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Background Previous studies have demonstrated that health behaviours may be one of the major mechanisms underlying the relationship between personality and health outcomes. Such health behaviours may be established by consciousness toward one's health that include health literacy. Thus, this study aimed to explore the relationship between health literacy and its correlates, including personality, among community-dwelling older adults. Methods This was a cross-sectional study with 683 older individuals (aged 60-84 years; 326 men and 357 women). A questionnaire was used to assess health literacy, personality, socioeconomic status, health status, and lifestyles. Health literacy was measured using the Communicative and Critical Health Literacy Scale, which is a self-report questionnaire comprising five items assessing degrees of health literacy. The Big Five personality traits were measured using the Japanese version of the Ten-Item Personality Inventory. Other variables were measured as factors associated with health literacy, including age, gender, education, subjective economic status, social isolation, chronic diseases, functional capacity, smoking and drinking. Results Multiple regression analysis showed that education (β = 0.10), subjective economic status (β = -0.09), social isolation (β = -0.08), functional dependence (β = -0.22), neuroticism, (β = -0.08), extraversion (β = 0.10), openness (β = 0.17), and conscientiousness (β = 0.09) were independently and significantly associated with health literacy (coefficient of determination = 0.28). Conclusions This study found significant and independent associations of personality, socioeconomic status, and health status with health literacy. These results may help facilitate the development of efficient strategies to improve health status by promoting health literacy in community-dwelling older adults.

The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20–30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson’s product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.

Background Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults. Methods This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI. Results The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy. Conclusions Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.

After the accident at the Fukushima nuclear power plant in 2011, caused by the Great East Japan Earthquake, some evacuees had no one to consult despite many local care providers offering assistance. This study identified the characteristics of individuals who did not receive consultations and the relevant determinants, and proposed the available measures to address this issue. Altogether, 32,699 participants aged 16 years or older and residing in the disaster area at Fukushima were surveyed. Those with no one to consult showed a significantly higher prevalence of psychological distress (16.2%, p &lt, 0.001) and drinking problems (21.5%, p &lt, 0.001). Multivariate analysis revealed that these behaviors were associated with the middle age group (i.e., 40–64 years old) (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.16–1.46), men (OR = 2.46, 95% CI, 2.27–2.66), bad financial circumstances (OR = 2.11, 95% CI, 1.96–2.27), and living alone (OR = 1.53, 95% CI, 1.39–1.68). This research verifies that people with such characteristics were more likely to be isolated and vulnerable to psychiatric problems, such as depression. We suggest that it is integral for local care providers to recognize those who have no one to consult and provide targeted support.

Aim As living alone is associated with poor mental health, seeking a moderating factor in this relationship may help enhance quality of life of older people living alone. Therefore, this study examined the moderating effect of leisure activity on the relationship between living alone and mental health in older people. Methods This study employed a cross-sectional analysis of questionnaire data. Research was conducted in a metropolitan Tokyo ward from September to October 2017. Participants were 314 community-dwelling Japanese individuals (158 women, 156 men) aged 70-84 years (mean ± SD, 77.7 ± 4.4). We analyzed mental health using the Japanese version of the World Health Organization-Five Well-Being Index as the outcome variable, and the 11 items of the Leisure Activity Scale and living arrangements as explanatory variables. Multivariate analyses were used to examine effects of leisure activity on living arrangements and mental health. Results The proportion of people living alone was 22.9% (N = 72), and the mental health score was mean ± SD, 14.2 ± 7.2. Multiple regression analysis showed that subjective economic status (β = -0.177), instrumental activities of daily living (β = 0.167), living arrangements (β = -0.142) and leisure activity (β = 0.481) were associated with mental health. The interaction effect between living arrangements and leisure activity on mental health was significant (β = 0.112). Conclusions Our findings show that leisure activity moderates poor mental health in older adults living alone. Accordingly, interventions should encourage older adults living alone to engage in leisure activity to improve their mental health. Geriatr Gerontol Int 2021; 21: 421-425.

This study explored the associations between personality traits and cognitive failure (including minor lapses and prospective and retrospective memory failure) among middle-aged and older adults living in Japan. The participants were 373 adults, aged 40–84 (167 men and 206 women). The 15-item Japanese version of the Short Inventory of Minor Lapses was used to evaluate minor lapses, and the 16-item Japanese version of the Prospective and Retrospective Memory Questionnaire was used to assess prospective and retrospective memory failure. The participants’ variables evaluated for their association with cognitive failure were gender, age, education, paid work, social network, chronic disease, sleep quality, and the Big Five personality traits (i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness). Multivariable regression analyses demonstrated that sleep quality (β = −0.232), neuroticism (β = 0.163), and conscientiousness (β = −0.295) were related to minor lapses; age (β = 0.152), sleep quality (β = −0.168), and conscientiousness (β = −0.290) were associated with prospective memory failure; and age (β = 0.268), sleep quality (β = −0.146), and conscientiousness (β = −0.221) were associated with retrospective memory failure. These findings may facilitate the development of efficient strategies for the prevention of cognitive dysfunction and its adverse consequences for personal health.

The 2011 nuclear disaster in Fukushima was not only a health disaster, but also an information disaster. Although media can promote health communication following disasters, studies have revealed associations between media information and negative psychological reactions. To clarify the relationship between media utilization and current health anxiety due to radiation exposure, a cross-sectional questionnaire survey was conducted in Fukushima. We selected 2000 subjects from evacuation (i.e., 500) and non-evacuation (i.e., 1500) areas by two-stage stratified random sampling. As the independent variable, participants were asked about current health anxiety due to radiation exposure at the time of answering the questionnaire. For utilization of media about radiation exposure, local media, national media, Internet media, public broadcasts, and public relations information from local government were set as the dependent variables. Questionnaire data were analyzed by evacuation type (i.e., forced/voluntary). In a multivariate logistic regression analysis, the use of public relations information was significantly associated with lower anxiety for the forced evacuees (odds ratio: 0.72, 95% confidence interval: 0.56&ndash, 0.93). Our findings highlight the importance of public relations information from local government in terms of it being associated with lower current health anxiety, and this could potentially aid in preparing for future disasters

Aim In general, physically activity contributes to better subjective well-being (SWB) in the elderly. However, the physical activity level of older people who experienced relocation after the Great East Japan Earthquake has been reported to be low, possibly leading to low SWB. This study aimed to examine the efficacy of group intervention involving physical activity on SWB among older returnees after the Great East Japan Earthquake. Methods The participants were randomly allocated to an intervention group (4 men, 10 women) or a control group (7 women). Participants in the intervention group attended a series of weekly classes over eight weeks to encourage daily physical activity, whereas participants in the control group received no intervention. SWB, the primary outcome, was assessed by the World Health Organization Five Well-Being Index. Results Median variation in the World Health Organization Five Well-Being Index scores at 3 months from the baseline in the intervention and control groups was -1.0 and -2.0 points, respectively; the difference was borderline significant (P = 0.06). There was no significant difference between the groups in the median of variation in muscle strength (P = 0.79) or mobility (P = 0.77) at 3 months. Conclusion The intervention might prevent deterioration in participants' SWB. Further studies involving older returnees with poor physical activity and/or sedentary lifestyle may be beneficial for health promotion in the area.

Older adults’ ever-improving health and changing lifestyles necessitate the development of a scale that can better measure their competence at a higher level. We developed the Japan Science and Technology Agency Index of Competence (JST-IC) via item analysis and assessed its psychometric properties. Participants were 1306 community-dwelling older adults (623 men and 683 women, 74.0 ± 2.8 years old) who completed the 54-item draft JST-IC to determine their level of independence. Three procedures (including item selection, factor analyses, and reliability and validity analyses) were conducted to finalize the JST-IC and evaluate its psychometric properties. The item selection resulted in exclusion of 26 items for the following reasons: (a) 15 because of very high ratios (80% or more) of responders who answered “yes”, (b) one because of gender differences (phi coefficient = 0.34), (c) five because of their weak association with the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Pearson correlation coefficient of 0.30 or smaller), and (d) five because of redundancy of meaning with other items. Through factor analyses, we selected 16 items with a four-factor solution for the final version. JST-IC score exhibited a near-normal distribution and significant gender and age differences, and had moderate correlations with size of social network and level of subjective well-being and strong correlations with TMIG-IC score, physical fitness, and health literacy. The JST-IC is useful for assessing competence at a higher level in community-dwelling older adults.

Objectives Leisure activities are important for older adults, not only to maintain their subjective well-being but also to prevent bedridden states. This study aimed to develop a leisure activity scale for contemporary older adults and examine its psychometric properties, based on a previous study from Iwasa et al. (2018). As people who actively engage in leisure activities are reportedly less likely to experience cognitive decline, the relationship between the scale score and cognitive function should be assessed while developing the scale. Specifically, the study was conducted to examine the reliability of the scale and its factor structure, confirm basic statistical characteristics, examine the scale's gender- and age-based differences, and the relationship between the scale score and cognitive function.Methods We surveyed Japanese older adults living in a community (aged 70-84 years; N=594) and used data from 306 participants (151 men and 155 women). We developed and administered a scale comprising 11 items that were measured using a 4-point Likert-type scale. Additionally, we used cognitive function scales including the Mini-Mental State Examination (MMSE), the Memory Impairment Screen (MIS), and the Word Fluency Test. Covariates in tests for independent associations between the leisure activity scale score and cognitive function were socioeconomic status, chronic disease, functional capacity, and living alone. We conducted two web surveys with two-week intervals for test-retest reliability purposes and used data from 192 of those participants (aged 70-79 years; 101 men and 91 women).Results A confirmatory factor analysis upheld the fact that the scale was comprised of one factor. The scale obtained high indicators of reliability: Cronbach's alpha coefficient (0.81) and test-retest reliability (0.81). The mean, standard deviation, median, skewness, and kurtosis of the scale score were 14.44, 7.13, 15, -0.12, and -0.73, respectively. The analysis of variance for the scale score indicated significant age-based differences (i.e., the score for those who were 70-74 years old was higher than for those who were 80-84 years old) and no significant gender differences. Multiple regression analyses demonstrated that the scale score was significantly and independently correlated with MMSE (β=0.31), MIS (β=0.24), and word fluency (β=0.25).Conclusion This study confirmed the psychometric properties of the leisure activity scale, including factor structure, reliability, basic statistical characteristics, no gender differences, significant age-based differences, and relationship to cognitive function. Future studies should examine the longitudinal relationship between the leisure activity scale score and cognition among older adults in community settings.

We aimed to (1) describe the subjective well-being (SWB) of older residents in Fukushima Prefecture seven years and seven months after the Great East Japan Earthquake (GEJE) and examine the effect of relocation to the restoration public housing (RPH) on SWB, social capital, and health indicators, and (2) investigate the association between social capital and SWB. Questionnaires were administered to collect data of both RPH and non-RPH residents (&ge, 65 years). Respondents&rsquo, SWB was collected via the Japanese version of the World Health Organization Five Well-Being Index. Additionally, residents&rsquo, social capital (trust, reciprocity, and participation), physical activity level, social network, functional health, history of chronic disease, and demographic data were collected. We analyzed 101 responses (valid response rate: approximately 34%) from RPH and 158 (53%) from non-RPH residents. SWB was lower in RPH compared to non-RPH residents but not statistically significant. Older RPH residents may demonstrate lower social capital and health indicators after the GEJE. Mistrust was found to be positively associated with low SWB in RPH residents. Future studies should examine the effectiveness of support for enhancing the trust of older RPH residents regarding, for example, the involvement of scientists&mdash, including medical professionals&mdash, in risk communications in promoting SWB.

Aim The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study. Methods We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period. Results During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers. Conclusion Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.

Objectives The purpose of this study was to examine the psychometric properties of the diet-related quality of life (DRQOL) scale among older adults. Specifically, the study was conducted to confirm the scale's factor structure and construct a short version of the scale. Further, the scale's internal consistency and gender- and age-based differences as well as the validity of the DRQOL scale and its short version were examined.Methods We surveyed a random sample of community-dwelling older Japanese adults (aged 60-84 years; N=1,200; response rate: 70.8%) and used the data of 780 participants (367 men and 413 women). We used the DRQOL scale, comprising 18 items that were measured using a five-point Likert-type scale. Additionally, we assessed subjective well-being, diet satisfaction, appetite, meal restriction, mastication, number of meals with others, frequency of using ready-made and instant food, information gathering regarding food, and dietary variety scores as external criterion variables; socioeconomic status and health habits were used to describe basic participant characteristics.Results Confirmatory factor analysis revealed a replication of the four-factor structure of the measure ("pleasure from a meal," "eating satisfaction," "circumstances of meal," and "diet diversity"). A short version of the measure comprising 8 items was developed. The DRQOL scale, its subscales, and its short version had high Cronbach's alpha coefficients as indicators of reliability (0.94; 0.86, 0.89, 0.77, and 0.72; and 0.90, respectively). There were significant sex differences in the scores of all constructs, and no significant age-based differences. The DRQOL scale scores had weak-to-moderate correlations with the external criterion variables mentioned above.Conclusion Overall, this study confirmed the psychometric properties of the DRQOL scale, including factor structure, reliability, gender and age differences, and its validity among older adults using data from the general population in Japan. In addition, a short version of the DRQOL scale was developed. Future studies should examine the factors associated with the DRQOL. The predictive validity of the scale, with health outcomes as external criteria, should be examined to test its usefulness for epidemiological surveys among older adults in community settings.

The Fukushima Medical University conducted a mental health care program for evacuees after the Fukushima Daiichi nuclear power plant accident. However, the mental health status of non-respondents has not been considered for surveys using questionnaires. Therefore, the aim of this study was to clarify the characteristics of non-respondents and respondents. The target population of the survey (FY2011-2013) is people living in the nationally designated evacuation zone of Fukushima prefecture. Among these, the participants were 967 people (20 years or older). We examined factors that affected the difference between the groups of participants (i.e., non-respondents and respondents) using multivariate logistic regression analysis. Employment was higher in non-respondents (p=0.022) and they were also more socially isolated (p=0.047) when compared to respondents; non-respondents had a higher proportional risk of psychological distress compared to respondents (p

Following the March 2011 accident at Fukushima Daiichi Nuclear Power Plant, many residents of Fukushima have faced anxieties about the health impacts of radiation exposure. Considering that source of information may influence resident anxiety, this study aimed to elucidate the correlation between the two. In addition, a health literacy query was included to examine a possible relationship between anxiety and health literacy skills. A mail survey was conducted in August 2016 among 2000 residents of Fukushima Prefecture aged 20 to 79 years. Survey items included questions about current health anxieties caused by radiation, trusted sources of information about radiation, and media used to obtain information on radiation. The survey valid response rate was 43.4%. Results of multiple linear regression analysis revealed that anxiety was significantly higher for the groups indicating "trust in citizen groups" and "use of internet sites." Anxiety was significantly lower for the groups indicating "trust in government ministries," "trust in local government," and "use of local broadcast television." Also anxiety was significantly lower for groups with higher health literacy. It was found that the significant relationship to anxiety varies depending on the sources of trust and media used. There is a possibility that this was caused by the difference between the contents of each information and media reports. In preparation for any future nuclear accident, government may consider action to improve the media literacy of residents. In addition, improving health literacy of both the recipient and the sender of information can improve access to information and thereby safeguard the health and well-being of the public.

We investigated the psychometric properties of the simplified Japanese version of the Athens Insomnia Scale (AIS‐SJ) using baseline data from the Fukushima Health Management Survey. Data from 22 878 men and 27 669 women aged 16 years and older were analysed (M age = 52.9 ± 18.6). Participants lived in the Fukushima evacuation zone and experienced the Great East Japan Earthquake. The AIS‐SJ was used to assess participants’ insomnia symptoms, and its validity was examined by administering the Kessler 6‐item Psychological Distress Scale (K6) and assessing education, self‐rated health and disaster‐related experiences. A confirmatory factor analysis revealed that the two‐factor model was a better fit than the one‐factor model. The AIS‐SJ and its subscales had acceptable reliability (Cronbach's alpha, 0.81). Test of measurement invariance confirmed strict invariance across groups for the participants’ characteristics of gender and mental illness history, but not for participants’ age. AIS‐SJ scores exhibited a near‐normal distribution (skewness, 0.45; kurtosis, −0.89). There were significant age differences only among women, and gender differences in AIS‐SJ scores with small effect sizes. The AIS‐SJ scores had weak‐to‐moderate correlations with mental illness history, bereavement, experiencing the tsunami, experiencing the nuclear power plant incident, housing damage and losing one's job (polyserial correlations, 0.36, 0.17, 0.13, 0.18, 0.13, and 0.15, respectively), and strong correlations with self‐rated health (polyserial correlation, 0.51), psychological distress (r s, 0.60) and post‐traumatic stress disorder (r s, 0.60). The AIS‐SJ is a useful instrument for assessing community dwellers’ insomnia symptoms.

Objectives The purpose of this study was to provide normative data of middle-aged and older adults for the Japanese version of the Ten-Item Personality Inventory (TIPI-J), based on the Big Five model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness).Methods We surveyed a random sample of community-dwelling middle-aged and older Japanese adults (aged 60-84 years, N=1,200, response rate: 70.8%) and used data from 776 participants (368 men and 408 women). We used the TIPI-J as a measure of the Big Five model of personality comprising ten items, which were measured on a seven-point Likert-type scale. We also assessed the socio-economic and health variables to describe the basic characteristics of participants.Results Standard psychometric methods showed a near-normal score distribution across all subscales; there were significant sex differences in Neuroticism and Openness, and there was no significant difference with respect to age.Conclusion This study provided a grand total table and normative data for the TIPI-J, and examined gender- and age-based differences in the TIPI-J among middle-aged and older adults using data from the general population of Japan. In the future, factors associated with the TIPI-J scores and predictive validity of the scale for health outcomes as external criteria should be examined to test the scale's usefulness for epidemiological surveys among middle-aged and older adults in community settings.

Objective: The aim of this study is to assess the risk factors for incident functional disability among long-term evacuees of Iitate village after Great East Japan Earthquake and nuclear disaster (GEJE). We also investigated the effectiveness of exercise classes as an intervention measure in this situation. Methods: 1159 subjects (75.2 &plusmn, 5.8 years, 57.5% female) were included at baseline, and followed-up for four years. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of incident functional disability according to the presence of risk factors evaluated by the municipality&rsquo, s self-assessment Basic Checklist (BCL). Evacuees from Iitate who participated in the exercise classes and those who did not were matched using the propensity scores, which were then used to obtain the HR of incident functional disability. Results: New functional disability occurred in 280 (24.2%) participants during the follow-up. Participants who scored negative for the &ldquo, Physical function&rdquo, domain in the BCL had a HR of 2.04 (95% CI: 1.54&ndash, 2.69) for incident functional disability when compared to those who scored positive for this domain. Similarly, the HR for &ldquo, Cognitive function&rdquo, was 1.37 (CI: 1.06&ndash, 1.77), and 1.60 (CI: 1.24&ndash, 2.08) for &ldquo, Depression&rdquo, Using a Cox proportional hazard regression model, both the group with low-participation in the exercise program and the group with high-participation in the exercise program had a significantly lower rate of incident functional disability compared to those who did not participate at all (HR = 0.27, CI: 0.16&ndash, 0.46, HR = 0.30, CI: 0.12&ndash, 0.74, respectively). Conclusions: Pre-disaster BCL domains were useful to identify individuals at risk of functional disability after a major socio-technical disaster. Therefore, this instrument can be used to identify at-risk older adults who would benefit from early exercise programs to prevent incident functional disability.

The disaster at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on March 11, 2011, might have affected the mental health status of children. To assess the mental health status, we measured the Strengths and Difficulties Questionnaire (SDQ) in 15 274 children (aged 4-15 years). The proportions of those who scored above the cutoff (≥16) of SDQ, reflecting the clinical range of the mental health status, were 25.0% (aged 4-6 years), 22.0% (aged 7-12 years, and 16.3% (aged 13-15 years), which were higher than that in the usual state (9.5%). We also explored the possibility that the distribution on the Fukushima prefectural map of the proportions of those who scored above the cutoff (≥16) of SDQ might correspond with the environmental radiation levels, but there was no significant correlation.

This study aimed to clarify the longitudinal relationship between leisure activities and cognitive decline among Japanese community-dwelling older adults, using a 5-year prospective cohort study design.A total of 567 men and women, aged 70years and over, participated in the study. The Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function. The change in cognitive function from baseline to follow-up was determined, and cognitive decline over 5years was used as the outcome variable. Leisure activities (hobby, social activity, and physical activity) were assessed at baseline and used as independent variables. Age, gender, number of years of education, presence of chronic diseases, instrumental activities of daily living, depressive symptoms, smoking, hearing deficits, and level of cognitive function at baseline were used as covariates.Multivariate logistic regression analysis, adjusted for potential confounders, showed that non-participation in a hobby was significantly and independently associated with cognitive decline (odds ratio: 1.87, 95% confidence interval: 1.16-3.02, p0.01). There were no significant relationships between social activity, physical activity and cognitive decline.Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals, suggesting that engaging in a hobby in later life can contribute to preserving cognitive function.

Inflammatory cytokines may contribute to lower physical function in elderly. The purpose of this study was to clarify the relation between circulating level of C-reactive protein (CRP) and physical performance among the community-dwelling elderly in Japan. Participants were 803 (329 men and 474 women) aged 65 years and over. Four physical performances were assessed using hand-grip strength, length of time standing on one leg, and walking speed (usual and maximal). Low physical performance was defined as the lowest 25% of study sample in each sex. Multiple logistic regression analysis showed that CRP was negatively associated with physical performance in hand-grip strength (odds ratio=OR=1.86, 95% confidence interval=95% CI=1.32-3.05, OR=2.92, 95% CI=1.53-5.58, for the middle and highest, respectively), time of one leg standing (OR=1.96, 95% CI=1.28-3.00, OR=2.16, 95% CI=1.19-3.92, for the middle and highest, respectively) and maximal walking speed (OR=2.46, 95% CI=1.23-4.93, for the highest) when adjusted for the confounding factors. The results showed the negatively associated between CRP level and physical performance when adjusted for the confounding factors. CRP level may be a useful indicator for detecting the lower physical performance in elderly.

Following the accident at the Fukushima Nuclear Power Plant in March 2011, both experts and the national government provided insufficient information on radiation, leading to widespread distrust in the community. This study aimed at clarifying the association between anxiety about radiation and health literacy among residents in evacuation and non-evacuation areas in Fukushima. A questionnaire survey was sent to randomly sampled residents between August and October 2016, and data from 777 responses (38.9% valid response) were analyzed. The questionnaire assessed current radiation anxiety and discrimination and prejudice based on radiation exposure through seven items and communicative and critical health literacy through five items. Multiple regression analysis of the association between radiation anxiety and health literacy showed that the level of health literacy was significantly negatively associated with radiation anxiety in the evacuation areas (marginally in the non-evacuation areas) and marginally negatively associated with discrimination and prejudice in the evacuation areas but not in the non-evacuation areas. Therefore, improving health literacy could alleviate radiation anxiety.

This study longitudinally examined the relationships between the specific domains of cognitive performance and functional decline among the community elderly. The study population was 119 men and 194 women aged 70-84 at baseline, who were examined at both baseline and in a 4-year follow-up survey. Katz's Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) were used for measuring the functional capacities of basic activities of daily living (BADL) and higher-level competence, respectively. For the purpose of analyses, declines in each subscale of functional capacity during the follow-up period were used as outcome variables; and specific domains of cognitive performances, including information processing speed, executive function, orientation, and episodic memory at baseline, were used as independent variables. Multiple logistic regression analyses, adjusted for the potential confounders, showed that information processing speed and orientation were associated independently and inversely with BADL decline, and that information processing speed and executive function were related independently and inversely to higher-level competence decline. These results suggested that information processing speed and orientation are reliable predictors for decline in BADL, and information processing speed and executive function are also reliable predictors for decline in higher-level competence among the community elderly.

AIM We examined the relationship between subjective well-being and all-cause mortality among middle-aged and elderly people, using a population-based prospective approach (Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging). METHODS The participants were 1,034 men and 1,413 women aged 52 to 77 years, living in an urban Japanese community. The baseline data on age, gender, number of years of education, hospitalization, lifestyle-related illness, subjective health status, living alone and subjective well-being (measured by Philadelphia Geriatric Center Morale Scale) were collected in 1993. RESULTS Mean subjective well-being scores for men and women were 12.3 +/- 3.2 and 11.9 +/- 3.5, respectively. Analysis of covariance controlling for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, revealed no inter-gender difference in subjective well-being. Multiple regression analysis to explore factors related to subjective well-being showed that age in men, and the number of years of education in both genders were significantly, independently and positively associated with subjective well-being, and that hospitalization, lifestyle-related illness and living alone in both genders were significantly, independently and negatively related to subjective well-being. From 1993 to 2000, there were 183 deaths and 258 dropouts. In Cox's multivariate hazard model adjusted for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, there was a significant and independent association between a low level of subjective well-being and the risk for all-cause mortality in both genders. CONCLUSION Satisfaction with life is an important factor affecting longevity among middle-aged and elderly people.

It is predicted that the future increase in the oldest-old (85 years and older) population will have a marked influence on society. However, little is known about the features of various functions in the oldest-old. The purpose of this study was to clarify the functional status of the oldest-old. We surveyed all oldest-old residents in a small area of Itabashi ward in metropolitan Tokyo to clarify their living conditions. The oldest-old themselves and their family members were invited to participate, and 235 out of 311 residents (75.6%) agreed to do so. Forty-two percent of the participants were dependent and needed care from others. The ADL status measured by the Barthel Index showed that 30% of independent participants also had some deterioration of physical function. These results are indicative of increased frailty in the oldest-old. Comparison between independent and dependent (need care from others in daily living) showed that the functional status was lower in dependent group. However, the psychological well-being was the same in this two groups. These results indicate progressive functional deterioation and psychological adaptation to it, in the oldest-old. Further research to elucidate the process of psychological adaptation to frailty is necessary in order to promote the well-being among the oldest-old, in whom functional limitation is evident.

This study was conducted to clarify the characteristics of cognitive function among physically independent very old people dwelling in an urban community in Japan. Five hundred and thirteen Old-Old (aged 75-84 years) and 168 Oldest-Old (aged 85-100 years) adults participated. We carried out the Mini-Mental State Examination (MMSE) for measuring cognitive functions in the elderly. Age-related differences in the total score and sub-scale scores of the MMSE were analyzed by sex using ANCOVA, controlling for education, vision and hearing problems. Mean MMSE scores for Old-Old and Oldest-Old males were 27.53 and 25.88, respectively, and those for Old-Old and Oldest-Old females were 27.77 and 24.98, respectively. Age-related differences in the MMSE total score between the Old-Old and Oldest-Old were observed in both sexes, suggesting that overall cognitive functions continue to decline over time in very old age. Age-related differences between the Old-Old and Oldest-Old in items measuring, registration, calculation and delayed recall were observed in both sexes, and in addition, time orientation, place orientation, delayed recognition, writing sentences, and copying figures were observed in females. These findings suggest that the faculties are those most sensitive to normal aging among very old individuals. There were no age group differences in five items: reverse spelling, naming objects, repeating a sentence, listening and obeying, and reading and obeying.

PurposeThis study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake.MethodThis was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis.ResultsOf the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation.DiscussionRenters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them.

Prevention of depressive symptoms is an essential issue with regard to the promotion of healthy lifestyles in older people. To date, few studies have examined the relation between fluctuations in physical activity and depression among older individuals. We thus conducted a longitudinal survey of older adults to examine the effect of long-term fluctuating physical activity on the incidence of depressive symptoms.A 3-year prospective cohort study was performed in a community-based environment. A total of 680 individuals (291 men and 389 women) aged 65 years and over at the baseline assessment participated. The 15-item Geriatric Depression Scale was used to assess depressive symptoms, with scores of ≥6 indicative of depression. Participants were categorized into the following four groups based on change in physical activity status between 2002 and 2003: sedentary, cessation, initiation, and maintenance.The incidence of depressive symptoms was 16.9% (16.8% in men and 17.0% in women) at the 3-year follow up (in 2006). Multiple logistic regression analyses showed that physical activity maintenance (odds ratio, 0.50; 95% confidence interval, 0.30-0.83) only reduced the incidence of depressive symptoms at the 3-year follow up after adjusting for confounding variables.Continuous physical activity may be a valuable and simple way to prevent depressive symptoms in community-dwelling older people. Therefore, it is necessary to implement interventions that teach older adults how to integrate physical activity into their daily lives.

Objectives Several studies have explored the prevalence and risk factors of sarcopenia, but they have been based on cross-sectional data. The objective of this study was to determine the incidence and predictors of the onset of sarcopenia over 4 years in community-dwelling elderly women. Design Four-year longitudinal follow-up study. Setting Urban community in Tokyo, Japan. Participants A total of 538 nonsarcopenic women older than 75 years. Measurements Body composition was determined by bioelectrical impedance analysis. Functional fitness measurements, including grip strength, usual walking speed, timed up and go (TUG), and interview surveys were conducted at baseline and 4-year follow-up. Blood samples were obtained to analyze serum albumin and hemoglobin A1c, and kidney function was analyzed using serum creatinine and cystatin C. Sarcopenia was defined based on the criteria suggested by the European Working Group on Sarcopenia in Older People, and the development of all stages, that is, presarcopenia, sarcopenia, and severe sarcopenia as well as the components of sarcopenia skeletal muscle index (SMI), grip strength, and walking speed, were analyzed. Results The incidence of total sarcopenia was 39.6% (presarcopenia 23.8%, sarcopenia 11.2%, severe sarcopenia 4.6%). Older age was significantly predictive of the development of presarcopenia and severe sarcopenia. Body mass index (BMI) lower than 21.0 kg/m 2 was significantly predictive of the development of all stages of sarcopenia, as well as declines in SMI, grip strength, and walking speed. Slow TUG was a predictor of the development of presarcopenia and severe sarcopenia. Increased calf circumference showed protective effects from the development of all stages of sarcopenia. Greater albumin levels also showed lower risk of declines in SMI, walking speed, and development of presarcopenia. Cystatin C was positively associated with the development of severe sarcopenia (odds ratio 1.83, 95% confidence interval 1.08–3.12). Heart disease and hyperlipidemia history were associated with presarcopenia and sarcopenia, respectively. Conclusion Age, BMI, calf circumference, and TUG were consistent predictors of the various stages and components of sarcopenia. The data also suggest that cystatin C was associated with higher odds of incident severe sarcopenia, and further study into kidney function and onset of sarcopenia in large populations is needed.

Background Cognitive function is an important contributor to health among elderly adults. One reliable measure of cognitive functioning is information processing speed, which can predict incident dementia and is longitudinally related to the incidence of functional dependence. Few studies have examined the association between information processing speed and mortality. This 8-year prospective cohort study design with mortality surveillance examined the longitudinal relationship between information processing speed and all-cause mortality among community-dwelling elderly Japanese. Methods A total of 440 men and 371 women aged 70 years or older participated in this study. The Digit Symbol Substitution Test (DSST) was used to assess information processing speed. DSST score was used as an independent variable, and age, sex, education level, depressive symptoms, chronic disease, sensory deficit, instrumental activities of daily living, walking speed, and cognitive impairment were used as covariates. Results During the follow-up period, 182 participants (133 men and 49 women) died. A multivariate Cox proportional hazards model showed that lower DSST score was associated with increased risk of mortality (hazard ratio [HR] = 1.62, 95% CI = 0.97-2.72; HR = 1.73, 95% CI = 1.05-2.87; and HR = 2.55, 95% CI = 1.51-4.29, for the third, second, and first quartiles of DSST score, respectively). Conclusions Slower information processing speed was associated with shorter survival among elderly Japanese.

We sought to examine the longitudinal relationship between cognitive function and all-cause mortality among Japanese community-dwelling older adults, using an 8-year prospective cohort study design with mortality surveillance.A total of 454 men and 386 women, aged 70 years and older, participated in the study. The Mini Mental State Examination (MMSE) was administered to assess global cognition. The total MMSE score and subscale scores were used as independent variables, and age, gender, education level, chronic disease, sensory deficit, depressive symptoms, and instrumental activities of daily living were used as covariates.During the follow-up period, 191 subjects (139 men and 52 women) died, and 64 subjects (31 men and 33 women) moved to a different region of Japan and were lost to follow-up. Use of the multivariate Cox proportional hazards model, adjusted for potential confounders, showed that global cognition was significantly and independently associated with mortality (hazard ratio [HR] = 1.59, 95% confidence interval [CI]: 1.14-2.23 and HR = 2.81, 95% CI: 1.77-4.36 for the middle [24-27 points] and lowest [0-23 points] categories, respectively). Among the MMSE subscales, place orientation (HR = 1.57, 95% CI: 1.09-2.25), calculation (HR = 1.67, 95% CI: 1.18-2.35), and delayed recall (HR = 1.42, 95% CI: 1.03-1.96), were also significantly and independently associated with mortality.Our study suggests that among older individuals, those with lower levels of cognitive function are more likely to have a shorter lifespan compared with those with higher cognitive functioning.

Background Improving Maternal and Child Health (MCH) is a prioritized global agenda in achieving the United Nations Millennium Development Goal 5. In this challenge, involving males has been an important agenda, and a program with such intent was conducted in Alfonso Lista, Ifugao, of the Philippines. The objectives of this study were: (1) to evaluate the effectiveness in knowledge, attitude, and practice before and after a MCH session; (2) to evaluate the session's effectiveness in relation to socio-demographic characteristics; and (3) to examine if males who have learned about MCH topics can teach another group of males. Methods A male community representative who received a lecture from the health office staff was assigned to teach a group of community males [Group 1, N = 140] in 5 sessions, using educational materials. 10 male volunteers from Group 1 then taught a different group of males [Group 2, N = 105] in their own barangays (villages). To evaluate its effectiveness, a self-administered questionnaire survey pertaining knowledge, attitude and practice regarding MCH was conducted at three different time points: before the session (Time 1, T1), after the session (Time 2, T2), and 3 months following the session (Time 3, T3). A repeated measures analysis of variance was conducted to test for changes over time and its interaction effect between specific socio-demographic variables. Results In Group 1, there was a significant positive increase in knowledge score over time at T1-T2 and T1-T3 (p < 0.001). For attitude, the score increased only at T1-T2 (p = 0.027). The effectiveness in knowledge and attitude did not vary by socio-demographic characteristics. As for practice, majority of the participants reported that they had talked about MCH topics in their community and assisted a pregnant woman in some ways. A comparison between Group 1 and Group 2 revealed that Group 2 had similar effectiveness as Group 1 in knowledge improvement immediately after the session (p < 0.001), but no such improvement in the attitude score. Conclusion Although the change in attitude needs further assessment, this strategy of continuous learning and teaching of MCH topics within community males is shown to improve knowledge and has a potential to uplift the MCH status, including the reduction of maternal deaths, in Alfonso Lista, Ifugao, Philippines.

Background: Few studies have examined whether declines over time in hand-grip strength (HGS) and fast walking speed (FWS) differ by sex and age among non-Western community-dwelling older adults. This study aimed to quantify changes in HGS and FWS over the 6-year period from 1994 to 2000 and examine whether these changes differed by sex and baseline age among older individuals in a Japanese community.Methods: We conducted a community-based prospective cohort study. The participants were 513 nondisabled men and women aged 67 to 91 years at the 1994 survey. Independent variables regarding time since baseline, in addition to various time-dependent and time-independent covariates, were obtained in 1994, 1996, 1998, and 2000. The outcome variables were HGS and FWS assessed at each survey. All data on independent and dependent variables that were collected at each survey were simultaneously analyzed using a linear mixed-effects model.Results: The linear mixed-effects model revealed significant declines in both HGS (−0.70 kg/year, P < 0.001) and FWS (−0.027 m/sec/year, P < 0.001) among nondisabled older participants who had analyzable data in any survey during the 6-year period. Sex was significantly associated with the rate of decline in HGS (P < 0.001), but not FWS (P = 0.211).Conclusions: In this analysis of nondisabled older Japanese, a mixed-effects model confirmed a significant effect of aging on declines in HGS and FWS and showed that men had a significantly steeper decline in HGS than did women during a 6-year period.

The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects.Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls.The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test-retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P0.001), HDS-R (r = 0.79, P0.001) and CDR (r = -0.79, P0.001) scores. The areas under receiver-operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90-1.00) and 0.99 (95% CI = 0.00-1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75-0.95) and 0.97 (95% CI = 0.00-1.00), and 0.86 (95% CI = 0.76-0.95) and 0.97 (95% CI = 0.00-1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI.The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community.

Objective This study aimed to examine a longitudinal relationship between depression status and functional decline among Japanese community-dwelling older adults, using a 12-year population-based, prospective cohort study design. Method A total of 710 men and women, aged 65 years and over, participated in the study. Katz's Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence were used to measure the functional capacities of basic activities of daily living (BADL) and higher-level competence, respectively. For the purpose of analysis, a decline in each subscale of functional capacity during the follow-up period were used as outcome variables; depression status assessed by the Japanese version of the 30-item Geriatric Depression Scale (GDS), with a cut-off of 11, was used as an independent variable; and age, gender, education level, history of chronic disease, hospitalization, smoking, physical activity, living alone, hearing problems, physical pain, dietary habits, and usual walking speed at baseline were used as covariates. Results Use of the multivariate Cox proportional hazards model adjusted for potential confounders showed that depression status was significantly and independently associated with BADL decline (risk ratio (RR) = 1.46, 95% confidence interval (CI): 1.13–1.89) and with higher-level competence decline (RR = 1.56, 95% CI: 1.18–2.04). Conclusion Our study found an independent relationship between depression status and longitudinal change in functional capacity among community-dwelling older individuals, suggesting that depression status is a reliable predictor of functional decline (both of BADL decline and higher-level competence decline) in older adults. Copyright © 2009 John Wiley & Sons, Ltd.

The present study was conducted to identify the characteristics of non-participants in secondary comprehensive health examinations among community-dwelling elderly.The subjects were 728 men and 984 women aged 70 years and over who had participated in comprehensive health examinations in 2002. Multiple logistic regression analysis was performed to assess the characteristics associated with non-participation in comprehensive health examinations after 2 years (in 2004).The rates of participation in follow-up health examinations were 66.3% for men and 67.3% for women. Logistic regression analysis showed that male non-participants had low cognitive function (odds ratio (OR) = 2.19, 95% confidence interval (CI) = 1.07-4.49), low education (OR = 1.58, 95% CI = 1.22-2.22), and suffered from health problems (OR = 1.82, 95% CI = 1.27-2.59), and that female non-participants had low cognitive function (OR = 2.01, 95% CI 1.13-3.59), tended to be smokers (OR = 2.05, 95%, CI = 1.13-3.72), and had no hobby (OR = 0.68, 95% CI = 0.50-0.92).Poor cognitive function, health problems, and unfavorable lifestyle factors are related to non-participation in comprehensive health examinations.It is necessary to devise various approaches to encourage participation of such individuals.

Previous studies have shown that low serum 25-hydroxyvitamin D [25(OH)D] level is a risk factor for falls among the elderly in European and North American populations. We used a cross-sectional community-based survey to study the association of serum 25(OH)D level and falls among Japanese community-dwelling elderly. A total of 2957 elderly persons (950 men and 2007 women) 65-92 yr of age who participated in mass health examinations for the prevention of geriatric syndrome for the elderly underwent an interview, blood analysis, and physical performance testing. Experience of falls over the previous year was assessed in an interview. Physical performance tests of handgrip strength, stork standing time with the eyes open, and normal waking speed as risk factors for falls among the elderly were conducted. Serum albumin and 25(OH)D concentrations were analyzed. Mean 25(OH)D concentration was significantly lower in women than in men (p < 0.001). Women showed a significant decline of 25(OH)D level with increased age (p < 0.001). There was also a significant difference in the prevalence of 25(OH)D insufficiency [25(OH)D level < 20 ng/ml] between the sexes (p < 0.001). The rate of falls was significantly higher in the lowest quartile of 25(OH)D level in women (p = 0.02) and in women with 25(OH)D insufficiency (p = 0.001). Women also showed significant declines in all three fall-related physical performance tests. Multiple logistic regression analysis showed significant and independent associations between 25(OH)D level and experience of falls in women only (p = 0.01). Low 25(OH)D level was significantly associated with a high prevalence of falls in Japanese elderly women because of their inferior physical performance. Low serum 25(OH)D levels appear preventable and easily treated; there is an evident need for greater awareness to screen and thus prevent this condition.

Objective Personality is an important factor in determining longevity. It has been reported that some personality traits can affect mortality via health-related behaviors, engaging in social interactions, and a tendency to experience negative emotions. The authors examined the relationships between five major domains of personality traits and all-cause mortality among Japanese community-dwelling elderly. Design A 5-year prospective cohort study design with mortality surveillance. Setting Community based. Participants A total sample of 486 men and 742 women aged 65 years and over at the baseline. Measurements The NEO five-factor inventory was administered to assess the “big five” personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Results During the 5-year follow-up period, 127 persons (73 men and 54 women) died. In Cox multivariate proportional hazards models adjusted for gender, age, number of years of education, living alone, presence of psychiatric problems, and presence of chronic diseases, conscientiousness (risk ratio [RR] = 0.50, 95% confidence interval [CI] = 0.33–0.76 and RR = 0.46, 95% CI = 0.29 to 0.71, for the middle and highest tertiles, respectively), extraversion (RR = 0.58, 95% CI = 0.37 to 0.92, for the highest tertile), and openness (RR = 0.62, 95% CI = 0.41 to 0.96, for the middle tertile) were independently and inversely associated with all-cause mortality. Neither neuroticism nor agreeableness was related to mortality. Conclusions Our results suggest that out of the five domains of personality traits, conscientiousness, extraversion, and openness are reliable predictors of all-cause mortality among community-dwelling elderly.

The aim of this study is to examine the relationship between personality traits and participation in mass health checkups among Japanese community-dwelling elderly.A data set of 327 men and 519 women aged 70 years and over was used in the analysis. The NEO Five-Factor Inventory was administered to assess the "big five" personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.In multivariate logistic regression analysis adjusted for gender, age, number of years of education, living alone, presence of psychiatric diseases, presence of chronic diseases, and history of hospitalization during a 1-year period, openness was independently associated with participation in mass health checkups [odds ratio (OR)=1.51, 95% confidence interval (CI)=1.08-2.12, P.01 and OR=1.38, 95% CI=0.96-1.97, P=.07 for the middle and highest tertile, respectively]. No other domains of personality were related to participation in the checkups.The results of the present study suggest that older individuals high in openness are likely to take part in checkups for the elderly. Our findings could help improve the participation rate in mass health checkups for the prevention of long-term care dependence in later life.

Background and aims: Recent studies have revealed that there are critical differences between participants and non-participants in health examinations. The aim of this study was to examine mortality differences between participants and non-participants in a comprehensive health examination for prevention of geriatric syndromes among community-dwelling elderly people, using a three-year prospective cohort study. Methods: The study population included 854 adults aged 70 to 84 at baseline. The following items were all studied: the status of participation in the comprehensive health examination as an independent variable, age, gender, number of years of education, living alone, presence of chronic diseases, experience of falls over one year, history of hospitalization over one year, self-rated health, body mass index, instrumental activities of daily living, and subjective well-being as covariates; and all-cause mortality during a three-year follow-up as a dependent variable. Results: In an adjusted Cox’s proportional hazard regression model, the mortality risk for participants in the comprehensive health examination was significantly lower than that of non-participants (Risk Ratio (for participants)=0.44, 95% confidence interval=0.24 to 0.78). Conclusions: The present study shows that there is a large mortality difference between participants and non-participants. Our findings suggest two possible interpretations: 1) There is a bias due to self-selection for participation in the trial, which was not eliminated by adjustment for the covariates in the statistical model; 2) There is an intervention effect associated with participation in the comprehensive health examination which reduces the mortality risk.

This study was conducted in order to examine the prevalence of geriatric syndrome (falls, incontinence, depression, and under-nutrition) in community-dwelling elderly people, and to analyze the health status of the elderly with geriatric syndrome risk compared to those of a group not at risk.The subjects comprised 1,784 residents (769 men and 1,015 women) aged 70 years or more living in Itabashi-ku, Tokyo, who took part in the study. For this study, we divided the subjects into two groups: those with geriatric syndrome (n=688) and those without (n=1,096).It was found that 33.6% of men and 42.4% of women had geriatric syndrome. Elderly with geriatric syndrome in both men and women had a significantly lower the proportion of subjects who perceived as 'healthy' in terms of the self-rated health, the higher-level functional capacity, higher prevalence of fear of falling, and decreased physical performance including handgrip strength and usual.maximal walking speed than those in the group who did not have geriatric syndrome. Logistic regression analysis showed that geriatric syndrome was associated with poor perceived self-rated health, a lower hemoglobin level and a slower usual walking speed in men, whereas in women it was associated with poor perceived self-rated health and fear of falling.Elderly individuals with geriatric syndrome have significantly decreased health status and physical performance compared to those without geriatric syndrome.

The present study was conducted to identify the characteristics of non-participants in intervention for geriatric syndrome among community-dwelling elderly.The subjects were 208 men and 399 women aged 70 years and over who were eligible for participation in intervention programs for geriatric syndrome (falls, urinary incontinence, depression, and malnutrition) after recruitment based on a baseline health examination survey in 2002. Multiple logistic regression analysis was performed to assess non-participation in the intervention program as a dependent variable, and the relevant characteristics for participation in the baseline survey as the independent variables.The rates of participation in the intervention were 16.8% for men and 32.6% for women. Logistic regression analysis showed that male non-participants had not participated in group social activity (odds ratio (OR)=2.46, 95% confidence interval (CI) 1.08-5.59), and had no medical history of heart disease (OR=0.38, 95%CI 0.17-0.89), whereas female non-participants had not lived alone (OR=0.53, 95%CI 0.34-0.83), and had no medical history of hyperlipemia (OR=0.54, 95% CI 0.34-0.84).Social activity, living arrangement, and medical history are related to non-participation in intervention for geriatric syndrome. It is necessary to devise various intervention programs and approaches to encourage participation.

We examined the prevalence and characteristics of urinary incontinence in community-dwelling elderly individuals.The participants were 1,783 individuals (768 men and 1,015 women) aged over 70 years who participated in a comprehensive health examination involving a medical examination and interview, plus physical performance tests. Differences in characteristics between individuals with and without urinary incontinence were examined, and multivariate logistic regression models were used to describe the characteristics associated with urinary incontinence.The prevalence of urinary incontinence was 13.4% in men and 23.3% in women. Urinary incontinence was significantly associated with a lower level of physical fitness. Multivariate logistic regression showed that urinary incontinence was significantly associated with a slower walking speed (Odds Ratio (OR) = 0.19, 95% Confidence Intervals (CI) 0.08-0.48) and lower serum albumin level (OR = 0.40, 95% CI 0.16-0.99) in men, and with a slower walking speed (OR = 0.29, 95% CI 0.15-0.56), a higher BMI (OR = 1.09, 95% CI 1.04-1.14), depression (OR = 3.06, 95% CI 1.40-6.69), and lack of physical activity (OR = 0.70, 95% CI 0.50-0.98) in women.The characteristics of urinary incontinence in this cohort of community-dwelling elderly individuals were a low level of physical fitness and poor nutritional state in men, and a low level of physical fitness, a tendency to be obese, a poor mental health state, and lack of physical activity in women.

We explored correlates of change in cognitive function during a two-year follow-up period among the community-dwelling elderly in Japan, using a population-based prospective approach.The participants analyzed in the present study were 260 men and 222 women aged 70 to 84 years at baseline, living in an urban Japanese community. Data such as change in cognitive function during two years (calculated by subtracting baseline Mini-Mental State Examination [MMSE] score from follow-up MMSE score: a negative value means a decrease in MMSE scores during the two-year period) as an outcome variable, age, education, hearing and vision problems, IADL deficit (measured by the Tokyo Metropolitan Institute of Gerontology of Index of Competence), problems related to memory complaint, living alone, hemoglobin level, as explanatory variables, and the baseline MMSE score, depressive status (measured by the Mini-International Neuropsychiatric Interview), chronic conditions (hypertension, stroke, and diabetes mellitus) as covariates, were collected during a comprehensive health examination survey for the elderly.We conducted multivariate regression analysis by genders to explore correlates of change in cognitive function. The results showed that higher age (beta = -0.18), presence of hearing problem (beta = -0.21), presence of IADL deficit (beta = -0.15), and memory complaint (beta = -0.20) in men, and higher age (beta = -0.27), low education level (beta = -0.25) and lower hemoglobin level (beta = 0.16) in women, were significantly associated with change in cognitive function when adjusting for the potential confounders. These factors may be reliable predictors for cognitive decline.

Background: Previous studies have shown that serum albumin or vitamin D is associated with physical performance. We hypothesized that older adults with concomitant lower serum albumin and vitamin D (25-hydroxyvitamin D, 25OHD) levels are associated with decreased physical performance compared to those with 1 or none of the 2 risk factors. Objective: To investigate the association of combined serum albumin and 25OHD levels with physical performance (muscle strength and balance capability) in community-dwelling elderly. Methods: A cross-sectional study in a community-based population in the province of Tokyo, Japan, was performed. For the study, 1,094 community-dwelling people aged 70 and older underwent an interview, anthropometric measurements, blood analysis and physical performance testing. The subjects were classified into 4 types by combining serum albumin and 25OHD levels: lower albumin only, lower vitamin D only, lower albumin and lower vitamin D, higher albumin and higher vitamin D. Results: Men with concomitant lower albumin and lower 25OHD levels had significantly decreased knee extension power, usual timed Up & Go and maximal timed Up & Go, even after adjusting for age and body mass index (BMI). In women, concomitant lower albumin and lower vitamin D was associated with significantly decreased handgrip strength and functional reach, even after adjusting for age and BMI. Subjects with combined lower albumin and lower vitamin D levels showed a significant decline in muscle strength and balance capability compared to higher albumin and higher vitamin D, even after adjusting for age, current drinking or smoking status, physical activity, history of chronic disease, basic activities of daily living, instrumental activities of daily living, BMI and bone mineral density. Conclusion: Concomitant lower serum albumin and lower vitamin D levels are associated with decreased muscle strength and balance capability in both men and women. These results suggest that serum albumin and 25OHD together may be an important target for strategies aiming to achieve a healthy life and prevent loss of independence in community-dwelling elderly.

Previous studies have indicated that memory complaints may predict cognitive decline and dementia among the elderly. The present study was therefore conducted to clarify memory complaint characteristics among elderly dwelling in an urban community in Japan.The participants analyzed in the present study were 453 men and 385 women aged 70 to 84 years living in an urban Japanese community. Data on problems related to memory complaints, cognitive decline (below 24 points on Mini-Mental State Examination), depression (measured by Mini-International Neuropsychiatric Interview), hearing and vision problems, I-ADL (measured by TMIG Index of Competence), self-rated health, age, sex, and years of education were collected at a comprehensive mass health examination for the elderly ("Otasha-kenshin").Twenty-seven percent of male respondents and 32% of female respondents reported having current trouble remembering things (reported as "frequently" or "sometimes"). We collected specific descriptions of the memory complaint difficulties the subjects were experiencing. A quarter of the responses indicated problems with forgetting persons' names, a fifth with forgetting where things had been left, 15% with leaving things behind, and a quarter with prospective memory failure. The results of multivariate logistic regression analysis to explore correlates showed that in men self-rated health and cognitive decline, and in women hearing problems and self-rated health were significantly and independently related to the memory complaint. These findings suggest that in addition to cognitive decline, self-rated health and hearing problems may influence memory complaints, and that memory complaints in men may be a reliable, simple indicator of cognitive decline. We now need to carry out a longitudinal study to clarify predictive validity.

This study was conducted to examine age-related differences in cognitive function, and their relation to higher-level competence of elderly living in an urban community.Participants were 438 individuals (males 168, females 270) aged 70 to 84 years living in an urban community in Tokyo. Three cognitive performance tests, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol, Word Fluency Test, and the WAIS-R Digit Span, were employed for estimating cognitive function, and the TMIG Index of Competence for measuring higher-level competence. In the Index, three constructions: "Instrumental Self-Maintenance", "Intellectual Activity", and "Social Role" were involved.Age-related differences in the cognitive tests were analyzed using ANCOVA controlling for educational year. Age-related differences between younger elderly (70-79 years old) and older elderly (80-84 years old) were observed with the WAIS-R Digit Symbol, Word Fluency Test and the WAIS-R Digit Span. The results indicate that information processing speed, executive function and primary memory in community-dwelling elderly continue to decline in old age, and this trend is salient in the old-old. We carried out partial correlation analysis and multiple regression analysis for exploring the relationships between cognitive function and the sub-scales in the TMIG Index of Competence, controlling for age and educational year. Cognitive function was significantly and positively related with the sub-scales in the Index, this being especially robust for "Intellectual Activity". The results suggest that higher-level competence can be modestly determined with reference to cognitive function, and "Intellectual Activity" may have a stronger relation with cognitive function than the other two sub-scales in the Index.

We conducted a comprehensive mass health examination for elderly subjects aged 70 or above, living in the community, to assess early deterioration to long-term care conditions and promote healthy and successful aging ("Otasha-Kenshin"). In this study, we clarified characteristic differences between participants and non-participants.A mass health examination was offered in October 2001 to 863 community elderly, including individuals suffering from falls (and fractures), incontinence, malnutrition, depression, mild cognitive impairment and less of functional capacity. Among the total, 438 (50.8%) opted for the "Otasha-Kenshin" examination. Differences in characteristics between the participants and non-participants were examined, parameters including sex and age distribution, self-rated health, functional capacity by the TMIG Index of Competence, depressed status by the General Health Questionnaire (GHQ), subjective well-being by the Philadelphia Geriatric Center Morale Scale: A revision (PGC-MS), frequency of falls, and prevalence of chronic diseases. The comparison was based on the results of measurements from the final survey conducted in 2000.1) The participation rate in the "Otasha-Kenshin" was 49.0% in males and 51.0% in females. The average age was 75.3 year olds in participants and 76.4 in non-participants, the difference being significant (t = 3.97, P0.0001). 2) Non-participants had a significantly lower level of self-rated health than participants. 3) There was no significant difference in hand grip strength between participants and non-participants. 4) Non-participants showed significantly lower level of functional capacity and subjective well-being, and they were more likely to be in a depressed state than participants. 5) There was no significant difference in fall rate between participants and non-participants. 6) The prevalence of hypertension and diabetes (found in more than 5% among the subjects surveyed in 2000) was not significantly different between participants and non-participants.With aging of society, new and specialized health maintenance systems for the elderly are essential, both for the prevention of deterioration to a long-term care condition (a bed-ridden status) and for the promotion of successful aging with autonomy. Participants in "Otasha-Kenshin" appear to be healthier and more independent than non-participants who were more frail and at higher risk group of a long-term care condition and a bed-ridden status. The major reason for non-participation in the health examination found in this study was subjective or mental deterioration rather than the presence of chronic illness or any geriatric syndrome per se. Frail elderly people like the non-participants in this study should be encouraged and mentally supported to avoid aggravation of their health status through intensive or specialized health surveillance system such as home-visit nursing.

Background Unhappiness at school is one of the main reasons for truancy among adolescents. In order to assess this problem more thoroughly in the context of Japanese adolescents, the present study examined the associations between feelings of unhappiness at school and lifestyle habits, school life realities, and mental health status. Method This study was designed as a cross-sectional survey. A self-administered questionnaire was provided to students enrolled in randomly selected junior and senior high schools throughout Japan. We calculated the percentages of both junior and senior high school students who felt unhappy at school based on factors related to school life, lifestyle habits, and mental health status. Multiple logistic regression analyses were performed in order to examine the associations between those factors and students' feelings of unhappiness at school. Results A total of 98,867 valid responses were analysed, 7.9% (Boys: 8.4%, Girls: 7.4%) of which came from students who responded that they felt unhappy at school. For both junior and senior high school students, the percentages of those who felt unhappy at school were significantly higher among those who had not yet decided on their future life course, who did not participate in extracurricular activities, did not eat breakfast every day, went to bed late, had used tobacco or alcohol in the previous 30 days, and had poor mental health compared with others. The results of multiple logistic regression analyses indicated that the adjusted odds ratios for feeling unhappy at school with regard to the above-mentioned factors were significantly high for both junior and senior high school students. Conclusions The present results suggest that school employees and administrators must provide health guidance to students, considering that irregular lifestyle habits, lower school engagement, smoking, drinking alcohol, and poor mental health status are all associated with maladaptation to school among adolescents.

Background Relocation following a disaster can impact the psychological well-being of evacuees. This study investigated the associations between residence-related factors and psychological distress among evacuees living in temporary housing after the Fukushima Daiichi Nuclear Power Plant accident. Methods Data from 525 participants living in temporary housing were collected. Associations between residence-related factors (frequent relocation, dissatisfaction with the residence, and plan to move to permanent housing) and psychological distress were measured. The psychological distress of evacuees was measured using the Japanese version of the 6-item Kessler scale (K6). We used a cut-off score of five to identify cases with psychological distress, the basis of Kessler’s 6 items for psychological distress. Results Multivariate logistic regression analysis (n = 418) showed that frequent relocation (OR = 2.05, 95% CI: 1.14–3.66, p = 0.016) and dissatisfaction with the residence (OR = 2.48, 95% CI: 1.60–3.83, p