近藤 克則

Dairy products formulated with bioactives are widely distributed in Japan, but it remains to be clear whether a regular consumption of these products would help reduce the risks of incidental functional disability and dementia in older adults. This study aimed to investigate Japanese subjects aged ≥65 y (n=629) that routinely consumed three functional dairy products, a calcium-enriched milk supplemented with Bifidobacterium longum BB536, a yogurt supplemented with lactoferrin, B. longum BB536 and heat-killed Lacticaseibacillus paracasei MCC1849, and a drinkable yogurt supplemented with lactoferrin, B. longum BB536 and heat-killed L. paracasei MCC1849, through a home delivery service. Intake frequency and intake duration of these functional dairy products were compared with the risk scores of incident functional disability and dementia, developed by the Japan Gerontological Evaluation Study. In the participants aged <75 y, the incident functional disability risk was significantly maintained or decreased in the participants with the long intake duration level compared with the short intake duration level (OR, 95% CI: 0.48, 0.25-0.93). In the participants aged ≥75 y, the dementia risk was significantly maintained or decreased in the participants with the high intake frequency level compared with the low intake frequency level (OR, 95% CI: 0.46, 0.22-0.95). A high intake frequency or long term duration of these functional dairy products may be effective in preventing an aging-related increase in the risks of incident functional disability and dementia in older adults, but this warrants further investigation using different products containing different bioactives.

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

Introduction: Oral frailty leads to poor nutritional status, which, in turn, leads to frailty. This cross-sectional study aimed to determine regional differences in the prevalence of oral frailty and to identify factors associated with oral frailty using 3-level multilevel models. Methods: This study comprised 165,164 participants aged ≥65 y without long-term care requirements in the Japan Gerontological Evaluation Study. The dependent variable was oral frailty, which was calculated based on age, number of teeth, difficulty in eating tough foods, and choking. The individual-level independent variables included sociodemographics, present illness, social participation, frequency of meeting friends, and social capital. The local district-level independent variable was social capital (n = 1,008) derived from exploratory factor analyses. The municipality-level independent variable was population density (n = 62). Three-level multilevel Poisson regression analysis was performed to calculate the prevalence ratios (PRs). Results: The prevalence of oral frailty in municipalities ranged from 39.9% to 77.6%. Regarding district-level factors, higher civic participation was significantly associated with a lower probability of oral frailty. At the municipality level, the PR of the rural-agricultural area was 1.17 (95% confidence interval, 1.11–1.23) (reference: metropolitan). Conclusion: These results highlight the usefulness of oral frailty prevention measures in encouraging social participation in rural areas. Knowledge Transfer Statement: The results of the present study showed regional differences in oral frailty. In particular, rural-agricultural areas show higher prevalence rates of oral frailty than those in metropolitan cities. Promoting measures of social participation among older adults may help prevent oral frailty in rural areas.

Background: Finger tapping impairment and frailty share overlapping pathophysiology and symptoms in older adults, however, the relationship between each other has not been previously studied. Objectives: To investigate how finger tapping movements correlate with frail status in older Japanese adults. Design, Setting, and Participants: Data were from a cross-sectional study called the Cognition and Activity in Rural Environment of Hokkaido Senior Survey 2018. A total of 244 community-dwelling older adults (mean age 75.3 years) were included. Measurements: Participants underwent physical examinations, gait and finger tapping tests, and completed self-administered questionnaires. Frailty was assessed using Fried’s frailty phenotype, and factor analysis was conducted to extract relevant finger tapping factors. Multinomial logistic regression was employed to analyze associations, generating adjusted odds ratios. Results: Of the participants, 18 were frail, and 145 pre-frail. Analysis identified three distinct finger tapping patterns: “Range of Motion - Nondominant Hand,” “Variability - Dominant Hand - Anti,” and “Variability - Nondominant Hand - Anti.” These patterns showed significant associations with aspects of Fried’s frailty phenotype, particularly low physical activity (P = 0.002), weakness (P = 0.003), and slowness (P = 0.004). A larger range of motion in the nondominant hand correlated with a lower frailty risk (Odds Ratio: 0.09, 95% CI: 0.02–0.46), while higher variability in the same hand increased the risk of pre-frailty (Odds Ratio: 2.19, 95% CI: 1.09–4.39). Conclusion: Finger tapping movements are significantly associated with frailty status as determined by Fried’s phenotype. The findings underscore the importance of further longitudinal studies to understand the relationship between motor function and frailty.

Abstract Objective Living a happy life is an essential issue for old adults. However, how eating with others contributes to happiness and whether this association is different by living arrangements or not is unknown. The current study examined the relationship between the frequency of eating with others and happiness among older adults according to their living arrangements using 3‐year longitudinal data. Methods The analyzed sample comprised 18,727 people (10,920 males and 7807 females) with low happiness (0–7 points on score of 0–10 points) from Japan Gerontological Evaluation Study (JAGES) in 2016. Our exposure was the frequency of eating with others: rarely, a few times a year, a few times a month, and a few times a week or more. We performed Modified Poisson Regression to examine the association between the frequency of eating with others and high happiness (8–10 points) in 2019 stratified by living arrangement (living alone/with others). Results A total of 4352 (23.2%) people showed high happiness in 2019. After adjusting for age, sex, marital status, education, household income, social participation, illnesses under treatment, and depressive symptoms in 2016, the cumulative incidence ratio (CIR) for high happiness in 2019 among people living alone was more significant, that is, 1.28 (95% confidence intervals: 0.88–1.87), 1.50 (1.05–2.14), and 1.82 (1.26–2.63), than 1.28 (1.11–1.48), 1.30 (1.12–1.50), and 1.33 (1.16–1.52) among people living with others for those who ate with others a few times a year, a few times a month, and a few times a week or more compared to those who rarely ate with others, respectively. The interaction between the frequency of eating with others and living arrangements was statistically significant. The trend test showed that higher frequency of eating with others was significantly associated with high happiness. Conclusions Eating with others was associated with improved happiness among older adults, with such an association being stronger among people living alone.

OBJECTIVES: Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes. DESIGN: Cross-sectional. SETTING: This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study. PARTICIPANTS: In total, 25,937 participants aged 65 years or older in 61 municipalities. MEASUREMENTS: Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman." RESULTS: The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes. CONCLUSIONS: Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.

本稿の目的は2つある。第一に高齢者の一日の平均歩行時間が健康に及ぼす影響を逆の因果(内生性)を考慮して明らかにすること、第二に得られた結果の政策的含意を健康政策と都市政策の2つの観点から考察することである。対象は、日本老年学的評価研究(Japan Gerontological Evaluation Study:JAGES)が2019年に実施した「健康とくらしの調査」に参加した要介護認定を受けていない65歳以上の高齢男性10,058名,女性10,601名である。被説明変数は、EQ-5D-5Lから算出した健康関連QOLスコアを用いた。内生性に対処するため、操作変数法を用いた解析を行った。操作変数として「徒歩圏内(おおむね1キロ以内)にある運動や散歩に適した公園や歩道の多さ」を用いた。その結果、平均歩行時間が30分増えると、健康関連QOLスコアは男性で0.124(0.022)点、女性で0.160(0.032)点高くなった。この結果を、健康状態として意味あるスコア差(Minimum Clinically Important Difference:MID)を考慮して、男女別に健康状態を一段上げる追加の歩行時間を試算した。さらに、健康状態を一段上げる追加の歩行時間が年間医療費に及ぼす影響についても試算した。今回の結果は、公園や歩道が整備され数が増えることで歩行時間が増える高齢者の健康への影響とも解釈できる。今後、健康を視野に入れた都市政策における歩行時間の目安として利用されるとともに将来的な医療経済評価に用いられることが期待される。(著者抄録)

本稿の目的は2つある。第一に高齢者の一日の平均歩行時間が健康に及ぼす影響を逆の因果(内生性)を考慮して明らかにすること、第二に得られた結果の政策的含意を健康政策と都市政策の2つの観点から考察することである。対象は、日本老年学的評価研究(Japan Gerontological Evaluation Study:JAGES)が2019年に実施した「健康とくらしの調査」に参加した要介護認定を受けていない65歳以上の高齢男性10,058名,女性10,601名である。被説明変数は、EQ-5D-5Lから算出した健康関連QOLスコアを用いた。内生性に対処するため、操作変数法を用いた解析を行った。操作変数として「徒歩圏内(おおむね1キロ以内)にある運動や散歩に適した公園や歩道の多さ」を用いた。その結果、平均歩行時間が30分増えると、健康関連QOLスコアは男性で0.124(0.022)点、女性で0.160(0.032)点高くなった。この結果を、健康状態として意味あるスコア差(Minimum Clinically Important Difference:MID)を考慮して、男女別に健康状態を一段上げる追加の歩行時間を試算した。さらに、健康状態を一段上げる追加の歩行時間が年間医療費に及ぼす影響についても試算した。今回の結果は、公園や歩道が整備され数が増えることで歩行時間が増える高齢者の健康への影響とも解釈できる。今後、健康を視野に入れた都市政策における歩行時間の目安として利用されるとともに将来的な医療経済評価に用いられることが期待される。(著者抄録)

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

OBJECTIVES: Poor medication adherence among older adults is a global concern as it causes adverse drug interactions and inappropriate dosing. This study aimed to assess the association between family pharmacy and medication adherence among older adults. METHODS: The Japan Gerontological Evaluation Study was a cross-sectional study of 18,792 people aged ≥65 years living in 61 municipalities in 25 prefectures who participated in a survey conducted in 2019 and did not require long-term care. Self-reported questionnaires were administered to evaluate whether the participants "always received medicines from the same pharmacy" and whether they had unused medicines. Modified Poisson regression was used to examine the association after adjusting for confounders. RESULTS: Unused medicines were present in 89.9% of the "have group" (individuals who always received their medicines from the same pharmacy). This group had a lower prevalence of unused medicines (prevalence ratio = 0.87, 95% confidence interval: 0.82-0.92) than the "none group" (individuals who did not always receive their medicines from the same pharmacy). In the stratified analysis by education level, the prevalence of unused medicines was lower among those with low levels of education (≤9 years: 0.82, 0.71-0.96; 10-12 years: 0.81, 0.74-0.88). DISCUSSION: Older adults who "always received medicines from the same pharmacy" had a lower prevalence of unused medicines, especially those with low levels of education. Thus, "always receiving medicines from the same pharmacy" may be effective in reducing the proportion of unused medicines and improving medication adherence.

PURPOSE: Laughter is expected to have health-protective effects, but the potential link between tooth loss and laughter remains unclear. Therefore, this study aimed to examine the association between tooth loss and a low frequency of laughter among older adults in Japan, to elucidate whether this association could be mitigated by dental prostheses, and to evaluate the magnitude of the association mediated by poor oral function. METHODS: We used cross-sectional data from 157,708 functionally independent participants aged ≥65 years (46.3% male) from the Japan Gerontological Evaluation Study. A modified Poisson regression model was applied to examine the association between the number of remaining teeth (≥20/10-19/0-9), dental prostheses use, and infrequent laughter (i.e., laughing never or almost never). Causal mediation analysis was performed to assess whether the association was mediated by difficulties in eating hard foods, choking, or dry mouth. RESULTS: Among the participants, 9,129 reported infrequent laughter. Participants with ≤9 and 10-19 teeth who did not use dental prostheses had a 1.29 and 1.14 times higher likelihood of infrequent laughter than those with ≥20 teeth, respectively. Furthermore, difficulty eating hard foods, choking, and dry mouth mediated 22.8%, 0.4%, and 4.3% of the association between fewer remaining teeth and infrequent laughter, respectively. Meanwhile, we did not find evidence for the differences in infrequent laughter between participants with ≤19 teeth using dental prostheses and those with ≥20 teeth. CONCLUSIONS: Tooth loss among individuals without dental prostheses was associated with infrequent laughter, and this association was mediated by poor oral function.

BACKGROUND: Poor diet can cause sleep disorders; however, this association has not been established in older populations. This study investigated the association between dietary patterns and insomnia symptoms in independent older adults. METHODS: This cross-sectional study targeted independent older Japanese adults aged ≥74 years. We used insomnia symptoms classified into three domains: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and insomnia. These symptoms were assessed as dependent variables by a self-reported questionnaire. Dietary patterns (DP), identified by principal component analysis of a self-administered diet history questionnaire, were used as independent variables. Poisson regression analysis was used to estimate the prevalence ratios and 95% confidence intervals with adjustment for potential confounders. RESULTS: Among 1,311 participants (mean age = 80.1; women, 48.5%), we identified three dietary patterns: DP1 was characterized by a high intake of vegetables, soy products, and fruits and a low intake of rice; DP2 was characterized by a high intake of fish, chicken, processed meat, and noodles and a low intake of soy products; and DP3 was characterized by a lower intake of fruits and confectionaries. Higher DP1 scores were significantly associated with a lower prevalence of DIS (p-for-trend = 0.012). A higher DP2 score was significantly associated with a higher prevalence of insomnia (p-for-trend = 0.032). There was no significant association between DP3 and insomnia symptoms (p-for-trend >0.05). CONCLUSION: Our results highlighted that a dietary pattern with a high intake of vegetables, soy products, and fruits may contribute to reducing insomnia symptoms among independent older adults.

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

We examined whether pre-disaster Sense of Coherence (SOC) mitigated the impact of housing damage on health and well-being of older survivors after the 2011 Japan Earthquake and Tsunami. A panel survey was conducted in a city located 80 km west of the epicenter seven months before and three years after the disaster (3594 respondents). Among respondents with lighter property damage, higher SOC was inversely associated with mental distress (coefficient - 0.29, 95% CI (confidence interval) - 0.39, - 0.19, p < .01), unhappiness (coefficient - 0.33, 95% CI - 0.43, - 0.23, p < .01), low expectation of mutual help (coefficient - 0.17, 95% CI - 0.27, - 0.07, p < .01), and weak community attachment (coefficient - 0.20, 95% CI - 0.30, - 0.11, p < .01). Conversely, among those who experienced housing loss, higher SOC was no longer protectively associated with health and well-being. Loss of generalized resistance resources due to serious damage led to difficulties in stress coping.

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

Abstract Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = −0.10; 95% confidence intervals (CI) = −0.13, −0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (&lt;9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

目的 健康日本21(第二次)の目標に「健康寿命の延伸と健康格差の縮小」が掲げられている。効果的・効率的な地域の健康づくりや保健活動を目指すPDCAサイクルの推進を図る国民健康保険保険者努力支援制度の事業評価が導入されたが,どのような活動が健康寿命と関連するかは明らかとなっていない。そこで,本研究は,同事業評価の各項目スコアと健康寿命との関連を明らかにすることを目的とした。方法 本研究は,健康寿命の算定の誤差が大きくなる人口1万2千人未満(2020年)の市区町村を除く1,154自治体を分析対象とした。国民健康保険保険者努力支援制度の事業評価に基づき,厚生労働省が公表した2020年度の事業評価スコア集計データを用いた。また,健康日本21の「日常生活に制限のない期間」の考え方に基づき,要介護2以上を不健康な期間とする「日常生活動作が自立している期間」を用いて,男女別に,65歳時の健康な期間の平均を算出し,これを健康寿命として用いた。市区町村の事業評価スコアを説明変数,健康寿命を目的変数,人口密度の対数・財政力指数を調整変数とし,重回帰分析を実施した。結果 男女ともに,特定健診受診率・特定保健指導実施率・メタボリックシンドローム該当者および予備群の減少率(男性:β=0.179,p<0.001,女性:β=0.155,p<0.001),重複・多剤投与者に対する取り組み(男性:β=0.076,p=0.009,女性:β=0.082,p=0.005),保険料収納率の向上(男性:β=0.211,p<0.001,女性:β=0.188,p<0.001),地域包括ケアの推進(男性:β=0.067,p=0.023,女性:β=0.093,p=0.002)の事業評価スコアが高いほど,健康寿命が有意に長い傾向がみられた。また,重症化予防の取り組み(男性:β=0.045,p=0.117,女性:β=0.099,p<0.001),第三者求償の取り組み(男性:β=0.008,p=0.782,女性:β=0.065,p=0.029)の事業評価スコアが高いほど,健康寿命が長い傾向がみられ,女性のみ有意であった。結論 特定健診受診率・特定保健指導実施率・メタボリックシンドローム該当者および予備群の減少率,重症化予防の取り組み,重複・多剤投与者に対する取り組み,保険料収納率の向上,地域包括ケアの推進,第三者求償の取り組みの事業評価スコアは,健康寿命と正の関連がみられた。今後,縦断データや個人データでの因果効果の検証が待たれる。(著者抄録)

目的 健康寿命延伸プランの主要3分野の1つに,高齢者のフレイル対策が掲げられ,その1つとして社会参加の活用が期待されている。しかし,これまでの先行研究では,社会参加の種類や数とフレイル発症との関連を縦断的に検証した報告はない。本研究では,大規模縦断データを用い,社会参加の種類や数とフレイル発生との関連について検証することを目的とした。方法 日本老年学的評価研究(Japan Gerontological Evaluation Study:JAGES)の2016年度と2019年度のパネル調査データを用いた縦断研究である。2016年度(ベースライン時点)と2019年度(追跡時)のJAGES調査に回答した高齢者から,ベースライン時点の日常生活動作の非自立者と無回答者,フレイル(基本チェックリスト8点以上/25点)とフレイル判定不能者などを除いた,28市町59,545人を分析対象とした。目的変数は追跡時のフレイル発症とし,説明変数はベースライン時点の9種類の社会参加の種類と数を用いた。調整変数には,ベースライン時点の性,年齢,等価所得,教育歴,婚姻,家族構成,就労,プレフレイル(基本チェックリスト4～7点/25点)の有無,喫煙,飲酒,都市度の11変数を用いた。多重代入法により欠損値を補完し,ポアソン回帰分析を用いて社会参加とフレイル発症との関連を検証した。結果 追跡時のフレイル発症は6,431人(10.8%)であった。多重代入法後(最小64,212人,最大64,287人)の分析の結果,老人クラブを除く8種類の社会参加先である介護予防(Risk Ratio:0.91),収入のある仕事(0.90),ボランティア(0.87),自治会(0.87),学習・教養(0.87),特技・経験の伝達(0.85),趣味(0.81),スポーツ(0.80)で,フレイル発症リスクが有意に低かった。さらに,社会参加数が多い人ほどフレイル発症リスクが有意に低かった(P for trend<0.001)。結論 社会参加とフレイル発症リスクとの関連を検証した結果,ベースライン時点で8種類の社会参加をしている人,社会参加数が多い人ほど3年後のフレイル発症リスクが低かった。健康寿命延伸に向けたフレイル対策の一環とし,社会参加の促進が有用であることが示唆された。(著者抄録)

Poor oral health has been linked to an increased risk of mortality. People with good cooking skills may be able to cope with problems caused by oral dysfunction, such as restricted food choice. This study investigated whether cooking skills modified the association between oral health status and mortality. A 3-year follow-up was conducted among participants of the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65-101 years. Oral health assessment comprised number of teeth and three oral functions (awareness of swallowing difficulty, decline in masticatory function, and dry mouth). Cooking skills were assessed using a valid scale adapted for Japanese participants. Mortality from 2016 to 2019 was analysed for 10,121 respondents. Cox regression models were used to estimate hazard ratios for mortality risk adjusting for potential confounders, including sociodemographic factors and health status. During the follow-up, there were 488 deaths (4.8% of all participants). Both fewer teeth and poor oral function were associated with a greater mortality risk. Cooking skills modified the association only for oral function. Stratification by cooking skill score showed that the hazard ratios for ≥2 oral difficulties (vs. none) was 2.06 (95% confidence interval: 1.43-2.96) among those with low cooking skills and 1.25 (95% confidence interval: 0.92-1.71) among those with high cooking skills after adjusting for potential confounders. Improving cooking skills may be key to mitigating health risks owing to poor oral functions.

OBJECTIVES: The sense of coherence refers to effectively using available resources to manage stress and promote overall health. Previous studies have linked it to various health outcomes; however, evidence regarding its association with the risk of incident dementia is limited. Hence, this study aimed to fill this research gap using data from a large-scale population survey. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: This study included 31,556 participants aged 65 years and older who were free from dementia and disabilities. The participants were enrolled in the 2010 baseline survey of the XXXX, and were followed up until the end of 2019. METHODS: The sense of coherence was assessed using a 6-item short-version questionnaire. Incident dementia cases were ascertained through the public long-term care insurance database in Japan. RESULTS: During a median follow-up of 8.3 years, 4326 incident dementia cases were identified. After adjusting for conventional risk factors, the hazard ratios (95% CIs) for each quintile compared to the lowest quintile of the sense of coherence were 0.82 (0.75-0.90), 0.75 (0.68-0.83), 0.76 (0.68-0.84), and 0.78 (0.70-0.87), respectively. The multivariable hazard ratio (95% CI) per 1-SD increment was 0.91 (0.88-0.95). These inverse associations did not exhibit any gender differences (P for gender interaction = .11) and were further confirmed after excluding early incident cases. Similar associations were found for its components; the corresponding multivariable hazard ratios (95% CIs) per 1-SD increment were 0.94 (0.91-0.97) for comprehensibility, 0.92 (0.89-0.95) for manageability, and 0.93 (0.90-0.97) for meaningfulness. CONCLUSIONS AND IMPLICATIONS: Moderate and above sense of coherence was associated with the lower risk of dementia among the older population, suggesting a beneficial role of stress management in maintaining the cognitive health of older adults.

Abstract Background and Objectives Evidence remains inadequate regarding the benefits of participation in community gathering places, which is Japan’s primary strategy for preventing functional disability in older adults, in other domains of health and well-being. This longitudinal study examined the associations of participation in community gathering places with an array of subsequent health and well-being outcomes among older adults. Research Design and Methods We used three-wave data (2013, 2016, and 2019) from Japan Gerontological Evaluation Study (n = 5,879 or 4,232 depending on the outcome). Our exposure was participation in community gathering places in 2016. We assessed 34 health/well-being outcomes in 2019 across six domains. We adjusted for pre-baseline covariates including prior outcome values in 2013. Results Compared with nonparticipation, participation in community gathering places was associated with some outcomes in the following three domains: physical/cognitive health (better higher-level functional capacity), social well-being (more frequent participation in hobby groups, senior citizens clubs, learning or cultural groups, and seeing more friends within a month), and pro-social/altruistic behaviors (more frequent participation in volunteering) (After Bonferroni correction as p &amp;lt; 0.0015, 0.05/34). Discussion and Implications Evidence was mixed and more modest for the outcomes in three other domains, mental health, psychological well-being, and health behaviors. Promoting participation in community gathering places may not only fulfill its original goal (i.e., preventing functional disability) but also enhance other domains of human well-being, potentially by increasing social interactions.

BACKGROUND: Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status. OBJECTIVE: This study examined the association between ACEs and marital status among older Japanese adults. PARTICIPANTS AND SETTING: This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan. METHODS: ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression. RESULTS: Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13-1.76) and females (RRR, 95%CI = 1.56, 1.28-1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02-1.53) and females (RRR, 95%CI = 1.41, 1.18-1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66-2.90; in females: 3.45, 2.71-4.38; p for interaction = 0.034). CONCLUSIONS: ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.

BACKGROUND: Identifying subpopulations that are particularly vulnerable to long-term adverse health consequences of disaster-related trauma is needed. We examined whether child adversities (ACEs) potentiate the association between disaster-related trauma and subsequent cognitive disability among older adult disaster survivors. METHODS: Data were from a prospective cohort study of older adults who survived the 2011 Great East Japan Earthquake. The baseline survey predated the disaster by 7 months. We included participants who completed follow-up surveys (2013 and 2016) and did not have a cognitive disability before the disaster (n=602). Disaster-related traumas (i.e., home loss, loss of friends, or pets) and ACEs were retrospectively assessed in 2013. Cognitive disability levels in 2016 were objectively assessed. RESULTS: After adjusting for pre-disaster characteristics using a machine learning-based estimation approach, home loss (0.19, 95%CI=0.09, 0.28) was, on average, associated with greater cognitive disability. Among individuals with ACEs, home loss was associated with even higher cognitive disability levels (0.64, 95%CI=0.24, 1.03). Loss of friends (0.18, 95%CI=0.05, -.32) and pets (0.13, 95%CI=0.02, 0.25) were associated with higher cognitive disability levels only among those with ACEs. CONCLUSION: Our findings suggest that individuals with a history of ACEs may be particularly vulnerable to adverse health consequences of specific disaster related.

BACKGROUND: Pneumonia is a leading cause of death worldwide. It is a particularly serious burden in older people, as they tend to have a weakened immune response. Identifying the role of oral self-care and pneumococcal vaccination in healthy, independent older people can aid pneumonia prevention among them. This study investigated the associations between oral self-care, pneumococcal vaccination, and pneumonia experience among independent older people. METHODS: This cross-sectional study used data from the 2016 Japan Gerontological Evaluation Study (JAGES). We used machine learning to examine the association between oral self-care and the experience of pneumonia over the previous year, stratified by pneumococcal vaccination. The covariates were sex, age, years of education, equivalent annual income, medical history of stroke, oral health status (choking, dryness, number of teeth), and smoking status. The analysis included 17,217 independent older people aged 65 and over. RESULTS: The prevalence of pneumonia experienced among those who brushed their teeth once or less per day was 4.5% and 5.3% for those with and those without pneumococcal vaccinations, respectively. In the unvaccinated group, the odds ratio of pneumonia experience for those who brushed their teeth once or less a day was 1.57 (95% CI 1.15-2.14) compared to those who brushed their teeth three or more times a day. By contrast, there was no significant association between the frequency of toothbrushing and the experience of pneumonia among people who received pneumococcal vaccination. CONCLUSION: Oral care influenced the experience of pneumonia among independent older people who did not receive pneumococcal vaccination.

BACKGROUND: Tooth loss is associated with reduced protein intake, which leads to sarcopenia and frailty in older adults. OBJECTIVE: To evaluate the protective effect of dental prostheses on decreased protein intake in older adults with tooth loss. METHODS: This cross-sectional study was based on a self-reported questionnaire targeting older adults. Data were obtained from the Iwanuma Survey of the Japan Gerontological Evaluation Study. We used % energy intake (%E) of total protein as the outcome and the use of dental prostheses and number of remaining teeth as explanatory variables. We estimated the controlled direct effects of tooth loss by fixing the use/non-use of dental prostheses based on a causal mediation analysis, including possible confounders. RESULTS: Among 2095 participants, the mean age was 81.1 years (1SD = 5.1), and 43.9% were men. The average protein intake was 17.4%E (1SD = 3.4) of the total energy intake. Among participants with ≥20, 10-19 and 0-9 remaining teeth, the average protein intake was 17.7%E, 17.2%E/17.4%E and 17.0%E/15.4%E (with/without a dental prosthesis), respectively. Compared to participants with ≥20 remaining teeth, those with 10-19 remaining teeth without a dental prosthesis did not have a significantly different total protein intake (p > .05). Among those with 0-9 remaining teeth without a dental prosthesis, total protein intake was significantly low (-2.31%, p < .001); however, the use of dental prostheses mitigated the association by 79.4% (p < .001). CONCLUSION: Our results suggest that prosthodontic treatment could contribute to maintaining protein intake in older adults with severe tooth loss.

日本老年学的評価研究機構の大規模な縦断コホートデータを用いて、さまざまな社会参加と要介護認定および死亡率の関連について検討した。13市町村に住む要介護認定を受けていない65歳以上の高齢者95827人のうち、最長6年間の追跡が可能であったフレイル高齢者9090人(女性5012人)を分析対象とした。参加者のうち、死亡は1770人(19.5%)に、要介護認定は1753人(19.3%)に発生した。最も参加比率が高いのは町内会(28.7%)であり、次いで趣味(23.8%)、老人クラブ(19.7%)、有償労働(17.0%)、スポーツ(11.5%)、業界団体(9.5%)、ボランティア(7.3%)であった。いずれのグループにも参加していない場合と比較して、趣味、スポーツへの参加は要介護認定発生と有意な負の関連を認め、趣味、スポーツ、老人クラブ、ボランティアも死亡率発生と有意な負の関連を認めた。社会参加による要介護認定および死亡の発生リスクの低下は健康な高齢者だけでなく、フレイル高齢者にも起こることが示唆された。

OBJECTIVES: The aim of this retrospective cohort study was to investigate the life course association between exposure to two household dysfunctions (father violence against mother and parental divorce) at childhood (≤18 years) with later number of remaining teeth (≥65 years) in functionally independent older Japanese population. This was the first study to investigate this research question in the Asian context. METHODS: The Japan Gerontological Evaluation study (JAGES) self-reported retrospective data gathered in 2013 was used (n = 21,604). Each household dysfunction was binary variable (Yes/No), while the five categories of the number of remaining teeth were ≥20, 10-19, 5-9, 1-4, and no teeth. Sex-stratified ordered logistic regression models were used to calculate the odds ratios (OR) of having fewer teeth. The models were adjusted for age, economic adversity in childhood, educational attainment, comorbidities, and smoking status. RESULTS: Overall, 46.4% were men and a total of 1149 participants (5.3%) experienced household dysfunction at childhood [men = 642 (6.4%), women = 507 (4.4%)]. The regression models showed higher OR of having fewer teeth among men who experienced a household dysfunction [OR = 1.16; 95% Confidence interval (CI) = 1.00-1.36] than men who did not. This association was not observed among women [OR = 0.94; 95% CI = 0.79-1.13]. Similar magnitude and direction of the association was observed among men but not among women when the two components of household dysfunction were used separately and aggregately as exposure variables. CONCLUSION: An exposure to a household dysfunction at childhood was associated with having fewer teeth in later life among men but not among women.

Objective Mutsuzawa town, Chiba Prefecture, relocated a "health-supportive" roadside station in 2019. The underlying hypothesis is that older people who use the roadside station will have better self-rated health than those who do not use it. We aimed to verify whether roadside station use was associated with a decrease in poor self-rated health.Method This was a longitudinal study that compared and evaluated the roadside station use and non-use groups using three-wave panel data before and after relocation of the roadside station in September 2019. To obtain three-wave panel data, self-administered questionnaires were mailed three times: in July 2018 (FY 2018) before the station was relocated and in November 2020 (FY 2020) and January 2022 (FY 2021) after the relocation in 2019. The dependent variable was poor self-rated health in FY 2021, and the independent variable was use of the roadside station as of FY 2020. Covariates included basic characteristics from FY 2018, as well as going out, social participation, and interacting on social networks in FY 2018 and FY 2020. A multivariate analysis was conducted using multiple imputation to complete missing values for the Crude model, which included the basic attributes of FY 2018 (Model 1); going out, social participation, and interacting on social networks in FY 2018 (Model 2); and going out, social participation, and interacting on social networks in FY 2020 (Model 3). The cumulative incidence rate ratio (CIRR), 95% confidence intervals, and P-values were calculated using a modified Poisson regression analysis for each model.Results Of the 576 participants, 344 (59.8%) were roadside station users. The multivariate analysis adjusted for basic attributes revealed that the number of people with poor self-rated health in the user group was significantly lower than that in the non-user group, with a CIRR of 0.67 (95% confidence interval: 0.45-0.99, P=0.043). However, the adjusted model showed a CIRR of 0.71 (95% confidence interval: 0.48-1.06, P=0.096) for going out, social participation, and interacting on social networks in FY2020 after the roadside station opened.Conclusion Findings of this study revealed that, after adjusting for confounding factors prior to relocation of the roadside station, the number of people with poor self-rated health decreased in the user group. Thus, such commercial facilities as roadside stations, which give users an opportunity to go out and meet people, can provide a "naturally healthy" environment.

Objective In Japan, measures to prevent frailty among older adults have been implemented. Promotion of social participation is a key measure, but few longitudinal studies have examined the relationship between the types and number of social participation and frailty onset. In this study, we aimed to clarify the relationship between the types and number of social participation and frailty onset using longitudinal data from a large sample of older adults in municipalities in Japan.Methods We used the 2016 and 2019 panel survey data from the Japan Gerontological Evaluation Study (JAGES). The analysis included 59,545 individuals from 28 municipalities who responded to the JAGES survey in both 2016 (at baseline) and 2019 (at follow-up). We excluded individuals who were dependent on activities of daily living at baseline and non-responders, and those who were frail or with no information about frailty. The dependent variable was frailty onset (≥8 out of 25 points on the basic checklist) at follow-up, and the independent variables were the types and number of types of social participation at baseline. We included 11 variables as potential confounders. We used multiple imputations to complete the missing values and used modified Poisson regression to examine the association between social participation and risk of frailty onset.Results Of the 59,545 participants, 6,431 (10.8%) were frail onset at follow-up. After multiple imputations (minimum 64,212, maximum 64,287), the risk of frailty onset at follow-up was lower for eight types of social participation, excluding senior citizens' clubs, (nursing care [risk ratio; 0.91], paid work [0.90], volunteer groups [0.87], neighborhood associations [0.87], learning or cultural groups [0.87], activities intended to teach skills or pass experiences to others [0.85], hobby groups [0.81], and sports groups or clubs [0.80]; P<0.05), than no social participation. Additionally, individuals who participated in more types of social participation were at a lower risk of frailty than those with no social participation (P for trend <0.001).Conclusions The risk of frailty onset was lower among individuals who participated in eight types of social participation at baseline and among those who participated in more types of social participation than those with no social participation. The results suggest that social participation is a useful measure to prevent frailty for extending healthy life expectancy.

Social integration, network, and support are beneficial to health. However, there is little evidence of the association between adverse childhood experiences (ACEs) and social integration in later life. This study investigates the association between ACE history and social integration in older people. We used data from the Japan Gerontological Evaluation Study (JAGES) 2013, which conducted a self-reported survey of functionally independent people aged ≥ 65 years from 30 municipalities across Japan and yielded information on ACE history. We conducted a Poisson regression analysis with robust error variances to assess the association between ACE history and social integration, adjusting for sex, age, childhood economic hardship, adult socioeconomic status, health status, living status, and trust in others. The number of respondents with at least one incident of ACE was approximately 36.8%. The prevalence ratios for those who reported a history of ACEs were as follows: housebound 1.495 (95% confidence interval [CI]: 1.19-1.88), small network size 1.146 (95% CI: 1.10-1.19), low network contact 1.059 (95% CI: 1.00-1.059), non-membership sports group 1.038 (95% CI: 1.00-1.07), and non-membership hobby group 1.06 (95% CI: 1.03-1.09). Among older people in Japan, a history of ACEs is inversely associated with social integration. These findings support the life course approach and suggest that adverse events in early life may have an impact on social life in old age. In order to promote healthy aging, it is important to recognize the significant impact of early-life adversities that can extend into later life.

BACKGROUND: Previous studies suggest that experience of natural disasters may heighten present bias. Research also suggests that impaired self-control (in particular, heightened present bias) could be linked to delayed-onset post-traumatic stress symptoms (PTSS) among survivors of natural disasters. We examined a hypothesis that the association between disaster experiences and delayed-onset PTSS is mediated through present bias among older survivors of the 2011 Japan earthquake and tsunami. METHODS: The baseline survey was conducted for older adults who lived in a city located 80 km west of the epicentre 7 months before the disaster. Approximately 2.5 and 8.5 years after the disaster, we surveyed older survivors to assess the trajectory of PTSS (2230 participants). We implemented analyses by three analytical groups: (1) resilient versus delayed-onset, (2) resilient versus improved and (3) resilient versus persistent. RESULTS: Logistic regression models showed that major housing damage was linked to raised present bias in all analytical groups (OR 2.47, 95% CI 1.04 to 5.87; OR 2.75, 95% CI 1.20 to 6.29; OR 2.65, 95% CI 1.15 to 6.10, respectively). The present bias, however, was significantly associated with only delayed-onset PTSS (OR 2.05, 95% CI 1.14 to 3.69). In the group of resilient versus delayed onset, housing destruction was also associated with delayed-onset PTSS (OR 2.44, 95% CI 1.11 to 5.37), and the association was attenuated by present bias (OR 2.36, 95% CI 1.07 to 5.18). CONCLUSIONS: Present bias could mediate the association between housing damage and delayed-onset PTSS among older survivors of a natural disaster.

背景・目的 医療経済学への社会的要請は高まっているが、担う人材は十分とは言えず、養成上の課題は多い。そこで医療経済学の人材養成の課題を把握し、解決策の方向を示すことを目的とした。方法 2つの調査を行った。量的調査では、主要2学会の抄録集を対象に近年10年間における医療経済学分野の研究発表数、人材数を調査した。質的調査では、国内の医療経済学分野における中堅研究者8人を対象に半構造化面接を行い、質的に分析した。結果 日本経済学会では一般演題に占める医療経済学関連の演題の割合が2000年代には2%～6%台だったが、2012年を境に8%～10%台へと増加していた。医療経済学会では、経済学系の発表者の割合が2000年代には4～7割の幅で上下していたが、2013年以降は、上昇に転じ、2015年～2016年は7割を超えていた。インタビュー調査からは、大学教育における医療経済学の課題、研究職ポストの不足、データ利用の促進の必要性、経済学系と医学系との協働の可能性の4つのカテゴリを抽出した。考察 量的・質的調査の結果、社会的ニーズの増大にもかかわらず、人材育成には課題があることが明らかになった。問題解決の方向性として1)重点的で継続的な人材養成、2)雇用ポストの創出、3)医療データの利用環境の改善促進、4)医学分野と経済学分野との協働の場の創設の4つが重要と考えられた。(著者抄録)