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Background: The integration of the Internet into daily life has potential implications for public health, especially in promoting preventive healthcare measures like annual health checkups. This study explores the association between Internet use and the likelihood of participating in these checkups among older Japanese citizens. Methods: Participants aged 65 and older were randomly selected from 37 municipalities in Japan, ensuring they required no long-term care. Out of 24,313 responses to a postal questionnaire, 11,495 participants were deemed eligible for analysis, achieving a valid participation rate of 70.1%. We applied propensity score matching to balance Internet users and non-users, resulting in 6,504 matched cases. Poisson regression analysis was then used to adjust for demographic, socioeconomic, and behavioral variables that could act as potential confounders. Results: Our findings show that 55.1% of participants used the Internet several times a month, and among these, 63.5% had attended an annual health checkup in the preceding year. After adjusting for potential confounders, Internet users were found to be 9% more likely to participate in annual health checkups compared to non-users (95% Confidence Interval: 1.02–1.15). Conclusions: This study concludes that there is a positive association between Internet use and participation in annual health checkups among older individuals in Japan. The results suggest that Internet use may serve as a tool to promote preventive healthcare practices in older populations. However, the study underscores the need for further investigation to understand the underlying mechanisms of this association and to establish a causal relationship. [ABSTRACT FROM AUTHOR]

Background Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs. Methods This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged≥65 years in 2010 over an 8-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A 2-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit. Results The mean age of the 8 429 participants was 73.7 years (standard deviation [ SD ] = 6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4 877.0 (SD  = 19 082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were −USD 1 089.9 (95% CI = −1 888.5 to −291.2) for dental preventive visits, −USD 806.7 (95% CI = −1 647.4 to 34.0) for treatment visits, and −USD 980.6 (95% CI = −1 835.7 to −125.5) for preventive or treatment visits. Conclusions Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce LTCI costs. [ABSTRACT FROM AUTHOR]

Background: Older adults who engage in group sports and exercises achieve greater health benefits than those who exercise by themselves. The benefits of group participation may vary depending on the type of sports/exercise they engage in. The present study aimed to identify the association between specific sports and exercise types performed in groups and evaluate the longitudinal changes in multidimensional frailty scores among community-dwelling older adults in Japan. Methods: We used 3-year follow-up data from the Japan Gerontological Evaluation Study and analyzed 33,746 men and 36,799 women aged ≥ 65 years. To elucidate the relationship between participation in 20 types of group sports/exercises in 2016 (baseline) and the change in frailty score (using the Kihon Checklist, KCL) from 2016 to 2019, we performed linear regression analyses through multivariate adjustments for age group, self-rated health, marital status, living alone, occupational status, years of education, alcohol drinking status, smoking status, equivalent income, and disease status using an inverse probability weighting method. P < 0.05 was considered statistically significant. Results: The mean change in KCL scores over 3 years was + 0.62 and + 0.61 points in men and women, respectively, implying the degree of frailty worsened. The sports/exercise types that significantly prevented increments in KCL scores for both sexes compared to non-participants were hiking (men: B, − 0.36; women: B, − 0.29), walking (men: B, − 0.26; women: B, − 0.24), tennis (men: B, − 0.23; women: B, − 0.24), ground golf (men: B, − 0.21; women: B, − 0.19), and weight exercises (men: B, − 0.19; women: B, − 0.16). Conclusion: Participation in specific sports and exercise groups offer significant physical and psychological benefits for frailty prevention among older adults in Japan. The results of this study may offer substantive evidence to encourage older adults to participate in group activities for the prevention of multidimensional frailty. It will also help public health stakeholders to decide which type of sports and exercise groups to promote in a community. [ABSTRACT FROM AUTHOR]

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. 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% confidence interval: 1.15–2.14) compared to those who brushed their teeth 3 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. Conclusions Oral care influenced the experience of pneumonia among independent older people who did not receive pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: It is important to identify older adults at high risk of functional disability and to take preventive measures for them at an early stage. To our knowledge, there are no studies that predict functional disability among community-dwelling older adults using machine learning algorithms. Objective: To construct a model that can predict functional disability over 5 years using basic machine learning algorithms. Design: A cohort study with a mean follow-up of 5.4 years. Participants: We used data from the Japan Gerontological Evaluation Study, which involved 73,262 people aged ≥ 65 years who were not certified as requiring long-term care. The baseline survey was conducted in 2013 in 19 municipalities. Main Measures: We defined the onset of functional disability as the new certification of needing long-term care that was ascertained by linking participants to public registries of long-term care insurance. All 183 candidate predictors were measured by self-report questionnaires. Key Results: During the study period, 16,361 (22.3%) participants experienced the onset of functional disability. Among machine learning–based models, ridge regression (C statistic = 0.818) and gradient boosting (0.817) effectively predicted functional disability. In both models, we identified age, self-rated health, variables related to falls and posture stabilization, and diagnoses of Parkinson's disease and dementia as important features. Additionally, the ridge regression model identified the household characteristics such as the number of members, income, and receiving public assistance as important predictors, while the gradient boosting model selected moderate physical activity and driving. Based on the ridge regression model, we developed a simplified risk score for functional disability, and it also indicated good performance at the cut-off of 6/7 points. Conclusions: Machine learning–based models showed effective performance prediction over 5 years. Our findings suggest that measuring and adding the variables identified as important features can improve the prediction of functional disability. [ABSTRACT FROM AUTHOR]

Purpose: Measuring health-related quality of life (HRQOL) in various health conditions in different countries is important given the regional differences. This study employed large-scale nationwide data targeting older adults in Japan to estimate the HRQOL in the key health conditions that are the major causes of disability. Methods: Our data were derived from two survey waves (2016 and 2019 surveys) of cross-sectional data from the Japan Gerontological Evaluation Study, an ongoing nationwide study targeting functionally independent older adults in Japan. A total of 28,345 individuals from 27 of the 47 Japanese provinces were analyzed. The EuroQoL 5-dimension 5-level instrument (EQ-5D-5L) was employed to assess the HRQOL utility scores. The targeted minimum loss-based estimator with sampling weighting methods was applied to estimate the utility score in eight major health conditions, including sensory organ disease, musculoskeletal disease, oral disorders, and depressive disorders. Results: The estimated HRQOL utility score for those with the poorest health conditions in self-rated health, hearing loss, vision loss, number of remaining teeth (e.g., no teeth with no denture use), oral dysfunction, depressive symptoms, chronic low back pain, and chronic knee pain was 0.576 (95% confidence interval (CI) 0.555–0.598), 0.768 (95% CI 0.737–0.800), 0.680 (95% CI 0.662–0.699), 0.809 (95% CI 0.796–0.821), 0.776 (95% CI 0.764–0.788), 0.723 (95% CI 0.710–0.737), 0.715 (95% CI 0.690–0.739), and 0.742 (95% CI 0.722–0.763), respectively. Conclusion: We successfully provided a catalog for the HRQOL utility score in key health conditions that are the leading causes of disability among older adults. [ABSTRACT FROM AUTHOR]

Background Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. Methods This cohort study used the Japan Gerontological Evaluation Study data, including participants aged ≥65 years. The outcome was death between August 2010 and March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. Results Analyses included 24 175 men and 27 888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (HR = 1.67, 95% confidence interval [CI] = 1.51–1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR = 1.37, 95% CI = 1.19–1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). Conclusions In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies. [ABSTRACT FROM AUTHOR]

Background this study aimed to identify distinct subgroups of trajectories of disability over time before 3 years of death and examine the factors associated with trajectory group membership probabilities among community-dwelling Japanese older adults aged 65 years and above. Methods participants included 4,875 decedents from among community-dwelling Japanese older adults, aged ≥ 65 years at baseline (men: 3,020; women: 1,855). The certified long-term care levels of the national long-term care insurance (LTCI) system were used as an index of functional disability. We combined data from the 2010 Japan Gerontological Evaluation Study and data from the 2010 to 2016 LTCI system. Group-based mixture models and multinominal logistic regression models were used for data analysis. Results five distinct trajectories of functional disability in the last 3 years of life were identified: 'persistently severe disability' (10.3%), 'persistently mild disability' (13.0%), 'accelerated disability' (12.6%), 'catastrophic disability' (18.8%) and 'minimum disability' (45.2%). Multinominal logistic regression analysis found several factors associated with trajectory membership; self-rated health was a common predictor regardless of age and gender. The analysis also showed a paradoxical association; higher education was associated with trajectory group membership probabilities of more severe functional decline in men over 85 years at death. Conclusions individual perception of health was a strong predictor of trajectories, independent of demographic factors and socio-economic status. Our findings contribute to the development of policies for the long-term care system, particularly for end-of-life care, in Asian countries. [ABSTRACT FROM AUTHOR]

It is unknown whether higher functions in sublevels of competence other than instrumental activities of daily living (IADL) are associated with vaccinations. This study examined whether higher functions, including intellectual activity (IA) and social role (SR), were associated with vaccinations among 26,177 older adults. Older adults with incapable activities in IA and SR had increased risks for non-receipt of influenza vaccinations (IA: for one incapable task/activity: incident rate ratio (IRR) = 1.05, 95% confidence interval (CI) = 1.02–1.09; SR: for two incapable tasks: IRR = 1.12, 95% CI = 1.08–1.16). Those with incapable activities in IADL and IA had increased risks for non-receipt of pneumococcal vaccination (IADL: for two incapable tasks: IRR = 1.13, 95% CI = 1.05–1.23; IA: for two incapable tasks: IRR = 1.10, 95% CI = 1.08–1.12). Those with incapable activities in IADL, IA, and SR had increased risks for non-receipt of both of the two vaccinations (IADL: for two incapable tasks: IRR = 1.17, 95% CI = 1.03–1.33; IA: for two incapable tasks: IRR = 1.18, 95% CI = 1.11–1.25; SR: for two incapable tasks: IRR = 1.13, 95% CI = 1.07–1.20). Having a family physician mitigated associations for non-receipt, regardless of competency. Our results suggest—maintaining the higher functions are important for older adults to undergo recommended vaccinations as scheduled; also, having a family physician to promote vaccinations is beneficial even for older adults with limited functions. [ABSTRACT FROM AUTHOR]

Aim: We investigated the association between subjective cognitive complaints (SCCs) and dental visits in older Japanese adults. Methods: This was a cross‐sectional study from the Japan Gerontological Evaluation Study (carried out in 2019). The participants were independent older adults aged ≥65 years without dementia. The presence/absence of dental treatment visits and dental checkup visits within the past 12 months were used as outcome variables. The SCC score measured using the Kihon Checklist was set as the explanatory variable. Possible confounders were also included as covariates. Prevalence ratios and 95% confidence intervals were estimated using a Poisson regression model. Results: The mean age was 74.1 years (standard deviation 6.0 years). Among the 19 677 eligible participants, 12 359 (62.8%) had dental treatment visits and 11 063 (56.3%) had dental checkup visits. Of these, 5966 (30.3%) had an SCC score of ≥1. The proportion of participants with dental treatment and dental checkup visits within the past 12 months was 63.2% and 56.7% among those with SCC score = 0, and 52.8% and 35.2% among those with SCC score = 3, respectively. In the fully adjusted model, no significant association was observed for participants with SCC scores of 1 and 2. Those with SCC score = 3 had less frequent dental checkup visits (prevalence ratio 0.74, 95% confidence interval 0.57–0.95). Conclusions: Our study highlights that SCC was not associated with limited access to dental care among those with mild SCC. However, those with the highest SCC score seemed to have disturbed access to dental care. Geriatr Gerontol Int 2022; 22: 773–778. [ABSTRACT FROM AUTHOR]

Mental health is important in older age; neighborhood environment is considered a protective factor of depression. Research has established that a critical indicator of neighborhood environment, street connectivity, is related to older people's health. However, little is known about the relationship between street connectivity and depression. We examined the relationship between street connectivity and depression among older people. Using Japan Gerontological Evaluation Study 2013–2016, the target population comprised 24,141 independent older people without depression (Geriatric Depression Scale scores below 5) in 2013. The outcome variable was depression in 2016; the explanatory variable was street connectivity calculated by intersection density and space syntax within 800 m around the subject's neighborhood in 2013. We used logistic regression analysis to calculate the odds ratio and 95% confidence interval for the new occurrence of depression among participants in 2016. This analysis demonstrated incidence of new depression after 3 years that is 17% and 14% lower among participations living in high-intersection density and high-street-connectivity areas, respectively, than those living in low-intersection density and low-street-connectivity areas. The association held after adjusting for physical activities and social interaction. Given the established connection between street connectivity and mental health, the findings can contribute to healthy urban planning. [ABSTRACT FROM AUTHOR]

Background: Urbanization and population aging may affect prevalence of chronic pain from various causes. This cross-sectional study aimed to investigate the prevalence of chronic musculoskeletal pain, including some subtypes, in independent Japanese older people, and whether population density and population aging rate explained prevalence and differences in pain levels between municipalities.Methods: We analyzed data from 12,883 independent older people living in 58 municipalities who completed mailed questionnaires and did not need support for daily living. We identified three types of pain: "chronic musculoskeletal pain" lasting ≥ 3 months (overall and in each part of the body), "chronic widespread-type pain" in the spinal and peripheral area, and "chronic multisite pain" in at least three sites. The latter two were measured using new definitions. These types of pain are correlated with depressive symptoms and we therefore examined the construct validity of the definitions by comparing the Geriatric Depression Scale score. We also used analysis of covariance to compare the prevalence of these three types of pain between municipalities. Odds ratios, median odds ratios, and the municipal variance in prevalence of chronic musculoskeletal pain were estimated by Bayesian multilevel logistic regression analysis using the Markov Chain Monte Carlo method.Results: The construct validity of the definitions of chronic widespread-type pain and chronic multisite pain was confirmed. The prevalence of the three types of pain (chronic musculoskeletal, widespread, and multisite pain) was 39.0%, 13.9%, and 10.3%, respectively. Chronic musculoskeletal pain showed a higher prevalence among older people and women. Individuals in underpopulated, suburban, or metropolitan areas tended to have more pain than those in urban areas, but this was not statistically significant (odds ratio [95% credible interval] 1.15 [0.86-1.51], 1.17 [0.93-1.43], 1.17 [0.94-1.46]). Population density and population aging rate did not explain the differences between municipalities.Conclusions: The prevalence of chronic musculoskeletal pain was consistent with previous global reports. Areas with overpopulation and depopulation tended to have higher pain prevalence, but population density and population aging rate did not explain municipal variance. Further research is needed to identify other factors that contribute to regional variance. [ABSTRACT FROM AUTHOR]

Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults. Data were from a nationwide cohort study of Japanese older adults aged ≥ 65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated. Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores = − 1.2%, 95%CI − 3.4, 1.1 higher versus lower optimism quintiles = − 4.1%, 95%CI − 11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well. Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts. [ABSTRACT FROM AUTHOR]

Purpose: Adverse childhood experiences (ACEs) have been linked to diminished health achievement across the life course. However, few studies have rigorously investigated the role of adult socioeconomic status (SES) as a mediator and an effect modifier of the association between ACEs and late-life depression. We used a four-way decomposition analysis to examine the relative contributions of mediation and interaction by low adult SES to the association between ACEs and late-life depression. Methods: Data came from two waves (2013 and 2016) of the Japan Gerontological Evaluation Study, a nationwide cohort of older people (n = 7271). ACEs were determined as ≥ 2 experiences of the following: parental loss, parental divorce, parental mental illness, domestic violence, physical abuse, psychological neglect, psychological abuse, and economic disadvantage. Low adult SES was defined as earning < 2 million yen of income and < 10 years of schooling. Depressive symptoms were assessed using the Geriatric Depression Scale. Results: Controlled direct effect (coefficient 0.28; 95% CI 0.08–0.46) accounted for 69.1% of the total effect, which was greater than the other three estimates for the decomposed effects (reference interaction 20.8%, mediated interaction 5.7%, and pure indirect effect 4.4%). Adult SES accounted for 10.1% (via mediation) and 26.5% (via exposure–mediator interaction) of the total association between ACEs and depressive symptoms, respectively. Conclusion: ACEs appeared to be a strong and independent determinant of depressive symptoms in later life. Nonetheless, the interaction between ACEs and adult SES indicates that achieving high adult SES could mitigate the adverse effect of ACEs on late-life depression. [ABSTRACT FROM AUTHOR]

Background: Among all physical activities, walking is one of the easiest and most economical activities for older adults' mental and physical health. Although promoting social participation may extend the walking time of older adults, the longitudinal relationship is not well understood. Thus, this study elucidates the relationship between nine types of social participation and change in walking time during a 3-year follow-up of older adults.Methods: We conducted a 3-year community-based longitudinal study of independent older adults in Japan. From the 2016 and 2019 surveys, we extracted 57,042 individuals. We performed multiple regression analyses, estimating associations between change in walking time after three years and nine types of social participation in 2016: volunteer, sports, hobby, senior, neighborhood, learning, health, skills, and paid work. We conducted subgroup analysis stratified by walking time in 2016 (i.e., < 60 or ≥ 60 min/day).Results: The mean (standard deviation) change in walking time for 3 years was - 4.04 (29.4) min/day. After adjusting potential confounders, the significant predictors of increasing or maintaining walking time (min/day) were participation in paid work (+ 3.02) in the < 60 min/day subgroup; and volunteer (+ 2.15), sports (+ 2.89), hobby (+ 1.71), senior (+ 1.27), neighborhood (+ 1.70), learning (+ 1.65), health (+ 1.74), and skills (+ 1.95) in the ≥ 60 min/day subgroup compared with non-participants.Conclusions: Paid work and community activities may be effective for maintaining or increasing walking time among older adults with less (< 60 min/day) and sufficient (≥ 60 min/day) walking time, respectively. [ABSTRACT FROM AUTHOR]

This study aimed to identify factors associated with engaging in sports and exercise volunteering among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), a nationwide mail survey of 20,877 older adults from 60 municipalities. Multilevel mixed-effects logistic regression analysis was used to investigate the correlation between engaging in sports and exercise volunteering and 39 variables classified into five factors: (1) demographic and biological, (2) behavioral, (3) psychological, cognitive, and emotional, (4) social and cultural, and (5) environmental factors. Among the analyzed samples, 1580 (7.6%) participants volunteered a few times/year or more often. Factors that showed positive association with the volunteering were older age, a current drinking habit, excellent self-rated health, high proportion of sports group participants in a living area, low municipal population density, and rich social and cultural features (i.e., social cohesion, support, network, and participation). Meanwhile, those that had a negative association were women, low level of education, deteriorated instrumental activities of daily living, having a past or current smoking habit, poor self-rated health, and depressive symptoms. We clarified the characteristics of the population that is more likely to participate in sports and exercise volunteering as well as those of the population that is less likely to participate and requires support. [ABSTRACT FROM AUTHOR]

Objectives: Art and cultural activities can benefit mental health. However, there is insufficient evidence on active engagement in art and cultural activities for preventing depressive symptoms among older adults. Therefore, we examined the association of active engagement in art and cultural activities with depressive symptom onset among older adults using 3-year longitudinal data.Methods: This longitudinal study recruited non-institutionalised older adults independent in daily living from the Japan Gerontological Evaluation Study (JAGES) established in 2010, and those without depressive symptoms were followed for three years. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Active engagement in nine art and cultural activities, including Japanese traditional cultural activities, were evaluated (musical performance, singing, dancing, handicrafts, painting, photography, poetry composition, calligraphy, and tea ceremony/flower arrangement).Results: Ultimately, 37,627 older adults without depressive symptoms at baseline were analysed. The participants' mean age (standard deviation) was 72.6 (5.5) years, and 51.5% were female. During the follow-up period, depressive symptoms occurred in 3844 participants (10.2%). Multivariable logistic regression analysis revealed that active engagement in art and cultural activities was inversely associated with depressive symptom onset (odds ratio = 0.80, 95% confidence interval = 0.73-0.87, p < 0.001). This association was confirmed regardless of age, gender, and socioeconomic status. Among the activities, especially dancing and photography were protective against depressive symptoms.Conclusion: Active engagement in art and cultural activities may contribute to preventing depressive symptoms among older adults. Promoting art and cultural engagement could be important to protect their mental health. [ABSTRACT FROM AUTHOR]

Background: While it has been recognized that visual impairment is associated with poor self-rated health (SRH), in addition to various negative health outcomes of visual impairment, the number of older adults with visual impairment is increasing due to population aging. As increasing evidence has been found for the effectiveness of social participation on good SRH, we examined whether there was an association between social participation and SRH and investigated whether the effect differed by visual status.Methods: Questionnaire data on self-reported visual status, social participation, socioeconomic status, and SRH were obtained in 2016. A total of 24,313 community-dwelling individuals aged 65 and over participated. We examined the association of social participation and SRH status among older adults with visual impairment. Stratified analysis and analysis with an interaction term between social participation and visual status were also conducted. Social participation was assessed by the number of participating groups (no participation, one, two, and three or more).Results: Overall visual impairment prevalence was 9.3% (95% CI: 8.9-9.7). Among those with and without visual impairment, prevalence of poor SRH was 38.4 and 13.1%, respectively. However, the association between social participation with SRH was similar, especially for those who participated in one or two groups. For people with (PR = 0.54) and without visual impairment (PR = 0.50), those who participated in two groups showed lower prevalence ratios for poor SRH compared to people without social participation.Conclusion: Social participation showed a beneficial association with SRH among older adults with visual impairment. Future interventions could focus on the potentially positive role of social participation on SRH among older adults with visual impairment. [ABSTRACT FROM AUTHOR]

Background: Gait was proved to be strongly associated with global cognitive function and multiple cognitive domains; however, previous research usually concentrated on individual gait parameters. This study used wearable sensors to measure gait parameters in different aspects and comprehensively explored the association of gait with global cognitive function and cognitive domains.Methods: The data of this cross-sectional study were obtained from 236 community-dwelling Japanese older adults (125 men and 111 women) aged 70-81 years. Gait was measured by asking participants to walk a 6-m course and back using the Physilog® sensors (GaiUp®, Switzerland). Global cognitive function and cognitive domains were evaluated by face-to-face interviews using the Japanese version of the Montreal Cognitive Assessment. Twenty gait parameters were summarized as independent gait factors using factor analysis. A generalized linear model and linear regression model were used to explore the relationship of gait with global cognitive function and cognitive domains adjusted for several confounding factors.Results: Factor analysis yielded four gait factors: general cycle, initial contact, propulsion, and mid-swing. Among them, general cycle factor was significantly associated with global cognitive function (β = - 0.487, [- 0.890, - 0.085]) and executive function (P = 0.049); initial contact was associated with executive function (P = 0.017).Conclusion: General cycle of gait might be the better marker of global cognitive function and gait is most strongly associated with executive function. The longitudinal relationships should be examined in future cohort studies. [ABSTRACT FROM AUTHOR]

Considering beneficial effects of leisure activities in later life on well-being and health, we investigated which type of social network among older adults is associated with starting their participation in leisure activities. We used data from a longitudinal Japan Gerontological Evaluation Study (JAGES) conducted in Japan every three years from 2010 to 2016. We extracted types of social networks of older adults who did not participate in leisure activities in 2013 and responded to items related to social networks (n = 3436) relying on latent class analysis to examine changes in leisure activity participation over a three-year period within each latent class while controlling for participants' activity in 2010. As a result, we identified five latent classes of social networks: the Neighborhood network, the Restricted network, which is characterized by limited social contacts, the Colleagues network, the Same-Interest network, and the Diverse network, from the most to the least prevalent. We found that members of the Neighborhood (Cohen's d = 0.161) and Same-Interest networks (d = 0.660) were significantly more likely to, and members of the Diverse (d = 0.124) and Colleague networks (d = 0.060) were not significantly more likely to start leisure activities than those in the Restricted network. Furthermore, we found that lower age, better mental health, and higher education level were positively associated with starting participation in leisure activities in some latent classes. Horticulture or gardening was most likely to be chosen across all latent classes. Supporting the formation of social networks facilitating leisure activities, and recommending activities that were likely to be selected could be one solution for getting and keeping older adults active. [ABSTRACT FROM AUTHOR]

Purpose: Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults.Methods: Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis.Results: The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses.Conclusion: There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults. [ABSTRACT FROM AUTHOR]

The current study investigated the relationship between the frequency of watching sports and depressive symptoms among older adults. This study used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide mail survey of 21,317 older adults. Depressive symptoms were defined as a Geriatric Depression Scale score of ≥ 5. Participants were queried regarding the average frequency at which they watched sports on-site and via TV/Internet over the past year. Among the 21,317 participants, 4559 (21.4%) had depressive symptoms, while 4808 (22.6%) and 16,576 (77.8%) watched sports on-site and via TV/Internet at least once a year, respectively. Older adults who watched sports on-site a few times/year (prevalence ratio, 0.70; 95% confidence interval, 0.65–0.74) or 1–3 times/month (0.66, 0.53–0.82) were less likely to have depressive symptoms compared to non-spectators after adjusting for frequency of playing sports, exercise activities, and other potential confounders. Meanwhile, a dose–response relationship was confirmed for watching via TV/Internet (prevalence ratio of 0.86, 0.79, and 0.71 for a few times/year, 1–3 times/month, and ≥ 1 time/week, respectively). This study suggested that watching sports on-site or via TV/Internet, regardless of whether they regularly engage in sports, may reduce the risk of depressive symptoms among older adults. [ABSTRACT FROM AUTHOR]

Background: Elder abuse is a serious public health issue worldwide, but large-scale epidemiologic studies remain sparse. Although social factors in human relations such as social support and social isolation have been proposed as the factors related to elder abuse, cognitive social capital has not been examined.Objective: This study aims to clarify the prevalence of and the factors associated with elder abuse among independent older adults in Japan.Methods: The study design is a retrospective observational study. The data were derived from the Japan Gerontological Evaluation Study (JAGES). These self-report data were collected from 26,229 people aged 65 years or older living in 28 municipalities in 2013. The types of elder abuse and factors associated with them were examined using logistic regression analysis.Results: The prevalence of elder abuse among the sample was 12.3% (11.1% in males and 13.3 in females). In the entire sample, physical, psychological, and financial abuses were reported to be 1.26, 11.12, and 1.45%, respectively. Factors associated with increased odds of experiencing abuse were being a woman, living with family members, having poor self-rated health, and having mild or severe depression. By contrast, age ≥85 years, being widowed, or unmarried, and having a positive view of community trust were associated with a lower risk of experiencing abuse.Conclusion: While particular demographic factors and health are associated with a greater risk of elder abuse, our findings that trust within the community lessens the risk indicates the importance of social capital. This should be taken into consideration when developing population-based strategies to prevent elder abuse. [ABSTRACT FROM AUTHOR]

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

Objectives: Lower socio-economic status (SES) may be associated with dementia later in life, but there is inconsistent evidence supporting this claim. We aim to examine the association between three SESs (education, job, and income indicators) and dementia onset in older adults.Methods: Study design was a 6-year prospective cohort study. Participants included a total of 52 063 community-dwelling adults aged 65 years or older without long-term care needs from the Japan Gerontological Evaluation Study. Outcome variable was dementia onset. Explanatory variables were educational years, the longest job held, and equivalised household income. We performed Cox proportional hazard analysis by gender with multiple imputation.Results: During the follow-up period, 10.5% of participants acquired dementia. The adjusted risks of dementia incidence of the participants with less than 6 years of education were 1.34 times (95% confidence interval [CI], 1.04-1.73) in men and 1.21 (1.00-1.45) times in women higher than those with more than 13 years of education. Females with less than 1.99 million yen (hazard ratio = 0.83, 0.72-0.96) of equivalised income were less likely to acquire dementia than those with four million yen or higher.Conclusions: Educational attainment had a robust impact on dementia onset compared with the other SES factors in both genders of older Japanese people. Securing an education for children could be crucial to prevent dementia later in life. The longest job held was less likely to be risks of dementia incidence, compared with the other two factors. [ABSTRACT FROM AUTHOR]

Objectives: Preventing the onset of depression among older people in Japan requires clarifying the social determinants of depression by using longitudinal data, while also taking biological and psychological factors into account. Identification of such determinants may enable more active intervention through social policy. We aimed to reveal the social factors related to depression in Japan's older people and consider associated policy implications. Method: Panel data obtained from a longitudinal survey (Wave 1 to Wave 2) of 3464 elderly subjects, aged 65 years or more, as part of the Aichi Gerontological Evaluation Study (AGES) project was employed. The outcome variable was depression, as evaluated by the Geriatric Depression Scale. Frequency of meeting with friends, social support, hobbies, participation in organizations, life events, illness, self-rated health, instrumental activities of daily living, and sense of coherence were entered as explanatory variables within a logit model for each gender. Results: Of the subjects without mental illness or depression at Wave 1, 14% had become depressed by Wave 2. In both men and women, life events predicted increased odds of depression, while sense of coherence predicted reduced odds. The frequency of meeting with friends, hobbies, and self-rated health predicted reduced odds of depression in men, while age predicted increased odds in women. Conclusion: Overall, social interaction is important for preventing depression in Japan, and that the establishment of a system capable of promoting social interaction and providing care to the elderly during life events may be a useful social policy approach to preventing depression. [ABSTRACT FROM AUTHOR]

BACKGROUND Many factors are associated with hypertension development. We focused on social participation as an aspect of social capital and investigated the contextual relationship between community-level social participation and hypertension using multilevel regression analyses. METHODS We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study—a population-based study of functionally independent adults aged 65 years or older. The sample comprised 116,013 participants nested in 818 communities. Hypertension and social capital were defined by questionnaires. Social capital was assessed at both the individual and the community levels in 3 dimensions: civic participation (as an index of social participation), social cohesion, and reciprocity. RESULTS The prevalence rate of hypertension was 43.7%, and 44.1% of the respondents were involved in civic participation. Community-level civic participation, but not social cohesion or reciprocity, was negatively associated with hypertension in the total population (prevalence ratio (95% confidence interval): 0.98 (0.96–0.99), P = 0.004) and female group (0.97 (0.95–0.99), P = 0.015), and the association neared significance in the male group (0.98 (0.96–1.005), P = 0.13) after adjustment for individual-level social capital dimensions including civic participation, individual-level covariates, and population density as a community-level covariate. The interaction between community-level civic participation and sex in relation to hypertension was significant (P = 0.012). CONCLUSIONS We found a contextual preventive relationship between community-level civic participation and hypertension. The design of the contextual characteristics of communities by the promotion of social participation may help reduce the prevalence of hypertension in older people. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence suggests an impact of childhood disadvantage on late-life functional impairment in Western countries. However, the processes by which childhood disadvantage affects functional capacity are influenced by several factors unique to particular societies. We examined the impact of childhood disadvantage on functional decline among older Japanese, using a large-scale prospective cohort study.Methods: Data came from surveys conducted in 2010 and 2013 as part of the Japan Gerontological Evaluation Study (JAGES), a nationwide cohort study targeting community-dwelling people aged 65 years and over. Childhood disadvantage included subjective childhood socioeconomic status (SES), body height, and educational level. The sample was stratified by age at baseline (65-69, 70-74, 75-79, and ≥ 80 years).Results: A total of 11,601 respondents were analyzed. In the 65-69-year group, lower childhood SES was associated with functional decline but this association was mediated by adult SES. In contrast, childhood SES was independently associated with functional decline in the older cohort. In the 75-79-year group, lower childhood SES was associated with functional decline. However, in the ≥ 80-year group, people with higher childhood SES were more likely to experience functional decline. Shorter height was associated with functional decline in the 70-74-year group. Higher education was related to functional decline in all age groups except the ≥ 80-year group.Conclusions: These findings suggest that childhood disadvantage affects functional decline but its effect varies by age cohort. The mechanisms underlying the association between childhood disadvantage and functional decline may be influenced by social and historical context. [ABSTRACT FROM AUTHOR]

Background: A life-course perspective is essential in understanding the determinants of higher-level functional limitations. We examine the impact of adverse childhood experiences (ACEs) on higher-level functional limitations in older people.Methods: Data were from the Japan Gerontological Evaluation Study 2013, a population-based cohort of independent people aged 65 years or older across Japan (n = 19,220). ACEs before the age of 18 were assessed in terms of seven adversities: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Associations between the cumulative number of ACEs and higher-level functional limitations were investigated by multivariate Poisson regression with robust error variances, adjusted for age, gender, childhood disadvantage, adult sociodemographics, adult health behaviors, and health status.Results: Of the older people, 36.3% reported at least one ACE. Older people who had experienced two or more ACEs showed significantly greater higher-level functional limitations than those with no ACE in a crude model (prevalence ratio, PR = 1.61, 95% confidence interval, CI = 1.51-1.71). After adjusting the covariates, this association remained (PR = 1.19, 95% CI = 1.12-1.27).Conclusions: ACEs showed robust independent effects on higher-level functional limitations among older Japanese without disabilities, even after adjusting for potential covariates in childhood and adulthood. The current findings may help in understanding the impact of the latent effects of ACEs on functional limitations in older people. [ABSTRACT FROM AUTHOR]

Background: Several previous studies reported social participation may reduce the incident of dementia; therefore, the type of positions held in the organization may relate to dementia onset. However, this hypothesis remains largely unknown. The purpose of the present study was to examine the additive effect of a leadership position in the organization on dementia onset and social participation among elderly people in a local community, according to data from a Japanese older adults cohort study.Methods: Of 29,374 community-dwelling elderly, a total of 15,313 subjects responded to the baseline survey and were followed-up from November 2003 to March 2013. To evaluate the association between dementia onset and social participation as well as the role in the organization, we conducted Cox proportional hazard regression analysis with multiple imputation by age group (aged 75 years older or younger). The dependent variable was dementia onset, which was obtained from long-term care insurance data in Japan; independent variables were social participation and the role in the organization to which they belonged (head, manager, or treasurer). Covariates were sex, age, educational level, marriage status, job status, residence status, alcohol consumption, smoking status, and walking time, instrumental activities of daily living, depression, and medical history.Results: During the follow-up period, 708 young-old elderly people (7.7%) and 1289 old-old elderly people (27.9%) developed dementia. In young-old elderly, relative to social non-participants, adjusted Hazard Ratio (HR) for dementia onset for participants (regular members + leadership positions) was 0.75 (95% confidence interval (CI), 0.64-0.88). Relative to regular members, adjusted HR for dementia onset for non-participants was 1.22 (95% CI, 1.02-1.46), for leadership positions 0.81 (95% CI, 0.65-0.99). The results for old-old elderly participants did not show that any significantly adjusted HR between dementia onset and social participation, the role in the organization.Conclusions: In young-old elderly people, social participation might have a positive effect on dementia onset, and holding leadership positions in organization could lead to a decrease in risk of dementia onset by almost 20% than regular members. [ABSTRACT FROM AUTHOR]

Objective: To study the association between the number of area-level and individual-level social participation items and cognitive function in the community-dwelling older populations of three towns in Hokkaido, Japan.Methods: A survey on the frequency of social participation was mailed to those in the Japan Gerontological Evaluation Study 2013 who were aged ≥65 years, were not certified as needing long-term care, and lived in Higashikawa, Higashikagura, or Biei. A subset of participants aged 70-74 years completed the Japanese version of the Montreal Cognitive Assessment in a home visit survey. Both the area-level and individual-level social participation and demographic information were obtained on the self-administered questionnaire. A multilevel analysis using a generalized linear mixed-effects model was used to examine the association between variables in the area-level and individual-level social participation items and cognitive function.Results: Out of 4042 respondents, data from 2576 were used in the area-level analysis. Of those, 180 were aged 70-74 years and completed the home visit survey for the individual-level analysis. A greater number of higher social participation items at the individual level was associated with higher cognitive function scores after adjusting for area-level social participation variables and confounders (regression coefficient: 0.19; 95% confidence interval: 0.03, 0.35). There were no significant associations between area-level social participation item averages and individual-level cognitive function scores.Conclusions: Older populations participating in many kinds of social activities exhibited preserved cognitive function even after adjusting for area-level social participation variables. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To determine whether oral health status predicts depressive symptoms in older Japanese people. Design Longitudinal study. Setting Twenty-four municipalities in Japan. Participants Community-dwelling individuals aged 65 years and older who responded to mail surveys performed by the Japan Gerontological Evaluation Study in 2010 and 2013 (N = 14,279). Measurements Depressive symptoms were assessed using the Geriatric Depression Scale ( GDS). Multiple imputations were used to deal with missing data. After excluding participants with depressive symptoms ( GDS ≥ 5) at baseline, odds ratios ( ORs) and 95% confidence intervals ( CIs) for incident depressive symptoms in 2013 were estimated using logistic regression models. Results After adjusting for sex, age, educational attainment, equivalized household income, marital status, present illness, exercise, frequency of going out, and visits for dental treatment, the following ORs (95% CIs) were observed in simultaneously added oral health variables: 10-19 teeth ( OR 1.16, 95% CI 0.99-1.37, reference: ≥20 teeth); 1-9 teeth (1.14, 0.94-1.38, reference: ≥20 teeth); no teeth (1.28, 1.03-1.60, reference: ≥20 teeth); more difficulty chewing tough foods now than 6 months ago (1.24, 1.04-1.47); choking when drinking tea or soup (1.02, 0.84-1.23); feelings of thirst (1.17, 0.99-1.40); difficulty eating food (0.98, 0.80-1.21), difficulty speaking clearly (1.19, 0.89-1.60); problems with smiling (1.24, 0.94-1.65); problems with emotional stability (1.32, 0.86-2.04); and problems enjoying oneself around family, friends, or other people (0.86, 0.42-1.78). Conclusion These findings suggest that having no teeth and oral health problems may play a role in the development or worsening of depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: We sought to examine social network diversity as a potential determinant of oral health, considering size and contact frequency of the social network and oral health behaviors. Methods: Our cross-sectional study was based on data from the 2010 Japan Gerontological Evaluation Study. Data from 19,756 community-dwelling individuals aged 65 years or older were analyzed. We inquired about diversity of friendships based on seven types of friends. Ordered logistic regression models were developed to determine the association between the diversity of social networks and number of teeth (categorized as ≥20, 10–19, 1–9, and 0). Results: Of the participants, 54.1% were women (mean age, 73.9 years; standard deviation, 6.2). The proportion of respondents with ≥20 teeth was 34.1%. After adjusting for age, sex, socioeconomic status (income, education, and occupation), marital status, health status (diabetes and mental health), and size and contact frequency of the social network, an increase in the diversity of social networks was significantly associated with having more teeth (odds ratio = 1.08; 95% confidence interval, 1.04–1.11). Even adjusted for oral health behaviors (smoking, curative/preventive dental care access, use of dental floss/fluoride toothpaste), significant association was still observed (odds ratio = 1.05 (95% confidence interval, 1.02–1.08)). Conclusion: Social connectedness among people from diverse backgrounds may increase information channels and promote the diffusion of oral health behaviors and prevent tooth loss. [ABSTRACT FROM AUTHOR]

Background: Social participation is known to predict longevity. However, little is known about the effect of social participation according to an individual's position in civic groups. We evaluated the influence of social position on mortality, using data from a large cohort of Japanese older adults (the AGES cohort).Methods: Of 14,804 individuals aged 65 years and older enrolled in the AGES, 14,286 individuals were followed up for approximately 5 years from 2003 to 2008. We performed inverse probability of treatment weighted (IPTW) Cox proportional hazards regression with multiple imputation of missing values to compute hazard ratios (HR) for all-cause mortality according to the individual's position in the community organization(s) to which they belonged. We examined participation in the following civic groups: neighborhood association/senior citizen club/fire-fighting team, religious group, political organization or group, industrial or trade association, volunteer group, citizen or consumer group, hobby group, and sports group or club. The values for IPTW were computed based on demographic variables, socioeconomic status, and self-reported medical condition.Results: During 22,718 person-years of follow-up for regular members of community groups and 14,014 person-years of follow-up for participants in leadership positions, 479 deaths and 214 deaths were observed, respectively. Relative to regular members, crude HR for all-cause mortality for occupying leadership positions (e.g. president, manager, or having administrative roles) was 0.72 (95 % CI:0.62-0.85). The IPTW-HR was 0.88 (95 % CI: 0.79-0.99) for participants occupying leadership positions.Conclusions: Holding leadership positions in community organization(s) may be more beneficial to health than being regular members. [ABSTRACT FROM AUTHOR]

Month of birth (MOB) has been linked to a variety of health conditions in adulthood. This study examined the association between MOB and mortality among the healthy elderly in Japan, where a practice of traditional age reckoning was employed up until the late 1940s. The results showed male participants born in December were more likely to die earlier while those born in January had lower mortality. It is possible that social factors in early life, such as the time period when a birth is officially registered, may have implications for health that stretch across the life course. [ABSTRACT FROM AUTHOR]

Background. We examined the associations between childhood socioeconomic status and adulthood height with functional limitations in old age. Methods. Data were obtained from the baseline survey of the Japan Gerontological Evaluation Study 2010, a population-based cohort of people aged ≥65 years enrolled from 27 municipalities across Japan (N = 15,499). People aged 65–69, 70–74, 75–79, and ≥80 years experienced the end of World War II when they were aged 0–4, 5–9, 10–14, and ≥15 years, respectively. Subjective socioeconomic status during childhood and current height were obtained by self-report through questionnaire in 2010. Higher-level functional capacity was assessed using a validated questionnaire scale. Poisson regression with robust variance estimator was employed to determine the association between childhood subjective socioeconomic status, height, and functional limitations. Results. Lower childhood subjective socioeconomic status was consistently associated with higher prevalence rate ratio of limitations in higher-level functional capacity, regardless of age cohort. Height was associated with functional limitation only among the group aged 70–74 years: taller (≥170cm for men and ≥160cm for women) people were 16% less likely to report functional limitation in comparison with shorter (<155 cm for men and <145 cm for women) individuals in the fully adjusted model (prevalence rate ratio: 0.84, 95% confidence interval: 0.74–0.96). Conclusions. Low childhood subjective socioeconomic status had a robust association with functional limitation regardless of age cohort. In addition, those who lived through World War II before they reached puberty and attained shorter height were more likely to report functional limitations in old age. [ABSTRACT FROM PUBLISHER]

Background: We examined the relationship between incident functional disability and social participation from the perspective of number of types of organizations participated in and type of social participation in a prospective cohort study. Method: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. We followed 13,310 individuals aged 65 years or older for 4 years. Analysis was carried out on 12,951 subjects, excluding 359 people whose information on age or sex was missing. Social participation was categorized into 8 types. Results: Compared to those that did not participate in any organizations, the hazard ratio (HR) was 0.83 (95% CI: 0.73–0.95) for participation in one, 0.72 (0.61–0.85) for participation in two, and 0.57 (0.46–0.70) for participation in three or more different types of organizations. In multivariable adjusted models, participation in the following types of organization was protective for incident disability: local community organizations (HR = 0.85, 95% CI: 0.76–0.96), hobby organizations (HR = 0.75, 95% CI: 0.64–0.87), and sports organizations (HR = 0.64, 95% CI: 0.54–0.81). Conclusion: Social participation may decrease the risk of incident functional disability in older people in Japan. This effect may be strengthened by participation in a variety of different types of organizations. Participating in a local community, hobby, or sports group or organization may be especially effective for decreasing the risk of disability. [ABSTRACT FROM AUTHOR]

Background: We developed and validated an instrument to measure community-level social capital based on data derived from older community dwellers in Japan. Methods: We used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide survey involving 123,760 functionally independent older people nested within 702 communities (i.e., school districts). We conducted exploratory and confirmatory factor analyses on survey items to determine the items in a multi-dimensional scale to measure community social capital. Internal consistency was checked with Cronbach's alpha. Convergent construct validity was assessed via correlating the scale with health outcomes. Results: From 53 candidate variables, 11 community-level variables were extracted: participation in volunteer groups, sports groups, hobby activities, study or cultural groups, and activities for teaching specific skills; trust, norms of reciprocity, and attachment to one's community; received emotional support; provided emotional support; and received instrumental support. Using factor analysis, these variables were determined to belong to three sub-scales: civic participation (eigenvalue = 3.317, α = 0.797), social cohesion (eigenvalue = 2.633, α = 0.853), and reciprocity (eigenvalue = 1.424, α = 0.732). Confirmatory factor analysis indicated the goodness of fit of this model. Multilevel Poisson regression analysis revealed that civic participation score was robustly associated with individual subjective health (Self-Rated Health: prevalence ratio [PR] 0.96; 95% confidence interval [CI], 0.94–0.98; Geriatric Depression Scale [GDS]: PR 0.95; 95% CI, 0.93–0.97). Reciprocity score was also associated with individual GDS (PR 0.98; 95% CI, 0.96–1.00). Social cohesion score was not consistently associated with individual health indicators. Conclusions: Our scale for measuring social capital at the community level might be useful for future studies of older community dwellers.

Background: Social participation is known to predict longevity. However, little is known about the effect of social participation according to an individual’s position in civic groups. We evaluated the influence of social position on mortality, using data from a large cohort of Japanese older adults (the AGES cohort). Methods: Of 14,804 individuals aged 65 years and older enrolled in the AGES, 14,286 individuals were followed up for approximately 5 years from 2003 to 2008. We performed inverse probability of treatment weighted (IPTW) Cox proportional hazards regression with multiple imputation of missing values to compute hazard ratios (HR) for all-cause mortality according to the individual’s position in the community organization(s) to which they belonged. We examined participation in the following civic groups: neighborhood association/senior citizen club/fire-fighting team, religious group, political organization or group, industrial or trade association, volunteer group, citizen or consumer group, hobby group, and sports group or club. The values for IPTW were computed based on demographic variables, socioeconomic status, and self-reported medical condition. Results: During 22,718 person-years of follow-up for regular members of community groups and 14,014 person-years of follow-up for participants in leadership positions, 479 deaths and 214 deaths were observed, respectively. Relative to regular members, crude HR for all-cause mortality for occupying leadership positions (e.g. president, manager, or having administrative roles) was 0.72 (95 % CI:0.62–0.85). The IPTW-HR was 0.88 (95 % CI: 0.79–0.99) for participants occupying leadership positions. Conclusions: Holding leadership positions in community organization(s) may be more beneficial to health than being regular members.

Abstract: Previous studies reported that social disorganization/fragmentation could predict mental well-being of residents in a community. The aim of this study is to examine how area and individual level of social distance could predict likelihood of mental health among older people in Japan. We empirically derived an index of “social distance” by taking averaged differences in sociodemographic characteristics that are income, education, hometown of origin, the duration of residency, and life stage, between the study participants and their neighbors. We used the study participants (n = 9147) from the Aichi Gerontological Evaluation Study, which targeted residents with aged 65 years or over in a central part in Japan. Depressive symptoms of the study participants were assessed using the short version of the Geriatric Depression Scale (GDS-15). We also tested if area-level social capital would moderate the association between social distance and depressive symptoms. Using multilevel analyses, we found that higher social distance from neighbors was associated with increased depressive symptoms, independently of respondents'' own values of income and educational attainment. At the individual level, each standard deviation in income-based and education-based social distance was associated with an odds ratio for depressive symptoms of 1.15 (95% CI: 1.01–1.30) and 1.17 (95% CI: 1.03–1.32), respectively. However, the area-aggregated indices of social distance were not associated with depressive symptoms. Additionally, area-level social capital indicating higher levels of trust between neighbors and social participation, buffered the adverse effect of social distance on depressive risk. In an instance of the “dark side” of social capital, we also found that stronger social cohesion increased depressive symptoms for residents whose hometown of origin differed from the communities where they currently resided. [Copyright &y& Elsevier]

Background: We sought to examine prospectively the difference in the association between incident functional disability and exercise with or without sports organization participation. Methods: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. In October 2003, self-reported questionnaires were mailed to 29,374 non-disabled Japanese individuals aged 65 years or older. Of these, 13,310 individuals were introduced to the Study, and they were followed for 4 years. Analysis was carried out on 11,581 subjects who provided all necessary information for the analysis. Results: Analysis was carried out on incident functional disability by 4 groups of different combinations of performance of exercise and participation in a sports organization Active Participant (AP), Exercise Alone (EA), Passive Participant (PP) and Sedentary (S). Compared to the AP group, the EA group had a hazard ratio (HR) of 1.29 (1.02-1.64) for incident functional disability. No significant difference was seen with the PP group, with an HR of 1.16 (0.76-1.77). When a measure of social networks was added to the covariates, the HR of the EA group dropped to 1.27 (1.00-1.61), and significant differences disappeared. In contrast, it showed hardly any change when social support was added. Conclusion: The results suggested that, even with a regular exercise habit, incident functional disability may be better prevented when a person participates in a sports organization than when he/she does not. In addition, participation in a sports organization correlates positively with social networks, which may lead to a small decrease in incident functional disability. [ABSTRACT FROM AUTHOR]

Abstract: Why are some communities more cohesive than others? The answer to the puzzle has two parts: (a) due to variations in the attributes of residents, and/or (b) due to variations in the attributes of places. However, few studies have sought to examine the community-level determinants of social capital. In the present study, we examined the associations between social capital and different area characteristics: (1) neighborhood walkability, (2) date of community settlement, and (3) degree of urbanization. We based our analysis on 9414 respondents from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. No significant positive association was found between the walkability score and any of the social capital indices. In contrast, community age and degree of urbanization were associated with many of the social capital indicators, even after controlling for characteristics of the residents. Community social capital thus appears to be more consistently linked to the broader historical and geographic contexts of neighborhoods, rather than to the proximal built environment (as measured by walkability). [Copyright &y& Elsevier]

Background: Few prospective cohort studies have assessed the association between social capital and mortality. The studies were conducted only in Western countries and did not use the same social capital indicators. The present prospective cohort study aimed to examine the relationships between various forms of individual social capital and all-cause mortality in Japan. Methods: Self-administered questionnaires were mailed to subjects in the Aichi Gerontological Evaluation Study (AGES) Project in 2003. Mortality data from 2003 to 2008 were analyzed for 14,668 respondents. Both cognitive and structural components of individual social capital were collected: 8 for cognitive social capital (trust, 3; social support, 3; reciprocity, 2) and 9 for structural social capital (social network). Cox proportional hazard models stratified by sex with multiple imputation were used. Age, body mass index, self-rated health, current illness, smoking history, alcohol consumption, exercise, equivalent income and education were used as covariates. Results: During 27,571 person-years of follow-up for men and 29,561 person-years of follow-up for women, 790 deaths in men and 424 in women were observed. In the univariate analyses for men, lower social capital was significantly related to higher mortality in one general trust variable, all generalised reciprocity variables and four social network variables. For women, lower social capital was significantly related to higher mortality in all generalised reciprocity and four social network variables. After adjusting for covariates, lower friendship network was significantly associated with higher all-cause mortality among men (meet friends rarely; HR = 1.30, 95%CI = 1.10-1.53) and women (having no friends; HR = 1.81, 95%CI = 1.02-3.23). Among women, lower general trust was significantly related to lower mortality (most people cannot be trusted; HR = 0.65, 95%CI = 0.45-0.96). Conclusions: Friendship network was a good predictor for all-cause mortality among older Japanese. In contrast, mistrust was associated with lower mortality among women. Studies with social capital indices considering different culture backgrounds are needed. [ABSTRACT FROM AUTHOR]

Abstract: The effect of social capital on one''s health has drawn researchers'' attention. In East-Asian countries, however, such an effect has been less studied than in Western countries. Mindful of this background, this study aimed to investigate the linkage between social capital and health at the level of a small area in Japan, and also to examine whether social capital mediates the relation between income inequality and health. The main survey targeted 34,374 people aged 65 years and older from 25 communities who were without the need of nursing care. We collected 17,269 questionnaires (response rate 50.2%), from which we used 15,225 (response rate 44.3%) which had complete information on self-rated health, age, and sex. The main outcome measure was self-rated health status (1=fair/poor; 0=very good/good). The individual-level variables of age, sex, equivalised income, marital status, educational attainment, and type of housing were included to control for compositional effects. Average income, social capital and the Gini coefficient were used as community-level variables. The variable of social capital was calculated as the percentage of individuals in the community samples who reported “yes” or “it depends” to the question “Generally speaking, would you say that most people can be trusted?” When the individual-level variables and the average equivalised income at the community level were controlled for, we found that high social capital and a decreased Gini coefficient were significantly associated with good self-rated health using a multilevel model. The association between social capital and self-rated health was insignificant after adjustment for the Gini coefficient. However, in other series of models, we also detected a statistically significant linkage between the increased Gini coefficient and negative responses to the question of individual-level trust using multilevel models. This suggests that people who live in conditions of high-income inequality tend to exhibit low trust levels, and that social capital mediates the relation between income inequality and health. This study is, to our knowledge, the first investigation of the linkage between social capital and health in Japan using multilevel analysis, and reports the first supported result of the relative income hypothesis in Japan. Additionally, the statistically significant linkage between the increased Gini coefficient and low trust observed in this study provides additional evidence to support the social cohesion and collective social pathway between income inequality and health. [Copyright &y& Elsevier]

• The caregiving burden is negatively associated with influenza vaccination among older adults. • The caregiving burden is not associated with pneumococcal vaccination among oldder adults. • Having a family physician mitigates the negative effect on influenza vaccination and it enhances both influenza and pneumococcal vaccinations among older adults. Influenza and pneumonia tend to be severe in older adults; thus, vaccination is necessary to prevent these illnesses. Vaccination is especially important for older family caregivers (OFCs) not only to prevent them from becoming ill, but also to prevent secondary infections in the family care receivers (FCRs), who are mostly frail older adults and have a higher risk of severe illness. Thus, we investigated whether caregiving burdens were associated with the vaccinations among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), which was conducted in 64 Japanese municipalities from November 2019 to January 2020. The target population consisted of 26,177 individuals aged 65 years or older who were independent and did not need public long-term care. The primary outcome was the uptakes of either or both influenza and pneumococcal vaccinations. Multinomial logistic regressions were performed, setting those who underwent neither vaccinations as the reference group. Among the participants, 23.3 %, 25.8 %, 9.4 %, or 41.5 % underwent neither, only influenza, only pneumococcal, or the both vaccinations, respectively. The caregiving frequency, time length in a day, or dementia of FCR were negatively associated with influenza vaccination (caregiving almost every day: relative risk ratio {RRR}: 0.39, 95 % confident interval {95 % CI} [0.24–0.63]; caregiving almost all day: 0.44, 95 % CI: 0.23–0.85; caregiving for FCR: RRR:0.55, 95 % CI: 0.34–0.91). On the other hand, those caregiving burdens were not associated with pneumococcal only or the both vaccinations. Having a family physician mitigated all the negative effect of the caregiving burdens on the vaccinations. Our results suggest that the caregiving burden is a barrier to influenza vaccination but not to pneumococcal vaccination and that having a physician mitigates the negative effect regardless of the burden kind. [ABSTRACT FROM AUTHOR]

• The uptake of PPSV23 in older adults was negatively associated with incident dementia who required daily living care. • Such associations were observed regardless of the follow-up period or influenza vaccination. • The uptake of IIV was not associated with incident dementia, regardless of the follow-up period or PPSV23. • PPSV23 was independently associated with incident dementia, whereas the IIV was not. It is unclear whether inactivated influenza vaccination (IIV) or pneumococcal vaccination are associated with the risk of dementia; however, both types of vaccination are recommended for older adults. Studies have shown that the IIV is negatively associated with incident dementia; however, the uptake of pneumococcal vaccinations has not been considered. We investigated the independent associations of IIV and 23-valent pneumococcal polysaccharide vaccine (PPSV23) with incident dementia in older adults. Health-related information on older Japanese adults was obtained through a baseline survey conducted in 2013 (baseline survey). The uptake of IIV and PPSV23 was determined in a second survey conducted in 2016 (second wave). Both surveys were conducted among independent Japanese older adults aged ≥ 65 years at the two surveys and who had not been certified as needing long-term care (LTC). In the second wave, 9,865 participants were followed up for 3.5 years (short-term follow-up), and 6,995 participants were followed up for six years and five months (long-term follow-up) until they required LTC due to dementia onset (incident dementia). A competing risk model with stabilized inverse probability weighting (SIPW) was constructed to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of incident dementia. PPSV23 uptake was negatively associated with incident dementia among participants in both the short- and long-term follow-up periods after SIPW (short-term follow-up: HR: 0.77, 95 % CI: 0.63 – 0.95; long-term follow-up: HR: 0.83, 95 % CI: 0.70 – 0.97). Conversely, IIV uptake was not associated with incident dementia among participants in either follow-up group (short-term follow-up: HR: 0.86, 95 % CI: 0.63–1.16; long-term follow-up: HR: 0.99, 95 % CI: 0.76–1.29). The PPSV23 uptake was negatively associated with incident dementia in participants without the IIV uptake (short-term follow-up: HR: 0.44, 95 % CI: 0.24 – 0.81; long-term follow-up: HR: 0.47, 95 % CI: 0.29 – 0.76). Conversely, the IIV uptake was not associated with incident dementia regardless of the PPSV23 status (short-term follow-up: HR: 0.87, 95 % CI: 0.62 – 1.23; long-term follow-up: HR: 1.00, 95 % CI: 0.74 – 1.35). Our results suggest that the PPSV23 uptake was independently associated with the incidence of dementia. However, the IIV uptake was not associated with the incidence of dementia. [ABSTRACT FROM AUTHOR]