近藤 克則

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.

Sports group participation may have greater effects on health outcomes than exercising alone. Unhealthy lifestyles were reported to be specifically associated with lower socioeconomic positions (SEPs), and child poverty and the bipolarization of sports participation are currently major policy concerns in children. However, it remains unclear whether childhood SEP has any long-latency effect on sports group participation among older Japanese. Data were obtained from the Japan Gerontological Evaluation Study 2010 project, which used self-report questionnaires to survey individuals aged ≥65 years without disability from 27 municipalities (n = 23,320). According to their answers, respondents were assigned to one of three SEP groups: high, middle, or low. Poisson regression with robust variance and multiple imputations was used to examine the association between childhood SEP and sports group participation. After adjusting for health-related factors, low childhood SEP was negatively associated with sports group participation in men (prevalence ratio [PR] = 0.82, 95% confidence interval [CI] = 0.74-0.91) and women (PR = 0.88, 95% CI = 0.80-0.97). The PR was greatly attenuated after adjusting for educational attainment in both men (PR = 0.92, 95% CI = 0.83-1.02) and women (PR = 0.98, 95% CI = 0.89-1.08), and the significant association disappeared. Low childhood SEP is thus associated with lower sports group participation among older Japanese, though this may be attenuated by education. These findings suggest that it may be necessary to consider childhood SEP and the importance of education to increase sports group participation at an older age.

BACKGROUND: While laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan. METHODS: The data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥ 65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1-5 days/week, 1-3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model. RESULTS: During follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (p for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (p for trend = 0.39). CONCLUSIONS: Low frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.

The strength of social connections in the community ("social capital") is hypothesized to be a crucial ingredient in disaster resilience. We examined whether community-level social capital is correlated with the ability to maintain functional capacity among older residents who experienced the 2011 Great East Japan Earthquake and Tsunami. The baseline of our cohort (mean age 74 years) was established in 2010, seven months before the disaster in Iwanuma, a Japanese city located 80-km from the epicenter. Disaster related personal experiences (e.g., housing damage/relocation) were assessed through a follow-up survey (n=3594; follow-up rate: 82.1%) conducted in 2013, two and a half years after the earthquake. Multiple membership multilevel models were used to evaluate the associations between functional capacity - measured by the Instrumental Activities of Daily Living scale - and three sub-scales of community-level social capital; social cohesion, social participation, and reciprocity. Community-level social participation was associated with a lower risk of functional decline after disaster exposure. The average level of social participation in the community also mitigated the adverse impact of housing damage on functional status, suggesting a buffering mechanism.

Rationale: Population aging in Japan has been accompanied by increases in those with visual impairment. No previous study has examined whether visual impairment is associated with reduced social participation in older people in Japan.Methods: In this cross-sectional study, questionnaires were mailed to older people living in 39 Japanese communities in 2016. Data from 24,313 respondents (70.3%, 74.0 +/- 6.2 years) included information on visual status, social participation, socioeconomic status, and health. Visual status was measured by self-report (excellent, very good, good, or fair/poor).Results: The prevalence of visual impairment (fair/poor) was 9.3%. After adjusting for individual covariates in multinominal logistic regression analysis with multiple imputations, visual status was significantly associated with reduced participation (once a week or more) in volunteer groups, sports groups, hobby groups, neighborhood associations, study/cultural groups, health promotion groups, and involvement in teaching skills/ passing on experiences to others (p for trend < 0.01). On the other hand, participation in senior citizen clubs was not associated with visual status (p for trend = 0.07). While excellent/very good vision was associated with increased volunteerism (e.g., involvement in teaching skills/passing on experiences to others: Odds ratios (OR) 1.78/1.21), poor vision disrupted participation in activities that require physical activity (e.g., sports groups: OR 0.64).Conclusion: These results suggest that vision status is an important determinant of social participation among older adults in Japan.

OBJECTIVES: Income inequalities in access to dental care have been reported worldwide. While geographical accessibility may affect inequalities, no study has examined whether the use of public transportation reduces income inequalities in access to dental care. Therefore, we examined whether the use of public transportation is associated with reduced income inequalities in access to dental care. METHODS: This cross-sectional study used data from the Japan Gerontological Evaluation Study conducted in 2016. Self-reported questionnaires were distributed to 34 567 community-dwelling independent older adults aged 65 years or over from 39 municipalities. The dependent variable was dental attendance for any treatment. The independent variables were daily public transportation use and household equivalent income. The covariates were age, years of education, marital status, self-rated health, number of teeth, car use, having bus stops or railway stations nearby for individual level and density of dental clinics for community level. After multiple imputation, a two-level linear regression analysis was performed and stratified by sex. RESULTS: The mean age of the 19 664 participants (response rate: 69.9%) was 73.8 years (standard deviation = 6.1). Among the participants with dental attendance for treatment in the past six months, daily public transportation users represented 45.5% of men and 56.1% of women. These users had higher levels of dental attendance for treatment (β = .109, 95% confidence interval (CI) = 0.051-0.166 for men, β = .094, 95% CI = 0.039-0.149 for women) than nondaily users. Household equivalent income was positively associated with higher dental attendance for treatment (β = .046, 95% CI = 0.029-0.062 for men, β = .029, 95% CI = 0.013-0.045 for women). Income inequalities in access to dental care were smaller among the daily public transportation users than in nondaily users, and a statistically significant interaction was observed only in men (P-value interactions = .025 for men, .188 for women). CONCLUSION: Income inequalities in access to dental care were smaller among older daily users of public transportation than in nondaily users. These results suggest that providing environment in which people can conveniently use public transportation is needed for reducing income inequalities in access to dental care, especially for men.

Levels of social capital can change after a natural disaster; thus far, no study has examined how changes in social capital affect the mental health of disaster victims. This study examined how pre-disaster social capital and its changes after a disaster were associated with the onset of mental disorders. In October 2013, we mailed a questionnaire to participants of the Japan Gerontological Evaluation Study living in Mifune town (Kumamoto, Japan) and measured pre-disaster social capital. In April 2016, the Kumamoto earthquake struck the region. Three years after the baseline survey, post-disaster social capital and symptoms of mental disorders were measured using the Screening Questionnaire for Disaster Mental Health (SQD) (n = 828). A multiple Poisson regression indicated that a standard deviation of 1 in pre-disaster social cohesion at community-level reduced the risk of depression (relative risk [RR] = 0.44); a decline in social capital after the disaster elevated the risk among women (RR = 2.44). In contrast to social cohesion, high levels of social participation at community-level were positively associated with the risk of depression among women. Policymakers should pay attention to gender differences and the types of social capital when leveraging social capital for recovery from disasters.

Consumption of green tea without sugar, as well as social networks, are associated with a lower risk of tooth loss. There is a possibility of confounding both factors because tea is often drunk with friends. Therefore, the present study aimed to examine whether green tea consumption is beneficially associated with the number of remaining teeth, while considering social networks. This cross-sectional study was based on the Japan Gerontological Evaluation Study (JAGES) in 2016. Self-administered questionnaires containing questions about green tea consumption were mailed to 34,567 community-dwelling residents aged ≥ 65 years. We used the number of remaining teeth as a dependent variable, and green tea consumption and the number of friends met over the past month (social network size) as independent variables. Linear regression models with multiple imputation were used. A total of 24,147 people responded (response rate = 69.9%), and 22,278 valid data were included into our analysis. Participants' mean age was 74.2 years (standard deviation = 6.3), and 45.9% were men. Among the participants, 52.2% had ≥ 20 teeth, 34.2% drank 2-3 cups of green tea per day, and 32.6% met ≥ 10 people over the past month. After adjusting for all potential confounders, both higher green tea consumption and a larger social network size were associated with more remaining teeth (both p for trend < 0.001). The association of green tea was greater among those with smaller social networks (p for interaction < 0.05). The protective association of green tea was remarkable among people with smaller social networks.

Poor sleep is associated with lifestyle, however, few studies have addressed the association between sleep quality and the neighborhood environment. This study aimed to investigate the associations between living environment factors and sleep quality in older people. Participants were community-dwelling people aged ≥65 years who participated in the 2010 Japanese Gerontological Evaluation Study. The data of 16,650 people (8102 men, 8548 women) were analyzed. Sleep quality (good or poor) was evaluated using a self-administered questionnaire. Multilevel Poisson regression analysis stratified by depressive status (measured by the Geriatric Depression Scale-15 [GDS]) was conducted with sleep quality as the dependent variable and social and physical environmental factors as explanatory variables. The 12,469 non-depressive respondents and 4181 depressive respondents were evaluated. The regression analysis indicated that non-depressive participants slept better if they lived in environments with few hills or steps (prevalence ratio [PR] = 0.75, 95% CI: 0.56-0.9) and with places where they felt free to drop in (PR = 0.51, 95% CI: 0.26-0.98). For depressive participants, these associations were not evident. Living alone, poor self-rated health, low income, and unemployment were associated with poor sleep quality. In addition to support with these individual factors, improving environmental factors at the neighborhood level may improve the sleep quality of community-dwelling older adults.

Importance: The prevalence of dementia in Japan has been increasing. Childhood poverty has been associated with increased risk of cognitive impairment, possibly mediated by individuals' educational paths. However, the associations between dementia and adverse childhood experiences other than poverty and education have not been well documented. Objective: To examine the association between adverse childhood experiences and dementia onset among Japanese individuals born before 1948 who grew up during and after World War II. Design, Setting, and Participants: A 3-year (2013-2016) follow-up was performed of 17 412 participants in the Japan Gerontological Evaluation Study, a population-based cohort study of adults aged 65 years or older. Data were analyzed in December 2019. Main Outcomes and Measures: Dementia onset was assessed through the public long-term care insurance system. Adverse childhood experiences before the age of 18 years were assessed by survey at baseline. Seven adverse childhood experiences were assessed: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Participants were classified according to whether they had 0, 1, 2, or 3 or more adverse childhood experiences. Cox regression models were used to estimate hazard ratios for the risk of dementia. Results: Among 17 412 participants (9281 women [53.3%]; mean [SD] age, 73.5 [6.0] years), dementia occurred in 703 participants (312 men and 391 women) during a mean follow-up of 3.2 years (range, 2.4-3.3 years). Among all participants, 6804 (39.1%) were older than 75 years; 10 968 (63.0%) reported 0 adverse childhood experiences, 5129 (29.5%) reported 1 adverse childhood experience, 964 (5.5%) reported 2 adverse childhood experiences, and 351 (2.0%) reported 3 or more adverse childhood experiences. Participants who experienced 3 or more adverse childhood experiences had a greater risk of developing dementia compared with those who grew up without adverse childhood experiences, after adjustment for age, sex, childhood economic hardship, nutritional environment, and education (hazard ratio, 2.18; 95% CI, 1.42-3.35). After successive adjustment for adult sociodemographic characteristics, social relationships, health behavior, and health status, this hazard ratio was attenuated but remained statistically significant (1.78; 95% CI, 1.15-2.75; P = .009). Conclusions and Relevance: This study found that having 3 or more adverse childhood experiences was associated with increased dementia risk among older Japanese adults.

This study compared the relationship between social participation, including work, and incidence of functional decline in rural and urban older people in Japan, by focusing on the number and types of organizations older people participated in. The longitudinal data of the Japan Gerontological Evaluation Study (JAGES) that followed 55,243 individuals aged 65 years or older for six years were used. The Cox proportional hazards model was employed to calculate the hazard ratio (HR) of the incidence of functional decline over six years and the stratification of rural and urban settings. In this model, we adjusted 13 variables as behavioral, psychosocial, and functional confounders. The more rural and urban older people participated in various organizations, the more they were protected from functional decline. Participation in sports (HR: rural = 0.79; urban = 0.83), hobby groups (HR: rural = 0.76; urban = 0.90), and work (HR: rural = 0.83; urban = 0.80) significantly protected against the incidence of decline in both rural and urban areas. For both rural and urban older people, promoting social participation, such as sports and hobby groups and employment support, seemed to be an important aspect of public health policies that would prevent functional decline.

Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = -0.39; 95% confidence interval: -0.72, -0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.

© 2020 Elsevier Ltd Few studies have tracked the long-term mental health outcomes following major disaster. We sought to document the trajectories of depressive symptoms and post-traumatic stress symptoms (PTSS) in the aftermath of the 2011 Great East Japan earthquake and tsunami. A cohort of community-dwelling older adults were followed for 5.5 years after the disaster at 3 waves (2010, 2013 and 2016). Depressive symptoms were measured by the Geriatric Depression Scale Short Form, while PTSS was assessed by the Screening Questionnaire for Disaster Mental Health. We examined the trajectories of mental illness symptoms based on the probabilities of persistence, recovery, and delayed onset. Among people without pre-disaster depressive symptoms, 13.6% had developed depressive symptoms 2.5 years after the disaster. Of these, half of those had recovered and half had persisted at the 5.5 year follow-up. 11.1% of survivors reported post-traumatic stress symptoms in 2013; of these, 58% recovered by 2016, while 4.8% experienced delayed onset. Job loss was associated with persistent PTSS (OR 2.03; 95%CI 1.01–4.12) while a drop in subjective economic status predicted delayed onset of PTSS (OR 2.13; 1.34–3.39). However, disaster-related experiences were unrelated to the trajectory of depressive symptoms at 5.5 years. The probabilities of remission (58%) and delayed onset (5%) of PTSS are consistent with prior disaster research. The experience of job loss and drop in subjective economic status appeared to exert a lingering influence on the persistence or delayed onset of PTSS. Depressive symptoms after the disaster had remitted in roughly half of the survivors after 5.5 years.

The World Health Organization (WHO) argues that governments can postpone declining capacity of older adults by providing sufficient support. Yet, to our knowledge, no study has focused on the role of local governments for realizing healthy ageing. This study examined the association between the intensity of community-based programs for frailty postponement by long-term care insurers (as municipalities) and the likelihood of frailty. We analyzed repeated cross-sectional data of three waves (2010-11, 2013, and 2016) from the Japan Gerontological Evaluation Study (JAGES). Participants included 375,400 older adults aged 65 years or older (M = 74.1) living in a total of 81 regions covered by insurers in Japan. Frailty was assessed by a governmental standardized index, the Kihon Check List (KCL; a basic function check list in Japanese). Estimations were obtained using a multilevel logistic model with random slopes. We found that every social activity per hundred older people organized by a long-term care insurer was significantly associated with an 11% reduction of the likelihood of frailty (Odds ratio = 0.89; 95% credible interval = 0.81, 0.99). Although the main effect of educational events was not significant, the point estimate was slightly larger for people with lower levels of education than for those with higher education. The results also suggested that insurer-organized social activities could be more beneficial in communities with few opportunities for civic participation. The variation in intensity of community-based programs by long-term care insurers may explain part of a disparity in the likelihood of frailty between municipalities.

<p>大震災の支援に当たった専門家による研究成果と経験に基づき，災害時のメンタルヘルスと自殺予防に資する留意点についてまとめた。</p><p>支援の対象と支援方法の重点は，被災からの時期・段階によって変化する。とくに被災による避難時と避難指示解除時はともに留意が必要である。対象のセグメンテーションを行い，必要な支援を必要なタイミングで届ける必要がある。</p><p>真に支援が必要な対象やテーマは表出されない場合があることに留意する。震災後に生まれた子どもや母親の被害，高齢者の認知症リスクも増えることが観察されている。被災者だけではなく，その支援を行う自治体職員や保健医療福祉職員のメンタルヘルスにも配慮する必要がある。避難地区だけでなく避難指示解除地区においても自殺率が高いという知見も得られている。</p><p>教育や就労支援，社会的役割やサポートまで，総合的・長期的な支援が必要で，保健医療関係者だけではない分野横断的なネットワークの構築が平時から必要である。</p><p>危機的な状況であるほど，なじんだ手段しか使えない。平時からの教育・訓練・ネットワーク化で被害の緩和を図っていく必要がある。</p>

© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health Objectives: Very few longitudinal studies have investigated the question of whether differences in company size may give rise to health inequalities. The aim of this study was to examine the relationship between company size of the longest-held job and mortality in older Japanese adults. Methods: This study used longitudinal data from the Japan Gerontological Evaluation Study. Surveys were sent to functionally independent individuals aged 65 or older who were randomly sampled from 13 municipalities in Japan. Respondents were followed for a maximum of 6.6 years. The Cox proportional hazards model was used to calculate mortality hazard ratios (HRs) for men and for women. Analysis was carried out on 35 418 participants (197 514 person-years). Results: A total of 3935 deaths occurred during the 6-year follow-up period. Among men, in Model 1 that adjusted for age, educational attainment, type of longest-held job, and municipalities, mortality HRs decreased significantly with increasing size of company (P for trend =.002). Compared to companies with 1-9 employees, the mortality HR (0.78, 95% confidence interval: 0.68-0.90) was significantly lower for companies with 10 000 or more employees. However, there were no significant differences among women (P for trend =.41). Conclusions: In men, mortality in old age may decrease with increasing size of company of the longest-held job. To reduce health inequalities in old age due to differences in size of company, studies should be conducted to determine the underlying mechanisms and moderating factors and those findings should be reflected in labor policies and occupational health systems.

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.

We examined whether pre-disaster social support functions as a disaster preparedness resource to mitigate post-disaster depressive symptoms among older survivors of the 2011 Great East Japan earthquake and tsunami. The participants were 3,567 individuals aged ≥65 years living in Iwanuma city who completed a baseline survey as part of the nationwide Japan Gerontological Evaluation Study seven months before the disaster. A follow-up survey was administered approximately 2.5 years after the disaster. The analysis included a total of 2,293 participants, and social support (giving and receiving emotional & instrumental help) before the disaster was measured using four items. Depressive symptoms were assessed using the GDS with a cut-off score of 4/5 (not depressed/depressed). We discovered that participants who gave and received emotional and instrumental support before the disaster were significantly less likely to develop depressive symptoms after the disaster compared to those without support (ARR = 0.70; 95% CI: 0.56-0.88). The risk of the onset of depressive symptoms was 1.34 (95% CI: 1.03-1.74) among those who experienced disaster damages but had also given and received social support, and 1.70 (95% CI: 1.03-2.76) among those who experienced damages but lacked support. Strengthening social aid may help cultivate psychological resilience to disasters.

Depression is considered the primary risk factor for older people's suicide. When considering suicide measures, it is necessary to clarify the relationship between depressive symptoms, social capital, and suicide rates. Therefore, we aimed to clarify the relationship between community-level social capital, depressive symptoms, and suicide rates among older people in Japan. We analyzed the data gathered from 63,026 men and 72,268 women aged 65 years and older, totaling 135,294 subjects in 81 municipalities with a population of over 100,000 participants in the 2013 Sixth Long-Term Care Needs Survey and another survey conducted by Japan Gerontological Evaluation Study (JAGES) in 2013 including the same question items as the survey in Japan. Multiple regression analysis revealed that the male suicide standardized mortality ratio (SMR) was positively correlated with depressive symptoms (B = 2.318, p = 0.002), and received emotional support (B = -2.622, p = 0.014) had a negative correlation with the male suicide SMR. In older males particularly, the received emotional support in the community was independently associated with the suicide rate. Therefore, fostering social support in a community could act as a countermeasure to suicide among older males in Japan.

BACKGROUND: While bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan. METHODS: We used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 through January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into three groups: low frequency (0-2 times/week), moderate frequency (3-6 times/week), and high frequency (≥7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model. RESULTS: Functional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios of the moderate- and high-frequency groups were 0.91 (95% confidence interval [CI], 0.75-1.10) and 0.72 (95% CI, 0.60-0.85) for summer and 0.90 (95% CI, 0.76-1.07) and 0.71 (95% CI, 0.60-0.84) for winter. CONCLUSION: High tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people's health.

Importance: Depression and posttraumatic stress disorder (PTSD) represent 2 common mental health sequelae of natural disasters. However, to date, no studies have examined whether postdisaster depression and PTSD are associated with increased risk of mortality among community-dwelling survivors of natural disasters. Objective: To assess whether postdisaster depression and PTSD were associated with mortality in older disaster survivors. Design, Setting, and Participants: In this cohort study, prospective data were retrieved from older Japanese adults in Iwanuma City, Miyagi Prefecture, which was directly affected by the 2011 Great East Japan Earthquake and Tsunami. The baseline was established 7 months before the disaster (August 2010), and follow-up surveys were conducted approximately 2.5 years afterward (October 1, 2013, to January 31, 2014). Invitations were mailed to every citizen 65 years or older in Iwanuma City. Mortality data were obtained through March 4, 2017. Data analysis was performed from December 1, 2018, to June 30, 2019. Exposures: Postdisaster depression (Geriatric Depression Scale Short Form score ≥5) and PTSD (Screening Questionnaire for Disaster Mental Health PTSD subscale score ≥4) were measured in 2013. Main Outcomes and Measures: Mortality data were obtained by linkage to the national long-term care insurance database. Cox proportional hazards regression models were adjusted for predisaster sociodemographic characteristics, health behaviors, social cohesion, predisaster depression, and disaster experiences. Results: The response rate for the baseline survey was 59.0% (5058 of 8567 individuals), and the follow-up rate was 82.1% (3594 of 4380 eligible respondents). A total of 2965 individuals (mean [SD] age, 73.4 [6.2] years; 1621 [54.7%] female) participated in the study. The mean (SD) follow-up since the 2013 survey was 3.3 (0.5) years. Overall, 974 (32.8%) reported postdisaster depression and 747 (25.2%) reported PTSD. In adjusted models, depression was associated with more than double the risk of mortality (hazard ratio, 2.29; 95% CI, 1.54-3.42); PTSD was not associated with increased risk of mortality (hazard ratio, 1.10; 95% CI, 0.73-1.64). When evaluating the association of the 4-category comorbid depression and PTSD variable with mortality, survivors with depression only (HR, 2.24; 95% CI, 1.43-3.49) as well as those with comorbid depression and PTSD (HR, 2.54; 95% CI, 1.50-4.27) were at increased risk of death during the follow-up period compared with those with neither depression nor PTSD. Conclusions and Relevance: Depression, but not PTSD, was associated with mortality during 3.3 years of follow-up among older disaster survivors. These findings suggest that long-term mental health consequences of natural disasters may exist and that treating depression in older survivors of disasters may be beneficial.

生活習慣に着目した21世紀における国民健康づくり運動[健康日本21(第一次)]は期待したほど成果が上がらなかった。そこで、21世紀における第二次国民健康づくり運動[健康日本21(第二次)]では基本的方向として"健康格差の縮小"が掲げられ"社会環境の整備"が推し進められることとなった。社会環境の整備がどのように人々の健康によい波及効果をもたらしているのか、それが無関心層にまで及ぶことが徐々に明らかにされつつある。健康日本21(第二次)の中間評価において国や地方自治体、企業などが実施する社会環境の整備が推進していることが示されたが、今後はそれらの政策や事業を評価し、次期政策の立案・実施・評価と好循環のマネジメントサイクルが期待される。しかし、評価に必要な個人および環境両要因のデータ収集には課題が残されている。課題克服のためには健康格差縮小に向け、国、地方公共団体、地域、会社組織などが連携した取り組みを進め、介入方法と評価方法の両面でより効果的で効率的な方法の開発が期待される。(著者抄録)

OBJECTIVES: Although inequalities in dental implant use based on educational level have been reported, no study has used income as a proxy for the socioeconomic status. We examined: (i) income inequalities in implant use; and (ii) whether income or education has a stronger association with implant use in elder Japanese. METHODS: In 2016, a self-reported questionnaire was mailed to participants aged 65 years or older living across Japan as part of the ongoing Japan Gerontological Evaluation Study. We used data from 84,718 respondents having 19 or fewer teeth. After multiple imputation, multi-level logistic regression estimated the association of dental implant use with equivalised income level and years of formal education. Confounders were age, sex, and density of dental clinics in the residential area. RESULTS: 3.1% of respondents had dental implants. Percentages of dental implant use among the lowest (≤ 9 years) and highest (≥ 13 years) educational groups were 1.8 and 5.1, respectively, and among the lowest (0 < 12.2 '1,000 USD/year') and highest (≥ 59.4 '1,000 USD/year') income groups were 1.7 and 10.4, respectively. A fully adjusted model revealed that both income and education were independently associated with dental implant use. Odds ratios for implant use in the highest education and income groups were 2.13 [95% CI = 1.94-2.35] and 4.85 [95% CI = 3.78-6.22] compared with the lowest education and income groups, respectively. From a model with standardised variables, income showed slightly stronger association than education. CONCLUSION: This study reveals a public health problem that even those with the highest education but low income might have limited accessibility to dental implant services.

OBJECTIVES: Psychosocial factors are known to affect knee pain. However, the magnitude of depression on the associations between socioeconomic status (SES) and knee pain in older individuals remains unknown. This study aimed to determine (1) the associations between SES and knee pain and (2) how depression mediates the associations between SES and knee pain. MATERIALS AND METHODS: We conducted a survey across 30 Japanese municipalities to collect cross-sectional data. Functionally independent, community-dwelling adults aged 65 years or above (n=26,037) were eligible for the study. Self-reported knee pain in the past year was used as the dependent variable. Past occupation and equivalized household income were separately added to the models as independent variables. Poisson regression analysis was used to examine the associations between SES and knee pain, adjusting for covariates. Mediation analysis was applied to estimate how depression explains these associations. RESULTS: The 1-year prevalence of knee pain was 56.0% in our study population. We found that income levels were significantly associated with knee pain: the lowest income level was more prone to experience knee pain compared with the highest income level at a prevalence ratio of 1.22 (95% confidence interval, 1.15-1.28). Depression explained 36.8% of the association of income with knee pain in females and 41.9% in males. DISCUSSION: Significant socioeconomic inequalities were observed regarding knee pain among older individuals in Japan. Depression somewhat explained the association between SES and knee pain.

AIM: A rotating savings and credit association - an informal local microfinance group - provides community-dwelling older adults with cohesive social capital. This study examined whether participation in mujin, a traditional Japanese rotating savings and credit association, affected the maintenance of higher-level functional capacity in older adults. METHODS: We studied 10 991 older adults living in 24 municipalities in Japan who were aged ≥65 years, and physically and cognitively independent. We carried out a baseline survey in 2013 and a follow-up survey in 2016. Higher-level functional capacity, consisting of instrumental activities of daily living, intellectual activity and social role, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. To address potential reverse causation, we used stabilized inverse probability weights to balance characteristics at baseline between mujin participants and non-participants. RESULTS: In our analytic sample, 406 out of 10 991 older adults (3.7%) participated in mujin at the baseline. Our weighted logistic regression showed that mujin participants were more likely to maintain higher-level functional capacity (i.e. full marks in the Tokyo Metropolitan Institute of Gerontology Index of Competence) 3 years later compared with non-participants (odds ratio 1.75, 95% confidence interval 1.29-2.39). Furthermore, independent social role functioning and intellectual activity were associated with participation in mujin for an equal number of both sexes, as well as people of high social standing. CONCLUSIONS: The present study suggests that rotating savings and credit associations can help older adults maintain their independence in a higher-level functional capacity. Furthermore, the members' diversity might add to these beneficial effects. Geriatr Gerontol Int 2019; 19: 1268-1274.

BACKGROUND: Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. OBJECTIVE: This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. METHODS: We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. RESULTS: Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)]. CONCLUSIONS: Older individuals with a lower SES were less likely to recover from a pre-frailty status.

OBJECTIVES: Our study aimed to examine the longitudinal association between social participation and both mortality and the need for long-term care (LTC) simultaneously. DESIGN: A prospective cohort study with 9.4 years of follow-up. SETTING: Six Japanese municipalities. PARTICIPANTS: The participants were 15 313 people who did not qualify to receive LTC insurance at a baseline based on the data from the Aichi Gerontological Evaluation Study (AGES, 2003-2013). They received a questionnaire to measure social participation and other potential confounders. Social participation was defined as participating in at least one organisation from eight categories. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were classified into three categories at the end of the 9.4 years observational period: living without the need for LTC, living with the need for LTC and death. We estimated the adjusted OR (AOR) using multinomial logistic regression analyses with adjustment for possible confounders. RESULTS: The primary analysis included 9741 participants. Multinomial logistic regression analysis revealed that social participation was associated with a significantly lower risk of the need for LTC (AOR 0.82, 95% CI 0.69 to 0.97) or death (AOR 0.78, 95% CI 0.70 to 0.88). CONCLUSIONS: Social participation may be associated with a decreased risk of the need for LTC and mortality among elderly patients.

＜文献概要＞【背景】通いの場参加による健康保護効果の機序の一端の解明を目的に,通いの場参加後に趣味・スポーツの会など通いの場以外の社会参加も増えるのか,また健康に対する心理面の変化との関連を検討した.【方法】全国7市町の通いの場109ヶ所の参加者3,305名を対象に調査を実施した.分析には,通いの場参加後の通いの場以外の社会参加状況と健康情報,健康意識(2指標)に関する変数を用いた.【結果】回答があった者のうち(回収率90.3%),2,159名を分析対象とした.通いの場以外の社会参加について,増えた者は全体の65.2%(1,407名)であり,その9割以上で,健康情報,健康意識のすべての指標で望ましい変化が認められた(p<0.001).【結語】通いの場参加をきっかけに通いの場以外の社会参加が増えたと認識していた者は6割以上で,その該当者で健康に対する心理面に望ましい変化が認められた.通いの場参加による健康保護効果の機序には,直接的効果以外に他の社会参加の増加による間接的な効果もあることが示唆された.