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Objective　In 2019, the Ministry of Health, Labour and Welfare emphasized the importance of promoting "Kayoi-no-ba" (or "places to go") initiatives according to the Plan-Do-Check-Action (PDCA) cycle. However, it proposed no specific promotion measures or standardized evaluation frameworks. This study is intended to propose a framework for local government officials to promote and evaluate "Kayoi-no-ba" initiatives according to the PDCA cycle.Methods　The working group (WG) conducted a narrative review of research and extracted evaluation models and indicators that could be used to create the framework. The co-researcher review committee discussed a draft framework prepared by the WG, and the WG revised it based on the discussion; this process was repeated four times. Using the completed framework, we calculated the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and conducted regional correlation analyses on the relationship between the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and the number of "Kayoi-no-ba" per 1,000 older persons.Results　The completed framework (named "ACT-RECIPE" by rearranging the underlined characters below) comprised the following six evaluation phases: (1) Comprehension: understanding the key lessons around disability and frailty prevention, and the necessity for "Kayoi-no-ba"; (2) Research and Planning: clarifying the current status of "Kayoi-no-ba," the strengths of the community, and the issues to be addressed through a community assessment, and developing a plan to resolve the issues; (3) Team Building and Collaboration: building a team by collaborating with organizations to solve problems; (4) Implementation: implementing the initiatives necessary to solve problems; (5) Evaluation: verifying changes in output and outcome indicators from the initiatives; and (6) Adjustment and Improvement: re-examining plans, teams, content, and goals based on the evaluation results. In these six phases, we designated 10 core items and accompanying subitems. The median score rate of the ACT-RECIPE framework in 50 municipalities was 75% for "Comprehension," 61% for "Research and Planning," 69% for "Team Building and Collaboration," 64% for "Implementation," 31% for "Evaluation," and 56% for "Adjustment and Improvement," and the mean ACT-RECIPE score rate was 57%. A significant positive correlation (r s =0.43, P=0.002) was observed between the ACT-RECIPE mean score rate and the number of "Kayoi-no-ba" per 1,000 older persons.Conclusion　We proposed the ACT-RECIPE as a framework for promoting and evaluating "Kayoi-no-ba" initiatives according to the PDCA cycle. We hope that this framework will lead to further progress in "Kayoi-no-ba" initiatives and facilitate evaluation of their effectiveness according to the PDCA cycle.

Introduction: Social isolation is associated with increased mortality risk. On the other hand, some older adults prefer to be alone. Additionally, predictors of isolation are mostly unchanged across interventions. Therefore, knowledge of how to prevent negative health outcomes in isolation would be beneficial. One of the factors that reduces the risk of mortality is regular exercise. However, to date, no studies to our knowledge have examined whether regular exercise reduces mortality among socially isolated individuals. This study aimed to determine the effects of the combination of social isolation and regular exercise on mortality among community-dwelling older adults., Methods: This prospective cohort study was part of the larger Otassha Study of community-dwelling older adults living in Itabashi Ward, Tokyo, Japan. In October 2012, 835 individuals (males = 350, females = 485; mean age 73.1 years) completed a comprehensive baseline health survey. Individuals were considered socially isolated if their frequency of interactions with others averaged less than once per week. Regular exercise was defined as exercise performed at least twice a week. The participants were assigned to one of the following four groups: (1) not isolated with regular exercise, (2) not isolated without regular exercise, (3) isolated with regular exercise, and (4) isolated without regular exercise. All-cause mortality information was obtained from the ward office database. Follow-ups were conducted until 1 November 2020. A Cox proportional regression analysis was performed., Results: A final analysis was performed on a complete dataset of 735 participants (males = 303, females = 432; mean age 72.9 years). A total of 132 (18.0%), 426 (58.0%), 27 (3.7%), and 150 (20.4%) participants were assigned to groups 1, 2, 3, and 4, respectively. The mortality rates in groups 1, 2, 3, and 4 were 6.1%, 9.2%, 7.4%, and 19.3%, respectively. Compared with group 1, isolated individuals who did not perform regular exercise had a significantly higher mortality rate [adjusted hazard ratio (aHR), 2.48; 95% confidence interval (CI), 1.12-5.52]. However, no significant association was noted in isolated individuals who performed regular exercise (aHR, 1.25; 95% CI, 0.26-5.91)., Conclusion: Regular exercise was associated with a decrease in mortality risk, regardless of social isolation status. Thus, our results indicate that encouraging isolated older adults to exercise regularly may reduce their negative health outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ejiri, Kawai, Imamura, Fujiwara, Ihara, Hirano and Obuchi.)

Purpose: Evidence regarding the dose-response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with/without frailty. We examined the dose-response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with/without frailty., Methods: We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65-84 years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried's frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose-response curves were examined using restricted cubic splines., Results: During 3.6 years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)■min/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51-0.74) was reached at around 3,000-4,000 METs■min/week. Although the shape of this association was consistent regardless of with/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300 min/day) of ST, the HRs for FD increased linearly as ST reached approximately 600 min/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01-1.71) for 1,080 min/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults., Conclusion: Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose-response manner. A significant positive nonlinear dose-response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Seino, Abe, Nofuji, Hata, Shinkai, Kitamura and Fujiwara.)

Generativity is defined as an individual's concern for and actions dedicated toward the well-being of others, especially youth and subsequent generations. It is a key stage of psychological development from midlife to older age and can be a guiding concept for promoting engagement of older adults in productive and contributive activities, which benefit their well-being. This study examined the longitudinal association between generativity and higher-level functional capacity (HLFC) decline in older Japanese adults. The two-year longitudinal data of 879 older adults aged 65-84 years were analyzed. Participants' HLFC and generativity were assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence and the Revised Japanese version of the Generativity Scale, respectively. The binary logistic regression analysis results showed that a higher generativity score was negatively associated with HLFC decline, indicating that generativity effectively prevents HLFC decline over 2 years. On adding the interaction term between generativity and sex to examine whether the protective effect of generativity differed by sex, we found that generativity was especially effective in protecting the HLFC decline in men with higher generativity. The study results highlight the importance of promoting engagement of older adults in generative activities to maintain their HLFC.

Aim: Working in old age not only solves the labor shortage in Japan, but also benefits the health of the older workers; however, work-related accidents are a major concern. Functional impairment is an important factor in such accidents. The first aim was to examine the association between frailty status and work-related accidents, and the second aim was to identify those who utilize the opportunity to learn about safe work., Methods: The participants were 7265 members of the Silver Human Resource Center in Tokyo, engaged in non-regular and indeterminate paid work. The frailty status (robust, pre-frail and frail) was assessed using the frailty screening index. We obtained data on self-reported work-related accidents that occurred in the past year, and the experience of participation in workshops and reading brochures for safe work. Modified Poisson regression analysis was carried out to calculate the prevalence ratio., Results: The prevalence of robust, pre-frailty and frailty were 26.3%, 63.3% and 10.4%, respectively. The percentage of participants who reported work-related accidents was 9.4%. Relative to robust participants, pre-frail and frail participants showed 1.57-fold (95% confidence interval [CI] 1.28-1.93) and 2.31-fold (95% CI 1.79-2.98) higher prevalence ratios of work-related accidents, respectively. The prevalence ratio in pre-frail and frail participants were 1.08 (95% CI 1.04-1.11) and 1.14 (95% CI 1.09-1.20), respectively, for non-participation in workshops, and 1.17 (95% CI 1.06-1.29) and 1.39 (95% CI 1.20-1.61), respectively, for not reading brochures., Conclusions: These findings suggest the importance of support for older workers with functional impairment, as well as those without to continue to work safely. Geriatr Gerontol Int 2023; 23: 234-238., (© 2023 Japan Geriatrics Society.)

This cluster nonrandomized controlled trial examined the effectiveness of a 2-year community-wide intervention (CWI) on population-level frailty and functional health among older adults. We allocated 18 districts in Ota City, Tokyo, Japan, to intervention (3 districts, A-C) and control (15 districts) groups. Of the 15,500 stratified randomly sampled residents aged 65-84 years, 11,701 (6009 in intervention and 5692 in control groups) gave valid responses to the baseline survey and were followed for 2 years. Using participatory action research framework, we developed an evidence-based CWI to promote frailty prevention. The outcomes were changes in frailty (primary), functional health (secondary, i.e., physical, nutritional, and psychosocial variables), and awareness. Primary analyses showed no significant group by time interactions in frailty prevalence (difference in multivariate-adjusted change between groups, 1.8 percentage points [PP] [95% CI, -0.1, 3.6]). Although changes in functional health were similar between groups, prespecified subgroup analyses showed a benefit for ≥150 min/week of walking (3.9 PP [1.9-5.8]) in district A, and for exercise ≥1 time/week (2.1 PP [0.1-4.0]), Motor Fitness Scale (0.10 points [0.01-0.20]), Dietary Variety Score (DVS) (0.10 points [0.01-0.18]), DVS of ≥7 (2.0 PP [0.01-4.1]), and going outdoors ≥1 time/day (2.1 PP [0.1-4.1]) in district C. Awareness of our CWI was significantly higher in the intervention group (multivariate-adjusted difference between groups, 5.8 PP [3.9-7.8]). This CWI increased awareness in intervention group and improved population-level functional health in intervention subgroups in the short term but was not effective for population-level frailty prevention at 2 years. Trial registration: UMIN-CTR (UMIN000026515)., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Eating alone is associated with an increased risk of depression symptoms. This association may be confounded by poor social networks. The present study aimed to determine the role of poor social networks in the association of eating alone with depression symptoms, focusing on cohabitation status., Methods: Seven hundred and ten community-dwelling older adults were categorized according to their eating style and social network size, evaluated using an abbreviated version of the Lubben Social Network Scale, with poor social network size (defined as the lowest quartile). Living arrangements and depression symptoms, detected using the Zung Self-Rating Depression Scale, were also assessed., Results: A mixed-design two-way analysis of covariance (eating style and social network size factors) for the depression scale score, adjusted by covariates, yielded significant effects of social network size and eating style without interaction. Greater depression scores were observed in eating alone and poor social network size. Analysis of participants living with others showed the same results. However, among older adults living alone, only a significant main effect of social network size was observed; poor social network size resulted in greater depression scores irrespective of eating style., Conclusions: Poor social network size, and not eating alone, was associated with greater depression symptoms among older adults living alone, whereas both factors may increase depression symptoms among older adults living with others. Poor social network size may show a stronger influence on depression than eating alone in older adults living alone; thus, social network size is an important health indicator.

Purpose: In Japan, for pharmaceutical products to be covered by public medical insurance, their efficacy and safety must first be confirmed in clinical trials. To our knowledge, this study is the first investigation into the off-label use of pharmaceutical products at a high-volume cancer treatment center in Japan. The objective of this study is to explore the framework necessary for future pharmaceutical development and regulatory approval in the field of oncology by surveying the frequency of and indications for off-label use of pharmaceutical products at the National Cancer Center Hospital in Tokyo, Japan., Materials and Methods: The pharmaceutical products used off-label in daily practice from 2003 to 2015 at the National Cancer Center Hospital were retrospectively examined based on applications that had been submitted to an internal review committee requesting off-label use., Results: A total of 1,390 applications were submitted during the study period. The most frequently used supporting documents were the results of phase II trials, followed by case series and phase III trials. The cancer most frequently treated with off-label drugs was sarcoma (15.1%), followed by urologic cancer (9.2%) and GI cancer (7.6%)., Conclusion: As reported in previous studies, pharmaceutical products were generally used off-label for the treatment of rare cancers, for which large-scale clinical trials are difficult to conduct. Continued discussion of the types of frameworks that are needed to guide pharmaceutical development is necessary., Competing Interests: Conflicts of Interest Statement:The authors have declared that no competing interests exist.

Objectives: This study aimed to determine the relationship between objective chewing ability and the nutritional status of Japanese community-dwelling elders., Design: A cross-sectional study., Participants: A total of 509 community-dwelling elders living in the Tokyo metropolitan area participated in a comprehensive survey conducted in October 2013., Measurements: The basic characteristics were sex, age, and body mass index. Undernutrition was examined through serum albumin levels. Chewing ability was examined through color-changeable xylitol gum by evaluating the color changes in chewing gum. Nutritional intake was examined using the semi-quantitative food frequency questionnaire., Results: In the poor chewing ability group, all nutrient intake levels were significantly low, except for carbohydrates, and intake levels for all food groups were significantly low, except for cereals, confectionery, sugars, seasonings, and spices. Additionally, after adjusting for covariates for sex, age, Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC) score, Mini-Mental State Examination (MMSE) score, body mass index (BMI), stroke, number of functional teeth, energy intake, and protein intake, chewing ability was found to be significantly associated with undernutrition., Conclusion: We concluded that chewing ability was closely associated with nutrient and different food groups' intake, as well as undernutrition, among Japanese community-dwelling elders. Thus, to ensure comprehensive nutritional management, nutritionists and dentists should collaborate when treating the same patients.

Recent research has suggested that the breadth and evenness of activity and activity diversity contribute to health outcomes among older adults. However, few established assessment tools for activity diversity have been developed. This study developed an Activity Diversity Questionnaire (ADQ) for older adults through expert consultation and a preliminary survey among 18 community-dwelling older adults. The diversity score was calculated according to Shannon's entropy. In study 1, the intraclass correlation coefficients (ICC) of the diversity scores were determined for community-dwelling older adults ( n = 30). In study 2, concurrent validity was tested with participants receiving comprehensive health checkups at the Itabashi ward in Japan in 2018 ( n = 766). The correlation coefficients of the diversity scores were then calculated in reference to the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence. The final version of the ADQ consisted of 20 total items with excellent test-retest reliability (ICC = 0.84) and moderate correlations with both the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence (r = 0.48 and 0.60, respectively). The ADQ was developed through scientific procedures and revealed sufficient reliability and validity. As such, it is a scientifically validated tool for assessing activity diversity among older adults., Competing Interests: The authors declare no conflict of interest.

Objective: Although it has been suggested that living alone is a "social risk factor" for adverse health outcomes, poor social network may confound the association. This study aimed to examine whether the interactive effects of living alone and poor social network contribute to adverse health outcomes., Design: A 4-year prospective observational study., Setting and Participants: Four hundred community-dwelling older adults living in Itabashi ward, an urban community in Tokyo. They participated in a health checkup (held in 2015 and 2017) and completed all the assessments., Methods: Participants were classified into 4 groups according to their living arrangements (living alone or not living alone) and social network size, which was assessed using an abbreviated version of the Lubben Social Network Scale-6. Poor social network was defined as the lowest quartile (4th quartile) of the Lubben Social Network Scale-6 score. Adverse health outcomes including disabilities, depressive symptoms, and physical and cognitive functions were measured., Results: Multiple and logistic regression models, adjusted for covariates such as financial status and educational level, showed that living alone and having a poor social network at baseline were significantly associated with increased depression symptoms, reduced grip strength, and disabilities of intellectual activity and social role at follow-up. Furthermore, older adults who did not live alone but had poor social networks showed significantly higher odds of subsequent homebound status and disability in activities of daily living., Conclusions and Implications: We found that living alone among older adults is not always a social risk factor for health, and adverse health outcomes among older adults living alone may be confounded by poor social network. Our results also suggest that the effect of poor social network on health status may exceed the effects of living alone. Health professionals must, thus, pay attention to poor social network among older adults., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Preventing and reducing frailty is an important challenge for Japan in the next decade, especially in metropolitan areas. We launched a community-wide intervention trial (the Ota Genki Senior Project) in 2016 to develop effective community-based strategies for frailty prevention in metropolitan areas. This report describes the study design and baseline survey., Methods: This study is a community-wide intervention trial that integrates participatory action research into a cluster non-randomized controlled trial for adults aged 65 years or older living in Ota City, Tokyo. We allocated 3 of 18 districts to an intervention group and the other 15 to a control group. Using a mailed self-administered questionnaire, we conducted a baseline survey of 15,500 residents (8,000 and 7,500 in the intervention and control groups, respectively) from July through August 2016. In addition to socioeconomic status and lifestyle variables, we assessed frailty status (primary outcome) and physical, nutritional, and psychosocial variables (secondary outcomes). Based on the baseline findings, an intervention to improve outcomes will be implemented as participatory action research. Follow-up surveys will be conducted in the same manner as the baseline survey., Results: A total of 11,925 questionnaires were returned (76.9% response rate; 6,105 [76.3%] and 5,820 [77.6%] in the intervention and control groups, respectively), and 11,701 were included in the analysis (mean age, 74.3 [standard deviation, 5.5] years; 48.5% were men)., Conclusions: This study is expected to contribute to development of a prototype of a community-wide frailty prevention strategy, especially in metropolitan areas in Japan., Trial Registration: UMIN Clinical Trials Registry (UMIN000026515).

Objectives　The importance of social capital in promoting interprofessional collaborations is well known. This study examined the effects of an interprofessional educational program for homecare professionals on building social capital in terms of homecare in an urban area.Methods　The program was conducted at Kita Ward, Tokyo, from July 2014 to January 2015. We used a self-administered questionnaire before and after the program to collect data from homecare professionals in the ward, as well as from those who were interested in providing homecare. Physicians attended a five-day program, while other professionals attended a four-and-a-half-day program. Participants' attitude toward homecare practices was assessed to evaluate their motivation level for the job (i.e., the formation of a practical view of homecare and efficacy to engage in homecare practices). Regarding social capital, we assessed trust and norm of reciprocity for those in the same profession as the respondent (bonding and cognitive social capital) as well as for those in a different profession (bridging and cognitive social capital). Additionally, to professionals other than physicians, we asked about trust and norm of reciprocity regarding physicians (bridging and cognitive social capital) and collaborative conditions with physicians, which included the two sub-domains of cooperation and interaction (bridging and structural social capital). A generalized estimating equation was used to detect the effect size.Results　Of the 54 program participants, 52 (including two physicians) completed both the pre- and post-program questionnaires. Participants' practical view of homecare was formed after the program, although their efficacy for homecare practices was unchanged. With regard to social capital, scores for both trust and norm of reciprocity for the same profession (bonding and cognitive social capital) increased, while those for different professions (bridging and cognitive social capital) were unchanged. Scores for both trust and norm of reciprocity regarding physicians and cooperation with physicians (bridging and cognitive social capital, and bridging and structural social capital) also increased. Finally, trust and norm of reciprocity for the participants improved after the program.Conclusion　The interprofessional educational program for homecare professionals may foster social capital among the participants. The study results imply that this program can be a possible strategy to foster social capital in the field of homecare.

Objectives　The aim of this research is to classify elderly adults who live alone by their marital status type and to clarify how those types affect their higher-level functional capacity and mental health with a 2-year follow-up survey.Methods　This research is based on the results from a survey in 2013. The base-line scores were from 757 participants who completed a survey by mail, carried out in B area of A ward, Tokyo, within the jurisdiction of community general support centers, with people who were not at nursing care levels 4 or 5 and who were not residents of welfare facilities. This study analyzed data for 517 of 527 participants, who answered all questions in the 2015 survey and indicated their marital status. This research categorized the respondents into 4 types of marital status: separation, divorce, bereavement, and unmarried groups. This study adopted the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) as the index of higher-level functional capacity, and the WHO-Five Well-Being Index (WHO-5-J) as the mental health index. In the analysis of the causes of 2-year variations in TMIG-IC total scores and WHO-5-J scores, the dependent variable was each variation. This study used an analysis of covariance in which the fixed factors were types of living alone, sex, annual income, and having children who lived separately in the 2013 survey, and the covariance comprised the base-line scores for the dependent variables, age, and chronic diseases in the 2013 survey.Results　With regards to the variation in TMIG-IC total scores, main effects of the types of living alone were observed. The adjusted variation of covariance decreased most in the separation group (-0.95). For the variation in WHO-5-J scores, main effects of the types of living alone were indicated. In the divorce group, the adjusted variation of covariance was significantly higher than for the unmarried group (2.33 vs. -0.55).Conclusion　The results revealed that the types of marital status: separated, divorced, bereaved, and unmarried, affect changes in the higher-level functional capacity and mental health status of elderly adults living alone, 2 years later. Thus, although previously regarded as a single category, types of marital status should be considered in the analysis of elderly adults who live alone.

Aim: Brain-derived neurotrophic factor (BDNF) have been implicated in the progression of neuronal survival, phenotyping differentiation and maintenance of various neurons, as well as neurogenesis. We studied how BDNF affects health parameters of older adults by carrying out a health examination of community-dwelling older adults., Methods: We measured the serum BDNF concentration of 898 older adults aged 65-84 years who participated in regional health examinations in the Tokyo area and also measured various parameters, such as the thickness of the quadriceps femoris, percentage of body fat, body mass index, grip strength, frequency of walking, and use of sleeping drugs and steroidal anti-inflammatory drugs., Results: We obtained significant relationships between serum BDNF values and thickness of the quadriceps muscle, body mass index or percentage of body fat. Individuals holding onto something when they stood up had lower serum BDNF values than individuals not holding onto something when they stood up. Smokers had higher serum BDNF values than non-smokers., Conclusions: Older adults who had higher serum BDNF had bigger quadriceps muscles, higher body mass index and higher body fat rate, and were also able to stand up without holding onto something from a sitting position. Geriatr Gerontol Int 2018; 18: 456-461., (© 2017 Japan Geriatrics Society.)

Objectives: The aim of this study was to clarify the effect of an intergenerational program on elderly persons' symptoms of depressive mood and in improving their sense of coherence, which is an element for successful coping with stressors., Method: We evaluated an intervention research project (Research of Productivity by Intergenerational Sympathy [REPRINTS]), in which volunteers >65 years old read picture books to children in a school setting. The intervention group (REPRINTS) was recruited through intensive weekly training seminars for three months. The no-contact control group members were also recreated to participate in health checks and surveys for data collection purposes. Eventually, 26 participants in the intervention group and 54 in the control group were included for data analysis., Results: The age or gender was not significantly different between the intervention and control groups. A two-way repeated-measures ANOVA shows a time × group significant interaction effects. Analyses of the simple main effects showed that sense of meaningfulness significantly increased for members of the intervention group at all terms, with no changes in the control group over time. Multiple mediation analysis revealed that participation in the intergenerational program was associated with a sense of manageability which was also significantly related to depressive mood., Conclusion: Intergenerational programs could serve as key health promoters among elderly people by decreasing the risk of social isolation and loneliness due to the greater sense of meaningfulness. However, given our limited sample size, generalizability was restricted and studies with larger cohorts are required to further validate our findings.

Objectives: This study examined the possibility and necessity for expansion and diffusion of a new employment support facility for older job seekers in metropolitan areas based on health and welfare measures. This longitudinal study assessed questionnaire responses from older job seekers at a new facility established in Ota ward in the Tokyo metropolitan area as a compliment to the conventional system comprised of Hello Work and the Silver Human Resources Center., Methods: We offered questionnaires to job seekers at their first facility visit and asked them to return them by mail (baseline survey). Follow-up surveys of the same respondents were conducted after 2, 4, 8, and 12 weeks, with questions about demographics, personal status, social activities, mental health, and job search status. The surveys were administered from January 2013 to March 2014., Results: We obtained 128 responses (average respondent age: 63.8 years) from 180 baseline survey questionnaires. The respondents included 82 males and 46 females. The response rates were over 90% for all follow-up surveys. Among respondents, 71.4% had less than a senior high school level of education. The average annual household income was less than 3 million yen and less than 1 million yen for 68.0% and 16.0% of the participants, respectively. The life circumstances were "hard" or "very hard" for 56.3% of respondents. Among respondents, 78.9% indicated that they were seeking employment for economic reasons. Women and those over 65 years of age were more likely to search for jobs for their well-being than men and respondents less than 65 years of age. The majority of respondents indicated that they wanted to make use of their abilities or experience and many hoped to work as garbage collectors, cooks, or apartment caretakers., Conclusion: We found that the main objective of older job seekers living at this facility was economic acquisition. Men and those less than 65 years of age were at particular risk for economic distress, poor mental health, and were more likely to be searching for regular employment. A relatively higher proportion of women and respondents over 65 years of age were seeking jobs for their well-being; a need for social relationships that may be more pronounced among women in this study population.

Objectives: This study investigated 1) the incidence of bicycle-related accidents and subsequent injuries and 2) the number of injuries (accidents) reported to the police (i.e., examining the number of potential accidents) among community-dwelling Japanese older adults, after examining the percentage of those who were regular cyclists., Methods: Based on local resident registration, we mailed questionnaires to 7083 community-dwelling older adults. The questionnaire included questions about the incidence of bicycle-related accidents and subsequent injury within a year, the degree of injury and presence or absence of reporting that injury (bicycle-related accident) to the police. For the bicycle-related accident, we asked regarding both riding and pedestrian accidents (i.e., accidents caused by a bicycle when walking)., Results: Excluding the blank responses (n=3539, 50.0%), the targets for analysis were 3098 older adults in riding accidents and 2861 older adults in pedestrian accidents. The results showed that 63.0% of older adults (n=1953) routinely rode a bicycle. Among them, 9.4% (n=184) experienced riding accidents, and 3.4% (n=98) experienced pedestrian accidents caused by a bicycle. For the riding accidents, 76.1% (n=140) had some injuries, and for the pedestrian accidents, 55.1% (n=54) had some injuries. Furthermore, in 70.2% (n=59) and 76.9% (n=20) of riding and pedestrian accidents, respectively, those who went to the hospital for treatment of their injury (i.e., injury requiring treatment) did not report the accident to the police., Conclusion: The present study revealed that there are many potential bicycle-related accidents in older adults. This suggests that there may be a large gap in the national survey data between reported bicycle-related accidents and the actual number of incidents in older adults.

We established our bio-repository in October 2002. One of the unique aspects of our bio-repository is that it is based on post-clinical test samples. Although the post-clinical test sample-based storage is beneficial because ample clinical information is available for each sample and samples are to be refreshed regularly, many bio-bankers are hesitant to store them because of the possible problems of de-identification procedures and sample quality. Currently, we have two different types of sample, not de-identified status and de-identified status. Most of the samples for storage are not de-identified status. A portion of the samples are transferred to new tubes before and after being frozen, without clinical patient identifications and the status is de-identified. This tube transfer is the only de-identification procedure in our bio-repository so far. After a procedure of de-identification, these samples are stored. The de-identified samples are collected under various project-based schemes. The quality standards of our samples are established by two factors: pre-analytical quality control efforts, and record keeping of sample history by sample tracking system. All the samples have been phlebotomized under strict control of pre-analytical requirements. By record keeping of sample history with the sample tracking system, we can tell the exact temperature and elapsed time in various situations since the phlebotomy procedure or on arrival at the clinical laboratory. In this article, we will disclose how we have dealt with the de-identification procedure and sample quality.

Purpose: 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., Method: 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., Results and Conclusions: 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.