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Objectives: This study aimed to examine the longitudinal association between social relationships and physical functioning among community-dwelling older adults with chronic conditions. Methods: Self-reported questionnaires were distributed and collected between 2014 and 2017 from participants ≥65 years old. The Index of Social Interaction was used to evaluate social relationships and the instrumental activities of daily living (IADL) subscale of the Tokyo Metropolitan Institute of Gerontology Index of Competence was used to examine functional status. Results: A total of 422 participants (190 males and 232 females) were included in the final analysis. High social relationships demonstrated significant adverse effects (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.64–0.93) on the decline of IADL in the overall sample, particularly for females (OR = 0.71, 95% CI: 0.55–0.93) but not as much for males (P = 0.131). Conclusion: This finding suggests that functional limitation was influenced by social relationships among disabled older adults and the influence of social relationships on functional limitation differed based on gender. Keywords: Interpersonal Relations; Functional Status; Gender; Aged; Chronic Disease; Longitudinal Studies; Health Behaviour; Japan.

Objectives: This study aimed to examine the long-term effects of parenting practice during preschool years on children’s movement performance in primary school. Methods: This three-year longitudinal study included 225 children aged 3–6-years-old. Parents reported baseline parenting practice and evaluated children’s movement performance three years later. Latent class analysis was used to explore latent classes of movement performance. A post hoc test was used to identify the characteristics of different patterns. Finally, adjusted multinomial logistic regression models were used to test the influence of parenting practice on identified patterns of movement performance. Results: Children in this study were grouped into three movement performance patterns, labelled as ‘least difficulties’ (n = 131, 58.2%), ‘low back pain’ (n = 68, 30.2%) and ‘most difficulties’ (n = 26, 11.6%). After controlling for age, gender, having siblings or not, family structure, standardised body mass index, sleep condition and dietary habits, the researchers found that if parents played games with children frequently, the children would have a 0.287 times lower probability of being in the ‘low back pain’ class (95% confidence interval [CI]: 0.105–0.783). In addition, if parents take children to meet peers of a similar age frequently, children would have a 0.339 times lower probability of being in ‘most difficulties’ class (95% CI: 0.139–0.825). Conclusion: Primary healthcare providers should pay careful attention to children with movement difficulties. The study provides longitudinal evidence to support the applicability of positive parenting practice in early childhood to prevent children’s movement difficulties. Keywords: Movement; Parenting; Latent Class Analysis; Child; Longitudinal Study; Japan.

This study aimed to examine the effect of increased cost sharing on long-term care (LTC) service utilization among home-dwelling older adults, using nationwide long-term care insurance (LTCI) claims data in Japan.In August 2015, the coinsurance rate for Japanese LTCI increased from 10% to 20% for higher-income beneficiaries. We analyzed 27,911,076 person-month observations between April 2015 and July 2016 from 1,983,163 home-dwelling older adults (aged ≥ 65 years). We employed a difference-in-differences approach to estimate the effect of the increased coinsurance rate on overall LTC service utilization and for each of the four main service subcategories. The control group comprised those whose coinsurance rates remained at 10%.The treatment group, whose coinsurance rate increased, accounted for 9.6% of all participants. The raised coinsurance rate caused statistically significant reductions of 0.46% (95% confidence interval [CI]: 0.36%, 0.56%) and $25.7 (95% CI: $23.7, $27.8) in the percentage of utilization of LTC services and total monthly LTC expenditures per person, respectively. Service utilization decreased in each of the four service subcategories.The increased coinsurance rate resulted in statistically significant but small reductions in LTC service utilization overall and in each service type among higher-income home-dwelling beneficiaries. Requiring more cost sharing from higher-income individuals may alleviate the fiscal burden on LTC systems without serious reductions in service utilization.

This study aimed to explore all the relevant subtypes of cognitive frailty among Japanese community-dwelling older adults with multimorbidity. Moreover, it examined the associations between these potential subtypes of cognitive frailty and social relationships. This study targeted relevant cross-sectional data regarding community-based older adults with multimorbidity. It employed a person-centered method to perform a latent class analysis and explore the subtypes of cognitive frailty among older adults. Moreover, a multinominal logistic regression analysis was employed to examine the association between potential subtypes of cognitive frailty and social relationships. Data for 396 participants (mean age, 75.8 [SD, 7.3] years; 51.3% females) were analyzed. Three cognitive frailty subtypes were subsequently revealed: the robust group (42.0%), the group with partial cognitive frailty (38.6%), and the group with cognitive frailty (19.4%). People with high levels of social relationships were more likely to be in the robust and the partial cognitive frailty groups. This study identified different subtypes of cognitive frailty among multimorbid older adults and highlighted the significance of social relationships. These findings could serve as a reference for conceptualizing cognitive frailty through the person-centered method. Promoting a high level of social relationships could be useful to prevent the cognitive frailty among older adults with multimorbidity.

Objectives This study aimed to explore the bidirectional association between frailty and social relationships in older adults while distinguishing between interpersonal and intrapersonal effects. Methods A prospective cohort study of community-dwelling older adults was conducted in Japan in three waves spanning six years with follow-ups in every three years. Random intercept cross-lagged panel model was used to explore temporal associations between frailty and social relationships. Results Data for 520 participants (mean age 73.02 [SD 6.38] years, 56.7% women) were analyzed. Across individuals, frailty was associated with social relationships (β = -0.514, p

Self-care ability and social skills are potential areas of difficulty for preschool children. However, values about young children's self-care ability are different worldwide. This longitudinal study examined the influence of early self-care ability on social skills at the end of the preschool years. Participants were 509 children recruited from kindergartens and child care centers across Japan, whose self-care ability and social skills were assessed at baseline year and three years later (Age of children in 2015 at baseline: M = 35 months, SD = 6.1 months). The study found that gender was significantly associated with social skills, while preschool facility entrance age was only associated with assertion skills. After controlling gender and entrance age, early self-care ability was still positively related to later assertion and cooperation (Assertion: OR = 2.55, 95% CI = 1.00–6.51; Cooperation: OR = 3.15, 95% CI = 1.23–8.07). Implications of the findings are discussed in the context of cultural diversity, highlighting the importance of cultivating children's age-appropriate self-care ability based on daily observations and evaluations.

This longitudinal study aimed to compare 1-year mortality between users of home- and community-based services (HCBS) and residential facilities (nursing homes, group homes, and geriatric apartments) among non-hospitalized frail older adults in Japan. Using three nationwide data sources, we conducted a nationwide pooled cohort study of 1-year follow-up among certified users of long-term care insurance (LTCI) aged 65 years and older from 2007 through 2016 to compare 1-year mortality using a logistic regression model. Overall, compared to HCBS users, mortality was higher in residents in nursing homes and geriatric apartments but lower in group home residents. While mortality gradually increased over time among those in residential facilities, it remained at a level similar to that of HCBS users. Since 2006, Japan's public health policy has been to increase end-of-life care in residential facilities. Our results indicate that this policy resulted in an increase in mortality in residential facilities, possibly due to accommodation of more severely ill people there, or a shift in their focus from transferring dying residents to hospitals to preserve the dignity of residents.

AIM The study assessed the association between boosting the workforce supply by types of long-term care services and in-home deaths among older people at the municipality level. METHODS A fixed-effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full-time equivalent numbers of care workers engaged in in-home services, day services, short-stay services, and long-term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates. RESULTS Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008-0.17). Although statistically non-significant, the number of care workers providing in-home services was positively associated with the proportion of home deaths, whereas the number of those providing short-stay services and providing long-term care facilities and nursing home services were inversely associated with home deaths. CONCLUSIONS Given the increased number of care-dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; 21: 712-717.

Social relationships are associated with physical function. However, little scholarly attention has been focused on the effect of changing social factors on physical function.This study was designed to examine the effects on physical function of changes in social relationships in adults aged 65 years and older.This study is part of a longitudinal, prospective cohort study that was conducted on community-dwelling older adults in a suburban area of central Japan. Baseline self-report data were collected in 2011, and a follow-up survey was conducted in 2017. Social relationships were assessed using the Index of Social Interaction, and physical function was evaluated using a subscale of the Kihon Checklist. Chi-square tests, Mann-Whitney U tests, and multiple logistic regression analysis were used to analyze data from 442 older adults who were functionally independent at baseline.After controlling for covariates in 2011, negative changes in social relationships (odds ratio [ OR ] = 3.20, 95% CI [1.18, 8.69]) were found to be associated with physical function decline. Moreover, 1-point increases in the different social-relationship values between baseline and follow-up were associated with protective effects against functional decline ( OR = 0.71, 95% CI [0.63, 0.80]). Furthermore, median trends between baseline and follow-up revealed associations between decreasing ( OR = 4.18, 95% CI [1.53, 11.39]) and continuously low ( OR = 2.98, 95% CI [1.42, 6.28]) social relationships and physical function decline.The findings support a strong association between negative changes in social relationships and physical function decline and highlight the importance of promoting social relationships to delay physical function decline in older adults.

This study aimed to clarify the association between sleep duration and various physical and psychosocial factors among older Japanese adults.Data from 295 367 households were obtained from the 2013 Comprehensive Survey of Living Conditions in Japan, a self-administered questionnaire survey. We restricted our analyses to 115 205 participants who responded to all the items required for this study. Multinomial logistic regression models examined the association between sleep duration and various factors.Overall, 26.0% of the participants slept for6 h, 56.0% slept for 6-8 h, and 18.0% slept for ≥8 h. Poor subjective health and mental health increased the risk of both short (poor subjective health: odds ratio [OR] 1.22, 95% confidence interval [CI] 1.17-1.27; severe mental distress: OR 2.21, 95% CI 2.04-2.40) and long (poor subjective health: OR 1.19, 95% CI 1.13-1.24; severe mental distress: OR 1.25, 95% CI 1.13-1.38) sleep duration. Many subjective symptoms, including chest, respiratory, musculoskeletal and urogenital symptoms, were associated with short sleep duration. However, only memory loss was associated with long sleep duration (OR 1.23, 95% CI 1.16-1.31).We need to be aware that older people with short sleep duration may have various physical symptoms. Moreover, as physical and mental problems, cognitive decline and unhealthy lifestyles are associated with long sleep duration, we also need to pay attention to the living conditions of those who complain of long sleep duration. The limitations of this study were that the variables were self-reported and sleep duration was not evaluated objectively. Geriatr Gerontol Int 2022; 22: 660-666.

Objectives To analyze the association of an incentivization program to promote death outside of hospitals with changes in place of death. Design A longitudinal observational study using national databases. Setting and Participants Participants comprised Japanese decedents (≥65 years) who had used long-term care insurance services and died between April 2007 and March 2014. Methods Using a database of Japanese long-term care insurance service claims, subjects were divided into community-dwelling and residential aged care (RAC) facility groups. Based on national death records, change in place of death after the Japanese government initiated incentivization program was observed using logistic regression. Results Hospital deaths decreased by 8.7% over time, mainly due to an increase in RAC facility deaths. The incentivization program was more associated with decreased in-hospital deaths for older adults in RAC facilities than community-dwelling older adults. Conclusions and Implications In Japan, the proportion of in-hospital deaths of frail older adults decreased since the health services system introduced the incentivization program for end-of-life care outside of hospitals. The shift of place of death from hospitals to different locations was more prominent among residents of RAC facilities, where informal care from laymen was required less, than among community residents.

Background Japan, with the oldest population in the world, faces a financial challenge caused by rising long-term care (LTC) expenditure. For policymakers to address this, it is important that we have a better understanding of how individual and regional characteristics affect LTC expenditure. Methods We linked national LTC insurance (LTCI) claim data, covering the entire population who used LTCI services in Japan, with municipality data on an individual level. Individuals 65 years and older (n=3 876 068) who had used LTCI benefits at least once in the fiscal year (FY) 2016 were included. We examined the associations of individual and municipality characteristics regarding supply and demand of healthcare with the LTC expenditures on facility care, home and community care, and total care (the sum of both types of care), after adjusting for regional differences in LTC extra charges. Results The following variables were associated with higher total expenditure; at the individual level: female, a higher care-need level, a lower income (0% co-payments) or a facility service user; at the municipality level: municipalities locating in metropolitan areas, with a higher proportion of single elderly households, more doctors per 1000 citizens, more nursing homes per 100 000 LTC benefit users or more outpatient medical spending per citizen ≥75 years old. Conclusions As we are able to identify several individual and municipality characteristics associated with higher LTC expenditure in Japan, the study offers insights into dealing with the rapidly growing LTC expenditure.

Objectives The national database for long-term care insurance (LTCI) of Japan (Kaigo DB) enables researchers to access comprehensive data from its LTCI registry, eligibility assessment records, claims for service usage, and information about service providers. However, studies regarding the death or mortality of beneficiaries cannot be conducted because Kaigo DB does not contain death records, and researchers are not allowed to link Kaigo DB to other databases, such as national death records. Therefore, we aimed to assess the validity of using an insurer's disqualification from an LTCI beneficiary as a proxy of death.Methods We used 510,751,798 monthly beneficiary records between April 2007 and March 2017 from the LTCI registry, while excluding data for ineligible persons for LTCI benefit or those younger than 65 years. We identified insurer cases disqualified from LTCI beneficiaries and linked them to national death records using deterministic linkage methods by dates of birth and death, sex, and residence. We considered the cases as positive if they were disqualified and their record was linked to a death. We used sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as validity indices.Results We identified 5,986,991 (1.17%) disqualified and 5,295,961 death cases. Sensitivity, specificity, PPV, and NPV of disqualification for death were 100%, 99.86%, 88.46%, and 100%, respectively. After stratification, PPV of disqualification was between 85% and 88% before 2012, 91% after 2012, 91.9% in men, and 85.9% in women. PPV increased with age (65-69 years: 80.6%, 70-74 years: 86.7%, 75-79 years: 86.4%, 80-84 years: 86.7%, 85-89 years: 88.0%, 90-94 years: 90.6%, and 95+ years: 93.4%) and level of care needed (support level: 72.2%, care level (CL) 1: 79.7%, CL2: 85.9%, CL3: 89.3%, CL4: 92.3%, and CL5: 94.0%).Conclusions Disqualification from the LTCI registry is an inappropriate measure to estimate mortality accurately because it has a 10% false-positive rate. However, it appears sufficiently valid to use disqualification as a proxy outcome of death, although the main effect or confounding of a possible predictor of death could be slightly underestimated.

The diversity of child social skills development is not well detected among Asian countries. Culturally validated assessments are needed for practitioners to evaluate child social skills. This study tested the measurement invariance of the Social Skill Scale (SSS) across Japanese and Chinese samples and explored country differences in child social skills development. The SSS utilizes a widely used factor structure (assertion, self-control, and cooperation subdomains) and has established Japanese and Chinese versions. We conducted investigations with an identical process and materials with different language versions, collecting data from 931 Japanese kindergarten children (M

Strong relationship exists between loneliness and depression in older adults. However, the effect of multifaceted social relationships on the relationship between loneliness and depression has not been explored. The purpose of the current study was to find out how multifaceted social relationships affect the aforementioned processes. We investigated and evaluated the loneliness status, depression symptoms, social relationships, and demographic information of 1116 older adults aged ≥65 years living in rural Japan. The final 555 participants were included in the analysis. Statistical evidence showed a direct effect between loneliness and depression symptoms. Additionally, the mediation model found that social curiosity and participation acted as mediators between loneliness and depression symptoms. Further, independence and participation, independence, and feeling safe played a conditional moderating role in the model of loneliness–social curiosity–depression symptoms and loneliness–participation–depression symptoms, respectively. Interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator. The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators.

Importance The provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life. Objective To assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life. Design, Setting, and Participants This cohort study of older adults in Japan’s long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020. Exposures Mean days of in-home care service used per week from the first day of the month before the month of death to the date of death. Main Outcomes and Measures Primary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014. Results Of the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points). Conclusions and Relevance This retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.

Background We aimed to investigate the nationwide epidemiology of food choking deaths in Japan. Methods Using Japan Vital Statistics death data (2006-2016), we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract). The demographics of people with food choking deaths; temporal trend of food choking deaths by the year (overall and by age group) and the day of year; and prefecture variations, were reported. Results 52,366 people experienced food choking deaths (median age, 82 years, 53% were men, and 57% occurred at home). The highest number of food choking deaths occurred in January 1, 2, and 3, in that order; and lowest in June. Despite a constant total number of cases at around 4000 yearly, the incidence proportion declined from 16.2 to 12.1 per 100,000 population from 2006 to 2016 among people aged 75-84 years. The proportion peaked at 53.5 (2008) and decreased to 43.6 (2016) among people aged ≥85 years. Prefecture variations occurred in the number of food choking deaths, highest in Niigata and lowest in Kyoto. Conclusions The results suggest targets (by age group, region, and day of the year) for the prevention of food choking deaths. Time trends and regional variations may be related to the consumption of Japanese rice cake (mochi), known as a major cause of food suffocation in Japan. Key messages The number of food choking deaths in Japan was highest on New Year’s Day.

Objectives Social relationships may help in maintaining functional status among older adults. This study examined the types of social relationships that were related to functional status among Japanese community-dwelling older adults. Study design This is a prospective cohort study. Methods We used baseline data from 2008 and conducted follow-up surveys six years later. Participants included individuals older than 65 years who lived in a suburban community in Japan. The Index of Social Interaction measure was used to assess multiple elements of social relationships. Two functional status outcomes were set: (1) functional decline and (2) functional decline and mortality. A multiple logistic regression model was used to examine the association between social relationships and functional decline six years later. Results After controlling for age, sex, family structure and disease status in 2008, poor social curiosity (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.02–1.69) and interaction (OR = 2.57, 95% CI: 1.20–5.51) were found to be associated with functional decline. Furthermore, social curiosity (OR = 1.39, 95% CI: 1.14–1.69) and interaction (OR = 2.84, 95% CI: 1.44–5.59) were also associated with the composite outcome. Conclusions Social curiosity and interacting with others were significantly associated with functional status. Promotion of social interaction may be essential for preventing future need for care.

Aim This study aimed to clarify the association between high-risk drinking and health outcomes (e.g. physical and psychosocial factors, including help-seeking behavior) among older Japanese adults. Methods Data were obtained from the 2013 Comprehensive Survey of Living Conditions in Japan, which surveyed 295 367 households. We restricted analyses to 55 147 current drinkers. Multinomial logistic regression models were used to examine associations between alcohol consumption and various factors. Results Overall, 35.3% of participants were in the low-risk group, 13.1% were in the at-risk group and 1.0% were in the high-risk group. Those in the at-risk and high-risk groups were more likely to be younger, male, employed and tobacco users. They were also more likely to report sleeping ≥9 h per night, and they were more likely to report unhealthy eating habits. Being in the high-risk drinking group was significantly associated with being divorced (OR 1.51, 95% CI 1.11-2.05) and having poor mental health (OR 1.57, 95% CI 1.13-1.68). The high-risk drinking group was more likely to include those who endorsed experiencing challenges without seeking aid (OR 1.87, 95% CI 1.39-2.53) or felt no need to seek aid (OR 1.39, 95% CI 1.15-1.68). Conclusions Being at high-risk for drinking is associated with poorer help-seeking behavior, suggesting a need for more aggressive outreach. Geriatr Gerontol Int 2019; 19: 1260-1267.

AIM To investigate the associations between self-reported hearing loss and outdoor activity limitations, psychological distress and self-reported memory loss among older people. METHODS We carried out a cross-sectional study using the data from the 2016 Comprehensive Survey of Living Conditions in Japan. The study population included people aged ≥65 years living at home, without a clinical diagnosis of dementia. The exposure of interest was self-reported hearing loss, whereas outcomes included outdoor activity limitations (Yes/No), psychological distress (Kessler Psychological Distress Scale score of ≥5) and self-reported memory loss (Yes/No). We carried out logistic regression analyses, adjusted for age, sex, smoking, alcohol, educational status, number of household members, household expenditure and number of clinical diagnoses requiring outpatient visits. RESULTS Among 137 723 older people (mean age 74.5 years [standard deviation 7.4 years], 45.1% men), 12 389 (9.0%) reported hearing loss. People with hearing loss showed a higher prevalence of outdoor activity limitations (28.9% vs 9.5%, P

AIM To identify facility-level characteristics associated with hospitalization within 30 days after admission to a geriatric intermediate care facility (GICF) (30-day hospitalization) in Japan. METHODS This retrospective cohort study used nationwide long-term care insurance claims data and a national survey of long-term geriatric care facilities. The study population was residents admitted to GICFs between October 2016 and February 2018. The outcome variable was 30-day hospitalization. The independent variables were facility-level characteristics such as level of healthcare professionals. RESULTS The final sample for analysis comprised 282 991 residents of mean age ± SD, 85.8 ± 7.2 years, of whom 12 814 (4.5%) experienced 30-day hospitalization. In a multivariable logistic generalized estimating equation model adjusted for facility- and resident-level characteristics, and clustering GICFs, the odds of 30-day hospitalization were 0.906 times lower (95% confidence interval [CI] 0.857-0.958) among residents in a GICF with dental hygienist than in those in a facility without. Furthermore, the risk of 30-day hospitalization was lower among residents who had been admitted to a GICF with higher staffing levels of pharmacists (adjusted odds ratio [aOR] 0.941, 95% CI 0.899-0.985), registered nurses (aOR 0.931, 95% CI 0.880-0.986), care workers (aOR 0.920, 95% CI 0.879-0.964) and speech-language pathologists (aOR 0.926, 95% CI 0.874-0.982) than in those who had been admitted to a GICF with fewer of these healthcare professionals. CONCLUSIONS Transitional care including dental hygienist or higher staffing levels of pharmacists, registered nurses, care workers and speech-language pathologists may be a more effective way to prevent 30-day hospitalization. Geriatr Gerontol Int 2021; 21: 1010-1017.

Background Social relationships may be the key to successful aging among older adults. However, little is known about the variability of social relationships among community-dwelling older people. This study aimed to describe the patterns of social relationships and examine the differences in sociodemographic characteristics and mental and physical health status among these patterns. Methods We obtained the data from a questionnaire survey in 2017 for older adults aged 65 and above who lived in a suburban area in Japan. The Index of Social Interaction (ISI) was used to evaluate social relationships. The final sample comprised 964 people who were independently mobile and answered at least one item of the ISI. To clarify the patterns of social relationships, latent class analysis was performed with five subscales of ISI treated as indicator variables. Multinomial logistic regression was conducted to examine the factors associated with the patterns of social relationships. Results The patterns of social relationships were classified into three classes: “Active” (73.6%), “Socially isolated” (14.7%), and “Less motivated” (11.7%). Persons who had depressive symptoms were more likely to be allocated to the “Socially isolated” (Odds Ratio [OR] 1.80, 95% Confidence Interval [CI] 1.13–2.86) or the “Less motivated” groups (OR 1.69, 95% CI 1.00–2.85) compared to the “Active” group. In addition, men (OR 1.72, 95% CI 1.07–2.76) and those living alone (OR 3.07, 95% CI 1.43–6.61) were more likely to be allocated to the “Socially isolated” group. Moreover, those who were dependent, according to the instrumental activities and daily living functions, were more likely to be assigned to the “Socially isolated” (OR 2.19, 95% CI 1.21–3.97) or “Less motivated” (OR 6.29, 95% CI 3.47–11.39) groups. Conclusion This study revealed the patterns of social relationships in older adults and suggested that there may be variations of social relationships among community dwellers. The results also indicated the necessity of assessing individual patterns of social relationships and devising strategies for each pattern in public health practice.

Aim Family caregivers can experience psychological distress, resulting in physical and mental health problems, and discontinuation of caregiving. This study's objective was to examine factors associated with caregiver psychological distress. Methods We analyzed data from the Comprehensive Survey of Living Conditions in 2007, 2010, 2013 and 2016, which included 12 504 pairs of caregivers and care recipients sharing a household in Japan. Kessler's Psychological Distress Scale (K6) was used to measure caregiver psychological distress. Multivariable logistic regression analyses identified factors associated with caregiver psychological distress (K6 score ≥5). Results Caregivers' median K6 score was 3 (interquartile range 0-7), and 38.6% had a K6 score ≥5. K6 scores ≥5 were positively associated with female sex (adjusted odds ratio 1.35, 95% CI 1.21-1.51), poor caregiver health status (compared with "very good," 9.48, 95% CI 7.91-11.37 for "not very good/poor"), longer care time (compared with "help only when needed," 1.40, 95% CI 1.25-1.58 for "almost all day") and dementia (1.16, 95% CI 1.05-1.28), lower respiratory tract disease (1.25, 95% CI 1.06-1.49) and diabetes (1.16, 95% CI 1.00-1.33) in care recipients. K6 scores ≥5 were negatively associated with older caregiver age (compared with 20-54 years, 0.65, 95%CI 0.58-0.74 for 55-64 years, 0.54, 95%CI 0.46-0.63 for 65-74 years and 0.50, 95% CI 0.40-0.62 for ≥75 years), employment (0.88, 95% CI 0.80-0.97) and being a care recipient's child-in-law (compared with spouse 0.75, 95% CI 0.61-0.92). Conclusions The findings identified several factors associated with caregiver psychological distress, showing that particular attention might need to be paid to caregivers with these risk factors. Geriatr Gerontol Int 2021; ••: ••-••.

Background: We examined regional disparities in dental care utilization and their associations with dental care utilization and socioeconomic factors in Japan. Methods: Using the Fourth NBD Open Data Japan, a database for the universal healthcare insurance claims, we conducted an ecological study by analyzing 216 million pieces of aggregated data from April 2017 to March 2018. We used nine indicators to represent dental care utilization: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan’s 47 prefectures, each of which was divided into three groups based on socioeconomic factors (i.e., average income per capita and the proportion of university enrollments). Kruskal-Wallis tests were performed among the three groups to examine the associations between the supply-adjusted nine indicators and the socioeconomic factors. Findings: The ratios between the maximum and minimum SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Income level was negatively associated with dental bridges and dentures. Educational level was positively associated with outreach services and dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures. Interpretation: In Japan, regional disparities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Educational level appears to be a more important determining factor than income level in dental care utilization. Funding Statement: This work was supported in part by a Health and Labour Sciences Research Grant (Multidisciplinary research project on measures against lifestyle-related diseases such as cardiovascular diseases and diabetes mellitus) “Research study aimed at the development of new evaluation indices and new evaluation methods for the preservation of dental and oral health: Health service research aimed at reducing health disparities in Japan” received by the principal investigator, Nanako Tamiya (Grant number: H31-19FA1001). Declaration of Interests: Takahiro Mori: His appointment as an associate professor at the University of Tsukuba was sponsored by JMDC Inc. in the financial year 2018 (i.e., April 2018 – March 2019), by SMS CO., LTD. in the financial year 2019 (i.e., April 2019 – March 2020), and by FAST DOCTOR CO., LTD in the financial year 2020 (i.e., April 2020 – present). JMDC Inc., SMS CO., LTD, and FAST DOCTOR CO., LTD did not play any role in the conception, design, conduct, or reporting of this study. Sakata Nobuo: His appointment as an associate professor at the University of Tsukuba was sponsored by JMDC Inc. in the financial year 2020 (i.e., April 2020 – present). JMDC Inc. did not play any role in the conception, design, conduct, or reporting of this study. The other authors declare they have no competing interests. Ethics Approval Statement: This study was approved by the University of Tsukuba Medical Ethics Committee (date of approval: December 17, 2019; approval number: 1446).

Background The trend in the characteristics of patients using an after-hour house-call (AHHC) medical service changed the coronavirus disease of 2019 (COVID-19) pandemic, but there has been no report on this issue since the start of the COVID-19 pandemic. The aim of this study was to investigate patients’ tendencies to seek an AHHC medical service for fever or common cold symptoms during the COVID-19 pandemic.Methods This cohort study compared the characteristics of patients with fever or symptoms of the common cold utilizing an AHHC medical service offered by a single large company between the control period (December 1, 2018 to April 30, 2019) and the COVID-19 pandemic exposure period (December 1, 2019 to April 30, 2020). It also assessed the proportion of these patients in relation to all patients calling for the service for any reason. Results During the control and COVID-19 pandemic exposure periods, 6,462 (median age: 8 [interquartile range {IQR}: 3, 11], males: 48.2%) and 10,003 (median age: 10 [IQR: 4, 33], males: 48.3%) patients, respectively, called for the AHHC medical service. Of these, 5,335 (82.6%) and 7,423 (74.2%) patients had fever or common cold symptoms, respectively. The disease severity was differently distributed between the groups: the proportions of people with severe, moderate, and mild illness were 0.3%, 28.7%, and 71.0% in the control period and 1.1%, 54.8%, and 44.1% in the COVID-19 pandemic exposure period (p < 0.001), respectively. The AHHC medical service identified six individuals with COVID-19.Conclusions During the COVID-19 pandemic, the proportion of patients with fever or symptoms of the common cold was lower than that in the control period, but the illness severity was substantially higher.

Objectives Despite the significant utilization of long-term care (LTC) services at the end of life, evidence on the trajectory of LTC expenditure in later life is scarce. This study aims to identify distinct trajectories of LTC expenditure in the last 5 years of life and to examine whether these trajectories differ according to cause of death. Design A nationwide retrospective longitudinal cohort study based on linked data of National LTC Claims and the Japan's National Vital Statistic. Setting and Participants Participants comprised decedents aged 70 years or older and who died in 2017. Methods We assessed 5 years of monthly LTC expenditure among participants and applied group-based trajectory model to identify distinct trajectories of LTC expenditure. Subsequently multinominal logistic regression analysis was performed to investigate how these trajectories vary according to cause of death. Results Among 1,124,335 decedents, 4 distinct trajectories of LTC expenditure were identified: persistently low (58.5%), late increase (9.8%), progressive increase then late decrease (8.8%), and persistently high (22.9%). Approximately 80.7% of total LTC expenditure was spent by the persistently high group. After adjustment for age and sex; deaths due to age-related physical debility and dementia were associated with persistently high LTC expenditure. Conclusions and Implications Ongoing discussions of LTC policy and reducing LTC expenditure may be more effective when emphasizing persistently high spenders. In addition, budget allocation for LTC at the end of life should be combined with data for health conditions.