近藤 克則

OBJECTIVES: We examined long-term trajectories of depressive symptoms among older adults following exposure to the 2011 Great East Japan Earthquake and Tsunami. We further characterized the pre- and post-disaster social relationship factors that predicted membership in each trajectory group. METHOD: Data from four time points (including pre-disaster data) were used to analyze the depression trajectories of 2,033 survivors through a group-based trajectory model. Multinomial logistic analysis was used to investigate the social relationship factors (i.e., social interactions with neighbors, social support, social participation, and social cohesion) that predicted membership to each trajectory group. RESULTS: Five distinct trajectories of depressive symptoms were identified; stably not depressed (12.4%), increased after the disaster (14.2%), decreased after the disaster (8.8%), persistent mild depressive symptoms (28.1%) and persistent severe depressive symptoms (36.5%). Compared to those who were stably not depressed, those who experienced an increase in symptoms were more likely to experience housing damage and not to participate in social activities. Compared to those who were stably mildly depressed, those who experienced a decrease in symptoms had higher pre-disaster social interactions with neighbors as well as higher post-disaster social support. Adults with persistent severe symptoms were physically, psychologically, and socially vulnerable preceding the disaster. DISCUSSION: The study revealed the heterogeneity of older adults experiencing depressive symptoms in the wake of major disaster. Those who experienced increased symptoms after the disaster showed a chronic rather than temporary rise, while those with pre-disaster depressive symptoms showed sustained symptoms regardless of disaster-related trauma.

Abstract Background Older adults who experience falls are at a high risk of injury and death and require long-term care. Notably, the risk of falls varies among different neighborhood environments. No prior longitudinal studies have examined the association between falls and neighborhood environment at the community level. Identifying such associations will help prevent people falling by improving their neighborhood environment. Herein, we aimed to identify neighborhood environmental factors associated with falls among older adults in Japan. Methods We analyzed the data of 27,346 older adults living in 416 communities who participated in the 2010, 2013, and 2016 Japan Gerontological Evaluation Study surveys. The dependent variable was the occurrence of falls in 2016, and the explanatory variables were the mean scores of each of eight community-level neighborhood environment variables, categorized into tertiles (high, middle, and low groups) in 2013. Our model was adjusted for covariates (e.g., sex, age, and socioeconomic status) using the variables from 2010. A multilevel Poisson regression analysis was performed to obtain the relative risk (RR) and 95% confidence interval (CI) between the neighborhood environment and falls. Missing variable values were supplemented by multiple imputations. Results Older adults living in neighborhood environments with more parks or foot paths suitable for exercise or walking had a lower risk of falling after 3 years compared to those living in neighborhood environments with fewer parks or foot paths (RR: 0.89; CI: 0.80-0.99). For the variable ‘locations difficult for walking, such as hills or steps’, older adults in the middle group had a lower risk of falling than those in the low group (RR: 0.94; CI: 0.88-0.99). Conclusions Parks or foot paths are important environmental improvements that may prevent falls. Having hills or steps in the neighborhood could be beneficial when properly integrated into the environment. Key messages • Older adults with access to parks, footpaths, and challenging terrains suitable for exercise and walking, had a lower risk of falling. • These findings could be applied in urban designs to prevent falls among older adults.

Serviced Housing for Older People (SHOP) is a community-based housing model in Japan that provides barrier-free apartments and support services for residents. Whether the SHOP model has positive effects on residents' health remains unclear. This follow-up study examines the association between living in SHOPs and functional decline. Using data from the Japan Gerontological Evaluation Study, we compared functional decline risks at one-year follow-up between older adults living in conventional housing (n = 2202) and SHOP residents (n = 160). Functional decline risk was assessed using the Kihon Checklist (KCL) and Care-Need Risk Assessment Scale (CNRAS). SHOPs residents had lower KCL and CNRAS scores than older adults living in conventional housing. In sensitivity analyses, these associations remained unchanged. The results, thus, showed that residing in SHOPs was associated with reduced functional decline; therefore, SHOPs designed to support residents' physical and social health could be important for supporting aging in place.

BACKGROUND: We sought to test the hypothesis that communities with a high degree of income inequality are ill-equipped to deal with crises. Specifically, we tested whether pre-disaster higher income inequality increases the risk of worse mental health conditions in the aftermath of disaster. METHODS: We examined the association between pre-disaster community income inequality and post-disaster mental health outcomes in a prospective cohort study of older adults (≥65 years) who survived the 2011 Great East Japan Earthquake. The baseline survey of participants (completed in 2010) predated the disaster by seven months. Survivors completed three waves of post-disaster surveys in 2013, 2016, and 2019. To assess the level of income inequality, the Gini index was calculated using individual income data in 2010 aggregated to 98 communities (range 0.05-0.50: median = 0.32) and categorized into tertiles (low, middle, high). Depressive symptoms and post-traumatic stress symptoms (PTSS) were assessed in the three post-disaster surveys using validated instruments. Multilevel analysis was conducted adjusting for pre-disaster characteristics. RESULTS: Higher levels of community income inequality were associated with higher PTSS scores across time (2013: β = 0.14, 95%CI = -0.01, 0.29; 2016: β = 0.16, 95%CI = 0.03, 0.29; 2019: β = 0.12, 95%CI = -0.01, 0.24). The association between income inequality and mental health was partly attenuated by adding the change in social capital to the model (2013: β = 0.14, 95%CI = -0.01, 0.29; 2016: β = 0.15, 95%CI = 0.03, 0.28; 2019: β = 0.11, 95%CI = -0.01, 0.22). CONCLUSION: Our findings suggest that pre-disaster income inequality may explain PTSS symptoms in the aftermath of a disaster, and the relation may be mediated by disaster-related change. Further study to reveal its mechanism is needed for the policy recommendation.

OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS: A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.