 [0.86–1.51], 1.17 [0.93–1.43], 1.17 [0.94–1.46]). Population density and population aging rate did not explain the differences between municipalities. Conclusions The prevalence of chronic musculoskeletal pain was consistent with previous global reports. Areas with overpopulation and depopulation tended to have higher pain prevalence, but population density and population aging rate did not explain municipal variance. Further research is needed to identify other factors that contribute to regional variance.

BACKGROUND: This study investigated the relationship between built environments and the onset of frailty after 3 years. METHODS: This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals. RESULTS: After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99). CONCLUSIONS: At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

There is a growing, but inconclusive, evidence on the beneficial influence of the Internet on the health/wellbeing of older people. This study aims to examine outcomes-wide associations between frequency of internet use and subsequent health/well-being among older individuals. We used the three-wave data (2013, 2016, and 2019) from the Japan Gerontological Evaluation Study. Our exposure was frequency of internet use (not at all/ use a few times a month/use a few times a week/use almost every day) in 2016. We assessed 34 health/wellbeing outcomes in 2019 across six dimensions. Pre-exposure characteristics and prior outcome levels in 2013 were adjusted. We included 5879 respondents for 4 outcomes (death, dementia, and functional disability) and 4232 respondents for 30 other outcomes. Using the Internet almost every day (vs. not using at all) in 2016 was associated with some outcomes in 2019 in three dimensions: physical/cognitive health (better instrumental activities of daily living), social well-being (more frequent participation in sports groups, meeting friends more frequently, and seeing more friends within a month), and health behaviors (receiving health screening) (p < 0.05 for these associations after Bonferroni correction). It was not associated with any outcomes of three other dimensions: psychological distress, subjective well-being, or pro-social/altruistic behaviors.

OBJECTIVES: Elder abuse is a growing global public health concern. Previous studies have reported that elder abuse increases the risk of dementia; however, to the best of our knowledge, no studies have investigated the association between different types of abuse and dementia onset yet. This study, therefore, investigated the association between physical, psychological, and financial abuses and dementia onset in independent older adults in Japan. METHODS: A 6-year prospective cohort data from the Japan Gerontological Evaluation Study (JAGES) were collected in 2010 through a mail survey conducted among 5,674 men and 6,562 women aged ≥65 years across Japan. Dementia was assessed using the nationally standardized dementia scale proposed by the Ministry of Health, Labor and Welfare. Poisson regression analysis was performed separately for each type of abuse to calculate the incidence rate ratios and 95% confidence intervals. RESULTS: During follow-up, 552 (9.7%) men and 728 (11.1%) women developed dementia. After adjusting for potential confounders, participants who experienced financial abuse were 1.53 (1.09-2.16) times more likely to develop dementia than those who did not. On the other hand, participants who experienced physical abuse were 1.53 (0.92-2.56) times more likely and those who experienced psychological abuse were 0.98 (0.82-1.17) times less likely to develop dementia than participants who did not experience such abuses. However, the difference was not significant. CONCLUSION: Financial abuse may promote dementia among older adults in Japan, suggesting that preventing this abuse may help prevent dementia onset. However, further studies with larger data sets are warranted.

Relative income deprivation (RID) is a known risk factor for poor health. Previous research has proposed several measures to assess RID, e.g., Income Rank and the Yitzhaki Index. Hounkpatin et al. (2020) presented a new approach - the CR˜i index - to account for the observation that individuals are more sensitive to the differences in incomes of others who are closer to them, rather than to comparisons with incomes of others far above them. Using a Japanese nationwide cohort of older adults (n = 62,438; mean [SD] age: 73.0 [5.6] years), this study compared the performance of alternative indices of RID in predicting health outcomes (depressive symptoms, functional capacity, and self-rated health), as well as the use of alternative CR˜i index weights (α weight range: -0.9 to 0.9). When 0<α<1, higher income differences lead to a more significant increase in relative deprivation, while when -1< α <0, excessively high incomes contribute less to the relative deprivation of lower income individuals in the same reference group. Results showed that all measures of relative income deprivation were associated with deteriorating mental and physical health among older Japanese adults. However, while the CR˜i index consistently outperformed the Yitzhaki Index, this did not hold true invariably when compared to the Income Rank - depending on the health outcome and the reference group. Also, while negative α parameters showed a good statistical fit in most models, the findings were not conclusive - the best-fitting CR˜i weight parameters ranged from -0.9 to 0.9. Therefore, a clear direction for the contribution of higher incomes to relative deprivation could not be established based on the study population.

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。

<title>Abstract</title><sec> <title>Background</title> Rurality can reflect many aspects of the community, including community characteristics that may be associated with mental health. In this study, we focused on geographical units to address multiple layers of a rural environment. By evaluating rurality at both the municipality and neighborhood (i.e., a smaller unit within a municipality) levels in Japan, we aimed to elucidate the relationship between depression and rurality. To explore the mechanisms linking rurality and depression, we examined how the association between rurality and depression can be explained by community social capital according to geographical units. </sec><sec> <title>Methods</title> We used cross-sectional data from the 2016 wave of the Japan Gerontological Evaluation Study involving 144,822 respondents aged 65 years or older residing in 937 neighborhoods across 39 municipalities. The population density quintile for municipality-level rurality and the quintile for the time required to reach densely inhabited districts for neighborhood-level rurality were used. We calculated the prevalence ratios of depressive symptoms by gender using a three-level (individual, neighborhood, and municipality) Poisson regression. Community social capital was assessed using three components: civic participation, social cohesion, and reciprocity. </sec><sec> <title>Results</title> The prevalence of depressive symptoms was higher in municipalities with lower population density than those with the highest population density; the ratios were 1.22 (95% confidence intervals: 1.15, 1.30) for men and 1.22 (1.13, 1.31) for women. In contrast, when evaluating rurality at the neighborhood level, the prevalence of depressive symptoms was 0.9 times lower for men in rural areas; no such association was observed for women. In rural municipalities, community civic participation was associated with an increased risk of depressive symptoms. In rural neighborhoods, community social cohesion and reciprocity were linked to a lower risk of depressive symptoms. </sec><sec> <title>Conclusions</title> The association between rurality and depression varied according to geographical unit. In rural municipalities, the risk of depression may be higher for both men and women, and the presence of an environment conducive to civic participation may contribute to a higher risk of depression, as observed in this study. The risk of depression in men may be lower in rural neighborhoods in Japan, which may be related to high social cohesion and reciprocity. </sec>

BACKGROUND: As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. METHODS: We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1-87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01-1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02-1.13), there was no association in urban areas (HR: 1.03; 0.99-1.06). CONCLUSIONS: Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.

BACKGROUND: The causal effect of physical activity on reducing dementia risk has been questioned due to the possibility of reverse causation. This study examined the potential causal effects of physical activity on reducing dementia risk using residency in a snowy area as an instrumental variable (IV) representing the physical activity of older adults. METHODS: We used cohort data from the Japan Gerontological Evaluation Study, a longitudinal cohort enrolling people aged 65 or older who were physically and cognitively independent in 2013; study participants were followed for an average of 5.7 years. Participants in the present study included 73,260 individuals living in 19 municipalities in Japan. Physical activity was measured by self-report questionnaires and the incidence of dementia was ascertained by linking participants to the public registries of long-term care insurance. IV estimation was obtained from a piecewise Cox proportional hazard model using a two-stage regression procedure. RESULTS: During the study period, we ascertained 8714 cases (11.9%) of dementia onset. In the IV analysis, we found that the frequency of physical activity per week was negatively associated with dementia risk, though the association weakened over time (Year 1: hazard ratio = 0.53, 95% confidence interval: 0.39-0.74; Year 4: 0.69, 0.53-0.90; Year 6: 0.85, 0.66-1.10). CONCLUSIONS: Our IV analysis indicated a potential causal effect of physical activity on reducing dementia risk that persisted for at least 4 years of follow-up. Thus, we conclude that physical activity should be recommended for older adults to reduce dementia risk.

The relationship between chemical concentrations in indoor air and the human sense of comfort and relaxation have been reported. We investigated the effect of the sum of volatile organic compounds (ΣVOCs; sum of 79 VOCs) on the level of relaxation in two laboratory houses with almost identical interior and exterior appearances. The electroencephalogram (EEG) was monitored to evaluate the degree of personal relaxation objectively. The experiments were conducted in laboratory houses (LH) A and B with lower and higher levels of ΣVOCs, respectively. A total of 168 healthy volunteers participated, who each performed the task for 20 min, followed by a 10-min break, and EEG was measured during the break. Simultaneously as subjective evaluations, the participants were asked to fill a questionnaire regarding the intensity of odor and preference for the air quality in each LH. The subjective evaluation showed a significant association between ΣVOCs and participants' relaxation (OR: 2.86, 95%CI: 1.24-6.61), and the objective evaluation indicated that the participants were more relaxed in the LH with lower levels of ΣVOCs than that with higher levels (OR: 3.03, 95%CI: 1.23-7.50). Therefore, the reduction of ΣVOCs and odors in indoor air would have an effect, which is the promotion of relaxation.

kkPeople's living environments and lifestyles have drastically changed with the times. It is necessary to reassess risk factors associated with changes in social conditions to prevent sick building syndrome (SBS). This study aimed to determine the association between the onset of SBS and participant characteristics, social and residential environments, and lifestyle. An online nationwide questionnaire survey involving 4996 participants was conducted. The risk factors for SBS were examined using logistic regression analyses. The main risk factors for SBS were female sex (odds ratio [OR] = 1.20, confidence interval [CI] = 1.01-1.42) and young age (OR = 2.42, CI = 1.55-3.78). Other risk factors included having a medical history of allergies and mental illness (OR = 1.75, CI = 1.34-2.29), special housing specifications for the indoor environment (OR = 0.77, CI = 0.63-0.95), smoking indoors (OR = 1.25, CI = 1.00-1.55), and others. Women, young individuals, and those with a history of diseases, such as allergies and mental illness, had an increased risk of SBS, indicating that such individuals need to pay attention to chemical exposure. The study results indicate the possibility of preventing SBS by the careful selection of indoor environments and lifestyle.

Background: The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people. Methods: We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model. Results: The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78–0.98). Conclusions: Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.

BACKGROUND: Farmers may have an increased risk for poor mental health. In connection with this, factors specific to the neighborhood environment such as farm density and the type of agriculture, might be important for mental wellbeing. In this study we aimed to clarify the cross-level interaction on depressive symptoms between farm density at the neighborhood level by type of agriculture and the longest occupation of individuals (farmer or non-farmer). METHODS: Data came from the 2016 wave of the Japan Gerontological Evaluation Study (JAGES) that were linked to governmental agricultural data. Information was analyzed from 147,549 respondents aged 65 years or older, residing in 1024 neighborhoods in 39 municipalities. We calculated farm (crop or animal husbandry) density at the neighborhood level, dividing the number of agricultural management entities by the population. Three-level (individual, neighborhood, and municipality) Poisson regression analysis was used to calculate the prevalence rate ratios of depressive symptoms. RESULTS: The prevalence of depressive symptoms was higher among individuals whose longest occupation was farmer compared to non-farmer. The estimated probability of depressive symptoms by a cross-level interaction analysis showed that among farmers of both genders, those who were residing in neighborhoods where the farm density was low had a higher prevalence of depressive symptoms, regardless of the type of agriculture. The slope of the relationship between depressive symptoms and animal husbandry farm density varied by occupation, with a higher prevalence of depressive symptoms observed in male farmers compared to male non-farmers. CONCLUSIONS: The high prevalence of depressive symptoms among farmers in neighborhoods with a low farm density may reflect a scarcity of formal and informal social support in such communities. The health effects of the neighborhood environment on farmers, such as farm density, which may vary by the type of agriculture, should be further researched.

Sidewalks are indispensable environmental resources for daily life in that they encourage physical activity. However, the percentage of sidewalks installation is low even in developed countries. We examined the association between neighborhood sidewalk environment and dementia in Japan. We conducted a 3-year follow-up (2010-2013) among participants in a Japan Gerontological Evaluation Study, a population-based cohort study of community-dwelling older adults. We ascertained the incidence of dementia for 76,053 participants from the public long-term care insurance system. We calculated sidewalk coverage (sidewalk area as a percentage of road area) within 436 residential neighborhood units using the geographic information system. Multilevel survival models were used to estimate hazard ratios (HR) for the incidence of dementia. During the follow-up, 5310 dementia cases were found. In urban areas, compared with the lowest quartile for sidewalk coverage, the HR was 0.42 (95% confidence interval (CI): 0.33-0.54) for the highest quartile, adjusting for individual covariates. After successive adjustments for other neighborhood factors (land slope, numbers of hospitals, grocery stores, parks, stations and bus stops, education level, and unemployment rate), the HR remained statistically significant (HR=0.75, 95% CI: 0.59-0.94). Living in neighborhoods with high sidewalks installation was associated with low dementia incidence in urban areas.

Depression among older adults is one of the most critical public health issues. The proximity of elementary schools has been positively associated with neighborhood social cohesion and quality of life. However, no studies have identified an association between the proximity of elementary school and older adults' mental health. Therefore, this study aimed to examine the association between the proximity of elementary schools, one of the core facilities of neighborhood communities in Japan, and depression in older adults. A total of 131,871 participants (63,430 men 73.7 ± 6.1 years, 68,441 women 73.8 ± 6.2 years) were analyzed from the Japan Gerontological Evaluation Study (JAGES) 2016 survey. Logistic regression analysis showed that there was no association between distance to elementary school and depression among males. However, among females, compared with the participants living within 400 m from the nearest elementary school, the odds ratio of depression for those living between 400 and 799 m and more than 800 m away were 1.06 (95% confidence interval (CI) 1.00-1.12) and 1.07 (95% CI 1.00-1.15), respectively. The findings may be useful when considering the design of communities around elementary schools and the planning of facilities as a population-based approach to promote mental health of older women.

It is well known that the indoor environment, particularly indoor air quality (IAQ), has significant effects on building-related symptoms (BRSs) in humans, such as irritation of mucosal membranes, headaches, and allergies, such as asthma and atopic dermatitis. In 2017, Chiba University launched the "Chemiless Town Project Phase 3" to investigate the relationship between IAQ and human health. Two laboratory houses (LHs) were built on a university campus in which the interiors and exteriors were similar, but the levels of indoor air volatile organic compounds (VOCs) were different. A total of 141 participants evaluated IAQ using their sensory perception. There was a significant relationship between differences in VOC levels and BRSs occurrence (OR: 6.89, 95% CI: 1.40-33.98). It was suggested that people with a medical history of allergies (OR: 5.73, 95% CI: 1.12-29.32) and those with a high sensitivity to chemicals (OR: 8.82, 95% CI: 1.16-67.16) tended to experience BRSs. Thus, when buildings are constructed, people with a history of allergies or with a sensitivity to chemicals may be at high risk to BRSs, and it is important to pay attention to IAQ to prevent BRSs.

Depression in older adults is a public health challenge. We aimed to clarify the relationship between depression in older adults and three types of neighborhood greenspaces: trees, grasslands, and fields. We utilized data from the Japan Gerontological Evaluation Study (JAGES) performed in 2016. Multilevel logistic regression analysis was used for non-stratified and stratified analyses for the urban-rural regions. The target population comprised 126,878 older adults (age ≥ 65 years) who responded to the depression questions and were living in 881 neighborhoods in Japan. Depression was diagnosed based on a Geriatric Depression Scale score ≥5, and 20.4% of the study population had depression. In the pre-stratification analysis, areas with more greenspaces revealed lower odds of depression (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.85-0.95). In urban areas, more trees correlated with lower odds of depression (OR 0.94, 95% CI 0.89-1.00). In rural areas, moderate amounts of grassland were associated with lower odds of depression compared to areas with fewer grasslands (OR 0.91, 95% CI 0.83-1.00). We found that urban areas with higher tree density and rural areas with moderate amounts of grassland were associated with lower odds of depression.

Elder abuse is a serious public health concern that increases the risks of negative health outcomes globally. It is well known that abuse in older adults is associated with depression; however, longitudinal studies investigating the causal relationship between these events are scarce. Because the cause precedes the result over time, the temporal relationships between abuse and depression should be verified from each direction. This longitudinal study, therefore, investigated and clarified whether depression causes or results from elder abuse among older Japanese adults. Two longitudinal analyses were conducted using data derived from the Japan Gerontological Evaluation Study. The data were collected in 2010 and 2013 through a mail survey of 1,737 people (983 females, 754 males) across Japan. Of those who did not experience abuse in 2010, 38 (5.0%) males and 53 (5.4%) females newly experienced abuse in 2013. Among respondents who did not have depressive symptoms in 2010, 60 (8.0%) males and 61 (6.2%) females newly reported depressive symptoms in 2013. After adjusting for demographic factors in Analysis 1, people who experienced abuse were 2.28-fold (95% confidence interval [CI] = 1.68-3.09) more likely to have depressive symptoms three years later than those who were not abused. In Analysis 2, respondents who had mild or severe depression in 2010 were 2.23-fold (95% CI = 1.61-3.10) more likely to have experienced abuse after three years than those who did not have depression. After adjusting for several demographic factors, the results showed that abuse can lead to depression and that depression can be a cause of abuse. Therefore, preventing abuse should be considered from both directions.

BACKGROUND: The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health. METHODS: We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual's type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability. RESULTS: Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46 kg/m; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8 cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11 mg/dl; 95% CI = 5.0, 17), and decreased high-density lipoprotein cholesterol (-3.1 mg/dl; 95% CI = -5.0, -1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes. CONCLUSIONS: Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.

Widowhood and living alone are linked to increased risk of depression. We examined prospectively whether community-level social capital can mitigate the adverse impact of widowhood and living alone on depressive symptoms. We used data of the Japan Gerontological Evaluation Study of functionally independent adults aged 65 years or older. Three waves of surveys were collected in 2010, 2013 and 2016. We conducted gender-stratified multilevel linear regression to examine the moderating effects of community-level social capital on depressive symptoms (as assessed by the 15-point Geriatric Depression Scale) associated with widowhood and living alone. Widowhood in the past 12 months in combination with living alone was associated with a marked worsening in depressive symptoms among men (beta coefficient = 1.67; 95% confidence interval: 1.38, 1.95). Community-level civic participation, but not social cohesion or reciprocity, was associated with lower depressive symptoms in men and women. In addition, community-level civic participation moderated the association between depressive symptoms and recent widowhood/living alone among men (coefficient per 1 standard deviation = -0.30; 95% confidence interval: -0.59, -0.02). We found no significant effect modification of community-level social capital on depressive symptoms associated with widowhood and living alone among women. Communities with greater civic participation appear to mitigate the onset of depressive symptoms among recently widowed men living alone. Promotion of community activities might be an effective community-level intervention to promote mental health in this vulnerable group.

This study examined the longitudinal association between the change in the step count of older adults and the neighborhood-built environment (BE) in Yokohama, Japan. We analyzed pedometer data in March 2016 and March 2019 that were acquired from 21,557 older adults aged 65-79 years at baseline, who lived in 758 neighborhoods in Yokohama City and participated in the Yokohama Walking Point Program (YWPP). Six BE variables were computed, for each of which neighborhoods were classified into quartiles. Using multilevel regression analysis, we examined the association between the BE variables, baseline step count, and change in step count. Higher population density, lower intersection density, and the second shortest quartile of the average distance to the nearest railway station were associated with a higher baseline step count. A lower intersection density and shorter average distance to the nearest railway station were associated with a smaller decline. The lowest quartile of population density was inversely associated with step-count decline. In conclusion, the neighborhood BEs were not only associated with their step count at baseline, but also widened the disparity of the step count over the three years. These findings would contribute to creating age-friendly cities where older adults can maintain and promote their health.

Herein, the concentrations of formic acid, acetic acid, and ammonia in samples of indoor air for 47 new houses were measured two weeks after completion. The houses were fabricated with light-gauge steel structures. The measurements were performed in living rooms and bedrooms without furniture and outdoors. Air samples were analyzed using ion chromatography. The mean values were 28 (living room), 30 (bedroom), and 20 μg m-3 (outdoor air) for formic acid; 166 (living room), 151 (bedroom), and 51 μg m-3 (outdoor air) for acetic acid; and 73 (living room), 76 (bedroom), and 21 μg m-3 (outdoor air) for ammonia. The total values of the three substances accounted for 39.4-40.7% of the sum of chemical compound values. The analyzed compounds were indicated by two principal components (PC), PC1 (30.1%) and PC2 (9%), with 39.1% total variance. Formic acid, acetic acid, and ammonia were positively aligned with PC1 and negatively aligned with PC2. Factors such as room temperature, aldehydes, and phthalates were positively aligned with PC1 and negatively aligned with PC2. Furthermore, concentrations of formic acid, acetic acid, and ammonia were significantly and positively correlated with room temperature (p < 0.05).

BACKGROUND: About one in ten mothers experience postpartum depression (PPD) in Japan. Although the individual and social risk factors of depression have been reported, few studies have focused on the neighborhood environmental features. In this study, we examined the association between neighborhood environmental features and PPD symptoms among Japanese women. METHODS: Questionnaire survey including women who participated in 3- or 4-month health checkup in Nagoya City, Japan in 2012 was used. PPD symptoms were evaluated using Edinburgh Postnatal Depression Scale (EPDS). As the neighborhood places where postpartum mothers often visit, we measured availability of grocery stores, community centers and asobiba (playground for children) within residential neighborhood unit using geographic information system. A multilevel analysis was conducted on 2,298 individuals nested within 388 school districts using Stata 15.1 software. RESULTS: Mothers who live in the neighborhood with more number of asobiba had lower EPDS score, even after adjustment for individual factors (B: -0.12, 95%CI: -0.24, -0.01), and additional adjustment for other neighborhood environmental factors (B: -0.14, 95%CI: -0.27, -0.02). LIMITATION: Our cross-sectional design limits to draw causal inferences. As for the evaluation of PPD symptoms, no diagnosis has been made. Moreover, we do not have the information on the accessibility to transportation, and the exact residential location of the survey respondents. CONCLUSION: Our findings suggest that the availability of asobiba in the community has a protective effect on PPD symptoms. Providing more asobiba in the neighborhood for new mothers may be a viable preventive strategy for PPD symptoms.

BACKGROUND: Elder abuse is a serious public health issue worldwide, but large-scale epidemiologic studies remain sparse. Although social factors in human relations such as social support and social isolation have been proposed as the factors related to elder abuse, cognitive social capital has not been examined. OBJECTIVE: This study aims to clarify the prevalence of and the factors associated with elder abuse among independent older adults in Japan. METHODS: The study design is a retrospective observational study. The data were derived from the Japan Gerontological Evaluation Study (JAGES). These self-report data were collected from 26,229 people aged 65 years or older living in 28 municipalities in 2013. The types of elder abuse and factors associated with them were examined using logistic regression analysis. RESULTS: The prevalence of elder abuse among the sample was 12.3% (11.1% in males and 13.3 in females). In the entire sample, physical, psychological, and financial abuses were reported to be 1.26, 11.12, and 1.45%, respectively. Factors associated with increased odds of experiencing abuse were being a woman, living with family members, having poor self-rated health, and having mild or severe depression. By contrast, age ≥85 years, being widowed, or unmarried, and having a positive view of community trust were associated with a lower risk of experiencing abuse. CONCLUSION: While particular demographic factors and health are associated with a greater risk of elder abuse, our findings that trust within the community lessens the risk indicates the importance of social capital. This should be taken into consideration when developing population-based strategies to prevent elder abuse.