近藤 克則

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.

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.

Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran’s I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

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.

【目的】近年、時代に即した医療課題の解決のため、適切な社会医学の人材育成がなされているかを、明らかにすることを目的とした。【方法】量的調査と質的調査を行った。量的調査では、近年20年間の社会医学分野の講座名称及び教員数の変化について名簿調査を行った。質的調査では、社会医学分野の研究者・教員9名及び高等教育行政、厚生行政、医学会関係者各1名ずつの計12名に対してインタビュー調査を行った。インタビュー調査は半構造化面接の方法で行い、質的に分析した。【結果】名簿調査では、20年間のうちに、医学教育において社会医学分野の教員数に変化はないが、基礎医学・臨床医学分野を合わせた教員の全体数が増加しているため、社会医学分野の教員の割合は3.0%(521人/17,224人)から2.1%(508人/24,121人)に減少していた。インタビューでは、公衆衛生大学院の創設や社会医学専門医制度などの開始、地方自治体や国際保健において社会医学人材の活躍が期待される一方で、魅力ある教育プログラムやキャリアパスのイメージが示されていないこと、実践現場と研究・教育の乖離などの課題が明らかとなった。【結論】量的・質的分析を合わせた結果、1)新たな課題に取り組む人材育成のため教育・専門医制度などの質の保証の充実、2)社会医学の可能性を伝え参入する若手を増やすための方策強化、3)現場と研究、教育の乖離が見られるためビッグデータやグローバルヘルスを使った現場と教育と研究の統合、の3つの課題を抽出することができた。(著者抄録)

BACKGROUND: Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults. METHODS: Data were from a nationwide cohort study of Japanese older adults aged ≥65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated. RESULTS: Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores= -1.2%, 95%CI: -3.4, 1.1 higher versus lower optimism quintiles= -4.1%, 95%CI: -11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well. CONCLUSION: Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts.

目的 介護予防の重点分野の1つ「閉じこもり」は，外出頻度が週に1回未満の者とされることが多い。しかし質問文に外出の定義がない場合，外出しても外出と認識せず，頻度を少なく回答し閉じこもりと判定される可能性がある。本研究では，高齢者対象の質問紙調査において，外出の定義の有無による閉じこもり割合，要介護リスクの違いを明らかにする。また，目的別の外出頻度を用いて，週1回以上外出しているにもかかわらず閉じこもりとなる「外出頻度回答の矛盾」に外出の定義の有無が関連しているかどうかを検討した。 方法 愛知県の4介護保険者A～D在住の自立高齢者に対し2006～2007年に行った自記式調査の回答者10,802人を対象とした。全般的な外出頻度を尋ねる際，保険者Dのみ「屋外に出れば外出とします」という定義を示した。また全4保険者で，買い物等5種類の目的別外出頻度を尋ねた。全般的な外出頻度で週1回未満の者を「全般的閉じこもり」，目的別外出頻度いずれかで週1回以上の者を「目的別非閉じこもり」とした。「全般的閉じこもり」について，約10年間の要介護認定ハザード比（Hazard Ratio, HR）の違いを検討した。「目的別非閉じこもり」かつ「全般的閉じこもり」の者を「外出頻度回答に矛盾がある者」とし，発生割合，発生に関連する要因のPrevalence Ratio（PR）を算出した。 結果 全般的閉じこもりの粗割合は保険者ABCでは11.7％であったのに対し，定義を示した保険者Dでは2.8％であった。保険者ABCに対し，保険者Dの全般的閉じこもりは要介護認定を受けるHRが有意に高かった（HR=1.56）。目的別非閉じこもりであるにもかかわらず全般的閉じこもりという矛盾回答は保険者ABCで10.2％，保険者Dで2.2％みられた。矛盾回答の発生に正の関連を示したのは女性，高い年齢，配偶者・子世代との同居，教育年数が短いこと，主観的健康感がよくないこと，うつ，島嶼部の居住者であることであった。外出の定義を示した保険者Dでは有意に矛盾が発生しにくかった（PR=0.29）。 結論 外出の定義の有無により閉じこもり割合，要介護リスクに違いがみられた。外出の定義がないことは外出頻度回答の矛盾発生に有意に関連していた。閉じこもりを把握するために外出頻度を尋ねる際には外出の定義を示すことが望ましい。

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350 and n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISCUSSION: Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.

Objectives Some older adults less interested in exercise may still meet the walking time of 30 minutes or more per day that is required to maintain and improve their health. This study aimed to clarify the characteristics of those who walk for 30 minutes or more per day stratified by the exercise stage of change.Methods This cross-sectional study used a self-administered mail survey conducted by the Japan Gerontological Evaluation Study (JAGES) in 2019. There were 45,939 participants, aged 65 years or above, who were not certified as requiring long-term care and who resided in 62 municipalities in 24 prefectures. The measures included daily walking time, stage of change for exercise (20 minutes or more once a week), and factors related to physical activities (eight demographic and biological; three psychological, cognitive, and emotional; eight behavioral; 40 social and cultural; and three environmental factors). The analysis was stratified into three groups according to the transformation stages: 1) pre-contemplation, 2) contemplation/preparation, and 3) action/maintenance. Poisson regression analysis was conducted with the dependent variable as walking time, the independent variables as physical activity factors, and the covariates as all eight demographic and biological factors.Results Of the 24,146 survey respondents (52.6% response rate), 18,464 were included in the analysis. Surveys with missing items that were important for the analysis and patients who needed care and assistance were excluded. The factors that were significantly associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and the contemplation/preparation stages, were three demographic and biological (married; age 80 years or above and non-independence of instrumental activities of daily living were negatively associated), two behavioral (going out at least once a week and watching sports on TV or the Internet), and six social and cultural factors (provision of instrumental support, frequency of meeting with friends more than once a week, participation in the neighborhood association, high reciprocity, reading habits; playing Go was negatively associated).Conclusions Among the demographic and biological factors, and the behavioral, social, and cultural factors, 11 items were found to be associated with walking 30 minutes or more per day only in the pre-contemplation stage, or only in the precontemplation and contemplation/preparation stages. To promote walking even in the lower stages of change, it may be useful to promote exchanges with others, rather than focusing predominantly on physical activities.

BACKGROUND: Homebound status is one of the most important risk factors associated with functional decline and long-term care in older adults. Studies show that neighborhood built environment and community social capital may be related to homebound status. This study aimed to clarify the association between homebound status for community-dwelling older adults and community environment-including social capital and neighborhood built environment-in rural and urban areas. METHODS: We surveyed people aged 65 years and older residing in three municipalities of Niigata Prefecture, Japan, who were not certified as requiring long-term care. The dependent variable was homebound status; explanatory variables were community-level social capital and neighborhood built environment. Covariates were age, sex, household, marital status, socioeconomic status, instrumental activities of daily living, the Geriatric Depression Scale-15, self-rated health, number of diseases under care, and individual social capital. The association between community social capital or neighborhood built environment and homebound status, stratified by rural/urban areas, was investigated using multilevel logistic regression analysis. RESULTS: Among older adults (n = 18,099), the homebound status prevalence rate was 6.9% in rural areas and 4.2% in urban areas. The multilevel analysis showed that, in rural areas, fewer older adults were homebound in communities with higher civic participation and with suitable parks or pavements for walking and exercising. However, no significant association was found between community social capital or neighborhood built environment and homebound status for urban older adults. CONCLUSION: Community social capital and neighborhood built environment were significantly associated with homebound status in older adults in rural areas.

BACKGROUND: Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities. METHODS: We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors. RESULTS: We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio, 0.93; 95% CI, 0.92-0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality. CONCLUSION: Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.

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)

AIM: Currently, there is little evidence on the relationship between laughter and the risk of dementia, and since laughter is mainly a social behavior, we aimed to examine the association between various occasions for laughter and the risk of dementia in Japanese older adults. METHODS: We draw upon 6-year follow-up data from the Japan Gerontological Evaluation Study, including 12 165 independent older adults aged 65 years or over. Occasions for laughter were assessed using a questionnaire, while dementia was diagnosed using the standardized dementia scale of the long-term care insurance system in Japan. Cox proportional hazards models were estimated, yielding hazard ratios and 95% confidence intervals (CIs). RESULTS: The multivariable hazard ratio of dementia incidence for all participants in the groups for high versus low variety of occasions for laughter was 0.84 (95% CI: 0.72-0.98, P for trend <0.001). A greater variety of occasions for laughter was associated with a lower risk of dementia 0.78 (95% CI: 0.63-0.96, P for trend <0.001) among women, but was less pronounced for men, with significant associations only for the medium group. Laughing during conversations with friends, communicating with children or grandchildren, and listening to the radio were primarily associated with decreased risk. CONCLUSION: A greater variety of laughter occasions in individual and social settings was associated with a reduced risk of dementia. Geriatr Gerontol Int 2022; 22: 392-398.

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.

AIM: This study examined the effects of a "community-based center" intervention to prevent the onset of functional disability among residents in disaster-affected areas. METHODS: We used data from a prospective cohort study conducted from 2010 to 2016 in Iwanuma City, Japan. Participants were community-dwelling independent adults aged ≥65 years. The exposure variable was the experience of using a community-based center. The outcome variable was functional disability onset. The average treatment effect on the treated (ATET) was estimated by adjusting for possible confounders. Additional analysis stratified by sex was conducted considering the sex differences in social participation rates. RESULTS: Among 3794 participants (mean ± SD age = 72.9 ±5.3 years, 46.0% men), 196 (5.2%) used the community-based center, and 849 (22.4%) exhibited disability onset. Of those with functional disabilities, 40 (20.4%) used the community-based center, while 809 (22.5%) did not. The ATET for functional disability onset with community-based center activities across all participants were not significant (ATET: 0.51 years [95% confidence interval [CI] = -0.23; 1.27]). However, the direction of the effect of community-based center activities differed by sex (ATET: -0.14, 95% CI = -2.59; 2.31 for men [n = 18], and 0.66, 95% CI = 0.18; 1.16 for women [n = 178]). Women exhibited a 15.63% (95% CI = 3.58; 27.68) increase in the time until functional disability onset. CONCLUSIONS: The use of community-based centers was associated with a longer period without functional disability in women. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

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.

乳製品の摂取頻度・宅配利用と認知症リスク評価尺度との関連性を調べるため、2つの試験を行った。Study1では愛知県内の牛乳販売店を介して利用者7000名に調査票を配布し、回答が得られた1536名のうち65歳以上の有効回答795名を分析した。一般高齢者は日本老年学的評価研究が2019年度に実施した「健康と暮らしの調査」における、愛知県下8市町在住の65歳以上2503名のデータを用いた。Study2では宅配製品利用者向け調査回答者のみ818名を分析した。Study1では宅配利用の有無による認知症リスク、Study2では機能性素材配合乳製品の摂取頻度と認知症リスクとの関連を調べた。その結果、後期高齢者において宅配利用により機能性素材配合乳製品をほぼ毎日摂取する者では認知症リスクが低いことが明らかになった。

時間依存性交絡の対応に適した分析手法を用いて、社会参加を継続させることが高齢者の抑うつ症状に与える効果を推定した。本研究では、65歳以上の高齢者を対象としたコホート研究である日本老年学評価機構のデータを使用した。本研究は2010年にベースライン調査、2013年と2016年に追跡調査を行っており、すべての調査に回答した32748名を分析対象とした。アウトカムは2016年の抑うつ症状で、測定にはGeriatric Depression Scale短縮日本語版を用いた。その結果、分析方法によらず、社会参加はおおむね抑うつ症状が少ないことと関連していた。しかし、関連の強さは社会参加の種類によって異なり、ボランティアで大きかった。社会参加の効果の推定値は、一時点での評価を行った場合よりも二時点での継続した社会参加の効果を推定したときのほうが効果の推定値が大きかった。スポーツ組織参加は一時点でのみ参加を評価した場合は有病割合差=-0.018、有病割合比=0.93であった。ところが、「2010〜2013の二時点で参加を継続したことの」効果を推定した場合、有病割合差=-0.030、有病割合比=0.87と関連の強さは大きくなった。

Evidence-based prevention of functional disability is a pressing issue for the health among the older population, due to the rapidly global aging. This study aimed to examine the association between leisure-time activities and the risk of functional disability. In a longitudinal prospective cohort study, we recruited 50,286 Japanese men and women aged ≥ 65 years who did not have functional disability at the baseline in 2010–2011, with a median follow-up of 5.8 years. We examined the association between 24 leisure-time activities and the risk of developing functional disability. Cox proportional hazards regressions were used to examine the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for functional disability. A total of 10,631 persons (4,497 men and 6,134 women) newly developed functional disability. The number of leisure-time activities was inversely associated with the risk of functional disability. With reference to no activity, the multivariable HRs (95% CIs) were 0.89 (0.82–0.97) for one activity, 0.72 (0.67–0.78) for two to four activities, and 0.66 (0.58–0.74) for five or more activities (P for trend, <0.001) for men, and for women, the corresponding HRs were 0.84 (0.78–0.90), 0.77 (0.72–0.82), and 0.70 (0.62–0.79), (P for trend, <0.001). Further, even lower-loading leisure-time activities such as computer for men and handicrafts for women, were also associated with a reduced risk of functional disability. Our study suggests the importance of engaging in various leisure-time activities among the older population.

Evidence-based prevention of functional disability is a pressing issue for the health among the older population, due to the rapidly global aging. This study aimed to examine the association between leisure-time activities and the risk of functional disability. In a longitudinal prospective cohort study, we recruited 50,286 Japanese men and women aged ≥ 65 years who did not have functional disability at the baseline in 2010-2011, with a median follow-up of 5.8 years. We examined the association between 24 leisure-time activities and the risk of developing functional disability. Cox proportional hazards regressions were used to examine the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for functional disability. A total of 10,631 persons (4,497 men and 6,134 women) newly developed functional disability. The number of leisure-time activities was inversely associated with the risk of functional disability. With reference to no activity, the multivariable HRs (95% CIs) were 0.89 (0.82-0.97) for one activity, 0.72 (0.67-0.78) for two to four activities, and 0.66 (0.58-0.74) for five or more activities (P for trend, <0.001) for men, and for women, the corresponding HRs were 0.84 (0.78-0.90), 0.77 (0.72-0.82), and 0.70 (0.62-0.79), (P for trend, <0.001). Further, even lower-loading leisure-time activities such as computer for men and handicrafts for women, were also associated with a reduced risk of functional disability. Our study suggests the importance of engaging in various leisure-time activities among the older population.

OBJECTIVES: Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined. METHODS: Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms. RESULTS: The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated. CONCLUSION: Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Objective Although the beneficial effects of laughter are abundantly reported, the physical function that is required as a premise for laughter has not been studied. The aim of this study is to investigate the association between visual status and frequency of laughter in a population-based sample of older adults. Methods and analysis We analysed cross-sectional data of community-dwelling independent individuals aged ≥65 years (n=19 452) in Japan. The outcomes were frequency of laughter and number of opportunities to laugh. We used multivariable logistic regression analysis with multiple imputations to investigate the association between visual status and laughter. Results The number of participants who laughed almost every day was 8197 (42.1%). After adjusting for individual covariates in the multivariable logistic regression analysis with multiple imputations, visual status was found to be significantly associated with the frequency of laugher and the number of opportunities to laugh (p for trend &lt;0.01). Compare to ‘normal vision’, while excellent/very good vision was associated with increased frequency and number of opportunities to laugh (ORs: 1.72 and 1.25, respectively), poor vision decreased the frequency and number of opportunities to laugh (ORs: 0.86 and 0.87, respectively). Conclusions There is a link between visual impairment and laughter, with poor vision having a negative impact while good vision has a positive effect. Improving vision may lead to laughter promotion.

We aimed to clarify the association between social activity and the development of dementia in older adults by hearing-impaired (HI) status. We applied a community-based prospective cohort study over 6 years as part of the Japan Gerontological Evaluation Study. The study included 53,549 participants aged 65 years and older who did not require long-term care. A baseline questionnaire survey was conducted; explanatory variables included physical and social activities, and the objective variable was dementia onset assessed by standardized protocol. Cox regression models were used to calculate hazard ratios (HRs) for dementia stratified by HI status. During the follow-up period, 6013 (11.2%) participants developed dementia. Analyses revealed increased dementia risk for participants with HI who participated in the following activities less than once a month: sport groups (HR 2.17, 95% CI 1.53-3.08), hobby groups (HR 1.70, 95% CI 1.34-2.17), going out (HR 2.19, 95% CI 1.51-3.17), and meeting with friends (HR 1.27, 95% CI 1.06-1.53). HI and lack of social activity increase the risk of dementia. The study results indicate that there is an association between low social activity and the development of dementia in people with HI; the strongest associations were found for low participation in sports and hobby groups.

OBJECTIVE: the present study aimed to investigate the relationship between the frequency of eating together and the risk of weight loss in older adults. METHODS: this was a three-year follow-up prospective cohort study based on a self-reported questionnaire. We used data from the Japan Gerontological Evaluation Study (JAGES) conducted in 2016 and 2019. The participants were independent older adults aged ≥65 years in Japan. We used >5% weight loss during follow-up as the outcome variable and frequency of eating together as the explanatory variable. The relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated based on the Poisson regression model with a Huber-White sandwich estimator for standard errors, including possible confounders. RESULTS: among 56,919 participants, the mean age was 73.0 years (1SD = 5.5) at baseline, and 47.9% were male. About 15.1% (n = 8,596) of the participants experienced >5% weight loss during follow-up. The proportion of each category of the eating together frequency was 36.6% for 'every day', 10.3% for 'several times a week', 26.8% for 'several times a month', 20.5% for 'several times a year' and 5.8% for 'seldom'. Compared to 'every day', only 'several times a year (RR = 1.07, 95% CI = 1.01-1.13)' and 'seldom (RR = 1.17, 95% CI = 1.08-1.27)' were significantly associated with the increased risk of >5% weight loss. CONCLUSION: there is a temporal association between less frequent opportunities to eat together and the increased risk of weight loss among independent older adults.