近藤 克則

© 2020 The Authors Socioeconomic disadvantage is a risk factor for arthritis, but its causal relationship remains unclear. This study examined the causal relationship between socioeconomic circumstances and new-onset arthritis by taking advantage of the “natural experiment” that resulted from the Great East Japan Earthquake and Tsunami. The baseline survey was conducted in August 2010, 7 months before the disaster. Self-reported questionnaires were mailed to all eligible residents of Iwanuma City in Miyagi Prefecture. The earthquake and tsunami occurred on March 11, 2011. The follow-up survey was conducted in October 2013, as well as the gathering of information about disaster damage (housing damage and subjective deterioration of economic circumstances) and health-related information. We used a two-stage least squares instrumental variable model to analyze 2360 survivors who did not have arthrosis at baseline, of whom 95 (4.0%) developed arthritis over the 2.5-year follow-up period. We used the linear probability model for the estimations. Our results revealed that both the subjective deterioration of economic circumstances and housing damage were associated with the development of arthritis (95% confidence interval [CI], 0.08 [0.03–0.12] and 0.02 [0.01–0.04], respectively). In addition, we also found that the disruption of access to orthopedics was associated with the development of arthritis. Our findings added robust evidence of the causal relationship between worsening economic circumstances and the development of arthritis. Our study emphasized the importance of recovery as well as the establishment of the post-disaster orthopedic medical system in the aftermath of a disaster.

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(2); 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.

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BACKGROUND: This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity. DESIGN: Retrospective, observational, longitudinal study. SETTING: Acute phase hospitals. PARTICIPANTS: From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0-3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8-60 days. MAIN OUTCOME MEASURES: The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation. RESULTS: Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke. CONCLUSIONS: These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.

Restrictions on going out, meeting other people, and participating in activities during the COVID-19 (coronavirus disease-2019) pandemic may have a prolonged effect on older people. This article discusses the importance of social relationships in the health of older people based on the results of the Japan Gerontological Evaluation Study (JAGES) that has conducted nationwide longitudinal studies. We selected cohort studies of JAGES, which investigated the relationships between social relationships and health, with more than 10 000 participants and published after 2010. The results showed that having contact with others, eating with others, and participating in social activities were negatively related to incident dementia, functional disability, depression, and premature death. A minimum of weekly contact with others, eating with others, and social participation by maintaining physical distancing are needed, even during the COVID-19 pandemic. For reducing the risks of transmission of coronavirus and its negative effects on health in the future, using the internet may be beneficial. The development of technological support networks for older people may be necessary.

AIM: Weight and height are usually self-reported in population-based epidemiological surveys. While the accuracy of self-reports has been extensively studied in younger populations, less is known in older populations. We investigated the accuracy of self-reported weight, height and body mass (BMI) in an older cohort in Japan, where overweight/obesity and underweight coexist. METHODS: We used data from older Japanese adults (≥65 years) participating in the Japan Gerontological Evaluation Study in 2016 to 2017 (7357 men and 9271 women). Self-report data were linked to objective data obtained from clinical examinations. RESULTS: The mean ± standard deviation (SD) age was 74.5 ± 5.8 years, mean ± SD weight, height and BMI were 55.7 ± 10.1 kg, 156.0 ± 8.9 cm and 22.8 ± 3.1, respectively. Results showed high intraclass correlation coefficients for self-reported and measured values (0.97 for weight; 0.96 for height). While weight/height were overestimated among men (weight by 0.096 kg; height by 0.27 cm) and women (weight by 0.18 kg; height by 0.27 cm), BMI tended to be slightly underestimated (-0.034 kg/m2 for men; -0.037 kg/m2 for women). However, the absolute differences between self-reported and measured values were not negligible; people had a higher risk for both under- and overestimation of their BMI category with increasing age. Lower education predicted BMI overestimation, whereas lower income predicted BMI underestimation. CONCLUSIONS: Overall accuracy of self-reported body habitus was higher in this cohort of older Japanese compared with previous reports. Nevertheless, misclassification of BMI due to the misreporting of their weight/height was more common among the oldest-old, as well as those with lower education and income. Geriatr Gerontol Int 2020; 20: 803-810.

Japan has the highest life expectancy in the world. However, this does not guarantee an improved quality of life. There is a gap between life expectancy and healthy life expectancy. This study aimed to reveal the features of healthy life expectancy across all secondary medical areas (n= 344) in Japan and examine the relationship among healthcare resources, life expectancy, and healthy life expectancy at birth. Data were collected from Japan's population registry and long-term insurance records. Differences in healthy life expectancy by gender were calculated using the Sullivan method. Maps of healthy life expectancy were drawn up. Descriptive statistics and correlation analysis were used for analysis. The findings revealed significant regional disparities. The number of doctors and therapists, support clinics for home healthcare facilities and home-visit treatments, and dentistry expenditure per capita were positively correlated with life expectancy and healthy life expectancy (correlation coefficients > 0.2). They also revealed gender differences. Despite controlling for population density, inequalities in healthy life expectancy were observed, highlighting the need to promote social policies to reduce regional disparities. Japanese policymakers should consider optimal levels of health resources to improve life expectancy and healthy life expectancy. The geographical distribution of healthcare resources should also be reconstituted.

OBJECTIVE: To compare the change in the prevalence of social isolation from 2010 to 2016 between older populations in Japan, the most aging and socially isolated country, and England, a country known for advanced social isolation measures. METHODS: Surveys from the Japan Gerontological Evaluation Study (JAGES) and the English Longitudinal Study of Aging (ELSA) included 70,751 and 4134 participants, respectively, aged 65 years or older in 2010 and 94,228 and 4295 participants in 2016. We assessed the social isolation of respondents on a scale from 0 to 5 points based on lack of social interactions with a spouse or partner, children, relatives, or friends and nonparticipation in any organization. RESULTS: Results of two-way analysis of variance confirmed significant interactions (nation × period) in men and women aged 65-74 years and women aged 75 years or older. In JAGES, all had higher scores in 2016 compared to 2010 (1.64-1.76, 1.28-1.36, and 1.55-1.60 points, respectively). Furthermore, the proportions of those with lack of interaction with relatives increased (52.7%-58.9%, 31.5%-41.1%, and 25.2%39.2%, respectively). In ELSA, women aged 75 years or older demonstrated a significantly lower mean score in 2016 than in 2010 (1.40 vs. 1.21). No significant changes were observed in other groups. CONCLUSION: Social isolation among older adults is more severe in Japan than in England. The difference has widened, especially for women and younger older adults. This is attributed to the weakening relationships with relatives in Japan.

BACKGROUND: Existing evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status. METHODS: We performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years old were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode. RESULTS: After exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs; 95% credible intervals [CrIs]) were 1.06 (1.05-1.08) for men and 1.08 (1.04-1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs (95% CrIs) of 1.32 (1.14-1.50) for men and 1.30 (1.11-1.49) for women in England. CONCLUSIONS: Older people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.

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.

BACKGROUND: Although adverse childhood experiences (ACEs) have been linked to negative health behaviors in adulthood, few studies have investigated if the impact continues until late adulthood. We examined the association between ACEs and fruit and vegetable intake (FVI) among older adults in Japan. METHODS: Data came from the Japan Gerontological Evaluation Study (JAGES), 2013 in which 24,271 individuals aged ≥65 years participated. The number of ACEs was calculated (0, 1 and ≥2) while low FVI was defined as consuming fruit and vegetables less than once a day. A sex-stratified multilevel Poisson regression analysis was used to investigate the association between ACEs and low FVI. RESULTS: Among men, 35.4% reported at least one ACE while the corresponding figure for women was 30.6%. Compared to those without ACEs, the prevalence ratios for low FVI among those who reported ≥2 ACEs were 1.51 (95% confidence interval [CI] = 1.30-1.75) for women and 1.28 (95% CI = 1.14-1.44) for men after adjusting for age and childhood economic hardship. Although these associations were attenuated after adjusting for socio-demographic and health-related variables, the link between ACEs and low FVI remained statistically significant among women. Of the seven individual forms of ACE, psychological neglect was significantly associated with low FVI (PR = 1.16, 95% CI = 1.03-1.31) among women in the final model. CONCLUSIONS: ACEs are associated with low FVI among older Japanese adults. Our results suggest that the detrimental effect of ACEs on health behavior may stretch across the life course.

This cohort study examines the long-term trajectories of posttraumatic stress and depressive symptoms among older, community-living adults who were affected by the 2011 Great East Japan earthquake and tsunami.Question What is the persistence of mental illness symptoms among individuals affected by the 2011 Great East Japan earthquake and tsunami 5.5 years after the disaster? Findings In a cohort study of 2781 community-dwelling older adults, approximately half of the individuals who reported posttraumatic stress symptoms and depression after the disaster had recovered by 5.5 years. The overall prevalence of depression remained stable between predisaster and postdisaster data. Meaning In this study, although mental illness symptoms persisted for more than 5 years among half of disaster survivors, the community-wide prevalence of depression remained unchanged, suggesting that the community itself was resilient.Importance Posttraumatic stress symptoms (PTSS) and depressive symptoms are common among survivors of a major disaster, yet few longitudinal studies have documented their long-term persistence at the community level. Objective To examine the trajectories of PTSS and depressive symptoms for as long as 5.5 years after the 2011 Great East Japan earthquake and tsunami. Design, Setting, and Participants This cohort study used data from 2781 participants in 3 waves of the Iwanuma Study (2010, 2013, and 2016), a cohort of community-dwelling older adults (>= 65 years in August 2010) in Iwanuma, Japan, who were directly affected by the 2011 disaster. The baseline assessment of mental health predated the disaster by 7 months, and survivors were followed up for 5.5 years after the disaster. Data analysis was performed from October 2019 to February 2020. Exposures The March 11, 2011, Great East Japan earthquake and tsunami. Main Outcomes and Measures PTSS were measured by 9 questions on the Screening Questionnaire for Disaster Mental Health, while depressive symptoms were measured by 15 items on the Geriatric Depression Scale short form. Results The analytic samples for trajectories of PTSS and depressive symptoms included 2275 and 1735 respondents, respectively. In the study population at baseline, there were slightly more women (1262 of 2275 [55.5%] and 882 of 1735 [50.8%]), and most participants were aged 65 to 74 years (1533 [67.4%] and 1224 [70.5%]) and married (1664 [76.2%] and 1319 [77.7%]). Overall, there was a 13.6% (95% CI, 11.7%-15.6%) incidence of depression among individuals who did not have depression before the disaster, while a further 11.1% (95% CI, 9.8%-12.4%) reported PTSS after the disaster. By 5.5 years of follow-up, approximately half of the survivors with new depressive symptoms in 2013 (85 of 168 [50.6%]) and PTSS (147 of 253 [58.1%]) had recovered. The prevalence of depression in the community remained remarkably stable (between 504 participants [29.0%] and 506 participants [29.2%]) comparing predisaster and postdisaster data. Conclusions and Relevance In this study, mental illness symptoms persisted for more than 5 years among half of disaster survivors, but the community-wide prevalence of depression remained stable, suggesting that the community itself was resilient.

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England.

We examined prospectively whether community-level social capital can mitigate the adverse effects of natural disaster on cognitive decline in the aftermath of the 2011 Great East Japan Earthquake and Tsunami. The baseline for our natural experimental study was established seven months before the disaster in a survey of older community-dwelling adults who lived in Iwanuma City, Japan, located 80 km west of the epicenter. Two and a half years after the disaster, we conducted a follow-up survey of survivors to gather information about their personal experiences during the disaster (n = 3560; 82.1% follow-up rate). Our primary outcome was the level of cognitive disability (measured on an 8-level scale) assessed within people's homes. Factor analysis established two subscales of community social capital: a cognitive dimension (perceptions of community social cohesion) and a structural dimension (informal socializing and social participation). The prevalence of cognitive decline at follow-up (11.5%) was three times higher than at baseline (4.2%). Our multiple membership multilevel model indicated that pre-versus post-disaster increases in community-level informal socializing and social participation were associated with lower risk of cognitive decline (coefficient = -0.12, 95% confidence interval: -0.20 to -0.04). In addition, social capital mitigated the risk of cognitive decline due to housing damage (interaction effect coefficient = -0.07, 95% confidence interval: -0.14 to -0.01). Community-level informal socializing and social participation buffers the impact of housing damage on cognitive decline in the aftermath of natural disaster. Relocating residents together with other community members may help to preserve community social capital and improve the cognitive resilience of older survivors.

AIM: To examine whether patterns of social participation vary in their associations with functional disability. METHODS: Data from 44 978 participants (22 750 men and 22 228 women) who participated in the 2010 Japan Gerontological Evaluation Study were analyzed; a study of those aged ≥65 years from 23 municipalities in eight prefectures. Social participation information was obtained at baseline with an eight-item questionnaire. Incidence of functional disability from 2010 to 2013 was defined as a new certification of eligibility for municipal public long-term care insurance. Social participation patterns were analyzed using exploratory factor analysis and participants were classified into quartiles of factor scores of social participation patterns. A competing risk model was used to calculate the hazard ratios and 95% confidence intervals for the incidence of functional disability in 3 years of follow-up. RESULTS: Two social patterns were identified: sports groups/clubs and hobby groups, and political groups/organizations and industry/trade associations. For both patterns, compared with participants in the lowest quartile, participants in the highest quartile were more likely to be male, college educated, high-income and current drinkers. Both patterns were associated with reduced incidence of functional disability (adjusted hazard ratios for top quartile of sports and hobby pattern: 0.66, 95% confidence interval: 0.59, 0.74; for political and industry/trade pattern: 0.81, 95% confidence interval: 0.72, 0.90; P for trend <0.001 for both). CONCLUSIONS: Those whose social participation patterns were characterized by frequent participation in sports groups/clubs and hobby groups or political groups/organizations and industry/trade associations were less likely to develop a functional disability. Geriatr Gerontol Int 2020; ••: ••-••.

BACKGROUND: Poor cooking skills have been linked to unhealthy diets. However, limited research has examined associations of cooking skills with older adults' health outcomes. We examined whether cooking skills were associated with dietary behaviors and body weight among older people in Japan. METHODS: We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study, a self-report, population-based questionnaire study of men (n = 9143) and women (n = 10,595) aged ≥65 years. The cooking skills scale, which comprises seven items with good reliability, was modified for use in Japan. We calculated adjusted relative risk ratios of unhealthy dietary behaviors (low frequency of home cooking, vegetable/fruit intake; high frequency of eating outside the home) using logistic or Poisson regression, and relative risk ratios of obesity and underweight using multinomial logistic regression. RESULTS: Women had higher levels of cooking skills, compared with men. Women with a moderate to low level of cooking skills were 3.35 (95% confidence interval [CI]: 2.87-3.92) times more likely to have a lower frequency of home cooking and 1.61 (95% CI: 1.36-1.91) times more likely to have a lower frequency of vegetable/fruit intake, compared with women with a high level of cooking skills. Men with a low level of cooking skills were 2.56 (95% CI: 2.36-2.77) times more likely to have a lower frequency of home cooking and 1.43 (95% CI: 1.06-1.92) times more likely to be underweight, compared with men with a high level of cooking skills. Among men in charge of meals, those with a low level of cooking skills were 7.85 (95% CI: 6.04-10.21) times more likely to have a lower frequency of home cooking, 2.28 (95% CI: 1.36-3.82) times more likely to have a higher frequency of eating outside the home, and 2.79 (95% CI: 1.45-5.36) times more likely to be underweight, compared with men with a high level of cooking skills. Cooking skills were unassociated with obesity. CONCLUSIONS: A low level of cooking skills was associated with unhealthy dietary behaviors and underweight, especially among men in charge of meals. Research on improving cooking skills among older adults is needed.

OBJECTIVE: Second-hand smoke (SHS) is considered a risk factor for a number of oral diseases. However, its influence on tooth loss, which is the final consequence of periodontal disease and caries, remains unknown. We aimed to evaluate the association between SHS experience and the number of remaining teeth among non-smoking older Japanese individuals. METHODS: Cross-sectional data from the Japan Gerontological Evaluation Study (JAGES) 2013 were used. From the 27,561 people ≥65 years of age who responded to a self-reported questionnaire (response rate = 71.1%), data of 18,865 respondents who had never smoked were analysed. Multinomial logistic regression with multiple imputations was applied to estimate the odds ratio of the frequency of SHS exposures on the number of remaining teeth. RESULTS: The prevalence of participants with ≥20 teeth, 10-19 teeth, 5-9 teeth, 1-4 teeth, and no teeth were 53.2%, 20.4%, 9.9%, 6.6%, and 9.9%, respectively. The proportion of participants with SHS was 37.5%. After adjusting for sex, the SHS experience tended to be associated with a lower risk of having the fewer number of remaining teeth (P < 0.05). However, after being adjusted for age and sex, participants with SHS exposure at "a few times a week" and "almost every day" were significantly associated with the fewer number of teeth. After adding all other covariates, compared to the participants without any exposure to SHS, the odds ratio for having no teeth rather than having ≥20 teeth among the participants with daily exposure to SHS was 1.35 (P < 0.01). CONCLUSION: Daily second-hand smoke was significantly associated with fewer remaining teeth based on the self-reported survey among older Japanese people.

During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population aged 65 years and above to approximately 28%. This study aimed to examine the changes in major health-related measures including physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, the present study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, BMI, walking speed, grip strength, and instrumental ADL, between 2007 (± 2 years) and 2017 (± 2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of the present study indicate that the phenomenon of "rejuvenation" is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be re-acknowledged.